Normative Values of the Berg Balance Scale and Timed Up and Go Test
Condition: Community Dwelling Older Adults
Study type: Observational

Summary: 
      Falls are a significant public health concern for older adults; early identification of
      people at high risk for falling facilitates the provision of rehabilitation treatment to
      reduce future fall risk. Berg balance scale is a reliable, valid and widely used tool to
      measure balance. Normal values of BBS declines with increasing age above 70 at a rate of 0.75
      points per year. Timed up and go test Assess mobility, balance, falls risk. Normative data on
      both these test for our population is not established. Therefore this study aimed at finding
      normal scores of both these in our community-dwelling elderly females. For this purpose, data
      will be calculated from community-dwelling elderly females. BBS and TUG would be performed on
      each subject meeting our inclusion criteria after their consent. Data will be recorded and
      analyzed using Statistical Package for the Social Sciences (SPSS) version 23. We will find
      the mean and standard deviation. Thus this study will provide normal reference values of BBS
      and TUG in our community
    

Detailed description: 
      Balance deficits in elderly adults can arise from the process of ageing, such as age-related
      changes associated with the sensory system (vestibular, visual, somatosensory) or diseases
      such as cerebrovascular accident, arthritis, peripheral neuropathies, or disuse due to
      immobility. Balance is maintained when all the forces acting on the body are balanced so that
      one's centre of gravity is controlled within the base of support in static postures, during
      movement, and when responding to external disturbances. Normative data are important when
      interpreting any balance tool. the knowledge that a person or group of people Have worse
      balance than a healthy person of the same age may assist the identification and effective
      management of balance problem.

      The BBS is a performance-based measure consisting of 14 items and a maximum score of 56.
      Originally developed to assess balance in older adults, it was subsequently adopted as a
      falls-risk prediction tool for older adults (although studies have differed in the
      recommended cut off score for falls risk. The BBS consists of 14 functional tasks of
      increasing difficulty, each scored from 0 to 4 (0¼unable to perform the task; 4¼task
      performed independently). The maximum score of 56 indicates no identifiable balance
      difficulties.

      The 'timed up and go' test (TUG) is a simple, quick and widely used clinical
      performance-based measure of lower extremity function, mobility and fall risk. The TUG has
      been studied in elderly populations Women) the test procedure for the TUG is relatively
      simple. Subjects are asked to stand up from a standard chair (seat height between 44 and 47
      cm), walk a distance of 3 m (marked on the floor) at a comfortable pace, turn, walk back and
      sit down. Subjects are permitted to use routine walking aids and are instructed not to use
      their arms to stand up. No physical assistance is given. The time to complete the task is
      measured with a stopwatch. Timing commences on the command 'go' and stops when the subject's
      back is positioned against the back of the chair after sitting down.

      Use of local normative data of the specific population is recommended for more meaningful
      interpretation of TUG result Therefore, the aim of this study was to identify the normative
      data of TUG test and berg balance scale among community-dwelling older adults.the research
      was conducted in 2014 on normative scores on berg balance scale declines after age 70 in
      healthy community-dwelling people. it was a systematic review. purpose of this study was to
      find What is the mean Berg Balance Scale score of healthy elderly people living in the
      community and how does it vary with age? Group of healthy community-dwelling people with a
      mean age of 70 years or greater that has undergone assessment using the Berg Balance Scale
      were included. Mean and standard deviations of Berg Balance Scale scores within cohorts of
      elderly people of known mean age were measured. The mean Berg Balance Scale scores ranged
      from 37 to 55 out of a possible maximum score of 56. Although participants aged around 70
      years had very close to normal Berg Balance Scale scores, there was a significant decline in
      balance with age at a rate of 0.7 points on the 56-point Berg Balance Scale per year. It was
      concluded that Healthy community-dwelling elderly people have modest balance deficits, as
      measured by the Berg Balance Scale, although balance scores deteriorate and become more
      variable with age.

      the study was conducted on 'Timed Up and Go' test: Age, gender and cognitive impairment
      stratified normative values of older adults' in 2017. The aim of this study was to establish
      'Timed up and Go' test (TUG) normative data among community-dwelling older adults stratified
      based on cognitive status, gender and age groups. A total of 2084 community-dwelling older
      adults from wave I and II were recruited through a multistage random sampling method. TUG was
      performed using the standard protocol and scores were then stratified based on with and
      without mild cognitive impairment (MCI), gender and in 5-year age groups ranging from ages of
      the '60s to '80s. 529(16%) participants were identified to have MCI. descriptive analysis
      showed, participants with MCI, women and older in age took a longer time to complete TUG, as
      compared to men with MCI across all age groups with exceptions for some age groups. These
      results suggested that MCI needs to be taken into consideration when testing older adults
      using TUG, besides age and gender factors.

      a study on "Berg balance scale" and "timed up and go" Discriminates between fallers and
      non-fallers, in people with Multiple S. Different cut-offs have been used for BBS. With a
      cut-off at >44; high specificity (90%) but low sensitivity (40%) were found. Using ≤55 as
      cut-off yielded high sensitivity (94%) but low specificity (32%).TUG has not shown
      discriminant ability. The aim was to examine discriminant validity for BBS and TUG; fallers
      vs. non-fallers and predictive properties using previously suggested cut-offs. Data from
      three samples of PwMS (n=220) with imbalance was used. Testing was conducted by experienced
      research physiotherapists. Participants were classified as fallers or non-fallers.
      Mann-Whitney U test and ROC were used. BBS median for fallers was 45 points (n:108) and for
      non-fallers 50 points (n:99). TUG median was 17.5 seconds (n=108) for fallers and 13.2
      seconds (n=99) for non-fallers.BBs: Using >44 points as cut-off correctly identified 51% of
      the fallers and 37% of the non-fallers. Using ≤55 correctly identified 96% fallers and 15%
      non-fallers.TUG: A cut-off (19.34 seconds) was chosen by maximizing the sum of sensitivity
      and specificity resulting in sensitivity at 70% and specificity at 43%.

      Susan W Muir et al. conducted a study in 2008 on Use of the Berg Balance Scale for Predicting
      Multiple Falls in Community-Dwelling Elderly People. it was A Prospective Study. The
      objective of this study was to examine the predictive validity of the Berg Balance Scale
      (BBS) for 3 types of outcomes-any fall (1 fall), multiple falls (2 falls), and injurious
      falls-by use of sensitivity, specificity, receiver operating characteristic (ROC) curves,
      area under the curve, and likelihood ratios. A sample of 210 community-dwelling older adults
      received a comprehensive geriatric assessment at baseline, which included the BBS to measure
      balance. Data on prospective falls were collected monthly for a year. They concluded that the
      use of the BBS as a dichotomous scale to identify people at high risk for falling should be
      discouraged because it fails to identify the majority of such people. The predictive validity
      of this scale for multiple falls is superior to that for other types of falls.
    

Observational model: Other
Time perspective: Other
Sampling method: Non-Probability Sample
Study population: 
        community-dwelling older adult females who are able to walk independently and can take
        self-care activities independently without any cognitive issues & any co-morbidity.
      
Keywords: falls; Frail Elders; balance