Responsiveness / sensitivity to change: [Reminder: studies below indicate only amount of BBS change after treatment; other outcome measures may have had a different responsiveness] The Berg has been used most often with people with neurological disorders. It is more responsive in the earlier stages post onset stroke where there is no ceiling effect. Population Descriptor N = Reference and intervention Yes/No Data Supporting Responsiveness s/p stroke 20 Duncan, 199873 23 treatments and 4 of a home program Experimental (n=10) Detailed program to improve strength, balance, endurance and encourage use of affected extremity Control group (n=10) Receiving traditional therapy no Treatment: 38.3 to 46.1 Control: 40.8 to 45.8 NS 13 Geiger, 200174 4 2-3x/week for 50 minutes (Exp- 35 min/session standard PT with 15 min Balance Master) Experimental group (n=7): Standard PT plus training on Balance Master Control (n=6): Standard PT no Experimental: gain of 6.6 Control: gain of 7.5 on BBS No difference between groups 46 Walker, 200075 Until discharge; mean=36-39 weeks Group 1: 22 training sessions Group 2: 23 training sessions All groups: Received PT and OT 2hr/day Experimental group 1(n=16): Balance Master training with visual feedback (30 min/day) Experimental group 2 (n=16): Conventional balance training (30 min/day) Control group (n=14): PT and OT 2 hrs/day no Initial Group 1: 36 Group 2: 37 Control: 36 End Group 1: 47 Group 2: 49 Control: 46 NS
Population Descriptor N = Reference and intervention Yes/No Data Supporting Responsiveness s/p Stroke 50 Nilsson, 200176 30 min/day; 5 days per week Experimental group (N=28): Treadmill training with body weight support Control group (N=32 patients with hemiparesis): Walking training on ground no At 10 month follow-up: Treatment: 24 to 48 (p<.001) Control: 23 to 48 (p<.001) NS between groups 7 200077 2x/week for 12 weeks Individuals 1 year post stroke Progressive resistance training at 70% of 1 RM yes Baseline: 46.9 (1.9) End: 52.6 (.8) (p=.003) 12% improvement 132 Duncan, 200378 36, 90 min/session; 12-14 weeks Experimental group (N=44): Structured, progressive exercise program targeting strength, endurance, balance and UE use Control group (N=48) Usual care yes Exp group change: 4.36 (.71) Control group change: 1.70 (.52) Exp group increased > control group (p<.01) 37 Hellstrom, 2003 37 Not standardized or controlled Unspecific rehab program yes Admission: 36 D/C: 40 10 mo. Follow-up: 45 Admission vs. discharge (p<.001) Discharge vs. follow-up (p=.001) 12 Chu, 2004 79 8 weeks, 3d/wk, 1h/session Experimental (n=6): Water-based exercise program Control (n=6): Arm exercise group no Exp initial: 52(5) End: 52(3) Control initial: 50(4) End: 52(4), NS 25 Eng, 200380 8 60 minutes, 3x/week Training focusing on balance and mobility yes Baseline 1: 44.7 (6) Baseline 2: 45.9 (5) End 1: 48 (5) End 2: 48.3 (4.3) P<.05 27 Garland, 2003 81 1 month Rehabilitation yes 14 (7) point improvement P<.001 24 Pomeroy, 200182 6 Experimental group (n=12): Weighted garments worn on paretic side Control (n=12): No weighted garments no Exp initial: 52 End: 51 Control initial: 50 End: 50 NS
