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BERG BALANCE SCALE

  1. Top of page
  2. BERG BALANCE SCALE
  3. DYNAMIC GAIT INDEX (DGI)
  4. GAIT VELOCITY
  5. PHYSICAL PERFORMANCE TEST (PPT)
  6. TIMED CHAIR STAND TEST
  7. TIMED UP AND GO
  8. TINETTI PERFORMANCE-ORIENTED MOBILITY ASSESSMENT (POMA)
  9. References

General Description

Purpose

To measure balance impairment in older adults through a performance-based test.

Content

The scale consists of 14 common movement tasks: sitting-to-standing, standing-to-sitting, transferring bed to chair, sitting and standing unsupported, standing eyes closed, standing feet together, tandem standing, single limb standing, reaching, picking up an object from the floor, alternating foot on stool, looking over the shoulders, and turning 360°.

Developer/contact information

The test was originally described in Berg et al (1,2).

Versions

There is only the original version. It is also available in Swedish.

Number of items in scale

There are 14 items.

Subscales

None.

Populations
Developmental/target

Older adults (>60 years of age).

Other uses

Patients post-stroke, post hip fracture (3).

WHO ICF Components

Activity limitation.

Administration

Method

Easily administered physical performance test.

Training

None required.

Time to administer/complete

Less than 15 minutes.

Equipment needed

Chair, bed, stopwatch, ruler, shoe/slipper, stool.

Cost/availability

Readily available and inexpensive. Available on the web at http://www.strokecenter.org/trials/scales/berg.html or http://www.chcr.brown.edu/BALANCE.HTM.

Scoring

Responses
Scale

5-point ordinal scale (0–4).

Score range

Range is 0–56 with higher scores indicating greater independence.

Interpretation of scores

The authors support a cut-off score of 45 of 56 for independent safe ambulation (4).

Method of scoring

Scores of the 14 items are summed.

Time to score

Less than 5 minutes.

Training to score

None.

Training to interpret

None.

Norms available

None. Newton (5) and Steffen, et al (6) have collected reference data for 251 and 96 community-dwelling elderly, respectively. There is still need for larger sample sizes to establish more definitive norms.

Psychometric Information

Reliability

Studies have reported high intra and interrater reliability for the Berg Balance Scale (intraclass correlation coefficient [ICC] 0.98 for interrater reliability and 0.97–0.99 for intrarater reliability) (1,7). Noren et al in a study with patients with rheumatoid arthritis, psoriatic arthritis, or other polyarthritis found an interrater reliability coefficient for the Berg of 0.97 (8). A Cronbach's alpha of 0.96 was reported for the internal consistency of the developmental sample (1).

Validity
Content

Validity was established in a 3-phase process utilizing 38 patients and 32 health care professionals (1).

Criterion

Validity has been supported by moderate to high correlations with other clinical performance measures (Balance sub-scale of Tinetti, Barthel Mobility sub-scale, timed “Up and Go,” and gait speed), but low to moderate correlations with laboratory postural sway measures using center of pressure recordings (4). Riddle and Stratford (9) pooled the data from 2 published articles by Shumway-Cook et al (10) (22 fallers, 22 nonfallers) and Bogle Thorbahn and Newton (11) (17 fallers, 49 nonfallers) to look at the validity of the test for predicting falls (using the cut-off point of 45). The analysis revealed a combined sensitivity of 64% and a specificity of 90%. Thus, the test appears to be better at identifying individuals who are not at risk for falling, than those at risk for falls. Riddle and Stratford encouraged the use of a lower cut-off point of 40 to improve clinical decision making regarding fall risk using likelihood ratios.

Sensitivity/responsiveness to change

Stevenson (12) concluded with a group of patients post-stroke through minimal detectable change analysis that a ± 6 point difference on the Berg Balance Scale would be recommended to be 90% confident of genuine change. Further study is needed to look at responsiveness of this scale in intervention trials with older adults and patients with arthritis.

Comments and Critique

The Berg Balance Scale is a commonly used performance-based scale for examining functional balance skills for clinical and research purposes. Its reported use for patients with arthritis has been limited; however, with the increased emphasis on examining balance in individuals with rheumatoid and osteoarthritis, it is a tool worth further study for its clinical usefulness (8,13). In examining patients with arthritis, one needs to be aware of potential ceiling effects with higher-level patients (8). Also, the scale does not include gait items, so gait speed and gait adaptability outcome measures often need to be collected in conjunction with the Berg Scale.

References

1.(Original) Berg KO, Wood-Dauphinee S, Williams JI, Gayton DG. Measuring balance in the elderly: preliminary development of an instrument. Physiother Can 1989;41:304–11.

2.Berg KO, Maki BE, Williams JI, Holliday PJ, Wood-Dauphinee SL. Clinical and laboratory measures of postural balance in an elderly population. Arch Phys Med Rehab 1992;73:1073–80.

3.Tinetti ME, Baker DI, Gottschalk M, et al. Systematic home-based physical and functional therapy for older persons after hip fracture. Arch Phys Med Rehabil 1997;78:1237–47.

4.Berg KO, Wood-Dauphinee SL, Williams JI, Maki B. Measuring balance in the elderly: validation of an instrument. Can J Public Health 1992;83 Suppl 2:S7–11.

5.Newton RA. Balance screening of an inner city older adult population. Arch Phys Med Rehab 1997;78:587–91.

6.Steffen TM, Hacker TA, Mollinger L. 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. Phys Ther 2002;82:128–37.

7.Berg K, Wood-Dauphinee S, Williams JI. The Balance Scale: reliability assessment with elderly residents and patients with an acute stroke. Scand J Rehabil Med 1995;27:27–36.

8.Noren AM, Bogren U, Bolin J, Stenstrom C. Balance assessment in patients with peripheral arthritis: applicability and reliability of some clinical assessments. Physiother Res Int 2001;6:193–204.

9.Riddle DL, Stratford PW. Interpreting validity indexes for diagnostic tests: an illustration using the Berg balance test. Phys Ther 1999;79:939–48.

10.Shumway-Cook A, Baldwin M, Polissar NL, Gruber W. Predicting the probability for falls in community-dwelling older adults. Phys Ther 1997;77:812–9.

11.Bogle Thorbahn LD, Newton RA. Use of the Berg Balance Test to predict falls in elderly persons. Phys Ther 1996;76:576–83; discussion 584–5.

12.Stevenson TJ. Detecting change in patients with stroke using the Berg Balance Scale. Aust J Physiother 2001;47:29–38.

13.Birmingham TB, Kramer JF, Kirkley A, Inglis JT, Spaulding SJ, Vandervoort AA. Association among neuromuscular and anatomic measures for patients with knee osteoarthritis. Arch Phys Med Rehabil 2001;82:1115–8.

DYNAMIC GAIT INDEX (DGI)

  1. Top of page
  2. BERG BALANCE SCALE
  3. DYNAMIC GAIT INDEX (DGI)
  4. GAIT VELOCITY
  5. PHYSICAL PERFORMANCE TEST (PPT)
  6. TIMED CHAIR STAND TEST
  7. TIMED UP AND GO
  8. TINETTI PERFORMANCE-ORIENTED MOBILITY ASSESSMENT (POMA)
  9. References

General Description

Purpose

To measure balance impairment in adults through a performance-based test that looks at the individual's ability to modify gait responses to task demands.

