Comparison of the Diagnostic Accuracy of Common Balance Measurement Tools in Community-Dwelling Older Adults
Abstract
Introduction: Balance screening has been identified as a major predictor of falls in the elderly. The current study compares the diagnostic accuracy of various balance instruments in community-dwelling older adults.
Materials and Methods: In this cross-sectional study, 145 older adults were recruited. The Berg balance scale (BBS), Fullerton advanced balance (FAB) scale, dynamic gait index (DGI), performance-oriented mobility assessment (POMA), timed up and go (TUG) test, gait speed, step length, step test, and single item question were administered. The receiver operating characteristics curve analysis was used to calculate diagnostic accuracy.
Results: All single-item tools had moderate diagnostic accuracy (area under the curve [AUC]=0.76-0.89) and all multi-item tools had high diagnostic accuracy (AUC=0.91-0.95) when using the recommended cut-off point of 45 for BBS. All multi-item tools maintained high to moderate diagnostic accuracy (AUC=0.85-1.00) in all thresholds while using BBS severity cut-off points. The FAB scale showed the highest diagnostic accuracy (AUC=0.95) among all assessment tools. Single-item question scores (Wald=22.61, df=1, P=0.0001, Exp(B)=8.82) were significant as covariates in the regression model.
Conclusion: For older adults with or without a history of falling, the FAB scale demonstrated the highest diagnostic accuracy. Along with single-item tools, the FAB scale may be a preferred multi-item tool.
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[2] Osoba MY, Rao AK, Agrawal SK, Lalwani AK. Balance and gait in the elderly: A contemporary review. Laryngoscope Investigative Otolaryngology. 2019;4(1):143-53. [DOI: 10.1002/lio2.252] [PMID: 30828632] [PMCID: PMC6383322]
[3] Mehdizadeh M, Mehraban AH, Zahediyannasab R. The effect of group-based occupational therapy on performance and satisfaction of stroke survivors: Pilot trail, neuro-occupational view. Basic and Clinical Neuroscience. 2017;8(1):69-76. [DOI: 10.15412/J.BCN.03080109] [PMID: 28446952] [PMCID: PMC5396176]
[4] Langley FA, Mackintosh SF. Functional balance assessment of older community dwelling adults: a systematic review of the literature. Internet Journal of Allied Health Sciences and Practice. 2007;5(4):13. [DOI: 10.46743/1540-580X/2007.1174]
[5] Rose DJ, Lucchese N, Wiersma LD. Development of a multidimensional balance scale for use with functionally independent older adults. Archives of Physical Medicine and Rehabilitation. 2006;87(11):1478-85. [DOI:10.1016/j/apmr.2006.07.263] [PMID: 17084123]
[6] Khan S, Hadian MR, Olyaei G, Arslan SA, Yekaninejad S, Tafakhori A. Research Paper: Comparing Falls Efficacy Scale-International and Berg Balance Scale in Predicting Recurrent Risk of Fall in Stroke Patients. Journal of Modern Rehabilition. 2017;11(2):103-8.
[7] Lima CA, Ricci NA, Nogueira EC, Perracini MR. The Berg Balance Scale as a clinical screening tool to predict fall risk in older adults: A systematic review. Physiotherapy. 2018;104(4):383-94. [DOI:10.1016/j.physio.2018.02.002] [PMID: 29945726]
[8] Hernandez D, Rose DJ. Predicting which older adults will or will not fall using the Fullerton Advanced Balance scale. Archives of Physical Medicine and Rehabilitation. 2008;89(12):2309-15. [DOI:10.1016/j.apmr.2008.05.020]
[9] Soubra R, Chkeir A, Novella J-L. A systematic review of thirty-one assessment tests to evaluate mobility in older adults. BioMed Research International. 2019: 1354362. [DOI:10.1155/2019/1354362] [PMID: 31321227] [PMCID: PMC6610744]
