Query: Berg balance scale

title: Age and gender related test performance in community dwelling elderly people: Six Minute Walk Test, Berg Balance Scale, Timed Up Go Test, and gait speeds.
abstract: The interpretation of patient scores on clinical tests of physical mobility is limited by a lack of data describing the range of performance among people without disabilities. The purpose of this study was to provide data for 4 common clinical tests in a sample of community dwelling older adults.  Ninety six community dwelling elderly people (61 89 years of age) with independent functioning performed 4 clinical tests.  Data were collected on the Six Minute Walk Test (6MW) Berg Balance Scale (BBS) and Timed Up Go Test (TUG) and during comfortable and fast speed walking (CGS and FGS) Intraclass correlation coefficients (ICCs) were used to determine the test retest reliability for the 6MW, TUG, CGS, and FGS measurements. Data were analyzed by gender and age (60 69, 70 79, and 80 89 years) cohorts, similar to previous studies. Means, standard deviations, and 95% confidence intervals for each measurement were calculated for each cohort.  The 6MW, TUG, CGS, and FGS measurements showed high test retest reliability (ICC [2,1].95 .97) Mean test scores showed a trend of age related declines for the 6MW, BBS, TUG, CGS, and FGS for both male and female subjects.  Preliminary descriptive data suggest that physical therapists should use age related data when interpreting patient data obtained for the 6MW, BBS, TUG, CGS and FGS. Further data on these clinical tests with larger sample sizes are needed to serve as a reference for patient comparisons.

title: The Balance Scale: reliability assessment with elderly residents and patients with an acute stroke.
abstract: The objective of this study was to assess the reliability of the Balance Scale. Subjects were chosen from a larger group of 113 elderly residents and 70 stroke patients participating in a psychometric study. Elderly residents were examined at baseline, and at 3, 6 and 9 months, and the stroke patients were evaluated at 2, 4, 6 and 12 weeks post onset. The Cronbach's alphas at each evaluation were greater than 0.83 and 0.97 for the elderly residents and stroke patients respectively, showing strong internal consistency. To assess inter rater reliability, therapists treating 35 stroke patients were asked to administer the Balance Scale within 24 hours of the independent evaluator. Similarly, caregivers at the Residence were asked to test the elderly residents within one week of the independent evaluator. To assess intra rater reliability, 18 residents and 6 stroke patients were assessed one week apart by the same rater. The agreement between raters was excellent (ICC 0.98) as was the consistency within the same rater at two points in time (ICC 0.97) The results support the use of the Balance Scale in these groups.

title: Predicting falls within the elderly community: comparison of postural sway, reaction time, the Berg balance scale and the Activities specific Balance Confidence (ABC) scale for comparing fallers and non fallers.
abstract: Simple reaction time, the Berg balance scale, the Activities specific Balance Confidence (ABC) scale and postural sway were studied in order to determine cut off scores as well as develop a model used in the prevention of fallers within the elderly community. One hundred and twenty five subjects, 45 fallers and 80 non fallers were evaluated throughout the study and results indicated that non fallers have significantly faster reaction times, have higher scores on the Berg balance scale and the ABC scale as well as sway at slower frequencies when compared to fallers. Furthermore, all risk factors were subsequently entered into a logistic regression analysis and results showed that reaction time, the total Berg score and the total ABC score contributed significantly to the prediction of falls with 89% sensitivity and 96% specificity. A second logistic regression was carried out with the same previous variables as well as all questions of the Berg and ABC scales. Results from the logistic analysis revealed that three variables were associated with fall status with 91% sensitivity and 97% specificity. Results from the following study would seem rather valuable as an assessment tool for health care professionals in the identification and monitoring of potential fallers within nursing homes and throughout the community.

title: Usefulness of the Berg Balance Scale in Stroke Rehabilitation: A Systematic Review
abstract: In a recent study of 655 physical therapists working with a stroke population, the Berg Balance Scale (BBS) was identified as the most commonly used assessment tool across the continuum of stroke rehabilitation. Given the widespread popularity of the BBS, it is important to critically appraise the BBS for its use with a stroke population.  The purposes of this study were to conduct a systematic review of the psychometric properties of the BBS specific to stroke and to identify strengths and weaknesses in its usefulness for stroke rehabilitation.  Twenty one studies examining the psychometric properties of the BBS with a stroke population were retrieved. Internal consistency was excellent (Cronbach alpha=.92 .98) as was interrater reliability (intraclass correlation coefficients [ICCs].95 .98) intrarater reliability (ICC=.97) and test retest reliability (ICC=.98) Sixteen studies focused on validity and generally found excellent correlations with the Barthel Index, the Postural Assessment Scale for Stroke Patients, Functional Reach Test, the balance subscale of Fugl Meyer Assessment, the Functional Independence Measure, the Rivermead Mobility Index (except for weight shift and step up items) and gait speed. Berg Balance Scale scores predicted length of stay, discharge destination, motor ability at 180 days poststroke, and disability level at 90 days, but these scores were not predictive of falls. Eight studies focused on responsiveness; all reported moderate to excellent sensitivity. Three studies found floor or ceiling effects.  The BBS is a psychometrically sound measure of balance impairment for use in poststroke assessment. Given the floor and ceiling effects, clinicians may want to use the BBS in conjunction with other balance measures.