Content

The DGI consists of 8 common gait tasks: walking on a level surface, changing gait speed, walking with vertical and horizontal head turns, pivot turning, stepping over an obstacle, and ascending/descending stairs.

Developer/contact information

The test was originally described by Shumway-Cook and Woollacott in 1995 (1).

Versions

A modified version is in the pilot testing phase as reported by Krishnan et al in 2002 (2).

Number of items in scale

There are 8 items.

Subscales

None.

Populations
Developmental/target

Older adults.

Other uses

Patients with vestibular disorders.

WHO ICF Components

Activity limitation.

Administration

Method

Performance-based. Easy-to-administer.

Training

None required.

Time to administer/complete

Less than 10 minutes.

Equipment needed

Shoebox, 2 cones, stairs with rails.

Cost/availability

No cost to use tool.

Scoring

Responses
Scale

4 point ordinal scale (0–3); 0 = Severe impairment, 3 = Normal.

Score range

Range is 0–24 with high scores indicating greater independence.

Interpretation of scores

Shumway-Cook et al (3) and Whitney et al (4) have used a cut-off score of ≤19 to predict fall risk.

Method of scoring

Scores of the 8 items are summed.

Time to score

Less than 5 minutes.

Training to score

None.

Training to interpret

None.

Norms available

None.

Psychometric Information

Reliability

Studies of reliability to date have yielded variable results. The developers report interrater reliability for the total DGI score of 0.96–1.00 (ICC) (5). Wrisley found kappa coefficients for inter-rater reliability of 0.64 and for intrarater reliability of 0.63 for the total DGI score (6). Individual item reliabilities ranged from 0.35 to 1.00 (kappa). Krishnan et al have modified the DGI to make the scoring criteria mutually exclusive and exhaustive for the following parameters: speed to perform task, assistive device use, quality of gait pattern, signs of unsteadiness, and level of physical assistance (2). These changes may especially assist with criteria for levels 2 (mild impairment and 3 (moderate impairment), however, development is still in the preliminary stages.

Validity
Content

No known formal study.

Concurrent

Validity has been supported by moderate correlations with the Berg Balance Scale (7).

Construct

Using logistic regression, sensitivity of the DGI to identify people with a history of falls using a cut-off score of ≤19 seconds was 59% with a specificity of 64% (3). The Berg Balance Scale combined with a self-reported history of imbalance was found to be more sensitive in the same group of subjects (sensitivity 91%, specificity 82%). Whitney et al (4) found patients with vestibular dysfunction with a DGI score of ≤19 were 2.58 times more likely to have reported a fall in the previous year than those above this score.

Sensitivity/responsiveness to change

Not yet studied for least detectable difference or clinically meaningful changes.

Comments and Critique

This measurement instrument has been used in clinical and research settings with older adults; however, there is no known peer-reviewed study of its use specifically with patients with arthritis. The strength of this tool is that it looks at the patient's ability to adapt movements during gait to meet environmental demands. Further studies are needed to examine the psychometric properties of the DGI, including the reliability of specific test items.

References

1.(Original) Shumway-Cook A, Woollacott M. Motor control: theory and practical applications. Baltimore: Williams & Wilkins;1995. p. 322–4.

2.Krishnan L, O'Kane KS, Gill-Body KM. Reliability of a modified version of the Dynamic Gait Index: a pilot study. Neurol Rep 2002;26:8–14.

3.Shumway-Cook A, Baldwin M, Polissar NL, Gruber W. Predicting the probability for falls in community-dwelling older adults. Phys Ther 1997;77:812–9.

4.Whitney SL, Hudak MT, Marchetti GF. The dynamic gait index relates to self-reported fall history in individuals with vestibular dysfunction. J Vestib Res 2000;10:99–105.

5.Shumway-Cook A, Gruber W, Baldwin M, Liao S. The effect of multidimensional exercises on balance, mobility, and fall risk in community-dwelling older adults. Phys Ther 1997;77:46–57.

6.Wrisley DM. Reliability of the dynamic gait index in vestibular disorders [Masters thesis]. Old Dominion University; 1998.

7.Whitney SL, Walsh MK, Pieffer MD, Furman J. Concurrent validity of the Berg Balance Scale and the Dynamic Gait Index in people with vestibular dysfunction. Neurol Rep 1997;21:167.

GAIT VELOCITY

  1. Top of page
  2. BERG BALANCE SCALE
  3. DYNAMIC GAIT INDEX (DGI)
  4. GAIT VELOCITY
  5. PHYSICAL PERFORMANCE TEST (PPT)
  6. TIMED CHAIR STAND TEST
  7. TIMED UP AND GO
  8. TINETTI PERFORMANCE-ORIENTED MOBILITY ASSESSMENT (POMA)
  9. References

General Description

Purpose

Gait velocity is commonly measured to assess walking functional mobility. Gait velocity has been shown to be the best predictor of community ambulation in patients post-stroke (1). It is highly dependent upon knee extension control (1). As a result, gait velocity has come to be used as a test of lower extremity function.

Content

Either time to walk a specified distance (3 meters &lsqbr;2&rsqbr;, 8 feet &lsqbr;3,4&rsqbr; 10 feet, 6 meters &lsqbr;5&rsqbr;, 50 feet &lsqbr;6–8&rsqbr;, 40 meters &lsqbr;9&rsqbr;) or distance walked in a specified time at either a comfortable pace (2), at maximum speed (7), or at twice the person's usual speed (4).

Developer/contact information

Not applicable.

Versions

Distance and times vary.

Number of items in scale

Not applicable.

Subscales

None.

Populations
Developmental/target

Developed for people with lower extremity weakness.

Other uses

Patients following stroke; people with arthritis; older adults; people with other lower extremity impairments.

WHO ICF Components

Activity limitation.

Administration

Method

Performance-based; easily performed.

Training

None.

Time to administer/complete

Less than 15 minutes.

Equipment needed

Walkway, stopwatch; can use photocells to trigger on and off times of walk.

Cost/availability

Readily available and inexpensive.

Scoring

Responses
Scale

Not applicable.

Score range

Not applicable.

Interpretation of scores

Patient's velocity compared with norms (see below).

Method of scoring

Time to walk specified distance or distance walked in specified time.

Time to score

Same as performance time.

Training to score

None.

Training to interpret

None.

Norms available

The usual reference value for healthy adults is approximately 80 meters/minute (10,11). Norms for 230 healthy adults have been provided by age, sex, and comfortable versus maximal speed (11). A time of 1.2–1.4 meters/second is considered desirable for healthy older adults (12,13).

Psychometric Information

Reliability

Estimates of intra-session intrarater reliability are high, ranging from 0.91 to 0.99 (2,8,14). Short term inter-session test-retest reliability had ICCs ranging from 0.80 to 0.88 (2). An estimate of 2–3 week inter-session intrarater reliability was 0.72 (4). A study of 2–3-week inter-session interrater reliability with many subjects tested in their homes found an ICC of 0.52 (4).

