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Rehab Measures: Berg Balance Scale

Link to instrument

Measure available at through external link (other languages available below) 

Title of Assessment

Berg Balance Scale 

Acronym

BBS

Instrument Reviewer(s)

Initially reviewed by Jason Raad, MS and Jennifer Moore, PT, DHS, NCS and the Rehabilitation Measures Team in 2010; Updated in 2011; Updated with references from the SCI population by Phyllis Palma PT, DPT, Christopher Newman PT, MPT, NCS, Jennifer Kahn PT, DPT, NCS and the SCI EDGE task force of the Neurology section of the APTA in 2012; Updated with references from the TBI population by Katie Hays, PT, DPT and the TBI EDGE task force of the Neurology Section of the APTA in 2012; Updated with references from the stroke, vestibular, cerebral palsy, and arthritis populations by Abby Lutz, SPT, Tiffanie Kimura, SPT, and Urvika Patel, SPT in 10/2012. Updated with references for individuals with vestibular disorders by Linda B. Horn, PT, DScPT, MHS, NCS, Karen H. Lambert, PT, MPT, NCS and the Vestibular EDGE task force of the Neurology Section of the APTA (2013).       

Summary Date

6/19/2013 

Purpose

A 14-item objective measure designed to assess static balance and fall risk in adult populations

Description

  • Static and dynamic activities of varying difficulty are performed 
  • Item-level scores range from 0-4, determined by ability to perform the assessed activity 
  • Item scores are summed 
  • Maximum score = 56

Area of Assessment

Balance Non-Vestibular; Functional Mobility 

Body Part

Lower Extremity 

ICF Domain

Activity 

Domain

Motor 

Assessment Type

Performance Measure 

Length of Test

06 to 30 Minutes 

Time to Administer

15-20 minutes

Number of Items

14-items 

Equipment Required

  • Stop watch
  • Chair with arm rests
  • Measuring tape/ruler
  • Object to pick up off the floor
  • Step stool

Training Required

None necessary

Type of training required

No Training 

Cost

Free 

Actual Cost

Cost of equipment

Age Range

Adult: 18-64 years; Elderly adult: 65+ 

Administration Mode

Paper/Pencil 

Diagnosis

Acquired Brain Injury; Arthritis; Multiple Sclerosis; Parkinson’s Disease; Spinal Cord Injury; Stroke; Traumatic Brain Injury 

Populations Tested

  • Brain injury
  • Community dwelling elderly
  • Multiple sclerosis
  • Orthopedic Surgery
  • Osteoarthritis
  • Parkinson’s Disease
  • Spinal Cord Injury
  • Stroke
  • Traumatic and acquired brain injury
  • Vestibular Dysfunction

Standard Error of Measurement (SEM)

Elderly:
 

(Donoghue et al, 2009; n = 118 people over 65 years of age without a previous history of stroke; mean age 85 (6.6) years; Elderly)

Berg Balance Scale Initial Score
 SEM
0 - 24
1.7
25 - 34
2.3
35 - 44
1.8
45 - 56
1.2

Stroke:

 

(Stevensen, 2001; n = 48 medically stable individuals over the age of 65 who were admitted to a stroke unit for rehabilitation following an acute stroke; mean age = 73.5 (7.0) years; mean time post CVA = 30.3 (23.3) days; Acute Stroke)

 

  • SEM for entire group (n = 48) = 2.49
  • SEM for individuals who ambulate with assistance (n = 16) = 2.93
  • SEM for individuals who ambulate with stand-by-assist (n = 17) = 2.15
  • SEM for individuals who ambulate independently (n = 15) = 2.26

(Liston and Brouwer, 1996; n = 22 subjects with hemiparesis associated with unilateral stroke; mean age = 64.0 (8.5) years; 6 months to 17 years post-stroke; Chronic Stroke)

  • SEM = 1.79 points

(Hiengkaew et al, 2012; n = 61; mean age = 63.5 (10) years; Chronic Stroke)

 

  • SEM = 1.68

(Flansbjer et al, 2012; n = 50; mean age = 58 (6) years; Chronic Stroke)

 

  • SEM = 1.49

Traumatic Brain Injury:

 

(Newstead et al, 2005; n = 5; mean age = 24.4 (5.3); time post injury ranged from 4-218 months, Rancho Los Amigo Scale > 6; TBI)

 

  • Calculated from statistics in paper, SEM = 1.65

 

Minimal Detectable Change (MDC)

Elderly:

 

(Donoghue et al, 2009; Elderly)

Berg Balance Scale Initial Score
 MDC
0 - 24
4.6
25 - 34
6.3
35 - 44
4.9
45 - 56
3.3

Institutionalized Older Adults:

 

