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Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, CanadaDepartment of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, CanadaDepartment of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
To identify components of postural control included in standardized balance measures for adult populations.
Data Sources
Electronic searches of MEDLINE, EMBASE, and CINAHL databases using keyword combinations of postural balance/equilibrium, psychometrics/reproducibility of results/predictive value of tests/validation studies, instrument construction/instrument validation, geriatric assessment/disability evaluation, gray literature, and hand searches.
Study Selection
Inclusion criteria were measures with a stated objective to assess balance, adult populations (18y and older), at least 1 psychometric evaluation, 1 standing task, a standardized protocol and evaluation criteria, and published in English. Two reviewers independently identified studies for inclusion. Sixty-six measures were included.
Data Extraction
A research assistant extracted descriptive characteristics and 2 reviewers independently coded components of balance in each measure using the Systems Framework for Postural Control, a widely recognized model of balance.
Data Synthesis
Components of balance evaluated in these measures were underlying motor systems (100% of measures), anticipatory postural control (71%), dynamic stability (67%), static stability (64%), sensory integration (48%), functional stability limits (27%), reactive postural control (23%), cognitive influences (17%), and verticality (8%). Thirty-four measures evaluated 3 or fewer components of balance, and 1 measure—the Balance Evaluation Systems Test—evaluated all components of balance.
Conclusions
Several standardized balance measures provide only partial information on postural control and omit important components of balance related to avoiding falls. As such, the choice of measure(s) may limit the overall interpretation of an individual's balance ability. Continued work is necessary to increase the implementation of comprehensive balance assessment in research and practice.
and comprehensive assessment is recommended for identifying impairments in postural control and informing the design of optimal balance exercise programs for fall prevention.
and extensive variation in their use has limited the ability to synthesize data on the effects of balance interventions. For example, a systematic review on the effectiveness of exercise interventions to improve balance in older adults identified 95 eligible trials
but was able to pool <50% of included studies because more than 25 different standardized balance measures were used across individual trials. Varied use of balance measures is also seen in clinical practice, as illustrated in a survey of balance assessment practices among Canadian physical therapists that reported use of more than 20 different measures.
These issues emphasize the need for consensus on the use of outcome measures to increase understanding of the most effective components of exercise interventions.
How to measure balance in clinical practice: a systematic review of the psychometrics and clinical utility of measures of balance activity for neurological conditions.
content validity should be a primary consideration. However, previous systematic reviews on standardized balance measures are limited by focusing only on clinical utility, task, and environment issues in a restricted subset of measures
How to measure balance in clinical practice: a systematic review of the psychometrics and clinical utility of measures of balance activity for neurological conditions.
How to measure balance in clinical practice: a systematic review of the psychometrics and clinical utility of measures of balance activity for neurological conditions.
Contemporary postural control theory views balance as the product of integrated inputs and the body as a mechanical system that interacts with the nervous system in a continuously changing environment.
in: Rowell L.B. Shepherd J.T. Handbook of physiology, Section 12, Exercise: regulation and integration of multiple systems. American Physiological Society,
New York1996: 255-292
Support for this theory has been provided by evidence from multiple laboratories that have demonstrated how imposed constraints or deficits in the underlying systems impair balance.
It describes 6 major components required for the maintenance of postural control—(1) constraints on the biomechanical system, (2) movement strategies, (3) sensory strategies, (4) orientation in space, (5) dynamic control, and (6) cognitive processing (table 1, column 1)—and highlights that each underlying component and type of control could independently lead to a balance impairment. As such, this framework emphasizes the need for individual assessment of each component and treatment on a case-by-case basis.
Scoping Review Adaptation of Component of Balance and Operational Definition
1. Biomechanical constraints: degrees of freedom, strength, limits of stability
1.
Functional stability limits: Ability to move the center of mass as far as possible in the anteroposterior or mediolateral directions within the base of support
2.
Underlying motor systems: eg, strength and coordination
3.