Validity
Concurrent

Validity has been determined by a positive correlation with the Index of Severity for Knee osteoarthritis (r = 0.66) (2).

Predictive

In a study of community-dwelling older adults, as baseline scores increased from ≤3.1 seconds to 5.7 seconds to walk 8 feet, a greater percentage of subjects had disability in activities of daily living 4 years later (3).

Construct

Gait speed was the best predictor of self-reported physical function as measured by the Body Care and Movement, Ambulation, Mobility and Physical Dimension scales of the Sickness Impact Profile (15). In patients following stroke, gait velocity was the best predictor of category of walking (household versus community) (1).

Sensitivity/responsiveness to change

There have been no studies of minimal detectable or clinically meaningful change. Gail velocity is weakly sensitive to change based on measures of disease activity in patients with rheumatoid arthritis (6,7). In a review of many studies of intervention with patients with rheumatoid arthritis, the mean change in 50-foot walk time in those studies that showed change was only 2 seconds (8).

Comments and Critique

Many factors can affect gait velocity. Performance tends to decline across decades of age (60s through 80s) (4,14). Depression and cognitive status are associated with lower gait speed (15). Significant differences occur between men and women, and ethnic differences are apparent (4). Female candidates for hip or knee arthroplasty walked slower than male candidates and 45% slower than healthy controls. Male candidates were 42% slower than healthy controls (9). Walk time is not useful as a measure of disease activity in patients with rheumatoid arthritis; it may be a better measure of lower extremity function (7).

Gait velocity looks primarily at only one aspect of gait, progression (active forward propulsion of the body). There is also a need to look at other gait requirements such as stability (maintenance of dynamic equilibrium), adaptability (response to changes in environmental and task demands), and long-term viability (ability to tolerate stress to locomotor structures across time and conserve energy) (16).

Methods of measurement need to be standardized. Many distances have been proposed; most are based on feasibility in the home or clinic. Gait velocity is reported in meters/second, centimeters/second, and meters/minute. There is no standardization regarding height-correcting the velocity measurements.

The test is a reliable but not very sensitive test to use as an outcome measure in clinical trials. More research is necessary to establish true norms with large samples.

References

1.Perry J, Garrett M, Gronley JK, Mulroy SJ. Classification of walking handicap in the stroke population. Stroke 1995;26:982–9.

2.Marks R. Reliability and validity of self-paced walking time measures for knee osteoarthritis. Arthritis Care Res 1994;7:50–3.

3.Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB. Lower extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med 1995;332:556–61.

4.Ostchega Y, Harris TB, Hirsch R, Parsons VL, Kington R, Katzoff M. Reliability and prevalence of physical performance examination assessing mobility and balance in older persons in the US: data from the third national health and nutrition examination survey. J Am Geriatr Soc 2000;48:1136–41.

5.Schwartz AV, Villa ML, Prill M, Kelsey JA, Galinus JA, Delay RR, et al. Falls in older Mexican-American women. J Am Geriatr Soc 1999;47:1371–8.

6.Ward MM. Clinical measures in rheumatoid arthritis: which are most useful in assessing patients? J Rheumatol 1994;21:17–27.

7.Spiegel JS, Paulus HE, Ward NB, Spiegel TM, Leake B, Kane RL. What are we measuring? An examination of walk time and grip strength. J Rheumatol 1987;14:80–6.

8.Grace EM, Gerecz EM, Kassam YB, Buchanan HM, Buchanan WW, Tugwell PS. 50-foot walking time: a critical assessment of an outcome measure in clinical therapeutic trials of antirheumatic drugs. Br J Rheum 1988;27:372–4.

9.Kennedy D, Stratford PW, Pagura SM, Walsh M, Woodhouse LJ. Comparison of gender and group differences in self-report and physical performance measures in total hip and knee arthroplasty candidates. J Arthroplasty 2002;17:70–7.

10.Waters RL, Lunsford BR, Perry J, Byrd R. Energy-speed relationship of walking: standard tables. J Orthop Res 1988;6:215–22.

11.Bohannon RW. Comfortable and maximum walking speed of adults aged 20 to 79 years: reference values and determinants. Age Ageing 1997;26:15–9.

12.Hageman PA, Blanke DJ. Comparison of gait of young women and elderly women. Phys Ther 1986;66:1382–7.

13.Ostrosky KM, VanSwearingen JM, Burdett RG, Gee Z. A comparison of gait characteristics in young and old subjects. Phys Ther 1994;74:637–46.

14.Steffen TM, Hacker TA, Mollinger L. 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. Phys Ther 2002;82:128–37.

15.Cress ME, Schechtman KB, Mulrow CD, Fiatarone MA, Gerety MB, Buchner DM. Relationship between physical performance and self-perceived physical function. J Am Geriatr Soc 1995;43:93–101.

16.Patla AE. A framework for understanding mobility problems in the elderly. In: Craik RL, Oatis CA, editors. Gait analysis: theory and application. St. Louis: Mosby; 1995. p. 436–49.

PHYSICAL PERFORMANCE TEST (PPT)

  1. Top of page
  2. BERG BALANCE SCALE
  3. DYNAMIC GAIT INDEX (DGI)
  4. GAIT VELOCITY
  5. PHYSICAL PERFORMANCE TEST (PPT)
  6. TIMED CHAIR STAND TEST
  7. TIMED UP AND GO
  8. TINETTI PERFORMANCE-ORIENTED MOBILITY ASSESSMENT (POMA)
  9. References

General Description

Purpose

To measure multiple dimensions of physical function in older adults through a performance-based test.

Content

The original full 9-item scale includes the following tasks: writing a sentence, simulated eating, lifting a book and putting it on a shelf, putting on and removing a jacket, picking up a penny from the floor, turning 360 degrees, 50-foot walk test, climbing stairs (2 items-time for 1 flight; and number of flights [with maximum up to 4]) (1). The modified 9-item scale includes chair rise and a progressive Romberg test (altering the base of support and eyes open versus closed), while excluding writing a sentence and simulated eating (2). The 8-item scale excludes the number of flights stair item (3). The 7-item scale excludes both stair items (1).

Developer/contact information.

The test was originally described by Reuben and Siu in 1990 (1).

Versions

Developers created 9-item (PPT-9) and 7-item scales (PPT-7) (1). Modifications to the 9-item scale (2) and an 8-item scale (3) have been more recently reported in the literature.

Number of items in scale

Up to 9 items.

Subscales

None.

Populations
Developmental/target

Older adults, both frail and community-dwelling.

Other uses

Patients with Parkinson's disease (1). Individuals with a variety of chronic diseases, including degenerative joint disease (4).

WHO ICF Components

Activity limitation.

Administration

Method

Easily administered physical performance test.

Training

None required.

Time to administer/complete

Less than 10 minutes.