(Conradsson et al, 2007; n = 45 institutionalized older adults from three residential care facilities; mean age = 82.3 (6.6); mean MMSE scores = 17.5 (6.3) points; Institutionalized Older Adults)

 

  • MDC = 8 points

Parkinsonism:

 

(Steffen and Seney, 2008; n = 37; mean age 71 years; mean Hoehn & Yahr classification = 2, scores ranged from 1 to 4; Parkinsonism)

 

  • MDC = 5 points

Stroke:

 

(Stevensen, 2001; during inpatient rehabilitation; Acute Stroke)

 

  • MDC for entire group (n = 48): 6.9
  • MDC for individuals who ambulate with assistance (n = 16): 8.1
  • MDC for individuals who ambulate with stand-by-assist (n = 17): 6.0
  • MDC for individuals who ambulate independently (n = 15): 6.3

(Liston and Brouwer, 1996; Chronic Stroke)

 

  • MDC = 2.5 points

 

(Hiengkaew et al, 2012; n = 61; mean age = 63.5 (10) years; Chronic Stroke)

 

  • MDC = 4.66

(Flansbjer et al, 2012; n = 50; mean age = 58 (6) years; Chronic Stroke)

 

  • MDC = 4.13

Minimally Clinically Important Difference (MCID)

Not Established

Cut-Off Scores

Balance Deficits:

 

(Kornetti et al, 2004; n = 100 community-dwelling veterans with balance deficits; sex: 99 males, 1 female; age range = 64-88 years; Balance Deficits)

 

  • Score of 45/56 indicates functional ability
  • 100% of subjects with a score > 45 succesfully completed alternating foot
  • 55% of subjects with a score > 45 succesfully completed standing on one leg
  • 76% of subjects with a score > 45 succesfully completed look behind

Elderly:

 

(Berg et al, 1992; n = 70 acute stroke patients; mean age = 71.6 (10.1) years; n = 113 individuals from a home for the elderly; mean age = 83.5 (5.3) years; n = 31 elderly individuals who agreed to participate in a laboratory study; mean age = 83.0 (6.9) years; Elderly)

 

  • Score of 56 indicates functional balance
  • Score of < 45 indicates individuals may be at greater risk of falling

(Shumway-Cook et al, 1997, n = 44, mean age = 74.6 (5.4) years for non-fallers, 77.6 (7.8) for fallers; Elderly)

 

  • History of falls and BBS < 51 or no history of falls and BBS < 42 predictive of falls (91% sensitivity, 82% specificity)
  • Score of < 40 on BBS associated with almost 100% fall risk

SCI:

 

(Wirz et al, 2010; n = 42 participants with SCI; mean age = 49.3 (11.5) years; ASIA A = 2, B = 2, C = 35, D = 3; injured within one year of assessment, Swiss sample; SCI)

 

  • No significant relationship between total falls and obtained BBS scores were found
  • No cutoff score was found that effectively discriminated fallers

Stroke:

 

(Doggan et al, 2011; n = 51; mean age = 60.7 (12.5) years; Hemiparetic Stroke)

 

  • Cut-off score = 45 out of 56

Normative Data

Community-Dwelling Elderly People:
 

(Steffen et al, 2002; n = 96 community-dwelling elderly people; mean age = 73 (8) years; participants had a mean of 1.8 (1.2) medical diagnoses including high blood pressure (n = 35), arthritis (n = 34), low back pain (n = 29), cancer and heart disease (n = 14), thyroid disease (n = 10) and diabetes (n = 9); Community-Dwelling Elderly People)

 
Berg Balance Score for Community-Dwelling Adults: 
Age
Gender
N
Mean
SD
95% CI
60-69
Male
15
55
1
55-56
Female
22
55
2
54-56
70-79
Male
14
54
3
52-56
Female
22
53
4
52-55
80-89
Male
8
53
2
51-54
Female
15
50
3
49-52
 

Institutionalized Older Adults:

 

(Conradsson et al, 2007; Institutionalized Older Adults)

 

  • Mean score = 30.1 (15.9) points

Osteoarthritis:

 

(Jogi et al, 2010; n = 54 patients, 26 with total hip arthroplasty (THA) and 28 with total knee arthroplasty (TKA); mean age for THA = 68 (8) years; mean age for TKA = 64 (10) years; Osteoarthritis)

 

  • Mean BBS score one week postoperative = 34 (8); 5-7 weeks postoperative = 50 (6)

Parkinsonism:

 

(Steffen and Seney, 2008; Parkinsonism)

 

  • Mean BBS score = 50 (7)
  • Range = 47 to 52

Parkinson’s Disease:

 

(Qutubuddin et al, 2005; n = 38; mean age = 71.1 (10.5); standing or walking unassisted and have mild to moderate disability; Parkinson’s Disease)

 

  • Mean BBS score = 40.22 (8.48)
  • Range = 21 to 53

(Brusse K et al. 2005; 25 community-dwelling individuals with Parkinson disease sex = 11 female, 4 male; age range = 76 (7) years.

