Validity of six balance disorders scales in persons with multiple sclerosis

Don Gnocchi Foundation, V. Capecelatro 66, 20148 Milan, Italy.
Disability and Rehabilitation (Impact Factor: 1.99). 07/2006; 28(12):789-95. DOI: 10.1080/09638280500404289
Source: PubMed


The aim of this study was to test concurrent and discriminant validity of several tests of static and dynamic balance in a sample of subjects suffering from MS.
A group of 51 patients were enrolled in the study. The following tests were administered: Berg Balance Scale (BBS), Timed Up and Go Test (TUG), Dynamic Gait Index (DGI), Hauser Deambulation Index (DI), Dizziness Handicap Inventory (DHI), and Activities-specific Balance Confidence (ABC). The scales used in this study were initially translated into Italian.
The sample of subjects reported a mean of 0.98 (1.8 SD) falls in the month prior to evaluation. The tests demonstrated good concurrent validity: Higher correlation coefficients among tests tapping the same aspect and lower correlation coefficients among tests tapping slightly different aspects. ABC and DHI tests discriminated better than the others between fallers and non-fallers and appeared the best predictors of fall status. BBS and DGI were not as efficient in discriminating between groups. Conversely all tests showed good difference validity in the prediction of patients who used an assistive device.
BBS, TUG, DI, DGI, ABC, DHI have acceptable concurrent validity. The scales have poor performance in discriminating between faller and non-faller.

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    • "The ABC scale is a valid and reliable scale of balance confidence used in individuals with MS [21] [24]; it is correlated with the outcomes of the instrumented tests of balance. It contains a 16- item self-report questionnaire rating balance confidence in performance of various ambulatory activities without losing balance [25] "
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    ABSTRACT: Objectives Impaired postural control in individuals with multiple sclerosis (MS) is associated with falls. The objective was to evaluate the direction-specific limits of stability in people with MS. Methods Balance control of 18 individuals with relapsing-remitting MS and 18 healthy controls was assessed using instrumented (Limits of Stability (LOS) test) and clinical (Berg Balance Scale (BBS) and Activities-specific Balance Confidence (ABC) scale) tests. Results There were significant differences in reaction time, movement velocity, endpoint excursion, maximum excursion, and directional control measures of the LOS test between individuals with MS and healthy controls. The BBS and ABC clinical balance measures were significantly lower in individuals with MS compared to control subjects. The directional control impairment was seen in the right side and backward diagonals (backward-right and backward-left) directions. A significant difference between the fallers and non-fallers was found on all the components of the LOS test. There was a significant correlation between the BBS and ABC scores and different components of the LOS test. Conclusions Direction-specific impairment of limits of stability components was observed in individuals with MS. This information could be used in balance rehabilitation of people with MS.
    Annals of physical and rehabilitation medicine 05/2015; 58(3). DOI:10.1016/
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    • "The Berg balance scale (BBS) is a clinical scale of functional balance that has 14 items that explore the ability to sit, stand, lean, turn and maintain the upright position on one leg. The BBS has been shown to have good reliability [20] and validity [16] "
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    ABSTRACT: The aim of this study was to investigate the relationship between foot vibration threshold and walking and balance functions in people with Multiple Sclerosis (PwMS). The study sample consisted of 34 participants with mean age of 49.5 years (SD 11.13). Participants were able to walk independently or with an assistive device. Participants underwent vibration threshold testing using the Neurothesiometer (NT), followed by the 6 minute walking test (6MWT), the Timed up and go test (TUG) and the Berg balance scale (BBS). We found a statistically significant relationship between foot vibration threshold and all outcome measures used. The first metatarsophalangeal joint had the strongest correlation with BBS (-0.585, p < 0.01), 6MWT (-0.557, p < 0.01) and TUG (0.498, p < 0.01). We also found that vibration threshold scores differed between those people with MS with and without walking limitations (Mann-Whitney U test, p < 0.01 for all testing points). In conclusion, these findings confirm the relationship between foot vibration threshold and clinical measures of walking and balance in PwMS and add to literature predictive validity of foot vibration threshold. They also suggest that vibration threshold may be important to consider when identifying people in need of intervention or when evaluating the effect of rehabilitation and exercise interventions.
    Gait & Posture 10/2014; 41(1). DOI:10.1016/j.gaitpost.2014.10.010 · 2.75 Impact Factor
    • "One clinical measure of balance during walking activities is the Dynamic Gait Index (DGI), which was found to be reliable in people with vestibular dysfunction (Whitney et al, 2003; Hall and Herdman, 2006) and has attracted interest for use in other diagnoses, e.g. multiple sclerosis (McConvey and Bennett, 2005; Cattaneo et al, 2006; Forsberg and Nilsagård, 2013) and stroke (Jonsdottir and Cattaneo, 2007). The Functional Gait Assessment (FGA) was developed from the DGI by adding three items and removing one item (Wrisley et al, 2004). "
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    ABSTRACT: Background/aim: Reliable and valid measures evaluating imbalance during walking are important for targeting rehabilitation efforts. This study aimed to investigate the reliability and validity of the Functional Gait Assessment (FGA) in people with peripheral vestibular disorder. Methods: This study used a cross-sectional design and tested the reliability and validity of the FGA in 43 participants with peripheral vestibular disorder. The participants' performance on the FGA was filmed. To test intra-rater reliability, three raters reassessed 39 of these participants using the video uptakes. Interrater reliability was assessed by five raters analysing the video uptakes. Concurrent validity was investigated using timed measures of dynamic balance and the Activities-specific Balance Confidence scale. Results: The intra-rater reliability for the FGA score was high, with a intraclass correlation coefficient (ICC) (model 2,1)=0.94 (95% CI=0.85; 0.97). The intra-rater percentage of agreement for all raters for separate items was moderate to high, and weighted kappa was good to very good, ranging from 0.61 for change in speed to 0.95 for stair climbing. The inter-rater reliability was ICC (model 2,1)=0.73 (95% CI=0.49; 0.86). Agreement for two random raters was 45-92%. Weighted kappa was fair to very good, ranging from 0.27 for change in speed to 0.87 for walking with a narrow base of support. The internal consistency was high (α=0.88). Gait with eyes closed had the lowest item-to-total (0.33) and item-to-item (<0.30) correlation. Concurrent validity was moderate to strong (rho=0.50-0.76) with the highest correlation coefficient for the Timed Up and Go test. Conclusions: The FGA is a reliable and valid measure in people with peripheral vestibular disorder. For improving internal consistency, removal of the item 'gait with eyes closed' may be considered.
    International Journal of Therapy and Rehabilitation 08/2014; 21(8):367-373. DOI:10.12968/ijtr.2014.21.8.367
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