Equipment needed

Stopwatch, pen and pencil, spoon and bowl, beans and coffee can, book, jacket, penny, chair (seat height of 40.6 cm), and stairs.

Cost/availability

Readily available and inexpensive.

Scoring

Responses
Scale

There is a 5-point ordinal scale (0–4); most of the items are timed and then the value is converted into an ordinal score.

Score range

PPT-9: 0–36 (1), Modified PPT-9: 0–36 (2), PPT-8: 0–32 (3), PPT-7: 0–28 (1). Higher scores indicate greater independence.

Interpretation of scores

The developers report that in general the rating “4” identifies individuals in the top 20% on each item and the rating “1” identifies individuals scoring in the lowest 20% on each item (1). A cut-off score of 15 has been used to predict falls with the PPT-7 version (5). Brown et al using the modified PPT-9, described a “frailty” classification in which 32–36 = not frail; 25–32 = mild frailty; 17–24 = moderate frailty; and <17 = unlikely to be able to function in the community (2).

Method of scoring

Scores to individual items are summed.

Time to score

Less than 5 minutes.

Training to score

None; review of standardized protocol.

Training to interpret

None; review of standardized protocol.

Norms available

None. Several investigators have collected reference data for community-dwelling and institutionalized older adults (146–10). There is still need for larger sample sizes to establish more definitive norms for the different versions of the test.

Psychometric Information

Reliability

Internal consistency for the PPT-9 and PPT-7 in the developmental sample using Cronbach's α was 0.87 and 0.79, respectively (1). Sherman and Reuben in a later study of the PPT-7 and National Institute of Aging (NIA) Battery of lower extremity function found an α value of 0.67 for the PPT-7 and an α value of 0.60 for the NIA (8). King et al in comparing internal consistency of the PPT-8 to the PPT-7 found α to be 0.79 and 0.74, respectively (3). The ICC for test-retest reliability for the PPT-8 has been reported as 0.88 (3).

Interrater reliability has been reported to be high for the PPT-9 (0.99) and PPT-7 (0.93) using the Pearson product moment correlation (1); and for the PPT-8 using the ICC (0.96) (3).

Validity
Concurrent

Validity has been supported for the PPT-9 and PPT-7 by correlating PPT scores in a sample of 183 patients with accepted functional status assessments (modified Rosow-Breslau, Instrumental and Basic Activity of Living Scales, and the gait component of the Performance-Oriented Movement Assessment) with Pearson correlations of r = 0.50–0.80 (1). Sherman and Reuben found high concurrent validity with the performance-based NIA (kappa = 0.71), but lower correlations with self-report functional status measures (BADL and IADL from the Functional Status Questionnaire [FSQ] and the SF-36 physical functioning subscale) (kappa = 0.37–0.49) (8).

Construct

Reuben et al. looked at construct validity in a study with 83 subjects. The self-administered Older Americans Resources and Services Instrumental Activities of Daily Living (OARS-IADL) and the performance based PPT-7 had comparable correlations with physical role limitations (Short Form-36 [SF-36]) with r = 0.49–0.50, while relationships with other SF-36 measures (e.g., emotional function) of health were low for both measures (11). In the Sherman and Reuben study, construct validity was evaluated for the PPT-7 and NIA. Patients with scores above the median and below the median on the PPT-7 were compared and significant differences were found for general constructs associated with physical function (general health, age, energy, and pain, but not for constructs with a less logical association (emotional state and patient satisfaction) (8).

Predictive

PPT test scores have been shown to have predictive validity for living situation (612) and mortality (6). VanSwearingen et al looked at the validity of the PPT-7 (using the cut-off point of 15) for predicting falls and found a sensitivity of 79% and a specificity of 71% (5). Combining use of the PPT-7 and the modified Gait Abnormality Rating Scale yielded a sensitivity of 91% and a specificity of 87% (5).

Sensitivity/responsiveness to change

Rozzini et al (47) and Brach et al (10) have emphasized in their studies that use of the PPT-7 is more likely to identify deficits in physical function than self-report measures. In the study by Brach et al (10), in testing 170 community-dwelling older adult women, only 7% scored at the ceiling of the PPT, but most scored at the ceiling for the self-report measures of the FSQ (BADL = 77%, IADL = 61%, and Social Activity = 94%). PPT scores changed following comprehensive geriatric assessment and an adherence intervention (9).

In an exercise intervention study by King et al the PPT-8 was shown to have a responsiveness index (mean change of intervention group/square root of twice the mean square error for the change in the control group) of 0.80 (3).

Comments and Critique

Subject age, lower extremity (LE) muscle strength, and LE range of motion in one study explained 77% of the variance in function as measured by the PPT-7 (12). Obstacle course performance, hip abduction strength, the semi-tandem portion of the Romberg, and coordination (pegboard) explained 73% of the variance in the modified PPT (2). Peak aerobic power (peak VO2max) is a significant independent predictor of performance on the modified PPT (13).

The PPT is a performance-based scale for assessing older adults which positively combines assessment of BADL, IADL, lower extremity strength, gait and balance for clinical and research purposes. It likely has applicability in testing patients with rheumatic disease with a range of functional limitations and disability because of its tendency not to have ceiling or floor effects (4710).

The psychometric properties of the different versions of the PPT have in general been well studied, with the PPT-7 having the most evidence. In some settings the space and number of props needed may not be feasible.

References

1.(Original) Reuben DB, Siu AL. An objective measure of physical function of elderly outpatients: The Physical Performance Test. J Am Geriatr Soc 1990;38:1105–12.

2.Brown M, Sinacore DR, Binder EF, Kohrt WM. Physical and performance measures for the identification of mild to moderate frailty. J Gerontol A Biol Sci Med Sci 2000;55:M350–5.

3.King MB, Judge JO, Whipple R, Wolfson L. Reliability and responsiveness of two physical performance measures examined in the context of a functional training intervention. Phys Ther 2000;80:8–16.

4.Rozzini R, Frisoni GB, Ferrucci L, Barbisoni P, Bertozzi B, Trabucchi M. The effect of chronic diseases on physical function: comparison between activities of daily living scales and the Physical Performance Test. Age Ageing 1997;26:281–7.

5.VanSwearingen JM, Paschal KA, Bonino P, Chen TW. Assessing recurrent fall risk of community-dwelling, frail older veterans using specific tests of mobility and the physical performance test of function. J Gerontol A Biol Sci Med Sci 1998;53:M457–64.

6.Reuben DB, Siu AL, Kimpau S. The predictive validity of self-report and performance-based measures of function and health. J Gerontol 1992;47:M106–10.

7.Rozzini R, Frisoni GB, Bianchetti A, Zanetti O, Trabucchi M. Physical Performance Test and Activities of Daily Living scales in the assessment of health status in elderly people. J Am Geriatr Soc 1993;41:1109–13.

8.Sherman SE, Reuben D. Measures of functional status in community-dwelling elders. J Gen Intern Med 1998;13:817–23.

9.Reuben DB, Frank JC, Hirsch SH, McGuigan KA, Maly RC. A randomized clinical trial of outpatient comprehensive geriatric assessment coupled with an intervention to increase adherence to recommendations. J Am Geriatr Soc 1999;47:269–76.