Static stability: Ability to maintain position of the center of mass in unsupported stance when the base of the support does not change (may include wide stance, narrow, 1-legged stance, tandem—any standing condition)
2. Orientation in space: perception of gravity, verticality
4. Verticality: Ability to orient appropriately with respect to gravity (eg, evaluation of lean)
3. Movement strategies: reactive, anticipatory, voluntary
5. Reactive postural control: Ability to recover stability after an external perturbation to bring the center of mass within the base of support through corrective movements (eg, ankle, hip, and stepping strategies)
6. Anticipatory postural control: Ability to shift the center of mass before a discrete voluntary movement (eg, stepping-lifting leg, arm raise, head turn)
4. Control of dynamics: gait, proactive
7. Dynamic stability: Ability to exert ongoing control of center of mass when the base of the support is changing (eg, during gait and postural transitions)
5. Sensory strategies: integration, reweighting
8. Sensory integration: Ability to reweight sensory information (vision, vestibular, somatosensory) when input altered
6. Cognitive processing: attention, learning
9. Cognitive influences: Ability to maintain stability while responding to commands during the task or attend to additional tasks (eg, dual-tasking)
Given its conceptual basis, comprehensive nature, and support from the physiological and biomechanical literature, the Systems Framework for Postural Control can help clarify the components of balance captured in existing measures and inform decisions when selecting measures for evaluating balance and informing rehabilitative interventions. The objectives of this study were to (1) identify existing validated standardized measures of standing balance in adult populations and (2) determine the components of postural control captured in each tool, as outlined by the Systems Framework for Postural Control. The review question was “What components of postural control are included in standardized balance measures whose validity and reliability are established in adult populations (18y and older)?”
Methods
Study design
A scoping review—a rigorous approach useful for identifying gaps in the existing literature
such as using an iterative approach to develop the research question, defining relevant concepts, and including quality indicators in the eligibility criteria. The steps are outlined below. Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations for systematic review conduct and reporting
also informed the methodology and were adopted where appropriate.
Develop a research question
What components of postural control are included in standardized balance measures whose validity and reliability are established in adult populations (18y and older)?
Search for relevant material
A professional librarian searched published literature indexed in MEDLINE (from 1946 to February week 4, 2014), EMBASE (from 1974 to March 10, 2014), and CINAHL (from 1981 to March 11, 2014), and the search strategies were reviewed by a second librarian. Combinations of the following terms were used: postural balance/equilibrium, psychometrics/reproducibility of results/predictive value of tests/validation studies, instrument construction/instrument validation, geriatric assessment/disability evaluation. A sample search strategy for MEDLINE is presented in supplemental appendix S1 (available online only at http://www.archives-pmr.org/). A comprehensive gray literature search was also conducted to identify measures not captured by the database searches, including the Canadian Agency for Drugs and Technologies in Health gray literature search checklist,
as well as a hand search of published narrative review articles describing balance measures identified in the database search, and a search of the Physiotherapy Evidence Database, a database of randomized trials, systematic reviews, and clinical practice guidelines for physiotherapy, to identify additional measures.
Define study selection
Level 1 title and abstract screening criteria included descriptive studies (1) focused on balance measurement, (2) in adult populations (18y and older), and (3) published in the English language. Screening criteria were piloted on a random 10% sample of abstracts and clarified where necessary. We were specifically searching for the “index” publication—a measure's first publication presenting its development and/or initial psychometric evaluation—as the definitive reference for the measure. However, in anticipation that not all measures would be published in a way that it would be possible to identify the first publication from the abstract, the names of all balance measures identified in the abstract screen were recorded for manual cross-checking and hand search for the index publication. Two research assistants independently screened the abstracts of studies identified in the database search using the screening criteria. Disagreements were resolved by the primary investigator (K.M.S.), who also reviewed the list of all measures identified in the abstract screening and flagged relevant abstracts for a follow-up hand search.
Level 2 full-text screening criteria included (1) index publication, (2) having a stated objective or commonly used to assess balance, (3) including at least 1 standing task, (4) having both a standardized testing protocol and a standardized evaluation criteria, and (5) having a minimum of 1 psychometric property (validity or reliability) evaluated. The last criterion (minimum of 1 psychometric property evaluated) was included for quality assessment purposes to prevent measures with no empirical support from being considered. Hand searches were triggered at this phase if (1) no psychometric data were reported in the index publication (to determine whether companion articles existed that would support the inclusion of the measure in the review) or (2) it was not clear from the full text whether the identified article was the index publication. Full-text screening was performed by 2 research assistants, with disagreements resolved by the primary investigator. Two coinvestigators (M.K.B. and K.V.O.) reviewed and approved the final list of included measures to confirm that all known relevant measures were included.