  • Mean (SD) Berg Balance Scale (BBS) score: 46 (7), range = 43 – 49.

SCI:

 

(Lemay & Nadeau, 2010; n = 32 individuals with an ASIA D SCI walking 10m independently with or without walking assistive devices; mean age = 47.9 (12.8); mean time post lesion 77.2 (44.3) days; SCI)

 

  • Mean BBS score: 47.9 (10.7)
  • Range = 17 to 56
  • Mean BBS score for Paraplegia: 44.8 (13.0)
  • Range = 17 to 56
  • Mean BBS score for Tetraplegia: 50.7 (7.5)
  • Range = 31 to 56

Test-retest Reliability

Elderly:

 

(Berg et al, 1992; Elderly)

 

  • Excellent test-retest reliability (ICC = 0.91)

Institutionalized Older Adults:

 

(Holbein-Jenny et al, 2005; n = 26; mean age = 85.3 (4.9) years; inclusion criteria, able to stand without an assistive device; mean BBS score = 41.3 (9); mean ABC = 54.0 (24.9); Institutionalized Older Adults)

 

  • Excellent test-retest reliability (ICC = 0.77)

Parkinsonism:

 

(Steffen and Seney, 2008; Parkinsonism)

 

  • Excellent test-retest reliability (ICC = 0.94)

Parkinson's Disease:

 

(Leddy et al, 2011; n = 80 community dwelling individuals with idiopathic Parkinson's Disease; mean age = 68.2 (9.3) years; mean disease duration = 8.5 (0.54) years; mean H & Y stage = 2.45 (0.64); test-retest sample = 24; Parkinson’s Disease)

 

  • Excellent test-retest reliability (ICC = 0.80)

Stroke:

 

(Liston and Brouwer, 1996; Chronic Stroke)

 

  • Excellent test-retest reliability (ICC = 0.98)

(Hiengkaew et al, 2012; n = 61; mean age = 63.5 (10) years; Chronic Stroke)

 

  • Excellent test-retest reliability (ICC = 0.95)

(Flansbjer et al, 2012; n = 50; mean age = 58 (6) years; Chronic Stroke)

 

  • Excellent test-retest reliability (ICC = 0.72)

TBI:

 

(Newstead et al, 2005; TBI)

 

  • Excellent test-retest reliability (ICC = 0.986)

Interrater/Intrarater Reliability

Community-Dwelling Elderly:

 

(Berg et al, 1992; Community-Dwelling Elderly)

 

  • Excellent intrarater reliability (ICC = 0.97) 

Institutionalized Older Adults:

 

(Conradsson et al, 2007; Institutionalized Older Adults)

 

  • Excellent intrarater reliability (ICC = 0.97)

(Holbein-Jenny et al, 2005; Institutionalized Older Adults)

 

  • Excellent Interrater reliability (ICC = 0.88)

Parkinson's Disease:

 

(Leddy et al, 2011; interrater sample = 15; Parkinson’s Disease)

 

  • Excellent interrater reliability (ICC = 0.95)

(Scalzo et al, 2009; n = 53 patients with Parkinson's Disease; mean age = 62 (7.9) years; UPDRS scores = 41.6 (17.8) points; BBS mean score = 47.2 (8.2) points; median Hoehn and Yahr Staging Scale = 2.5; Brazilian sample; Parkinson’s Disease)

 

  • Excellent interrater reliability (ICC = 0.84)

SCI:

 

(Wirz et al, 2010; Chronic SCI)

 

  • Excellent interrater reliability (ICC = 0.95)

Stroke:

 

(Mao et al, 2002; n = 123 stroke patients, 32 with cerebral hemmorhage, 74 with cerebral infarction, and 17 others; sex = 66 males, 57 females; mean age = 69.3(11.2) years; Acute Stroke)

 

  • Excellent interrater reliability in individuals 14 days post (ICC = 0.95)

(Berg et al, 1995; n = 113 elderly residents and 70 stroke patients; mean age = 84.4(5.0) years; Acute Stroke)

 

  • Excellent interrater and intrarater reliability in individuals 2,4,6 & 12 weeks post onset (ICC = 0.98; ICC = 0.97) (n = 18 residents and 6 stroke patients)

Internal Consistency

Parkinsonism:

 

(Steffen and Seney, 2008; Parkinsonism)

 

  • Excellent Internal consistency (Cronbach's alpha, day 1 = 0.86; day 2 = 0.87)

