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Rehab Measures: Short Form Berg Balance Scale 3 Point

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Title of Assessment

Short Form Berg Balance Scale 3 Point  

Acronym

SF BBS-3P

Instrument Reviewer(s)

Initially reviewed by Rati Iyer PT, MPT in 10/2012

Summary Date

2/7/2013 

Purpose

A performance-based measure of balance during specific movement tasks. The purpose of Short Form Berg Balance Scale is to assess the static and dynamic balance and fall risk in adult and geriatric populations.

Description

  • 7 item scale measures static and dynamic balance during specific movement tasks
  • Each item has a 3 point score, ranging from 0-4 (0,2 & 4 from the original BBS)
  • Each item is scored depending on the ability to perform the specific task and the score on each item is summed
  • Minimum score=0 (poor balance); Maximum score=28 (good balance)

Area of Assessment

Balance Non-Vestibular; Functional Mobility 

Body Part

 

ICF Domain

Activity 

Domain

 

Assessment Type

 

Length of Test

06 to 30 Minutes 

Time to Administer

10 minutes (half the time needed to administer the original BBS)

Number of Items

7 items 

Equipment Required

  • Stop watch or watch with second hand
  • Chair of reasonable height with arm rests
  • Measuring tape/ruler/any indicator of 2, 5 and 10 inches

Training Required

None necessary

Type of training required

No Training 

Cost

Free 

Actual Cost

Cost of the equipment

Age Range

 

Administration Mode

 

Diagnosis

Geriatrics; Pain; Stroke; Vestibular Disorders 

Populations Tested

  • Stroke
  • Cervicogenic dizziness, balance and neck pain
  • Community dwelling elderly people (65 years and older)
  • Orthopedic surgery (hip and knee replacements)

Standard Error of Measurement (SEM)

Acute Stroke: (Chou, 2006; n=113; medically stable 14 days post stroke; mean age=68.1 (11.3) years)

  • SEM for the entire group(n=113): 4.2

Chronic Stroke: (Liaw et al, 2012; n=52; mean (SD)age=60.4 years(13.4); median time post stroke =24 months)

  • SEM for entire group (n=52) was calculated by the square root of error variance: 1.02

Hip/Knee Arthroplasty: (Jogi et al, 2010; n=54 combination of hip (n=26) and knee(n=28) arthroplasty, evaluated before and after 5-7weeks home exercise program using the original BBS and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Scores for reduced versions of the BBS and WOMAC were extracted from the original version)

  • SEM for entire group(n=54) was calculated using : Standard Deviation from the 1st test x (square root of (1-ICC)): 1.414

Elderly Population: (Karthikeyan et al, 2012; n=76; mean age=74.96(6.45) years)

  • SEM for the entire group (n=76) was calculated using : Standard Deviation from the 1st test x (square root of (1-ICC)): 0.899

Minimal Detectable Change (MDC)

Acute Stroke: (Chou et al, 2006)

  • The calculation used is: MDC = 1.96 x SEM (4.2) x square root of 2: MDC=11.641 points

Chronic Stroke: (Liaw et al, 2012; n=52; MDC was calculated based on SEM)

  • MDC individual: 2.83 points
  • MDC group (n=52): 0.39 points

Hip/Knee Arthroplasty: (Jogi et al, 2010)

  • The calculation used is: MDC = 1.96 x SEM (1.414) x square root of 2: MDC= 3.92 points

Elderly Population: (Karthikeyan et al, 2012)

  • The calculation used is: MDC = 1.96 x SEM (0.899) x square root of 2: MDC= 2.492 points

Minimally Clinically Important Difference (MCID)

Not Established

Cut-Off Scores

Score below 23 is considered as risk of falling.

Normative Data

Acute Stroke: (Chou et al, 2006)

  • Mean (SD) SFBBS-3P score: 22.1(22)

Chronic Stroke: (Liaw et al, 2012)

  • Mean (SD) SF BBS 3P session 1: 17.46(9.11)

Hip/Knee Arthroplasty: (Jogi et al, 2010)

  • Mean (SD) SFBBS 3P score 1st occasion: 16(5)

Elderly population: (Karthikeyan et al, 2012)

  • Mean (SD) SFBBS 3P score 1st occasion: 20.605(4.079)

Older Adults with balance, dizziness and chronic neck pain: (Hawk et al, 2009)

  • Mean (SD) SF BBS 3P at baseline: 22.1(2.3)
  • Mean (SD) SF BBS 3P after 1 month: 22.3(2.1)
  • Mean (SD) SF BBS 3P after 2 months: 22.7(2.0)

Test-retest Reliability

Acute Stroke: (Chou et al, 2006)

  • Excellent test-retest reliability (ICC=.99)

Chronic Stroke: (Liaw et al, 2012)

  • Excellent test-retest reliability (ICC=. 99)

Elderly Population: (Karthikeyan et al, 2012)

  • Excellent test-retest reliability (ICC=.9514)

Interrater/Intrarater Reliability

Not Established

Internal Consistency

Acute Stroke: (Chou et al, 2006)