[10] Whitney SL, Marchetti GF, Schade A, Wrisley DM. The sensitivity and specificity of the Timed" Up & Go" and the Dynamic Gait Index for self-reported falls in persons with vestibular disorders. Journal of Vestibular Research. 2004;14(5):397-409. [DOI: 10.3233/VES-2004-14506] [PMID: 15598995]
[11] Faber MJ, Bosscher RJ, van Wieringen PCW. Clinimetric properties of the performance-oriented mobility assessment. Physical Therapy. 2006;86(7):944-54 [DOI:10.1093/ptj/86.7.944] [PMID: 16813475]
[12] Herman T, Inbar-Borovsky N, Brozgol M, Giladi N, Hausdorff JM. The Dynamic Gait Index in healthy older adults: The role of stair climbing, fear of falling and gender. Gait & Posture. 2009;29(2):237-41. [DOI:10.1016/j.gaitpost.2008.08.013] [PMID: 18845439] [PMCID: PMC2709498]
[13] Schlenstedt C, Brombacher S, Hartwigsen G, Weisser B, Möller B, Deuschl G. Comparing the Fullerton Advanced Balance Scale with the Mini-BESTest and Berg Balance Scale to assess postural control in patients with Parkinson disease. Archives of Physical Medicine and Rehabilitation. 2015;96(2):218-25. [DOI:10.1016/j.apmr.2014.09.002] [PMID: 25261718]
[14] Whitney S, Wrisley D, Furman J. Concurrent validity of the Berg Balance Scale and the Dynamic Gait Index in people with vestibular dysfunction. Physiotherapy Research International. 2003;8(4):178-86. [DOI:10.1002/pri.288] [PMID: 14730722]
[15] Franchignoni F, Velozo CA. Use of the Berg Balance Scale in rehabilitation evaluation of patients with Parkinson’s disease. Archives of Physical Medicine and Rehabilitation. 2005;86(11):2225-6. [DOI:10.1016/j.apmr.2005.09.006] [PMID: 16271578]
[16] Mehta T, Young H-J, Lai B, Wang F, Kim Y, Thirumalai M, et al. Comparing the Convergent and Concurrent Validity of the Dynamic Gait Index with the Berg Balance Scale in People with Multiple Sclerosis. Healthcare (Basal). 2019;7(1):27. [DOI:10.3390/healthcare7010027] [PMID: 30769934] [PMCID: PMC6473448]
[17] Mitchell KD, Newton RA. Performance-Oriented Mobility Assessment (POMA) balance score indicates need for assistive device. Disability and Rehabilitation: Assistive Technology. 2006;1(3):183-9. [DOI:10.1080/17483100500519325] [PMID: 19260186]
[18] Moreh E, Jacobs JM, Stessman J. Fatigue, function, and mortality in older adults. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences. 2010;65(8):887-95. [DOI:10.1093/gerona/glq064] [PMID: 20418349]
[19] Rolstad S, Adler J, Rydén A. Response burden and questionnaire length: is shorter better? A review and meta-analysis. Value in Health. 2011;14(8):1101-8. [DOI: 10.1016/j.jval.2011.06.003] [PMID: 22152180]
[20] Kubicki A. Functional assessment in older adults: Should we use timed up and go or gait speed test? Neuroscience Letters. 2014;89:577-94. [DOI: 10.1016/j.neulet.2014.06.014]
[21] Macdonald HM, Nettlefold L, Bauman A, Sims-Gould J, McKay HA. Pragmatic Evaluation of Older Adults’ Physical Activity in Scale-Up Studies: Is the Single-Item Measure a Reasonable Option? Journal of Aging and Physical Activity. 2021;1:1-8. [DOI:10.1123/japa.2020-0412] [PMID: 34348228]
[22] Viccaro LJ, Perera S, Studenski SA. Is timed up and go better than gait speed in predicting health, function, and falls in older adults? Journal American Geriatrics Society. 2011;59(5):887-92. [DOI:10.1111/j.1532-5415.2011.0336.x] [PMID: 21410448] [PMCID: PMC3522463]
[23] Eskandarnejad M, Tagizadeh S. A comparison of distance perception in active and inactive elderly with an emphasis on physical activity. Iranian Journal of Geriatric Nursing. 2015;2(1):79-90.