Parkinson’s Disease:

 

(Franchignoni et al, 2005; n = 70 ambulant patients with Parkinson's Disease; mean age = 71 (range = 41-81); mean duration of disease = 7 (1-21); Mean H & Y score = 3 (1.5 - 4); mean Berg scores = 46.5 (34-54); mean TUG scores = 13.5 (9-27); Parkinson’s Disease)

 

  • Excellent internal consistency (Cronbach's alpha = 0.95)

Parkinson's Disease:

 

(Scalzo et al, 2009; Parkinson’s Disease)

 

  • Excellent internal consistency (Cronbrach’s alpha = 0.92)

SCI:

 

(Wirz et al, 2010; Chronic SCI)

 

  • Excellent for both single items (0.84-0.98, p < 0.001) and for the total score (ICC = 0.95, 95% confidence interval = 0.910-0.975)

Stroke:

 

(Berg et al, 1995; Acute Stroke)

 

  • Excellent internal consistency 2,4,6 & 12 weeks post onset (Cronbach's alphas > 0.97)

(Mao et al, 2002; Acute Stroke)

 

  • Excellent internal consistency 14, 30, 90, & 180 weeks post onset (Cronbach's alphas =  0.92-0.98)

(Chou et al, 2006; n = 226 individuals with acute stroke; mean age = 68.2 (10.1) for the development of the BBS shortform; mean age = 68.1 (11.3) for the testing of the BBS short form; Taiwanese sample; Acute Stroke)

 

  • Excellent internal consistency 14 days post onsent (Cronbach's alpha = 0.98)

Criterion Validity (Predictive/Concurrent)

Concurrent validity:

 

Stroke:

 

(Mao et al, 2002; n = 123; mean age = 69.3 (11.2) years; Acute Stroke)

  • Excellent correlations with the balance subscale of the Fugl-Meyer at 14, 30, 90 and 180 days post stroke (r = 0.90 to 0.92)
  • Excellent correlations with Postural Assessment Scale for Stroke patients (PASS) (r = 0.92 to 0.95)

Predictive validity:

 

Elderly Population:

 

(Shumway-Cook et al, 1997; Elderly Population)

  • Excellent correlation with Dynamic Gait Index (r = 0.67)

(Bogle et al, 1996; n = 66; mean age = 79.2 (6.2) years; irrespective of age, gender or disability; Elderly Population)

  • High specificity (96%) for predicting non-fallers
  • Low sensitivity (53%) in positive prediction of falls

**Note, in a 1996 PT Journal Letter to the Editor, Ted Stevenson, MSc(PT) challenged the results of this study.  Instead, he suggested the Sensitivity and Specificity should actually be 82% and the Specificity 85%. (Stevenson, Ted; PT Journal; Volume 76, Number 10, October 1996)

Parkinson's disease

(Brusse et al. 2005; n = 25; mean age = 76 (7) years)

UPDRS total

FFR

BFR

TUG

Comfortable gait speed

Fast gait speed

BBS

Excellent

-0.64

Excellent

0.50

Excellent

0.51

Excellent

-0.78

Excellent

0.73

Excellent

0.64

Spearman correlation coefficients, All p < 0.001

BBS- Berg Balance Scale
FFR – Forward Functional Reach

BFR – Backward Functional Reach

TUG – Timed Up and Go

P < 0.05

 

SCI:

 

(Ditunno et al, 2007; n = 146; ASIA B = 36, C = 90, D = 20; average age = 32 (range = 16 - 69); mean Berg score = 4.85 (range = 0-42); SCI) 

 

Predictors of the Walking Index for Spinal
Cord Injury at 12 Months*
Baseline
3 months
6 months
Berg Balance Scale
0.47
0.84
0.89
Lower Extremity Motor Score
0.73
0.81
0.86
FIM Locomotor
0.30
0.79
0.85
FIM Total
0.12
0.63
0.69
Speed
0.71
0.81
Distance
0.77
0.80
FIM=Functional Independence Measure
*Spearman's rho

 

(Wirz et al, 2010; Chronic SCI)

 

SCIM
mobility
WISCI
Speed,
10MWT
FES-I
AIS Motor
Scores

BBS

Excellent: 0.89

Excellent: 0.82

Excellent: 0.93

Excellent:0.81

Excellent; 0.62

Spearman correlation coefficients, all p < 0.001
BBS - Berg Balance Scale
WISCI - Walking Index for Spinal Cord Injury
FES-I - Falls Efficacy Scale-International
AIS - ASIA Impairment Scale
SCIM - Spinal Cord Injury Independence Measure

 

Stroke:

 

(Mao et al, 2002; Acute Stroke)

 