title: Brazilian version of the Berg balance scale.
abstract: The purpose of the present study was to translate and adapt the Berg balance scale, an instrument for functional balance assessment, to Brazilian Portuguese and to determine the reliability of scores obtained with the Brazilian adaptation. Two persons proficient in English independently translated the original scale into Brazilian Portuguese and a consensus version was generated. Two translators performed a back translation. Discrepancies were discussed and solved by a panel. Forty patients older than 65 years and 40 therapists were included in the cultural adaptation phase. If more than 15% of therapists or patients reported difficulty in understanding an item, that item was reformulated and reapplied. The final Brazilian version was then tested on 36 elderly patients (over age 65) The average age was 72 years. Reliability of the measure was assessed twice by one physical therapist (1 week interval between assessments) and once by one independent physical therapist. Descriptive analysis was used to characterize the patients. The intraclass correlation coefficient (ICC) and Pearson's correlation coefficient were computed to assess intra and interobserver reliability. Six questions were modified during the translation stage and cultural adaptation phase. The ICC for intra and interobserver reliability was 0.99 (P 0.001) and 0.98 (P 0.001) respectively. The Pearson correlation coefficient for intra and interobserver reliability was 0.98 (P 0.001) and 0.97 (P 0.001) respectively. We conclude that the Brazilian version of the Berg balance scale is a reliable instrument to be used in balance assessment of elderly Brazilian patients.

title: How much change is true change? The minimum detectable change of the Berg Balance Scale in elderly people.
abstract: To determine the minimum detectable change at 95% confidence for the Berg Balance Scale in a group of elderly people, undergoing physiotherapy rehabilitation.  Multi centre, test retest design. SUBJECTS Cross sectional sample of convenience of people over 65 years (n 118) without a previous history of stroke, Parkinson's disease or recent hip arthroplasty.  Physiotherapists working with elderly people, drawn from the Physiotherapy Research into Older People group, ranging in experience from newly qualified to 39 years qualified.  Each participant was assessed using the Berg Balance Scale and again within 48 hours by the same physiotherapist. The minimum detectable change at 95% was established.  A change of 4 points is needed to be 95% confident that true change has occurred if a patient scores within 45 56 initially, 5 points if they score within 35 44, 7 points if they score within 25 34 and, finally, 5 points if their initial score is within 0 24 on the Berg Balance Scale.  A clinician with a working knowledge of these minimum detectable change values can be up to 95% confident that a true change or not a true change in a patients' functional balance has occurred and can therefore alter their interventions accordingly to ensure quality, focused rehabilitation.

title: Use of the Berg Balance Scale for Predicting Multiple Falls in Community Dwelling Elderly People: A Prospective Study
abstract: 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. The objective of this prospective cohort 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. The predictive validity of the BBS for the identification of future fall risk was evaluated.  The BBS had good discriminative ability to predict multiple falls when ROC analysis was used. However, the use of the BBS as a dichotomous scale, with a threshold of =45, was inadequate for the identification of the majority of people at risk for falling in the future, with sensitivities of 25% and 45% for any fall and for multiple falls, respectively. The use of likelihood ratios, maintaining the BBS as a multilevel scale, demonstrated a gradient of risk across scores, with fall risk increasing as scores decreased.  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, and the use of likelihood ratios preserves the gradient of risk across the whole range of scores.

