Use of the Berg Balance Test to Predict Falls in Elderly Persons

Department of Physical Therapy, Bryn Mawr Rehabilitation Hospital, Malvern, PA 19355, USA.
Physical Therapy (Impact Factor: 3.25). 07/1996; 76(6):576-83; discussion 584-5.
Source: PubMed

ABSTRACT The purpose of this study was to determine whether the Berg balance test could be used to predict an elderly person's risk of falling.
Sixty-six residents of two independent life-care communities, aged 69 to 94 years (X = 79.2, SD = 6.2), participated.
Subjects completed a questionnaire pertaining to their fall history and activity level. The Berg balance test, consisting of 14 functional subtests, was then administered. Six months later, subjects again completed the questionnaire.
Performance of activities of daily living predicted 43% of the subjects' scores. There was a difference between the subjects who were prone to falling and those who were not prone to falling, but the test demonstrated poor sensitivity for predicting who would fall. The specificity of the test was very strong. The use of an assistive device was a strong predictor of performance on the Berg balance test. No relationship was noted between increasing age and decreasing performance on the Berg balance test.
Although the Berg balance test demonstrated only 53% sensitivity, the results support the test developers' use of 45 (out of 56) as a generalized cutoff score. Older adults who scored higher than the cutoff score on the test were less likely to fall than were those adults who scored below the cutoff score. Decreased scores, however, did not predict increased frequency of falls. Results must be viewed cautiously because self-report was the sole means of documenting fall history.

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    • "plane of motion during gait, the inter-joint coordination is expected to be more robustly controlled and illustrated. Although fallers included in this study performed significantly poorer than non-fallers in all three clinical balance tests, their balance scores did not reach the clinical cutoff values for being indicated at risk of falls (Bogle Thorbahn and Newton, 1996; Shumway-Cook et al., 1997, 2000). This limited data set could restrict our findings on the correlation between measures from clinical balance tests and inter-joint coordination during gait. "
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    ABSTRACT: BACKGROUND: Walking requires coordination among multiple joints. Little is known about the association between the coordination ability and fall risks in elderly adults. This study investigated variability of inter-joint coordination in elderly adults and determined its correlation to clinical balance measures. METHODS: Gait analyses of 15 non-fallers and 15 fallers were performed during walking. Continuous relative phase, derived from phase angles of two adjacent joints, was used to assess the inter-joint coordination. Variability of inter-joint coordination was calculated as the average standard deviation of all points on the ensemble continuous relative phase curve over a gait cycle, namely the deviation phase. Outcomes from three clinical balance tests, including Berg Balance Test, Dynamic Gait Index and Timed Up-and-Go, were examined. FINDINGS: No significant group differences were detected in hip-knee deviation phase values after accounting for differences in walking speeds. For the knee-ankle deviation phase, fallers demonstrated significantly greater values in the stance phase but smaller values in the swing phase. The hip-knee deviation phase values demonstrated a negative correlation with Dynamic Gait Index, and the knee-ankle deviation phase values had a negative correlation with Dynamic Gait Index and a positive correlation with Timed Up-and-Go time. INTERPRETATION: Excessive variability of the supporting limb and reduced variability of the swing limb in knee-ankle inter-joint coordination of fallers may contribute to their risk of imbalance or tripping during walking. Compared to Berg Balance Test and Timed Up-and-Go, Dynamic Gait Index scores might be more sensitive to reflect declines in inter-joint coordination during walking.
    Clinical biomechanics (Bristol, Avon) 03/2013; 28(4). DOI:10.1016/j.clinbiomech.2013.03.001 · 1.88 Impact Factor
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    • "Inter-and intra-rater reliability is good. The BBS has been first validated among older people, in whom a score higher than 45 is related to a low risk of fall [5]. Nevertheless, a recent study showed that a change of eight points is required to reveal a genuine change in function among older people who are dependent in activities of daily living [9]. "
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    ABSTRACT: Three main issues have to be addressed by the examination of a patient complaining from balance disorders: physiopathology and aetiology, severity and consequences, and evolution. A precise clinical analysis must be then conducted, including close anamnesis and clinical examination, with scale measurements depending on the objectives. Daily consequences can be assessed by the Dizziness Handicap Inventory, which considers a large field of daily activities. The International Classification of Functioning evaluates activities and participation, influence of environmental factors, and quality of life. Then, patient's examination aims at objectifying and measuring the balance disorder. Quantified measurement is possible even in a simple doctor's office. Clinical scales for balance assessment should be used for a standardized assessment and to allow comparison of different subjects. Although the Tinetti test is the most-widely used in older people, it is quite approximate. The Berg Balance Scale has also been first validated in older people, it is rather easy to use, but uncertainty between two close scores is frequent. The Timed Up-and-Go Test is the simplest one and probably the most reliable. The Unipodal Stance Testing is also a simple test and a good predictor of fall. The Functional Ambulation Classification focuses attention on the physical support needed by the patient during walking. The Postural Assessment Scale for Stroke Patients (PASS) is easy to use after a recent stroke. Instrumental analysis by means of static and dynamic platforms, often coupled together with accelerometers or video, can be used to complete the clinical examination. Its main interest is to contribute to give insight into physiologic and pathologic mechanisms underlying the postural trouble.
    Neurophysiologie Clinique/Clinical Neurophysiology 01/2009; 38(6):439-45. DOI:10.1016/j.neucli.2008.09.008 · 1.46 Impact Factor
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    • "Frändin et al. used the same procedure for testing that we did; however, their study population was younger than ours. Use of walking aids has previously been shown to be an indicator of impaired balance (Powell & Myers, 1995; Thornbahn & Newton, 1996). In agreement with those studies we found an independent association between use of walking aids outdoors and poor performance in climbing high steps without support. "
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    ABSTRACT: The aim of this study was to investigate walking and health among woman age 75 yr or older, in the associations between the highest step up performed without support by an individual and balance, walking, and health among women age 75+. Records of the highest step, balance, walking, and health were made for 307 women age 75-93 yr living in the community. Eighty percent managed to climb steps higher than 20 cm. There was a statistically significant negative relationship between age and stair-climbing capacity. The highest steps registered were significantly and independently associated with a short time on the timed up-and-go test, long functional reach, low body weight, lack of perceived difficulty walking outdoors, low number of "missteps" when walking in a figure of 8, longer time in one-leg stance, ability to carry out tandem stance, no walking aids outdoors, and not being afraid of falling. These variables together explained 67% of the variance in the step-height score.
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