  • Excellent predictive validity of the BBS at 14, 30 and 90 days at predicting Motor Assessment Scale (MAS) scores at 180 days post stroke (r = 0.82, 0.84, 0.91 respectively)

(Liston and Brouwer, 1996; Chronic Stroke) 

 

  • Excellent predictive validity of the BBS at 14 and 30 days to the Barthel Index at 90 days (r = 0.76 and 0.81 respectively)

(Wang et al, 2004; n = 226; mean age = 59.8 (11.9) years; Taiwanese sample; Acute Stroke)

 

  • Dynamic Balance Master test variables correlated with the Berg Scores as follows:
    • Excellent Correlation with: forward and backward (FB) 3sec (r = -0.62), Limits of stability path sway (LOSP) (r = -0.61)
    • Adequate Correlation with: eyes open (EO) sway (r = -0.39), Target Sway (TAR) (r = -0.45), Left to right (LR) 3sec(r = -0.51*), Left to right 2sec (r = 0.48*), Forward and backward 2sec (r = -0.53*), Limits of stability movement time (LOSM) (r = -0.55*)
    • Poor Correlation with: eyes closed sway (= -0.10)
  • Excellent correlation with 10-meter walk test self selected velocity (r = 0.81)

Vestibular Dysfunction:

(Whitney et al, 2003; n = 70; mean age = 64.9 (17.0) years)

  • Adequate correlation with Dynamic Gait Index (r = 0.71)

Construct Validity (Convergent/Discriminant)

Osteoarthritis:

 

(Jogi et al, 2010; Osteoarthritis)

 

Correlation Coefficients between Original and Reduced versions of the BBS: 0.92 (0.86, 0.95) 1 week postoperative, and 0.97 (0.95, 0.98) 5-7 weeks postoperative

 

SCI

 

(Lemay & Nadeau, 2010; SCI)

 

Convergent Validity Evidence:

Measure

2MWT

10MWT

TUG

BBS

0.781**

0.792**

-0.815**

2MWT

0.932 a**

-0.623 a**

10MWT

-0.646 a**

a = Pearson’s product moment correlation; other coefficients are Spearman’s r

**Significant at < 0.01

Convergent Validity Evidence:

Measure

SCI-FAI

SCI-FAI

assistive devices

SCI-FAI

mobility

BBS

0.747**

0.714**

0.740**

Spearman’s r

SCI-FAI – Spinal Cord Injury Functional Ambulation Inventory

**Significant at p < 0.01

(Wirz et al, 2010; Chronic SCI)

  • Using ROC analysis, investigated ability of Berg to discriminate fallers from non fallers.
  • ROC Area under the Curve was Poor (-0.48, unable to discriminate fallers from non fallers)

(Ditunno, 2007; SCI)

BBS

50FW-S

LFIM

FIM

WISCI

3mo

Excellent

0.81*

Excellent

0.89

Excellent

0.76

Excellent

0.91*

6mo

Excellent

0.86

Excellent

0.86

Excellent

0.72

Excellent

0.89*

12mo

Excellent

0.78

Excellent

0.86

Excellent

0.77

Excellent

0.92*

p < 0.001

BBS – Berg Balance Scale

50FW-S – 50 foot walking speed

LFIM – locomotor Functional independence Measure

FIM- Functional Independence Measure

WISCI – Walking Index for Spinal Cord Injury

 

Stroke:

 

(Wee et al, 1999; n = 128; mean age = 69.9 (11.6) years; retrospective study; Acute Stroke)

  • Excellent correlations between Admission BBS and Admission FIM (r = 0.76)

(Berg et al, 1992; n = 70 elderly participants; Acute Stroke)

  • Adequate to excellent correlation with global ratings of balance provided by a carer (r = 0.47 to 0.61)
  • Adequate correlation with self-ratings of balance (r = 0.39 to 0.41)
  • Adequate correlation with Timed Up and Go scores (r = -0.48)
  • Excellent correlation with mobility items of the Barthel Index (r = 0.67)

 (Mao et al, 2002; Acute Stroke)

  • Excellent convergent validity with Barthel Index at
    • 14 days after stroke (rs = 0.89)
    • 30 days after stroke (rs = 0.94)
    • 90 days after stroke (rs = 0.90)
    • 180 days after stroke (rs = 0.91)
  • Excellent predictive validity with Motor Assessment Scale (administered at 180 days):
    • 14 days after stroke (rs = 0.82)
    • 30 days after stroke (rs = 0.84)
    • 90 days after stroke (rs = 0.91)

(Wang et al, 2004; Acute Stroke)

  • Excellent convergent validity with Barthel Index (r = 0.85)

Content Validity

  • Items were selected based on interviews with 12 geriatric clients and 10 clinical professionals
  • Resultant items were then pretested and revised

Face Validity

  • One study from Canada indicated that PTs commonly used the BBS (Korner-Bitensky et al, 2006; n = 1804 rehabilitation specialists)

Floor/Ceiling Effects

Parkinson Disease:

(Leddy)

  • Poor ceiling effects in which 10% of those tested had perfect scores including 1 faller and 46% had scores in the top 10% of the test including 5 fallers; scores were significantly left skewed (komogorov-Smirnov test p = 0.035)
  • Those in Hoehn and Yahr stages 4 are by definition usually reliant on assistive devices and so would likely exhibit floor effects and those in Hoehn and Yahr stages 5 cannot be tested.