title: Pediatric Balance Scale: A Modified Version of the Berg Balance Scale for the School Age Child with Mild to Moderate Motor Impairment
abstract: The Pediatric Balance Scale (PBS) a modification of Berg's Balance Scale, was developed as a balance measure for school age children with mild to moderate motor impairments. The purpose of this study was to determine the test retest and interrater reliability of the PBS.  To determine test retest reliability, 20 children (aged five to 15 years) with known balance impairments were tested by one examiner on the PBS. Ten pediatric physical therapists independently scored 10 randomly selected videotaped test sessions.  There was no significant difference in total test scores [intraclass correlation coefficient (ICC) model 3,1 0.998] or individual items (Kappa Coefficients, k 0.87 to 1.0; Spearman Rank Correlation Coefficients, r 0.89 to 1.0) measured by one therapist on two occasions. No significant difference among ratings by different physical therapists was found on the PBS for total test score (ICC 3,1 0.997)  The PBS has been demonstrated to have good test retest and interrater reliability when used with school age children with mild to moderate motor impairments.

title: Validating the Berg Balance Scale for patients with Parkinson's disease: a key to rehabilitation evaluation.
abstract: To assess the criterion related validity of the Berg Balance Scale (BBS) in subjects with Parkinson's disease (PD) DESIGN Prospective, correlational analysis between the BBS and accepted measures of PD motor and functional impairment.  The federally funded PD research center, an interdisciplinary center of excellence for people with PD within a Veterans Affairs medical center.  Thirty eight men (average standard deviation, 71.1+ 10.5 y) with confirmed PD. Their initial diagnosis had been made on average 5.8+ 3.6 years earlier. All could stand or walk unassisted and had mild to moderate disability. Patients who could not ambulate without assistive devices were excluded.  Not applicable.  Correlational analyses between the BBS and the Unified Parkinson's Disease Rating Scale (UPDRS) motor scale, Modified Hoehn and Yahr Staging (Hoehn and Yahr) Scale, and the Modified Schwab and England Capacity for Daily Living Scale (S&E ADL Scale) RESULTS BBS score showed significant correlations with indicators of motor functioning, stage of disease, and daily living capacity. BBS score was inversely associated with the UPDRS motor score .58, P .005) Hoehn and Yahr Scale staging .45, P .005) and S&E ADL Scale rating .55, P .005) In all 3 correlations, lower scores on the BBS (indicating greater balance deficits) correlated with higher UPDRS scores (indicating greater motoric or functional impairment) CONCLUSIONS Results support the criterion related validity of the BBS. Its utility in other balance conditions of older adults has been established. Rehabilitation interventions have been shown to improve the balance deficits associated with PD. Early referral and periodic reassessment is vital to achieving and maintaining improvements. Our research results agree with other published research in suggesting that the BBS may be used as a screening tool and ongoing assessment tool for patients with PD.

title: Comparison of Reliability, Validity, and Responsiveness of the Mini BESTest and Berg Balance Scale in Patients With Balance Disorders
abstract: Recently, a new tool for assessing dynamic balance impairments has been presented: the 14 item Mini BESTest.  The aim of this study was to compare the psychometric performance of the Mini BESTest and the Berg Balance Scale (BBS) Design A prospective, single group, observational design was used in the study.  Ninety three participants (mean age=66.2 years, SD=13.2; 53 women, 40 men) with balance deficits were recruited. Interrater (3 raters) and test retest (1 3 days) reliability were calculated using intraclass correlation coefficients (ICCs) Responsiveness and minimal important change were assessed (after 10 sessions of physical therapy) using both distribution based and anchor based methods (external criterion: the 15 point Global Rating of Change [GRC] scale)  At baseline, neither floor effects nor ceiling effects were found in either the Mini BESTest or the BBS. After treatment, the maximum score was found in 12 participants (12.9% with BBS and in 2 participants (2.1% with Mini BESTest. Test retest reliability for total scores was significantly higher for the Mini BESTest (ICC=.96) than for the BBS (ICC=.92) whereas interrater reliability was similar (ICC=.98 versus .97, respectively) The standard error of measurement (SEM) was 1.26 and the minimum detectable change at the 95% confidence level (MDC95) was 3.5 points for Mini BESTest, whereas the SEM was 2.18 and the MDC95 was 6.2 points for the BBS. In receiver operating characteristic curves, the area under the curve was 0.92 for the Mini BESTest and 0.91 for the BBS. The best minimal important change (MIC) was 4 points for the Mini BESTest and 7 points for the BBS. After treatment, 38 participants evaluated with the Mini BESTest and only 23 participants evaluated with the BBS (out of the 40 participants who had a GRC score of =3.5) showed a score change equal to or greater than the MIC values.  The consecutive sampling method drawn from a single rehabilitation facility and the intrinsic weakness of the GRC for calculating MIC values were limitations of the study.  The 2 scales behave similarly, but the Mini BESTest appears to have a lower ceiling effect, slightly higher reliability levels, and greater accuracy in classifying individual patients who show significant improvement in balance function.