123 Mao, 2002 9 Assessed at 14-30 days after stroke onset and in later stages 90 to 180 days post stroke BBS was less responsive than the Fugl-Meyer and the Postural Assessment Scale 48 Stevenson, 2001 83 Reassessed after 1-2 weeks of intervention (N=48) Inpatient rehabilitation Only 25/45 subjects showed agreement between statistical change and clinicians’ perceptions of change. Yes/no Minimal detectable change estimated to be + 6 BBS points (90% confident of genuine change) Population Descriptor N = Reference and intervention Yes/No Data Supporting Responsiveness s/p Stroke 42 Wang, 200584 40 min sessions, 5/wk; 20 sessions total Spastic group: Bobath tx vs. orthopedic tx Pts with relative recovery: Bobath tx vs. orthopedic tx no Spastic grp: Bobath pre=6 Post=20.5 (p=.001) Ortho pre=10.7 Post=20.4 (p=.000) Rel recov grp: Bobath pre=16 post=35 (p=.001) Ortho Pre=33 Post=40.3 (p=.000) Change scores between Bobath and grps are not significant for either spastic or relative recovery grp. 20 Leroux, 2005 85 1 hr, 2x/week for 8 weeks pre/post measures Intervention: Group sessions aimed at strengthening UEs and LEs, balance, mobility, coordination yes Pre: 45 (7) Post: 49(5) (p<.008) 91 Salbach, 2004 86] 3x/week for 6 weeks Experimental Group (N=44): Functional task activities to increase LE strength, balance, speed and walking distance Control Group (N=47): UE activities no Control: Pre: 40 Post: 41 Exp: Pre: 42 Post: 44, NS 91 Salbach, 2006 87 3x/week for 6 weeks Grp 1 (N=47): UE intervention Grp 2 (N=44): Task-oriented interventions targeting walking Low correlation between BBS and ABC scale after interventions: -.05 walking grp -.06 UE grp Predictive model research
18 Hart, 2004 88 1 h, 2x/wk for 12 wks Experimental Group (N=9): Tai Chi exercise Control Group (N=9): Physiotherapy exercises focusing on balance no Control grp showed improved balance (p=.01), Exp grp did not show change in balance Population Descriptor N = Reference and intervention Yes/No Data Supporting Responsiveness 103 Wang, 2005 89 (N=42) symptoms of short duration (<6 mo.) (N=61) symptoms of long duration (>12 mo.) Tested with and without an AFO on hemiparetic side no Short duration: With AFO=51 Without=51 Long duration: With AFO=52 Without=51 No significant differences between conditions stroke patients living at home 63 Pang, 200790 Intervention group n=32 Underwent a fitness and mobility exercise(FAME) program - 1 hour sessions, sessions/week for 19 weeks Control group n=31 Underwent a seated upper extremity program No Intervention group pretest 47.6 (6.7) post test 49.6 (4.4) change (95% CI) 2.1 (0.8-3.3) Control group pretest 47.3 (6.1) post test 49.2 ( 5.8) change (95%CI) 1.9 S/P stroke in unit 15 Allison, 200791 Intervention group n= 7 conventional treatment plus additional session of standing practice Control group n=10 conventional treatment yes in change scores Intervention group median week 1 8 (2.5-21.75) week 2 24 (7.25-45) week 12 47 (11.25-51.5) difference from week 1-12 37 (6.5-42) Control group median week 1 16.5 (2 – 26.5) week 2 28 (8-44) week 12 44 (11-52) difference from week 1-12 20.5 (1.5-31) Status post stroke before and after 10 Cikazjlo, 200992 stroke rehab intervention yes Initial score 23(15) following treatment39(11) P<0.001 status post stroke before and 51 Amusat stroke rehabilitation no BBS admission score 25(16) discharge score 36(13) p= NS
Population Descriptor N = Reference and intervention Yes/No Data Supporting Responsiveness status post stroke 68 Yelnik, 200893 both groups received 20 sessions in 4 weeks group 1 n=35 –- a conventional neurodevelopmental theory based treatment (NDT) that used a general approach for sensorimotor rehabilitation 2 n=33- a multisensorial approach based on higher intensity of balance tasks and exercise during visual deprivation no BBS Score (95% CI) day 0 47(39;53) day 30 53(43;55) day 90 51(44;55) day 0 49(42;53) day 30 53(48;55) day 90 53(49;55) p<,.06 at day 90 community dwelling individuals post-stroke 50 Hamzat, 200894 Group 1 – those walking with a cane (N=25) group 2 - those walking