  • Excellent internal consistency 14 days post stroke (Cronbach’s α=.96)

Criterion Validity (Predictive/Concurrent)

Predictive Validity:

Acute Stroke: (Chou et al, 2006)

  • Excellent predictive validity (n=81) at 14 days post stroke predicting Barthel Index (BI)scores at 90 days post stroke (r=.60)

Concurrent Validity:

Acute Stroke: (Chou et al, 2006)

  • Excellent concurrent validity (n=113)of the SF BBS -3P at 14 days post stroke validating original BBS at 14 days post stroke (r=0.99)

Hip/Knee Arthroplasty: (Jogi et al,2010)

  • Excellent concurrent validity (n=54) of the SF BBS(3P) at 1 week and 5-7 weeks validating original BBS at 1 week and 5-7 weeks post home exercise program (r=0.92, 0.97 respectively).

Construct Validity (Convergent/Discriminant)

Convergent Validity: 

Acute Stroke: (Chou et al, 2006)

  • Excellent convergent validity of the SF BBS at 14 days post stroke validating Barthel Index (r=.86)
  • Excellent convergent validity of the SF BBS at 14 days post stroke validating Fugl-Meyer Motor test (FM) (r=.68)

Content Validity

Acute Stroke: (Chou et al, 2006)

  • The authors selected items from the original BBS featuring the highest internal consistency and greatest responsiveness.
  • Data retrieved for this study were randomly divided into 2 groups: calibration group (n=113) for developing the SF BBS and validation group (n=113) for comparing the psychometric properties of the SF BBS with those of the original BBS.
  • To develop the SF BBS, the best items were determined by selecting the items with the lowest values from an overall item index of each item.
  • The overall item index of each item is the product of the 2 rank orders (the rank order of the corrected item total correlation for an item and the rank order of the effect size of an item).
  • The rank of the effect size is useful in removing test items that show little sensitivity to change.
  • Lower values for the overall item index indicated better items.

Face Validity

Not Established

Floor/Ceiling Effects

Acute Stroke: (Chou et al, 2006)

  • Poor floor effect: 41.6%

Responsiveness

Acute Stroke: (Chou et al, 2006)

  • Large responsiveness (n=81) with ES=0.80

Hip/Knee Arthroplasty: (Jogi et al,2010)

  • Small responsiveness (n=54) calculated using Standardized Response Mean (SRM): BBS(1.9) and SF BBS (1.8)

Older Adults with balance, dizziness and chronic neck pain: (Hawk et al, 2009)

  • Small responsiveness (n=14) between baseline and one month of SFBBS-3P score with ES=0.06
  • Moderate responsiveness (n=14) between baseline and 2 months of SFBBS-3P score with ES=0.25

Adult group with balance, dizziness and chronic neck pain: (Strunk et al, 2009)

  • Large responsiveness (n=15) between baseline and 8 weeks of SF BBS-3P score with ES=1.2

Professional Association Recommendations

Considerations

  • The SF BBS was quicker to use in a busy clinical environment than the original BBS
  • BBS seemed to provide more accurate balance assessment than the SF BBS in patient population that received intervention.
  • The SF BBS scores have not been interpreted and cut-off scores have not been set for different patient populations
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Bibliography

Chou, C. Y., Chien, C. W., et al. (2006). "Developing a short form of the Berg Balance Scale for people with stroke." Phys Ther 86(2): 195-204. Find it on PubMed

Hawk, C. and Cambron, J. (2009). "Chiropractic care for older adults: effects on balance, dizziness, and chronic pain." J Manipulative Physiol Ther 32(6): 431-437. Find it on PubMed

Jogi, P., Spaulding, S. J., et al. (2011). "Comparison of the Original and Reduced Versions of the Berg Balance Scale and the Western Ontario and McMaster Universities Osteoarthritis Index in Patients Following Hip or Knee Arthroplasty." Physiother Can 63(1): 107-114. Find it on PubMed

Karthikeyan, G., Sheikh, S. G., et al. (2012). "Test-retest reliability of short form of berg balance scale in elderly people." 

Liaw, L. J., Hsieh, C. L., et al. (2012). "Test–retest reproducibility of two short-form balance measures used in individuals with stroke." International Journal of Rehabilitation Research 35(3): 256-262.

Oliveira Bezerra de Figueiredo, K. M., Costa Lima, K., et al. (2008). "Instruments for the assessment of physical balance in the elderly." Brazilian Journal of Kinanthropometry and Human Performance 9(4): 408-413.

Strunk, R. G. and Hawk, C. (2009). "Effects of chiropractic care on dizziness, neck pain, and balance: a single-group, preexperimental, feasibility study." J Chiropr Med 8(4): 156-164. Find it on PubMed

Year published

 

Instrument in PDF Format

Yes 
Approval Status Approved 
 
Attachments
Created at 2/7/2013 1:28 PM  by Jason Raad 
Last modified at 1/3/2014 4:08 PM  by Jason Raad