Chart the data
Descriptive data abstraction was performed by a research assistant and reviewed by the primary investigator. The research assistant used a standardized template to extract the measures' stated purpose and development methods, characteristics (evaluation parameters and number of items), and results of preliminary psychometric testing (reliability and/or validity data).
The components of balance evaluated in each measure were explored by coding the individual items and tasks according to the Systems Framework for Postural Control. Review of the framework by the research team suggested that in some cases, multiple constructs were captured in the original 6 domains (eg, reactive and anticipatory postural control under “movement strategies”). As such, the 6 domains were adapted by the primary investigator into 9 operational definitions of balance components that may be uniquely evaluated. These operational definitions were reviewed and revised by two coinvestigators (M.K.B. and K.V.O.) both before and iteratively during coding and validated by an external reviewer with expertise in neurophysiology of postural control. The final operational definitions are presented in table 1. Two investigators (K.M.S. and M.K.B.) independently reviewed the tasks and scoring criteria of each measure and identified on a binary scale (yes/no) which balance components were included in each measure. Individual components were defined as included if they were inherent to task performance, even if not explicitly part of the measure's evaluation criteria. Disagreements were resolved through consensus discussion with a third investigator (K.V.O.).
Collate, summarize, and report results
Data abstraction and mapping results were tabulated and descriptive statistics (frequencies and percentages) were calculated for all variables using SAS (version 9.2).a
Results
Data synthesis
The study selection process is illustrated in figure 1. The MEDLINE, CINAHL, and EMBASE searches yielded a total of 1213 records. The hand search and gray literature search yielded an additional 18 records, and the Physiotherapy Evidence Database search did not produce any additional results. After duplicates were removed, and 974 abstracts were identified for review. Of these, 847 records were excluded after the abstract screening and 128 articles were selected for full-text review. After full-text screening, 66 articles representing the index publication of a standardized balance measure for adults were included. Full references for the index publication of all included measures are provided in supplemental appendix S2 (available online only at http://www.archives-pmr.org/).
Supplemental Table S1 (available online only at http://www.archives-pmr.org/) presents selected characteristics of each measure. The 66 included measures were published between 1986 and 2014. Thirty-seven measures (56%) stated at least 1 component of balance included in the Systems Framework for Postural Control. Reported development methods for each measure ranged from no description (n=33, 50%), to expert or clinician consultation (n=12, 18%), to statistical analysis (eg, Rasch analysis and item response theory; n=13, 20%). The number of items in each measure ranged between 1 and 53, with a median of 9 items. Twelve measures (18%) included some graded progression in which participants must meet specific criteria to complete additional items. Thirty-eight measures (58%) were evaluated on a categorical scale (ranging between 2 and 9 categories), 26 (39%) used a continuous scale, and 2 (3%) used a combination. Psychometric data published with the index publication are presented in supplemental table S2 (available online only at http://www.archives-pmr.org/).
Components of balance evaluated in each measure
Coding agreement by the 2 independent reviewers was 87%, and 100% agreement was achieved after consensus discussion with the third investigator. Coding results identifying the components of balance included in each measure are presented in table 2. Underlying motor systems were evaluated in all 66 measures (100%), anticipatory postural control in 47 measures (71%), dynamic stability in 44 measures (67%), static stability in 42 measures (64%), sensory integration in 32 measures (48%), functional stability limits in 18 measures (27%), reactive postural control in 15 measures (23%), cognitive influences in 11 measures (17%), and verticality in 5 measures (8%). Figure 2 illustrates the distribution of number of components evaluated in each measure. Thirty-four measures (52%) evaluated 3 or fewer components of balance, 22 measures (33%) evaluated between 4 and 6 components of balance, 9 measures (14%) evaluated 7 or 8 components of balance, and 1 measure evaluated all 9 components of balance (Balance Evaluation Systems Test [BESTest]).
Table 2Components of balance evaluated by standardized measures
Measure
Static Stability
Underlying Motor Systems
Functional Stability Limits
Verticality
Reactive Postural Control
Anticipatory Postural Control
Dynamic Stability
Sensory Integration
Cognitive Influences
Other Constructs not Included in Systems Framework
A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission.