without a cane (N=25) Yes BBS score39.72(9.19) BBS score 53.68(2.81) P<.001 Patients with chronic stroke 30 Wing, 200895 Intervention was whole body intensive training 3-6 hours per day, 4-5 days per week,≥ 2weeks, yes mean ±SEM pretest 46.5(2.3) seconds post test 47.2(1.9) seconds Patients with chronic stroke 14 Yen, 200896 Control group n=7 received general stroke physical therapy experimental group n=7 received bodyweight supported treadmill training in addition to general stroke physical therapy yes pretest 50.57 (3.55) posttest 51.57(3.1) p=NS pretest 50.29(3.25) posttest52.43(2.88) p=.016 Population Descriptor N = Reference and intervention Yes/No Data Supporting Responsiveness Older adults 77 Wolf, 200197 12 sessions over 4-6 Persons with functional balance problems, > 75 years old living independently or in a residential care facility Experimental (n=37): Individualized balance training Control group (n=40) Yes initially but not at Exp initial: 37(12) End: 43(11) p 4wks: 42(11) Control initial: 34(13) End: 38(13) p 4 wks: 38(14) Exp>Control P<.001 Effect disappeared at 1 year follow-up.
parkinsons patients living at home, repeat fallers 142 Ashburn, 2007108 personalized home program of exercises and strategies Intervention n=70 (at start) individualized treatment program, weekly visits from physical therapist, 6 weeks initial treatment period Control group n=72 (at start) contact with nurse, advice about exercises at the end of follow-up. No at 8 and 6 months intervention group baseline 44.3 (9.8) n=70 8 45.8 (9.2) n=67 6 months 45.3 (10.0) n=64 control group baseline 43.6 (10.5) n=72 8 weeks 45.2 (9.9) n=66 6 months 44.6 (11.0) n=64 p=N.S. Patients with Parkinsons disease 31 Cakit, 2007109 Training (n=21) 8 week exercise program using incremental speed dependent treadmill training Control group n=10 no intervention yes BBS baseline 37.0(9.41) at 8 weeks 44.09(7.11) change 7.09(1.27) p<0.01 BBS baseline 42.6(9.37) at 8 weeks 41.4(10.65) change -1.42(±0.23) p<0.01 Community dwelling older adults 429 Shumway-Cooke, 2007110 experimental group n=212 multifaceted interventionincluding3x/wk group exercise, 6 hours of fall prevention control group n=217 received brochures on fall prevention yes Experimental group Initial score50.3(5.6) Final score 51.1(6.2) Control group Initial score 50.2 (6.0) Final score 49.4 (7.4) Adjusted mean difference 1.5 points(95%CI, 0.8-2.3) p<.001
adults with hip fracture 20 Mendelsohn, 2008116 Training group n=10 patients used an arm crank ergometer 3 times a week for 4 weeks in addition to physical therapy and occupational therapy 5 times per week Control group n=10 patients received physical and occupational therapy 5 times per week yes change score 60.3(47.4) 48.7(19.2) p<0.05 older male veterans 95 Bishop, 200766 subjects who did or did not complete the program program completed program not completed no 39.8(7.4) 37.5(7.7) p=NS Population Descriptor N = Reference and intervention Yes/No Data Supporting Responsiveness healthy older volunteers 100 Melzer, 2007117application of voluntary step execution test fallers n=11 nonfallers n=71 no 50,6(4.6) seconds 52.5(3.4) seconds p=0.079 Ceiling & floor effect: Ceiling effects are reported in clients with minimal hemiparesis.9, 118, 119. This means the BBS will not capture balance impairments in patients with minimal hemi paresis, as they will achieve a high score while still possessing balance impairments. Mao (2002)9 reports floor effects in 35% of participants 14 days post stroke. Those not able to sit independently score the lowest score on this test. Reference data: Subjects N = BBS