SCI:

 

(Lemay & Nadeau, 2010; SCI)

 

  • Poor ceiling effects (37.5%)

Stroke:

 

(Mao et al, 2002; Acute Stroke)

 

  • Poor floor effects at 14 days post stroke (35%)
  • Patients who experience floor effects may be more accurately assessed with the Postural Assessment Scale for Stroke Patients (PASS)

(Chou et al, 2006; Acute Stroke)

 

  • Poor floor effects 14 days post stroke (23.9%)

(Salbach et al, 2001; n = 50 subjects with residual gait deficits after first time stroke; sex = 31 men, 19 women; mean age = 68 (13) years; Acute Stroke)

 

  • Poor floor effects 38 days post stroke (26%)

Responsiveness

Stroke:

 

(Mao et al, 2002; Acute Stroke)

 

  • Moderately responsive at detecting changes < 90 days of stroke onset; greatest responsiveness between 14 and 30 days

(Chou et al, 2006; Acute Stroke)

 

  • Large responsiveness (Effect Size (ES) = 0.85)

 

(Wood-Dauphinee et al, 1996; n = 70 individuals who have recently sustained a stroke; Acute Stroke)

 

  • Moderate responsiveness from 2 to 6 weeks (ES = 0.66)
  • Moderate responsiveness from 6 to 12 weeks (ES = 0.25)
  • Large responsiveness from 2 to 12 weeks (ES = 0.97)

Vestibular Dysfunction:

(Cohen et al, 2008; n = 80 (40 normal and 40 patients); mean age = 38.1 (12.9) years for normal and 57.4 (13.7) years for patients)

Using a cut-off score of 45 to identify balance impairments in individuals with vestibular dysfunction:

  • Sensitivity (95% CI): 75 (58-87)
  • Specificity (95% CI): 75 (58-87)
  •  Likelihood ratio: 3.00
  • Post-test probability: 0.75

 

Professional Association Recommendations

Recommendations from the Neurology Section of the American Physical Therapy Association’s StrokEDGE Taskforce, MSEDGE Taskforce, SCI EDGE Taskforce, TBI EDGE Taskforce are listed below.  These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

 

For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

 

Abbreviations:

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

 

Recommendations for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

StrokEDGE

R

HR

HR

SCI EDGE

R

R

R

 

Recommendations based on level of care in which the assessment is taken:

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

StrokEDGE

R

HR

HR

HR

HR

MS EDGE

HR

HR

HR

HR

HR

TBI EDGE

LS

R

LS

R

LS

 

Recommendations based on SCI AIS Classification:

 

AIS A/B

AIS C/D

SCI EDGE

LS

R

 

Recommendations for use based on ambulatory status after brain injury:

 

Completely Independent

Mildly dependant

Moderately Dependant

Severely Dependant

TBI EDGE

LS

LS

LS

NR

 

Recommendations based on EDSS Classification:

 

EDSS 0.0 – 3.5

EDSS 4.0 – 5.5

EDSS 6.0 – 7.5

EDSS 8.0 – 9.5

MS EDGE

HR

HR

HR

NR

 

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Is this tool appropriate for use in intervention research studies? (Y/N)

StrokEDGE

Yes

Yes

Yes

SCI EDGE

Yes

Yes

Yes

MS EDGE

Yes

Yes

Yes

TBI EDGE

Yes

Yes

Yes

Considerations

  • The Berg may be better suited for use with acute stroke patients since the majority of these patients are not able to obtain the measures maximum scores at rehab admission
  • No common interpretation of BBS scores currently exists
  • The Berg may take longer than other balance measures to administer
  • Declines in performance with increasing age have been observed in both men and women
  • In SCI, BBS scores not associated with the number of falls and not able to discriminate fallers from non fallers (Wirz et al, 2010)
  • BBS may be limited in use in PD to those in the middle stages (H&Y 2-3) as it has been noted to exhibit ceiling effects (Leddy)
  • In Parkinson disease those in Hoehn and Yahr stages 4 and 5 would be unable to complete the test since an assistive device cannot be utilized during testing.
  • For vestibular dysfunction, the Berg Balance Scale may not be the best measure to identify individuals at risk of falling (Whitney et al, 2003)