A discriminative measure for static postural control ability to prevent in-hospital falls: reliability and validity of the Standing Test for Imbalance and Disequilibrium (SIDE).
Clinical testing of an innovative tool for the assessment of biomechanical strategies: the Timed “Up and Go” Assessment of Biomechanical Strategies (TUG-ABS) for individuals with stroke.
Interrater reliability and construct validity of the Posture and Postural Ability Scale in adults with cerebral palsy in supine, prone, sitting and standing positions.
To our knowledge, this work represents the first attempt to synthesize the literature on standardized balance measures for adult populations and analyze the content of measures with respect to an established theoretical framework for postural control. The primary findings of this review are the large number of independently validated standardized measures available to assess balance in adults, and the high proportion of measures that assess only a few components of balance as identified by the Systems Framework for Postural Control. These findings highlight a number of issues relevant to selecting standardized balance measures, as well as broader issues related to the theoretical basis of postural control.
With respect to the high number of standardized balance measures, although 66 distinct measures were included in the present study, it is important to note that there was significant overlap in the specific balance tasks performed. For example, alternating steps onto a stool or platform were common across multiple measures (eg, Activity-based Balance Level Evaluation scale, BESTest, Berg Balance Scale, and Community Balance and Mobility scale). Moreover, some stand-alone measures were incorporated as tasks in larger tests, such as single leg stance and functional reach (included in BESTest and Berg Balance Scale), and several “new” measures were developed as combinations, adaptations, or evolutions of other balance measures (eg, Equiscale, Postural Assessment for Stroke Scale, and Unified Balance Scale). However, recent data on clinical balance assessment practices indicate that refined and/or newer standardized balance measures are yet to be widely adopted
; therefore, it is difficult to determine whether actual balance assessment is improving with these changes. Rather, the pool of balance measures continues to widen with additional combinations of tasks in a circuitous fashion.
Although several components of balance were included in a high proportion of measures (such as underlying motor systems, anticipatory postural control, static stability, and dynamic stability in more than two thirds of measures), certain functionally relevant components were not included in most measures. For example, reactive postural control—corrective responses after instability—was included in only 23% of the measures. The lack of measures evaluating reactive control is concerning because the ability to successfully recover from instability is the most critical component of balance for fall avoidance.
Similarly, cognitive contributions to postural control and fall risk are well established, yet only 17% of the measures included a secondary cognitive task.
Finally, vertically was the least commonly included component (8% of the measures). Verticality and appropriate orientation to gravity are important for establishing an efficient stable “starting position” for balance,
the absence of which may put an individual in an inherently less stable position, which could lessen the likelihood of successful balance recovery, and for whom individuals with sensory or neurological conditions may be particularly at risk.
Half of the measures included in this review evaluated 3 or fewer components of postural control. Some of these tests are commonly used in clinical practice, such as the Single Leg Stance test,
and as such, users need to be aware of what balance information they are getting when they choose a limited-scope measure. These types of tests may be appropriate for screening or risk assessment, but not for treatment planning and intervention selection. For a comprehensive balance assessment, multiple measures can be combined, or users can select a measure that includes most or all components of balance. Only 1 measure contained an explicit evaluation of all 9 components of postural control: the BESTest. Published in 2009, it was developed with the goal of helping clinicians identify underlying postural control systems that may be responsible for poor functional balance—the only identified measure with this specific purpose. However, the BESTest developers also authored the most comprehensive description of the Systems Framework for Postural Control, so it is not unexpected that this measure is the closest match. Four measures included 8 components of balance (Clinical Gait and Balance Scale, Fullerton Advanced Balance Scale, Mini-BESTest, and Unified Balance Scale). From a theoretical perspective, these are the most complete standardized balance measures available to date. However, none of these measures has yet been widely adopted in clinical practice,
highlighting the need to study factors influencing balance assessment practices and use of standardized measures in more detail.