10.Brach JS, VanSwearingen JM, Newman AB, Kriska AM. Identifying early decline of physical function in community-dwelling older women: performance-based and self-report measures. Phys Ther 2002;82:320–8.

11.Reuben DB, Valle LA, Hays RD, Siu AL. Measuring physical function in community-dwelling older persons: a comparison of self-administered, interviewer-administered, and performance-based measures. J Am Geriatr Soc 1995;43:17–23.

12.Beissner KL, Collins JE, Holmes H. Muscle force and range of motion as predictors of function in older adults. Phys Ther 2000;80:556–63.

13.Binder EF, Birge SJ, Spina R, et al. Peak aerobic power is an important component of physical performance in older women. J Gerontol A Biol Sci Med Sci 1999;54:M353–6.

TIMED CHAIR STAND TEST

  1. Top of page
  2. BERG BALANCE SCALE
  3. DYNAMIC GAIT INDEX (DGI)
  4. GAIT VELOCITY
  5. PHYSICAL PERFORMANCE TEST (PPT)
  6. TIMED CHAIR STAND TEST
  7. TIMED UP AND GO
  8. TINETTI PERFORMANCE-ORIENTED MOBILITY ASSESSMENT (POMA)
  9. References

General Description

Purpose

To assess lower body strength in older adults as an indicator of functional status.

Content

Either the amount of time it takes to rise from a chair 10 (1), 1 (2), or 5 (34) times or the number of times someone can rise from a chair in 30 seconds (5).

Developer/contact information

The test was originated by Csuka and McCarty (1).

Versions

Not applicable.

Number of items in scale

Not applicable.

Subscales

Not applicable.

Populations

Developmental/target

Patients with polymyositis and proximal lower extremity weakness (1). People with lower extremity weakness.

Other uses

Arthritis, older adults.

WHO ICF Components

Activity limitation.

Administration

Method

Performance-based; easily performed.

Training

None.

Time to administer/complete

Less than 5 minutes.

Equipment needed

Chair with 40–44.5-cm seat height and no arms; stopwatch.

Cost/availability

Readily available and inexpensive.

Scoring

Responses
Scale

Not applicable.

Score range

Not applicable.

Interpretation of scores

Not applicable.

Method of scoring

Time to perform 1, 5, or 10 stands or number of stands performed in 30 seconds (5).

Time to score

Same as performance time.

Training to score

None.

Training to interpret

None.

Norms available

Formal norms have not yet been established. Csuka and McCarty have established upper limits for different sexes and ages on 39 healthy adults (1).

Psychometric Information

Reliability

Estimates of intra-session interrater reliability are high with an ICC of 0.95 (5). An estimate of 2 to 3-week inter-session interrater reliability with many subjects being tested in their homes yielded an ICC of 0.71 (6). Intrarater reliability over longer periods (up to 132 days) is not as high with a reliability of 0.25 for a single chair stand and 0.67 for 5 chair stands (7).

Test-retest reliability 2–5 days apart is 0.84 (5). An estimate of 2 to 3-week inter-session intrarater reliability was 0.64 (6). Test-retest reliability 10 weeks apart is 0.88 (8).

Validity
Concurrent

Validity was demonstrated with a positive correlation with weight-adjusted leg press measurements (r = 0.77) (5) and also with positive correlations with 50 ft walk time (r = 0.66) and lower extremity manually tested muscle strength (r = 0.47) (8).

Construct

Validity was explored by examining the ability of the chair stand test to discriminate people with high levels of physical activity from those with low levels of activity (5). The test distinguished a group with rheumatoid arthritis (RA) from a group without RA (8). Disease severity accounted for most of the slow performance in subjects with RA (8).

Predictive

Validity was determined by finding that better scores at baseline predict less disability 4 years later (3). In elderly Mexican American women, those with the fastest and slowest performance were more likely to fall than those with average times (4).

Sensitivity/responsiveness to change

The timed chair stand test has not been studied for least detectable difference or clinically meaningful change.

Comments and Critique

Many factors can affect results of this test. Performance declines across decades of age (60s through 80s) (156). Women perform the timed chair stand test significantly more slowly than men, and ethnic differences are apparent (6). Floor effects occur when time to perform 10 sit-to-stand transfers is recorded; many subjects are not able to do 10. Timing the number of transfers performed in 30 seconds eliminates floor effects (5). More research is needed to determine the responsiveness to change of the timed chair stand test.

References

1.(Original) Csuka M, McCarty DJ. A simple method for measurement of lower extremity muscle strength. Am J Med 1985;78:77–81.

2.Cress ME, Schechtman KB, Mulrow CD, Fiatarone MA, Gerety MB, Buchner DM. Relationship between physical performance and self-perceived physical function. J Am Geriatr Soc 1995;43:93–101.

3.Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB. Lower extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med 1995;332:556–61.

4.Schwartz AV, Villa ML, Prill M, Kelsey JA, Galinus JA, Delay RR, et al. Falls in older Mexican-American women. J Am Geriatr Soc 1999;47:1371–8.

5.Jones CJ, Rikli RE, Beam WC. A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Res Q Exerc Sport 1999;70:113–9.

6.Ostchega Y, Harris TB, Hirsch R, Parsons VL, Kington R, Katzoff M. Reliability and prevalence of physical performance examination assessing mobility and balance in older persons in the US: data from the third national health and nutrition examination survey. J Am Geriatr Soc 2000;48:1136–41.

7.Newcomer KL, Krug HE, Mahowald ML. Validity and reliability of the timed-stands test for patients with rheumatoid arthritis and other chronic diseases. J Rheumatol 1993;20:21–7.

8.Jette AM, Jette DU, Ng J, Plotkink DJ, Bach MA, The Musculoskeletal Impairment Study Group. Are performance-based measures sufficiently reliable for use in multicenter-trials? J Gerontol A Biol Sci Med Sci 1999;54:M3–6.

TIMED UP AND GO

  1. Top of page
  2. BERG BALANCE SCALE
  3. DYNAMIC GAIT INDEX (DGI)
  4. GAIT VELOCITY
  5. PHYSICAL PERFORMANCE TEST (PPT)
  6. TIMED CHAIR STAND TEST
  7. TIMED UP AND GO
  8. TINETTI PERFORMANCE-ORIENTED MOBILITY ASSESSMENT (POMA)
  9. References

General Description

Purpose

To test basic mobility skills of frail elderly patients.

Content

Time in seconds for patient to rise from sitting in a standard arm chair, walk 3 meters, turn, walk back to the chair, and sit down using regular footwear and customary walking aid.

Developer/contact information

Adapted by Podsiadlo and Richardson (1) from Mathias et al (2).

Versions

Original Get Up and Go test (2) used an ordinal scoring system based on the observer's assessment of the patient's risk of falling, Timed Up and Go (TUG) uses time in seconds.

Number of items in scale

Not applicable.

Subscales

Not applicable.

Populations
Developmental/target

Frail elderly patients 60–90 years old referred to a geriatric day hospital. Community dwelling frail elders.