Berg Balance Scale translations:

Chinese (traditional):
http://www.pt.ntu.edu.tw/mhh/course/neuro/BS/Basic%20assessment/2004%E4%BC%AF%E6%A0%BC%

Danish:
http://fysio.dk/fafo/Maleredskaber/Maleredskaber-alfabetisk/Bergs-balanceskala/

French:
http://www.csssvc.qc.ca/telechargement.php?id=559

German:
http://www.patientensicherheit.ch/dms/de/themen/3121_sturz_berg_balance_scale_d/Berg%20Balance

Japanese:
http://www.shiraume.or.jp/research/2013/01/10/121228 研究論文 大人見 リハ科 BBS%20HP原

Spanish (p 48-51):
http://www.huntingtonargentina.com.ar/informacion_util/Guiafisioterapeutas.pdf

These translations, and links to them, are subject to the Terms and Conditions of Use of the Rehab Measures Database. RIC is not responsible for and does not endorse the content, products or services of any third-party website, and does not make any representations regarding its quality, content or accuracy. If you would like to contribute a language translation to the RMD, please contact us at rehabmeasures@ric.org

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Bibliography

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Berg, K., Wood-Dauphinee, S., et al. (1995). "The Balance Scale: reliability assessment with elderly residents and patients with an acute stroke." Scand J Rehabil Med 27(1): 27-36. Find it on PubMed

Berg, K. O., Maki, B. E., et al. (1992). "Clinical and laboratory measures of postural balance in an elderly population." Arch Phys Med Rehabil 73(11): 1073-1080. Find it on PubMed

Berg, K. O., Wood-Dauphinee, S. L., et al. (1992). "Measuring balance in the elderly: validation of an instrument." Can J Public Health 83 Suppl 2: S7-11. Find it on PubMed

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

Cohen, H. S. and Kimball, K. T. (2008). "Usefulness of some current balance tests for identifying individuals with disequilibrium due to vestibular impairments." Journal of Vestibular Research 18(5): 295-303.

Conradsson, M., Lundin-Olsson, L., et al. (2007). "Berg balance scale: intrarater test-retest reliability among older people dependent in activities of daily living and living in residential care facilities." Physical Therapy 87(9): 1155-1163. Find it on PubMed

Datta, S., Lorenz, D. J., et al. (2009). "A multivariate examination of temporal changes in Berg Balance Scale items for patients with ASIA Impairment Scale C and D spinal cord injuries." Arch Phys Med Rehabil 90(7): 1208-1217. Find it on PubMed

Desrosiers, J., Noreau, L., et al. (2002). "Predictors of handicap situations following post-stroke rehabilitation." Disability & Rehabilitation 24(15): 774-785. Find it on PubMed

Ditunno, J. F., Barbeau, H., et al. (2007). "Validity of the walking scale for spinal cord injury and other domains of function in a multicenter clinical trial." Neurorehabil Neural Repair 21(17507642): 539-550.

Dogğan, A., MengüllüoGĞlu, M., et al. (2011). "Evaluation of the effect of ankle-foot orthosis use on balance and mobility in hemiparetic stroke patients." Disability & Rehabilitation 33(15-16): 1433-1439.

Donoghue, D. and Stokes, E. K. (2009). "How much change is true change? The minimum detectable change of the Berg Balance Scale in elderly people." J Rehabil Med 41(5): 343-346. Find it on PubMed

Flansbjer, U. B., Blom, J., et al. (2012). "The reproducibility of Berg Balance Scale and the Single-leg Stance in chronic stroke and the relationship between the two tests." PM R 4(3): 165-170. Find it on PubMed

Franchignoni, F., Martignoni, E., et al. (2005). "Balance and fear of falling in Parkinson's disease." Parkinsonism Relat Disord 11(7): 427-433. Find it on PubMed

Hiengkaew, V., Jitaree, K., et al. (2012). "Minimal detectable changes of the Berg Balance Scale, Fugl-Meyer Assessment Scale, Timed "Up & Go" Test, gait speeds, and 2-minute walk test in individuals with chronic stroke with different degrees of ankle plantarflexor tone." Arch Phys Med Rehabil 93(7): 1201-1208. Find it on PubMed

Holbein-Jenny, M. A., Billek-Sawhney, B., et al. (2005). "Balance in personal care home residents: a comparison of the Berg Balance Scale, the Multi-Directional Reach Test, and the Activities-Specific Balance Confidence Scale." J Geriatr Phys Ther 28(2): 48-53. Find it on PubMed 

Kojovic, J., Miljkovic, N., et al. (2011). "Recovery of motor function after stroke: a polymyography-based analysis." J Neurosci Methods 194(2): 321-328. Find it on PubMed

Korner-Bitensky, N., Wood-Dauphinée, S., et al. (2006). "Best versus actual practices in stroke rehabilitation: results of the Canadian National Survey." Stroke 37: 631.