Study limitations
Although the focus of this review was on balance assessment for treatment planning and intervention selection, theoretical construct is only one characteristic of a measure. Consideration of measure purpose (eg, risk assessment versus outcome measurement) would be beneficial for evaluating the appropriateness of individual measures for their intended function. Examination of evaluation parameters would also be useful because quantitative measurements may provide more precise information than do observed behaviors. Furthermore, this review did not consider the difficulty of individual items related to a particular balance component, such as whether static stability was assessed by normal or narrow stance, tandem stance, or single-leg stance. Nor did we consider how dual-task assessments were conducted and whether instructions were to prioritize the postural or cognitive task. These are important functional distinctions not reflected in the present analysis, and attempts to evaluate particular components of balance across the continuum of difficulty likely have contributed to the proliferation of so many measures. Given the complexities of standardized balance measurement, we suggest that readers interpret our findings in conjunction with the previous reviews that address some of these issues
and refer to the Rehabilitation Measures Database—a National Institute of Disability and Rehabilitation Research-funded, searchable Web site containing evidence-based summaries of more than 250 rehabilitation measures.
In conducting this review, we identified a number of gaps in postural control theory that require attention to move the field forward. First, although the systems-based nature of postural control is accepted and supported throughout the literature, there is no criterion-standard description of all known components and their interactions. Second, the Systems Framework for Postural Control, the model selected for the current review, accounts for all balance components equally, without any hierarchy or order to the individual components. It also considers only standing balance, when sitting balance is an important functional task recognized in a number of the measures included in this review. Indeed, in this review we excluded measures that included only sitting balance (n=8) because they could not be captured in the model. Refinement of the theory to address such issues may more accurately reflect the nature of postural control in vivo as well as facilitate increased efficiency of balance assessment in time- and resource-constrained clinical environments. For example, reactive postural control may be considered a more challenging component than anticipatory control, and if an individual cannot effectively engage anticipatory strategies, it may not be appropriate to explicitly assess reactive control. Conversely, appropriate anticipatory actions do not necessarily indicate that reactive control is “normal,” requiring continued probing. Incorporating such logic to more standardized assessment strategies may preserve the theoretical integrity of balance measures while optimizing efficiency. Two included measures, the Balance Computerized Adaptive Testing system and Hierarchical Balance Short Forms, did incorporate such a system into their approach but lacked consideration of all components of postural control in their models. Continued refinement of these systems from a comprehensive perspective may be a practical approach moving forward.
Conclusions
The theoretical components of postural control included in standardized balance measures for adults vary greatly, with some measures omitting important components relevant for avoiding falls. As such, the choice of the measure may limit the overall interpretation of an individual's balance ability. Continued work is necessary to increase implementation of comprehensive assessment in research and practice to facilitate individualized identification of balance deficits and customization of training programs.
Supplier
a.
SAS, 100 SAS Campus Dr, Cary, NC 27513-2414.
Supplemental Appendix S1. Sample Search Strategy
Database: Ovid MEDLINE(R), Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily, and Ovid OLDMEDLINE(R) <from 1946 to February week 4, 2014>
To address shortcomings of previous balance measures that do not address adaptive and reactive control and do not assess the interaction between impairment and disability components of the task used
Postural control in standing and walking
Not specified
Not specified
12
Categorical
4
No
Balance Computerized Adaptive Testing (CAT) system
Entire range of balance function (items with wide range and even distribution of difficulty)
Stroke
Pool of 41 items identified on the basis of predefined balance concepts, clinical expert consultation, and field testing to finalize item description and scoring; items administered by 5 raters to 764 patients and item response theory model fit to data and item parameters estimated
34
Categorical
26 items have 2 scoring categories, and 8 items have 3 scoring categories
divided into 3 hierarchical function-related balance levels (sitting, standing, and stepping); simulation program used to make an item selection algorithm proposing 6 candidates (each with 6 items) for each balance level, simulation data used to select candidates with highest reliability, adopted opinions of stroke-related clinicians and psychometricians to determine the final set of 6-item balance short form for each sitting, standing, and stepping level
16
Continuous (binary counts transformed into continuous measure)