[24] Hill KD, Bernhardt J, McGann AM, Maltese D, Berkovits D. A new test of dynamic standing balance for stroke patients Reliability, validity and comparison with healthy elderly. Physiotherapy Canada. 1996;48(4):257-62. [DOI:10.3138/ptc.48.4.257]
[25] Franchignoni F, Martignoni E, Ferriero G, Pasetti C. Balance and fear of falling in Parkinson's disease. Parkinsonism & Related Disorders. 2005;11(7):427-33. [DOI:10.1016/j.parkreldis.2005.05.005] [PMID: 16154789]
[26] Bennie S, Bruner K, Dizon A, Fritz H, Goodman B, Peterson S. Measurements of balance: comparison of the Timed" Up and Go" test and Functional Reach test with the Berg Balance Scale. Journal of Physical Therapy Science. 2003;15(2):93-7. [DOI: 10.1589/jpts.15.93]
[27] Jeon Y-J, Kim G-M. Comparison of the Berg Balance Scale and Fullerton Advanced Balance Scale to predict falls in community-dwelling adults. Journal of Physical Therapy Science. 2017;29(2):232-4. [DOI: 10.1589/jpts.29.232] [PMID: 28265146] [PMCID: PMC5332977]
[28] Pardasaney PK, Latham NK, Jette AM, Wagenaar RC, Ni P, Slavin MD, et al. Sensitivity to change and responsiveness of four balance measures for community-dwelling older adults. Physical Therapy. 2012;92(3):388-97. [DOI: 10.2522/ptj.20100398] [PMID: 22114200] [PMCID: PMC3291380]
[29] Panel on Prevention of Falls in Older Persons AGS, Society BG. Summary of the updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. Journal American Geriatrics Society. 2011;59(1):148-57. [DOI:10.1111/j.1532-5415.2010.03234.x] [PMID: 21226685]
[30] Foroughan M, Jafari Z, Shirin Bayan P, Ghaem Magham Farahani Z, Rahgozar M. Validation of mini-mental state examination (MMSE) in the elderly population of Tehran. Advances in Cognitive Science. 2008;10(2):29-37.
[31] Azad A, Sabet A, Taghizadeh G, Mohammadi-Nezhad T. Clinical assessment of Persian translation of Fullerton Advanced Balance Scale in community-dwelling older adults. Disability and Rehabilitation. 2020;42(4):567-73. [DOI:10.1080/09638288.2018.1503731] [PMID: 30624094]
[32] Jahantabi-Nejad S, Azad A. Predictive accuracy of performance oriented mobility assessment for falls in older adults: A systematic review. Medical journal of the Islamic Republic of Iran. 2019;33(1):229-34. [DOI:10.3417/mjiri.33.38] [PMID: 31456962] [PMCID: PMC6708086]
[33] Salbach NM, Mayo NE, Higgins J, Ahmed S, Finch LE, Richards CL. Responsiveness and predictability of gait speed and other disability measures in acute stroke. Archives of Physical Medicine and Rehabilitation. 2001;82(9):1204-12. [DOI;10.1053/apmr.2001.24907] [PMID: 11552192]
[34] Bayle N, Patel AS, Crisan D, Guo LJ, Hutin E, Weisz DJ, et al. Contribution of step length to increase walking and turning speed as a marker of Parkinson’s disease progression. PLOS ONE. 2016;11(4):e0152469. [DOI:10.1371/journal.pone.0152469] [PMID: 27111531] [PMCID: PMC4844147]
[35] Jung D. Fear of falling in older adults: Comprehensive review. Asian Nursing Research. 2008;2(4):214-22. [DOI:10.1016/S1976-1317(09)60003-7] [PMID: 25029959]
[36] Whitney SL, Poole JL, Cass SP. A review of balance instruments for older adults. American Journal of Occupational Therapy. 1998;52(8):666-71. [DOI:10.5014/ajot.52.8.666] [PMID: 9739401]
[37] O'BRIEN K. Clinical measures of balance in community-dwelling elderly female fallers and non-fallers. Physiother Can. 1998;50:212-21.
[38] Blum L, Korner-Bitensky N. Usefulness of the Berg Balance Scale in stroke rehabilitation: A systematic review. Physical Therapy. 2008;88(5):559-66. [DOI:10.2522/ptj.20070205] [PMID: 18292215]
[39] Berg KO, Wood-Dauphinee SL, Williams JI, Maki B. Measuring balance in the elderly: Validation of an instrument. Canadian Journal of Public Health. 1992;83:S7-11. [PMID: 1468055]
[40] Fischer JE, Bachmann LM, Jaeschke R. A readers' guide to the interpretation of diagnostic test properties: clinical example of sepsis. Intensive Care Medicine. 2003;29(7):1043-51. [DOI:10.1007/s00134-003-1761-8] [PMID: 12734652]
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| Files | ||
| Issue | Vol 17 No 1 (2023) | |
| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/jmr.v17i1.11310 | |
| Keywords | ||
| Accidental falls Diagnostic tests Geriatric assessment Older adults Postural balance | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Meimandi M, Taghizadeh G, Moulodi B, Azad A. Comparison of the Diagnostic Accuracy of Common Balance Measurement Tools in Community-Dwelling Older Adults. jmr. 2023;17(1):103-113.