La Porta, F., Caselli, S., et al. (2012). "Is the Berg Balance Scale an internally valid and reliable measure of balance across different etiologies in neuro-rehabilitation? A revisited Rasch analysis study." Archives of physical medicine and rehabilitation.

Leddy, A. L., Crowner, B. E., et al. (2011). "Functional gait assessment and balance evaluation system test: reliability, validity, sensitivity, and specificity for identifying individuals with Parkinson disease who fall." Physical Therapy 91(1): 102-113. Find it on PubMed

Lemay, J. F. and Nadeau, S. (2010). "Standing balance assessment in ASIA D paraplegic and tetraplegic participants: concurrent validity of the Berg Balance Scale." Spinal Cord 48(3): 245-250. Find it on PubMed 

Liston, R. and Brouwer, B. (1996). "Reliability and validity of measures obtained from stroke patients using the balance master." Archives of physical medicine and rehabilitation 77(5): 425-430. Find it on PubMed

Mao, H. and Hsueh, I. (2002). "Analysis and comparison of the psychometric properties of three balance measures for stroke patients." Stroke 33(4): 1022. Find it on PubMed

Newstead, A. H., Hinman, M. R., et al. (2005). "Reliability of the Berg Balance Scale and balance master limits of stability tests for individuals with brain injury." J Neurol Phys Ther 29(1): 18-23. Find it on PubMed

Salbach, N. M., Mayo, N. E., et al. (2001). "Responsiveness and predictability of gait speed and other disability measures in acute stroke." Archives of Physical Medicine and Rehabilitation 82(9): 1204-1212. Find it on PubMed

Scalzo, P. L., Nova, I. C., et al. (2009). "Validation of the Brazilian version of the Berg balance scale for patients with Parkinson's disease." Arquivos de Neuro-Psiquiatria 67(3B): 831-835. Find it on PubMed

Shumway-Cook, A., Baldwin, M., et al. (1997). "Predicting the probability for falls in community-dwelling older adults." Physical Therapy 77(8): 812-819. Find it on PubMed

Steffen, T. and Seney, M. (2008). "Test-retest reliability and minimal detectable change on balance and ambulation tests, the 36-item short-form health survey, and the unified Parkinson disease rating scale in people with parkinsonism." Physical Therapy 88(6): 733-746. Find it on PubMed

Steffen, T. M., Hacker, T. A., et al. (2002). "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." Physical Therapy 82(2): 128-137. Find it on PubMed

Stevenson, T. J. (2001). "Detecting change in patients with stroke using the Berg Balance Scale." Aust J Physiother 47(1): 29-38. Find it on PubMed

Tyson, S. and Connell, L. (2009). "The psychometric properties and clinical utility of measures of walking and mobility in neurological conditions: a systematic review." Clin Rehabil 23(11): 1018-1033. Find it on PubMed

Wang, C. H., Hsueh, I. P., et al. (2004). "Psychometric properties of 2 simplified 3-level balance scales used for patients with stroke." Physical Therapy 84(5): 430-438. Find it on PubMed

Wee, J. Y., Bagg, S. D., et al. (1999). "The Berg balance scale as a predictor of length of stay and discharge destination in an acute stroke rehabilitation setting." Archives of Physical Medicine and Rehabilitation 80(4): 448-452. Find it on PubMed

Wee, J., Wong, H., et al. (2003). "Validation of the Berg Balance Scale as a predictor of length of stay and discharge destination in stroke rehabilitation1." Archives of physical medicine and rehabilitation 84(5): 731-735. Find it on PubMed

Whitney, S., Wrisley, D., et al. (2003). "Concurrent validity of the Berg Balance Scale and the Dynamic Gait Index in people with vestibular dysfunction." Physiotherapy Research International 8(4): 178-186. Find it on PubMed

Wirz, M., Muller, R., et al. (2010). "Falls in persons with spinal cord injury: validity and reliability of the Berg Balance Scale." Neurorehabil Neural Repair 24(1): 70-77. Find it on PubMed

Wood-Dauphinee, S., Berg, K., et al. (1996). "The balance scale: responsiveness to clinically meaningful changes." Canadian Journal of Rehabilitation 10: 35-50.

Year published

1989 

Instrument in PDF Format

Yes 
Approval Status Approved 
 
Attachments
Created at 10/30/2010 11:36 AM  by Dawood Ali 
Last modified at 6/6/2014 1:59 PM  by Jason Raad