To help physical therapists identify underlying postural control systems that may be responsible for poor functional balance
Biomechanical constraints, stability limits/verticality, anticipatory postural adjustments, postural responses, sensory integration, and stability of gait
Not specified
Initial test proposed by Horak and Frank, then clinicians provided feedback on clarity, sensitivity, and practicality at 38 workshops over 4y, interrater reliability evaluated, then test revised
36
Categorical
4
No
Brief Balance Evaluation Systems Test (Brief BESTest)
To assess balance performance in 6 specific contexts of postural control to allow for identification of specific balance systems responsible for poor balance
Mechanical constraints, limits of stability, anticipatory postural adjustments, postural responses to induced loss of balance, sensory orientation, and gait
Not specified
Evaluated internal consistency of items in each section of the BESTest
Haines et al. Arch Phys Med Rehabil 2007;88:1614-21
To be a global standing balance outcome measure for elder rehabilitation
Global standing balance (static, dynamic, and function)
Older adults undergoing rehabilitation
Cross-sectional survey with expert panel, selection of 4 stand-alone tests, multicenter prospective cohort randomly divided into development and validation data sets to perform item scaling
with highest internal consistency and greatest responsiveness in development cohort of patients, and compared 4, 5, 6, and 7-item versions of the SFBBS with 3 and 5 assessment levels
To assess the effects of specific stroke physiotherapy interventions for balance disability poststroke
Not specified
Stroke
14-point hierarchical prototype test proposed with progressively difficult tasks, validated by decreasing pass rates for each item, acceptable coefficients of stability and reproducibility
To identify postural instability, evaluate change after intervention, and inform rehabilitation team about balance and mobility status of ambulatory individuals with traumatic brain injury returning to community environment
Multitasking, sequencing of movement components, complex motor skills
Ambulatory people with traumatic brain injury
Literature review, interviews with physical and occupational therapists, ambulatory people with brain injury living in community over multiple phases
and BBS 40; trial-and-error procedure: administered to 55 patients 1–3 times and Rasch analysis used to explore psychometric validity; 2 items deleted because too easy and uninformative
8
Categorical
3
No
Fast Evaluation of Mobility, Balance and Fitness (FEMBAF)
To assess risk of falling, ability to complete functional tasks, and assess reports of fear, pain, mobility, difficulty, and perception of strength deficits
To identify balance problems of varying severity in functionally independent older adults and evaluate system(s) that might be contributing to balance problems
Sensory systems and strategies, internal representations, musculoskeletal components, and anticipatory and adaptive mechanisms
Functionally independent older adults
Review of conceptual frameworks, scientific literature, and previously published tests; developed test items and evaluated appropriateness of items, clarity of instructions, and scoring by clinical experts; pilot test of preliminary scale with older adults to establish appropriate test protocols, scoring procedures, and better instructions
To measure balance in lower levels of function in more severely impaired people
Standing balance
Not specified
Developed over 2y by physical therapists; scale developed for lower-functioning patients, to document progress in an objective and quantifiable way, quick to use, no math, no equipment; during development, therapists were encouraged to talk to each other about experiences with scale; script of therapist instruction to patients subsequently developed
Clark et al. Arch Phys Med Rehabil 1997;78:1078-84
To assess multiple indices of dynamic balance performance by evaluating individual’s ability to volitionally move the center of gravity to 8 predetermined positions
Dynamic balance
Not specified
Not specified
8
Continuous (center of gravity velocity, excursion, endpoint, directional control)
Continuous (time and “footfall score” [+1 when part of foot placed on line, +2 when foot falls outside line or reached for something to maintain balance])
To practically assess performance-oriented mobility tasks that incorporate useful feature of both disease-oriented and gait analytic approaches
Not specified
Not specified
Reviewed previous work by bioengineers, orthopedists, neurologists, rheumatologists, and physical therapists to identify what observations should be included and how they should be made; adapted this work to make instrument with 8 position changes for balance and 8 gait observations; 90% agreement between raters when tested in 15 ambulatory people; added 5 balance maneuvers
with highest internal consistency and greatest responsiveness in development cohort of patients and compared 5, 6, and 7-item versions of the SFPASS with 3 and 5 assessment levels
Ford-Smith et al. Arch Phys Med Rehabil 1995;76:77-81
To assess ability to make effective use of visual, vestibular, and proprioceptive inputs separately and the ability to suppress inaccurate sensory information
A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission.
A discriminative measure for static postural control ability to prevent in-hospital falls: reliability and validity of the Standing Test for Imbalance and Disequilibrium (SIDE).