Other uses

Patients with arthritis, stroke, vertigo (3). The TUG did not prove helpful with cognitively impaired frail elderly people because 35.5% of the group were unable to physically perform the test (4).

WHO ICF Components

Activity limitation.

Administration

Method

Easily administered physical performance test.

Training

None.

Time to administer/complete

15 minutes or less.

Equipment needed

Arm chair with about 46-cm seat height and 65-cm arm height; 3-meter walkway; stopwatch or wrist watch with a second hand.

Cost/availability

Readily available and inexpensive. Available on the web at http://statmaster.sdu.dk/courses/st111/Data/tug.html.

Scoring

Responses
Scale

Not applicable.

Score range

Not applicable.

Interpretation of scores

A cut-off score of ≥13.5 seconds has been shown to predict falling in community-dwelling frail elders, but this score has not been verified in other studies (5). Scores of ≥30 seconds correspond with functional dependence in people with pathology (1). Standardized cut-off scores to predict risk of falling have not yet been established.

Method of scoring

Time in seconds.

Time to score

Same as the time of the test.

Training to score

None.

Training to interpret

None.

Norms available

Formal norms are not available. Healthy adults over 79 years old took 7–10 seconds (1); frail elderly subjects took 10– 240 seconds to perform, although 45 of 57 subjects able to perform the test took less than 40 seconds (1); all healthy community dwelling subjects 65–84 years of age performed the test in <20 seconds without an assistive device (6).

Psychometric Information

Reliability

Interrater reliability is high with a same day, three-rater ICC of 0.99 (1). In another study of interrater reliability among 3 physiotherapists, the reliability was 0.97 (7). For a physical therapist, physician, and patient attendant on consecutive visits, the ICC was 0.99, and consecutive visit intrarater reliability (ICC) was also 0.99 (1). In another study of intra-session, test-retest reliability, the ICC (model 2,1) was 0.97 (8). Intrarater reliability over longer periods (up to 132 days) is not as high with a reliability of 0.74 (9). Test-retest (2–7 days) standard error of measurement has been measured as 1 second (7).

Validity
Criterion

Validity has been determined by moderate to high correlations with scores on Berg Balance Scale, gait speed, and the Barthel Index of Activities of Daily Living Scale (17).

Construct

Validity has been explored by examining differences in scores for patients who were independent and dependent in basic transfers. All subjects who completed the TUG in <20 seconds were independent in transfers. Subjects requiring ≥30 seconds were dependent (1).

The TUG scores for community-dwelling subjects (65–95 years old) with a history of falling were slower than for people with no history of falling (510). Using logistic regression, sensitivity of the TUG to predict falls using a cut-off score of ≥13.5 seconds was 0.80 with a specificity of 1.00 (5). TUG scores correlate with mobility and strength complaints (1011).

The TUG is capable of discriminating people at risk of falling from healthy elderly subjects and young control subjects (12). In elderly Mexican-American women, those with the best and worst performance on the TUG were more likely to fall than those with moderate performance (13).

Sensitivity/responsiveness to change

The TUG has not been studied for least detectable difference or clinically meaningful change. TUG scores changed following a quadriceps and hamstrings strengthening program for patients with rheumatoid arthritis compared with subjects who received no strengthening (14).The timed test would be more sensitive to change than ordinal measures.

Comments and Critique

Many factors may affect performance on the TUG. A history of arthritis increases the risk of falling as measured by balance tests such as the TUG (13). As a test of balance, the TUG may be most useful for patients with rheumatoid arthritis in functional class IV (7). Scores differed based on type of footwear worn. They were longest with dress shoes and shortest with walking shoes (15).

Cognitively impaired subjects took longer to perform the TUG than unimpaired subjects (4). Chair type (standard arm chair, armless chair and easy chair) does not affect speeds (3). There is a tendency for TUG times to increase with age (8).

Including a cognitive or manual task concurrent with the TUG increased the times. Sensitivity for predicting falls was 0.80 and specificity was 0.93 (5). The use of an assistive device increased the TUG times (5). A cane increased the time the least, followed by a rolling walker and then a pick up walker (6).

Female candidates for hip or knee arthroplasty took 2.2 times longer than healthy controls; male candidates took 1.9 times as long (16).

The TUG measures limited aspects of balance (rising, walking, turning, sitting).

References

1.(Original) Podsiadlo D, Richardson S. The timed “up & go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991;39:142–8.

2.(Original) Mathias S, Nayak USL, Isaacs B. Balance in elderly patients: the “get-up and go” test. Arch Phys Med Rehabil 1986;67:387–9.

3.Eekhoff JAH, DeBock GH, Schaapveld K, Springer MP. Short report: functional mobility assessment at home. Timed up and go test using three different chairs. Can Fam Physician 2001;47:1205–7.

4.Rockwood K, Awalt E, Carver D, MacKnight C. Feasibility and measurement properties of the functional reach and the timed up and go tests in the Canadian study of health and aging. J Gerontol A Biol Med Sci 2000;55A:M70–3.

5.Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the timed up and go test. Phys Ther 2000;80:896–903.

6.Medley A, Thompson M. The effect of assistive devices on the performance of community dwelling elderly on the timed up and go test. Issues Aging 1997;20:3–7.

7.Norén AM, Bogren U, Bolin J, Stenstrom C. Balance assessment in patients with peripheral arthritis: Applicability and reliability of some clinical assessments. Physiother Res Int 2001;6:193–204.

8.Steffen TM, Hacker TA, Mollinger L. 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. Phys Ther 2002;82:128–37.

9.Jette AM, Jette DU, Ng J, Plotkink DJ, Bach MA, The Musculoskeletal Impairment Study Group. Are performance-based measures sufficiently reliable for use in multicenter-trials? J Gerontol A Biol Med Sci 1999;54:M3–6.

10.Gunter KB, White KN, Hayes WC, Snow CM. Functional mobility discriminates nonfallers from one-time and frequent fallers. J Gerontol A Biol Sci Med Sci 2000;55:M672–6.

11.Di Fabio RP, Seay R. Use of the “fast evaluation of mobility, balance, and fear” in elderly community dwellers: validity and reliability. Phys Ther 1997;77:904–17.

12.Wall JC, Bell C, Campbell S, Davis J. The timed get-up-and-go test revisited: measurement of the component tasks. J Rehabil Res Dev 2000;37:109-13.

13.Schwartz AV, Villa ML, Prill M, et al. Falls in older Mexican-American women. J Am Geriatr Soc 1999;47:1371–8.

14.McMeeken J, Stillman B, Story I, Kent P. The effects of knee extensor and flexor muscle training on the timed-up-and-go test in individuals with rheumatoid arthritis. Physiother Res Int 1999;4(1):55–67.

15.Arnadottir SA, Mercer VS. Effects of footwear on measurements of balance and gait in women between the ages of 65 and 93 years. Phys Ther 2000;80:17–27.

16.Kennedy D, Stratford PW, Pagura SM, Walsh M, Woodhouse LJ. Comparison of gender and group differences in self-report and physical performance measures in total hip and knee arthroplasty candidates. J Arthroplasty 2002;17:70–7.

