Assessment Overview

Purpose: Assesses static balance and fall risk in adults

Equipment: Stopwatch, standard chair with armrests, standard chair without armrests, step, ruler, shoe

ICF Category: Activity

Assessment Handout

Assessment Psychometrics

Stroke

The BBS is recommended for use in patients with acute stroke and highly recommended for patients with subacute and chronic stroke is recommended for use in acute care and highly recommended for inpatient rehabilitation, skilled nursing facilities, outpatient rehabilitation, and home health. This measure should be taught to students and is appropriate for use in research. Below are the psychometrics for the CVA population:

• Concurrent Validity: Excellent correlation with balance subscale of Fugl-Meyer from 14-180 days post stroke (r =0.90 to 0.92), Excellent correlation with PASS (r=0.92 to 0.95)

• Construct Validity: Excellent correlation between BBS and FIM at admission (r=0.76), Excellent convergent validity with Barthel Index (r=0.85)

• Content Validity: In chronic stroke, determined by a senior physical therapist

• Cutoff Score: ≤ 44 indicates high risk of falls

• Floor/Ceiling Effects: Acute stroke: Poor floor effects 14 days after stroke (23.9%), Significant ceiling effects for higher functioning patients

• Interrater Reliability: Excellent (0.97)

• Intrarater Reliability: Excellent (0.98)

• Mean Data: 41.4

• MDC: Acute Stroke 6.9, Chronic Stroke 2.7

• Responsiveness: Acute Stroke: Large responsiveness (Effect Size=0.85), Chronic Stroke: Moderate responsiveness (SRM =0.81)

• SEM: Acute stroke 2.49, Chronic stroke 0.98

• Test-retest: Excellent (ICC=0.99)

Multiple Sclerosis

Neuro PT EDGE highly recommends (4/4) the BBS in all settings with the MS population. It is also highly recommended (4/4) for individuals with an EDSS score <6.5. There has not been any clinical utility found for people with significant disability. Students should learn to administer this tool with the MS population, and this tool is validated for research purposes. The current psychometric properties of this test with the MS population are presented in the list below.

• Concurrent Validity: Moderately to highly correlated with NeuroCom SMART Balance Master (r=0.5-0.81); Spearman correlation: .78 with DGI; -.62 with the TUG; .48 with the ABC; and -0.32 with the Dizziness Handicap Inventory

• Floor/Ceiling Effects: Ceiling: in 76 patients with EDSS scores of 3.5-6.0, 17% scored the max of 56 points

• Interrater Reliability: ICC=0.99, 9 patients ; ICC=0.96 in 25 patients ; ICC=.9 with 50 patients

• MCID: 6 points

• Responsiveness: After 6 wks of a home program, 13 patients with MS improved significantly, 5.8 pts.

• Test-retest Reliability: ICC=0.85 in 19 patients ; ICC=0.96 in 25 patients

One strength of using the BBS with people with MS is that the BBS has been considered a core outcome measure by the ANPT. This signifies that it is a good assessment tool that should be used with all adults with neurologic disorders. Some gaps in the literature regarding the BBS and MS is that no SEM or MDC have been established for this population. The cut-off for fall risk is less than 45 out of 56 for older adults. In 51 patients with MS, the same cut-off was shown to have a sensitivity of 40% and a specificity of 90% differentiating fallers from non-fallers.

Parkinson's Disease

The BBS is highly recommended for use with PD patients in Hoehn and Yahr stages II-III, and not recommended in Hoehn and Yahr stage I, IV, or V. Students do not need to be taught this the BBS or be exposed to it, but it is appropriate for use in intervention research studies.

• Criterion Validity: Excellent with TUG (-0.78), comfortable gait speed (0.73), fast gait speed (0.64); Poor association with fall risk

• Cutoff Score: ≤52/56 to assess fall rates

• Floor/Ceiling Effects: Poor ceiling ; Level 4: floor effects ; Level 5: cannot be tested

• Interrater Reliability: Excellent (ICC=0.95)

• Intrarater Reliability: Excellent (ICC=0.84)

• Mean Data: 50

• MDC: 5

• Test-retest: Excellent (ICC=0.80)

Spinal Cord Injury

According to the PT Edge Recommendations, the BBS is recommended (3/4) for acute, subacute, and chronic SCI patients. It is recommended for SCI patients with an AIS C and D diagnosis, and reasonable to use for patients with AIS A or B diagnosis. Students should be taught to use this outcome measure, and this tool is valid and reliable to use in research. The psychometric properties for SCI and the BBS are reported in the list below.

• Construct Validity: Significant correlation with the 2 meter walk test (0.781), 10MWT (0.792), and the TUG (-0.815).

• Criterion Validity: High with Walking Index for SCI, r=0.89-0.92, High with Functional Independence Measure, r=0.72-0.77.

• Cut-off Score: No distinction between fallers and non-fallers

• Floor/Ceiling Effects: Poor ceiling effects, 37.5%

• Internal Consistency: Excellent for both single items (0.84-0.98) and the total score (ICC=0.95)

• Interrater Reliability: Excellent, ICC=0.99

• Intrarater Reliability: Excellent, ICC=0.97

• Mean: 47.9 for AISA D

Traumatic Brain Injury

There is not yet evidence to suggest the use of the BBS with patients after a brain injury who are completely independent, mildly dependent, moderately dependent, but it is not recommended with those who are severely dependent. The BBS has limited studies on use in acute care, skilled nursing facilities, and home health but is recommended for use in inpatient rehabilitation and outpatient rehabilitation. This measure should be taught to students and is appropriate for use in research. Below are psychometrics for the TBI population:

• SEM: 1.65

• Test-retest: Excellent (ICC=0.99)

Instructional Video

Application Videos