To be a single tool with proven measurement properties, allowing the measurement of balance “from bed to community” regardless of the etiology of the neurological lesion causing the loss of balance
Quiet stance, anticipatory postural adjustments/transitions, responses to external perturbations, sensory orientation, stability during gait
Unpublished pilot study with 31 health volunteers (16 women, mean age, 35y) assessing interrater and test-retest reliability Pilot interrater ICC=.99 and test-retest ICC=.95
2
Continuous (time)
NA
No
Timed Up-and-Go Assessment of Biomechanical Strategies (TUG-ABS)
Clinical testing of an innovative tool for the assessment of biomechanical strategies: the Timed “Up and Go” Assessment of Biomechanical Strategies (TUG-ABS) for individuals with stroke.
Interrater reliability and construct validity of the Posture and Postural Ability Scale in adults with cerebral palsy in supine, prone, sitting and standing positions.
1. 5 raters administered 41 items 2. 764 patients with stroke and stimulation study using data of patients who had participated in item pool development
1. Raw sum score of initial 41 items ICC=.95 2. Item simulation study average reliability=.94
Interrater reliability (evaluated once, then test revised and evaluated again)
Reliability session 1: 12 ambulatory adults with a range of balance function (age, 50 to 80y) Reliability Session 2: 11 subjects, including 4 from first session (age, 67 to 88y)
Total score ICC=.91; subsection ICC range=.79 to .96
Yes
Concurrent validity
Correlated score of most experienced rater to Activity-Specific Balance Confidence Scale
1. Physical therapists’ ratings of importance of scale items on 5-point scale from “not at all important” to “extremely important,” correlation to global balance rating 2. Compared with gait velocity
36 people with traumatic brain injury attending neurorehabilitation (mean age, 31y)
12 blind people aged 19 to 61y and 12 sighted people aged 26 to 60y
Correlation with force plate assessment and single-leg stance test for blind subjects: −.13 and .77 for left leg and −.78 and .89 for the right leg, sighted people: correlation was −.56 (NS) and .93 for the left leg and −.61 and .71 for the right leg
Correlation with BBS total score: forward reach r=.476, backward reach r=.356, right reach r=.389, and left reach r=.39 Correlation with TUG: forward reach r=−.442, backward reach r=−.333, right reach r=−.26, and left reach r= −.31
Hierarchical Assessment of Balance and Mobility (HABAM)
1. Average κ coefficient= .72 (range= 0.45 to 1), Pearson r=.99 2. Average k-coefficient= .88 (range, 0.64 to 1), Pearson r=.98
Yes
1. Construct validity 2. Predictive validity
1. Correlated scores with motricity, somatosensory threshold, spatial inattention, spasticity, and functional status and instrumental measures of sitting balance, when available 2. Correlated with FIM score
“Strong correlations with the transferring and locomotion sections of FIM, with motricity, sensibility, and spatial neglect scores, negative correlations with postural stabilization (r=.48; P<.0001) and postural orientation with respect to gravity (r=.36; P=.05); strong correlation to total FIM score (r=.75; P<.0001)
Short Form of Postural Assessment Scale for Stroke Patients (SFPASS)
A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission.
58 community-dwelling adults older than 65y (29 fallers and 29 nonfallers)
1. Gait speed r=.53, TUG r=−.67, Single limb stance r=.54, and Tandem stance r=.55 2. Significant difference between fallers and nonfallers (T= 11.6; P=.001)
Standing Test for Imbalance and Disequilibrium (SIDE)
A discriminative measure for static postural control ability to prevent in-hospital falls: reliability and validity of the Standing Test for Imbalance and Disequilibrium (SIDE).
Clinical testing of an innovative tool for the assessment of biomechanical strategies: the Timed “Up and Go” Assessment of Biomechanical Strategies (TUG-ABS) for individuals with stroke.
Interrater reliability and construct validity of the Posture and Postural Ability Scale in adults with cerebral palsy in supine, prone, sitting and standing positions.
How to measure balance in clinical practice: a systematic review of the psychometrics and clinical utility of measures of balance activity for neurological conditions.
in: Rowell L.B. Shepherd J.T. Handbook of physiology, Section 12, Exercise: regulation and integration of multiple systems. American Physiological Society,
New York1996: 255-292
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