TINETTI PERFORMANCE-ORIENTED MOBILITY ASSESSMENT (POMA)

  1. Top of page
  2. BERG BALANCE SCALE
  3. DYNAMIC GAIT INDEX (DGI)
  4. GAIT VELOCITY
  5. PHYSICAL PERFORMANCE TEST (PPT)
  6. TIMED CHAIR STAND TEST
  7. TIMED UP AND GO
  8. TINETTI PERFORMANCE-ORIENTED MOBILITY ASSESSMENT (POMA)
  9. References

General Description

Purpose

To measure balance and gait in older adults through a performance-based test.

Content

The originally developed assessment consists of 13 balance tasks and 9 gait characteristics (1). A commonly used and slightly modified version includes 9 balance tasks and 7 items to assess gait characteristics (2). The balance tasks include balance during sitting, rising, attempting to rise, immediate standing (first 5 seconds), standing with alterations in base of support, sternal nudge, standing with eyes closed, standing with neck turning, standing with back extension, reaching an item on a shelf in standing, bending down to pick up a small object, turning 360°, and standing to sitting. The 7 gait characteristics examined include initiation, step length and height, step symmetry, step continuity, path, trunk stability, and walking stance (step width).

Developer/contact information

The test was originally described by Tinetti in 1986 (1).

Versions

Since the original version there have been several modifications to the tool reported in the literature by Tinetti as well as other investigators (3–5). There are also reports of using only the Balance portion of the POMA (BPOMA) (5–8). Other languages: None known.

Number of items in scale

There are 16 items in most commonly used version (9).

Subscales

Balance (BPOMA), Gait (GPOMA).

Populations
Developmental/target

Older adults, both frail and community-dwelling.

Other uses

None.

WHO ICF Components

Activity limitation.

Administration

Method

Easily administered physical performance test. Individual being tested can use usual assistive devices.

Training

None required.

Time to administer/complete

Less than 15 minutes.

Equipment needed

Hard, armless chair (seat height not specified); stopwatch or wrist watch with second hand.

Cost/availability

No cost to use tool. Available at http://www.sgim.org/TinettiTool.Pdf (16-item version).

Scoring

Responses
Scale

2 point (0–1) and 3 point (0–2) ordinal scales are used for items in the 16-item version.

Score range

Range is 0–28 with higher scores indicating greater independence.

Interpretation of scores

In a study by Tinetti et al using a 7-item version of the test there were 4 items related to balance (unsteady standing to sitting, unable to stand in single limb stance, unsteady turning 360°, and unsteady when nudged) and three items related to gait (increased trunk sway, increased path deviation, and unable to adapt speed) used to identify fall risk. When the number of balance-gait abnormalities is in the 3–5 range, the adjusted odds ratio for falls risk is 1.4, while when the number of balance-gait abnormalities is in the 6–7 range, it is 1.9 (10). Harada et al have used a cut-off score of 14 of 16 for the BPOMA for identifying older adults in a nursing home setting who would benefit from physical therapy (5).

Method of scoring

Scores of individual items are summed.

Time to score

Less than 5 minutes.

Training to score

None.

Training to interpret

None.

Norms available

None.

Psychometric Information

Reliability

The developer reported an interrater reliability of the original test version in the form of a percent agreement of 85% (±10%) (1). In a study of the interrater reliability of the BPOMA, Kappa coefficients of 0.40–0.75 were found across raters of varied experience, indicating fair to good reliability (6).

Validity
Content

No known formal study.

Concurrent

Validity has been supported by moderate correlations of the gait component of the POMA with the 9-item Physical Performance Test (0.78) (11) and total ankle range of motion (0.63) (7); moderately high inverse correlations of the BPOMA, GPOMA, and total POMA with a functional obstacle course measure (−0.73 to −0.78) (12); and high correlations of the BPOMA with the Berg Balance Scale (0.91) (13).

Predictive

Thapa et al in a study with frail, nursing home residents found the BPOMA independently predicted risk of future recurrent falls (14). Harada et al studied the predictive validity of the BPOMA (using a cut-off score of 14) for identifying older adults in a nursing home setting who would benefit from physical therapy and found a sensitivity of 68% and a specificity of 78% (5). Shumway-Cook et al, in an investigation that prospectively evaluated the effects of a multi-dimensional exercise program on balance, mobility, and risk of falls in community-dwelling older adults, found through stepwise regression analysis that the variables associated with successful response to intervention included degree of adherence to exercise program and pretest score on the POMA (15).

Sensitivity/responsiveness to change

Not yet studied for least detectable difference or clinically meaningful changes.

Comments and Critique

This measurement instrument has been used in clinical and research settings with older adults, however there is no known peer reviewed study of its use specifically with patients with rheumatic disease. The evaluation of the psychometric properties of this tool is complicated by the number of versions and the lack of clear identification of which version is used in a specific study (16, 17). The strength of this tool is its effectiveness for screening purposes for predicting fall risk in frail older adults and for predicting who may benefit from balance retraining intervention (5, 14, 15). Users should be cautioned regarding using the tool as on outcome measure, especially for higher functioning older adults, because of the likely ceiling effects of the ordinal scales used in the tool .

Table  . Summary Table for Measures of Adult General Functional Status*
Measure/scaleContent/purposeMeasure outputsNo. of itemsResponse formatMethod of administrationTime for administrationValidated populationsPsychometric properties
ReliabilityValidityResponsiveness
Berg Balance ScaleTo examine static and some components of dynamic balance control in adults through common movement tasks.0–56 with high scores indicating independent performance145 point ordinal scale (0–4)Performance<15 minutesDevelopmental: Older adults (>60 years of age). Other: Patients post-stroke and post hip fracture.Interrater and intrarater reliability are high.Good construct validity as an indicator of balance. Sensitivity and specificity of the Berg Scale to predict falls are moderate.Limited studies to date for analyzing least detectable difference or clinically meaningful change. Changes seen in scores with intervention studies.
  • *

    NA = not applicable; OA = osteoarthritis.

