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Rehab Measures: Balance Outcome Measure for Elder Rehabilitation

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Title of Assessment

Balance Outcome Measure for Elder Rehabilitation  



Instrument Reviewer(s)

Initially reviewed by Kartik Srinivasan, PT, MHS; Evan Papa, DPT, PhD for The University of North Texas Health Science Center, DPT Class of 2015 in June 2014

Summary Date



Assesses standing balance and functional mobility in the elderly population. A global multi-item static, dynamic, and functional balance measure throughout all settings of elder rehabilitation. Collaboration of 4 test scores used to measure balance, mobility and perceived confidence in the geriatric population.


  • Four assessments include: Timed Up-and-Go (TUG), Functional Reach Test (FRT), step test, and a test of static standing with feet together and eyes closed
  • Scores range from 0 to 16
  • To scale each item, 4 cutoff points were selected creating 5 ordinal categories (scores range 0-4). An overall score was created by summing the scores for each item (scores range 0-16)

Area of Assessment


Body Part


ICF Domain




Assessment Type


Length of Test

06 to 30 Minutes 

Time to Administer

5-10 minutes (may vary with patient’s abilities)

Number of Items

TUG = 1 item; FRT = 1 item; Static standing with eyes closed and feet together = 1 item; Step test = 1 item 

Equipment Required

  • stopwatch
  • chair with armrests
  • ruler or tape measurer
  • duct tape
  • cone
  • yard stick
  • 7.5 cm high step

Training Required

No Training

Type of training required

No Training 



Actual Cost


Age Range


Administration Mode




Populations Tested

  • 17 geriatric assessment and rehabilitation units (inpatient, outpatient, domiciliary) (Haines, 2007)
  • 2 Geriatric rehabilitation units (Kuys, 2011)
  • Acute care setting (Kuys, 2014)

(Across the sites the populations included: Older adults age 60-88, patients with a stroke, patients with various neurological diseases, patients with orthopedic referrals, patients with other geriatric impairments)

Standard Error of Measurement (SEM)

Older adults with dementia: (Fox et al. 2014; n=12; male: 1; female: 11; mean age = 83.25 + 9.94 years)

The SEM for the components of BOOMER are as follows:

  • Step test R foot (steps): 2.654
  • Step test L foot (steps): 2.192
  • TUG (s): 5.959 Functional Reach (cm): 6.080
  • Static Timed Standing (s): 24.462

Minimal Detectable Change (MDC)

Not Established

Minimally Clinically Important Difference (MCID)

Elderly: (Haines et al., 2007; n =1769; mean age=74 (13.5) years; data from several rehabilitation units including various diagnoses: stroke, neurologic, orthopedic etc.)

  • 3 points on the 0-16 point scale

Cut-Off Scores

Elderly: (Haines et al., 2007)

  • 4 cut off points were selected allowing for 5 categories

Step Test (average number of steps)
TUG test (s)
>/= 30
FRT (cm)
Static Standing eyes closed (s)

  • An overall score is created by summing the scores for each item (ranging from 0-16)

Normative Data

Not Established

Test-retest Reliability

Older adults with dementia (Fox et al. 2014; n =12; female = 11, male = 1; mean age: 83.25 + 9.94 years)



ST R foot

0.696 (Adequate)

ST L foot

0.790 (Excellent)


0.857 (Excellent)


0.384 (Poor)

Static Timed Standing

0.469 (Adequate)

Excellent test-retestreliability - TUG and ST L foot

Adequate test-retest reliability – ST R foot and Static Timed Standing


test-retest reliability - FR

Interrater/Intrarater Reliability

Not Established

Internal Consistency


  • Excellent internal consistency (Cronbach’s alpha 0.87 to 0.89) for admission and discharge assessments (Haines et al, 2007).

Criterion Validity (Predictive/Concurrent)

Concurrent Validity:

Geriatric rehab setting: (Kuys et al, 2011; n = 134, mean age = 78 (11) years)

  • Excellent correlation between BOOMER and BBS (ρ = .91, P < .01 at admission; ρ = .89 P < .01 at discharge)
  • Excellent correlation between BOOMER and gait speed (ρ = .67, P < .01 at admission; ρ = .68, P < .01 at discharge)

Geriatric rehab setting: (Haines et al., 2007)

  • Excellent concurrent validity of the BOOMER with the motor FIM (admission data, ρ = .73; discharge data, ρ =.72) and the Modified Elderly Mobility Scale (MEMS) (admission data, ρ =.88; discharge data, ρ =.83). Each of these associations was statistically significant (P<.001).

Acute Inpatient setting: (Kuys et al 2014, n = 44; mean age= 77 (7) years)

  • Excellent correlation with BBS (ρ =.93, p<0.001)
  • Excellent correlation with de Morton Mobility Index (ρ =.89, p<0.001)
  • Adequate correlation with Activities-Specific Balance Confidence scale (ρ =.52, p<0.001)

Elderly: (Lindenberg et al. 2014; n=227; age > 60 years; mean age = 79(9) years)

  • Adequate correlation of discharge total BOOMER score < 4 to discharge to Residential Aged Care Facility (RACF) (r = -0.47)

Outcome Measure

Correlation with discharge to RACFa

BOOMER total score


Boomer Total score < 4




10MWT (unable to perform)




Rehabilitation LOS


a Spearman rank correlation

b Significant when P < 0.05

Construct Validity (Convergent/Discriminant)

Elderly population: (Haines et al. 2007; Phase 3; n=272; mean age = 75 (14) years)

  • Excellent correlation between BOOMER, the Modified Elderly Mobility Scale (MEMS – admission data, ρ=.88; discharge data, ρ=.83), and the Functional independence measure (FIM – admission data, ρ=.73; discharge data, ρ=.72) motor score across scores at admission and discharge.

Content Validity

  • Items were selected by an expert panel made up of 8 senior clinical physiotherapists with 5 to 20 years of clinical experience. (Haines et al., 2007)
  • The expert panel deemed that items encompassed a range of static and dynamic tasks incorporating a range of functional activities including both motor and sensory challenges to balance.
  • The panel further determined that the four tests selected adequately sampled the range of balance domains while preserving the desire for the tool to be practically applicable.

Face Validity

Not Established

Floor/Ceiling Effects

Floor/Ceiling Effects Elderly: (Haines et al., 2007)

  • Small floor effects at admission (6.5%)


Not Established

Professional Association Recommendations




Fox B, Henwood T., et al. (2014). “Relative and absolute reliability of functional performance measures for older adults with dementia living in residential aged care.” Int Psychogeriatr 26(10): 1659-1667.

Haines, T, Kuys, S, et al. (2007). “Development and Validation of the Balance Outcome Measure for Elder Rehabilitation.” Arch Phys Med Rehabil 88: 1614-21.

Kuys SS, Morrison G, et al. (2011). “Further validation of the balance outcome measure for elder rehabilitation.” Arch Phys Med Rehabil. 92(1):101-105.

Kuys SS, Crouch T, et al. (2014). “Use and validation of the Balance Outcome Measure for Elder Rehabilitation in acute care.” New Zealand Journal of Physiotherapy 42(1): 16-21.

Lindenberg K, Nitz JC., et al. (2014). “Predictors of discharge destination in a geriatric population after undergoing rehabilitation.” J Geriatr Phys Ther 37(2): 92-98.


Year published


Instrument in PDF Format

Approval Status Approved 
Created at 3/27/2015 4:00 PM  by Jason Raad 
Last modified at 9/4/2015 8:53 AM  by Jason Raad