Dynamic Gait Index (DGI)To measure balance impairment in adults through a test that looks at the individual' ability to modify gait responses to task demands.Score 0–24 with high scores indicating independent performance84 point ordinal scale (0–3); 0 = Severe impairment, 3 = NormalPerformance<10 minutesDevelopmental: Older adults. Other: Patients with vestibular disorders.Interrater and intrarater reliability are high for the total DGI score, but more study needs to be conducted on the reliability of individual items.Good construct validity as an indicator of gait adaptability. Able to predict risk of falling.Not formally studied but changes in response to intervention.
Gait VelocityTo test lower extremity function through timed walking.Either time to walk a specified distance (3 m, 8 ft, 10 ft, 6 m, 50 ft, 40 m) or distance walked in a specified time at either a comfortable pace, at maximum speed, or at twice the person's usual speed.NAVelocityPerformance<15 minutesDevelopmental: People with lower extremity weakness. Other: Patients following stroke; people with arthritis; older adults; people with other lower extremity impairmentsIntra-session and inter-session test-retest reliability is generally high. Inter-session interrater reliability is moderate.Reasonable construct validity as an indicator of severity of knee OA. Predictive validity-baseline scores predict later disability, self-reported physical function, and category of walking.No studies of minimal detectable or clinically meaningful change. Weakly sensitive or insensitive to change based on measures of disease activity in patients with rheumatoid arthritis.
Physical Performance Test (PPT)To test multiple dimensions of physical function in older adults.PPT-9: 0–36 Modified PPT-9: 0–36 PPT-8: 0–32 PPT-7: 0–28 High scores indicate independent performance7, 8, and 9- item versions5 point ordinal scale (0–4); most of the items are timed and then the value is converted into an ordinal score.Performance<10 minutesDevelopmental: Older adults, both frail and community- dwelling. Other: Patients with Parkinson's disease. Individuals with a variety of chronic diseases, including degenerative joint diseaseInter-rater reliability and internal consistency are high for the different versions of the test.Good construct validity as an indicator of function. Predictive validity for living situation and mortality. Able to predict fall risk.Limited studies to date for analyzing least detectable difference or clinically meaningful change. Scores have been shown to change with intervention.
Timed Chair StandTo assess lower body strength in older adults as an indicator of functional status (repeatedly rising from a chair).Time it takes to rise from a chair 1, 5, or 10 times or the number of times someone can rise from a chair in 30 seconds.NATimePerformance<5 minutesDevelopmental: Patients with polymyositis and proximal lower extremity weakness. Target: People with lower extremity weakness. Other: People with arthritis, older adultsIntra-session test-retest reliability is generally high. Test-retest reliability over longer periods is moderate for repeated stands. Inter-session interrater reliability is goodGood construct validity as an indicator of lower extremity strength and function. Predictive validity-better scores predict less disability later. Fast and slow performances predict likelihood of falls.Not formally studied but performance changes in response to intervention.
Timed Up and Go (TUG)To test basic mobility skills of frail elderly patients (rise from a standard arm chair, walk 3 meters, turn, walk back to the chair, and sit down using regular footwear and customary walking aid).Time in seconds to perform the activity.NATimePerformance<15 minutesDevelopmental: Frail elderly patients referred to a geriatric day hospital, 60–90 years old. Target: Community dwelling frail elders. Other: Patients with arthritis, stroke, vertigo. Not helpful with cognitively impaired frail elderly people.Interrater and intrarater reliability are high. Inter-session intrarater reliability over longer periods is moderate.Good construct validity as an indicator of balance and lower extremity function Predictive validity-sensitivity and specificity of TUG scores to predict falls are both highHas not been studied for least detectable difference or clinically meaningful change. Performance changes with intervention. The timed test would be more sensitive to change than ordinal measures.
Tinetti Performance Oriented Mobility Assessment (POMA)To measure balance and gait in older adults through a combination of balance and gait tasks.0–28 with high scores indicating independent performance16 items in most commonly used version2 point (0–1) and 3 point (0–2) ordinal scales are used for items in the 16 item versionPerformance<15 minutesDevelopmental: Older adults, both frail and community-dwelling.Reliability studies lacking for the different test versions and components of test. Moderate interrater reliability for the balance component of POMAGood construct validity as an indicator of balance and function. Predictive validity-Able to predict whether patients will benefit from intervention.No studies of minimal detectable or clinically meaningful change. Limited ordinal scale tends to cause problems with ceiling effects especially for higher functioning older adults.

References

  1. Top of page
  2. BERG BALANCE SCALE
  3. DYNAMIC GAIT INDEX (DGI)
  4. GAIT VELOCITY
  5. PHYSICAL PERFORMANCE TEST (PPT)
  6. TIMED CHAIR STAND TEST
  7. TIMED UP AND GO
  8. TINETTI PERFORMANCE-ORIENTED MOBILITY ASSESSMENT (POMA)
  9. References
  • 1
    (Original) Tinetti ME. Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc 1986; 34: 11926.
  • 2
    Galindo-Ciocon DJ, Ciocon JO, Galindo DJ. Gait training and falls in the elderly. J Gerontol Nurs 1995; 21: 107.
  • 3
    Tinetti ME, Ginter SF. Identifying mobility dysfunctions in elderly patients:standard neuromuscular examination or directassessment? JAMA 1988; 259: 11903.
  • 4
    Robbins AS, Rubenstein LZ, Josephson KR, Schulman BL, Osterweil D, Fine G. Predictors of falls among elderly people: results of two population-based studies. Arch Intern Med 1989; 149: 162833.
  • 5
    Harada N, Chiu V, Damron-Rodriguez J, Fowler E, Siu A, Reuben DB. Screening for balance and mobility impairment in elderly individuals living in residential care facilities. Phys Ther 1995; 75: 4629.
  • 6
    Cipriany-Dacko LM, Innerst D, Johannsen J, Rude V. Interrater reliability of the Tinetti Balance Scores in novice and experienced physical therapy clinicians. Arch Phys Med Rehabil 1997; 78: 11604.
  • 7
    Mecagni C, Smith JP, Roberts KE, O'Sullivan SB. Balance and ankle range of motion in community-dwelling women aged 64 to 87 years: a correlational study. Phys Ther 2000; 80: 100411.
  • 8
    Raiche M, Hebert R, Prince F, Corriveau H. Screening older adults at risk of falling with the Tinetti balance scale. Lancet 2000; 356: 10012.
  • 9
    Whitney SL, Poole JL, Cass SP. A review of balance instruments for older adults. Am J Occup Ther 1998; 52: 66671.
  • 10
    Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med 1988; 319: 17017.
  • 11
    Reuben DB, Siu AL. An objective measure of physical function of elderly outpatients: The Physical Performance Test. J Am Geriatr Soc 1990; 38: 110512.
  • 12
    Means KM, Rodell DE, O'Sullivan PS, Winger RM. Comparison of a functional obstacle course with an index of clinical gait and balance and postural sway. J Gerontol A Biol Sci Med Sci 1998; 53: M3315.
  • 13
    Berg KO, Maki BE, Williams JI, Holliday PJ, Wood-Dauphinee SL. Clinical and laboratory measures of postural balance in an elderly population. Arch Phys Med Rehabil 1992; 73: 107380.
  • 14
    Thapa PB, Gideon P, Brockman KG, Fought RL, Ray WA. Clinical and biomechanical measures of balance as fall predictors in ambulatory nursing home residents. J Gerontol A Biol Sci Med Sci 1996; 51: M23946.
  • 15
    Shumway-Cook A, Gruber W, Baldwin M, Liao S. The effect of multidimensional exercises on balance, mobility, and fall risk in community-dwelling older adults. Phys Ther 1997; 77: 4657.
  • 16
    Arnadottir S, Stemmons V. Functional assessment in geriatric physical therapy. Issues Aging 1999; 22: 312.
  • 17
    VanSwearingen JM, Brach JS. Making geriatric assessment work: selecting useful measures. Phys Ther 2001; 81: 123352.