Validating the Berg Balance Scale for patients with Parkinson's disease: A key to rehabilitation evaluation

Southeastern Parkinson's Disease Research, Education, and Clinical Center, McGuire Veterans Medical Center, Richmond, VA 23249, USA.
Archives of Physical Medicine and Rehabilitation (Impact Factor: 2.57). 05/2005; 86(4):789-92. DOI: 10.1016/j.apmr.2004.11.005
Source: PubMed


To assess the criterion-related validity of the Berg Balance Scale (BBS) in subjects with Parkinson's disease (PD).
Prospective, correlational analysis between the BBS and accepted measures of PD motor and functional impairment.
The federally funded PD research center, an interdisciplinary center of excellence for people with PD within a Veterans Affairs medical center.
Thirty-eight men (average +/- standard deviation, 71.1+/-10.5 y) with confirmed PD. Their initial diagnosis had been made on average 5.8+/-3.6 years earlier. All could stand or walk unassisted and had mild to moderate disability. Patients who could not ambulate without assistive devices were excluded.
Not applicable.
Correlational analyses between the BBS and the Unified Parkinson's Disease Rating Scale (UPDRS) motor scale, Modified Hoehn and Yahr Staging (Hoehn and Yahr) Scale, and the Modified Schwab and England Capacity for Daily Living Scale (S&E ADL Scale).
BBS score showed significant correlations with indicators of motor functioning, stage of disease, and daily living capacity. BBS score was inversely associated with the UPDRS motor score (-.58, P <.005), Hoehn and Yahr Scale staging (-.45, P <.005), and S&E ADL Scale rating (.55, P <.005). In all 3 correlations, lower scores on the BBS (indicating greater balance deficits) correlated with higher UPDRS scores (indicating greater motoric or functional impairment).
Results support the criterion-related validity of the BBS. Its utility in other balance conditions of older adults has been established. Rehabilitation interventions have been shown to improve the balance deficits associated with PD. Early referral and periodic reassessment is vital to achieving and maintaining improvements. Our research results agree with other published research in suggesting that the BBS may be used as a screening tool and ongoing assessment tool for patients with PD.

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Available from: Rashelle B Hayes, May 07, 2014
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    • "In addition, with the aim to evaluate the patient's static and dynamic balance abilities, the Berg Balance Scale (BBS) (Qutubuddin et al., 2005) was administered , and the Timed Up and Go test (TUG) was used to assess the basic functional mobility and safety with mobility (Morris S, Morris ME & Iansek, 2001). "
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    ABSTRACT: Background: Several studies have clearly shown that physical exercise can reduce the progression of motor symptoms in Parkinson's Disease (PD). However, little is known about the effects of a Nordic Walking (NW) program in PD patients. Objective: To determine the effects of a NW program on motor and non-motor symptoms, functional performances and body composition in PD patients. Methods: Twenty PD patients (16M, 4F, 67.3 ± 7.8 years) were enrolled and randomly assigned to NW group (NWg, n = 10) and Control group (Cg, n = 10). The training consisted in 2 sessions per week for 12 weeks. Training effects were assessed by functional and instrumental tests and motor and non-motor symptoms were assessed by UPDRS-III, Hoehn and Yahr scale, PD Fatigue Scale, Beck Depression Inventory-II, Starkstein Apathy Scale, and Non-Motor Symptoms Scale. Results: Significant changes in resting HR, in walked distance (p < 0.05), and in lower limbs muscles strength (p < 0.005) were observed in NWg. Both balance abilities and safety with mobility were increased (p < 0.005). Significant variations in some circumferences and body composition were registered. Finally, a significant improvement in motor and non-motor symptoms was detected: UPDRS-III, HY scale, PFS-16, BDI-II, SAS, NMSS. Conclusions: A tailored exercise program including NW proved to be an effective way to improve daily activities and both motor and non-motor symptoms in PD patients.
    Neurorehabilitation 10/2015; 37(2). DOI:10.3233/NRE-151257 · 1.12 Impact Factor
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    • "Patients were not asked to change their medication timing; rather, the assessment timing was accommodating the patient's routine medication schedule. Instruments included several standard PD measures: Hoehn and Yahr (HY; stage of disease) (Hoehn and Yahr 1967), Unified Parkinson's Disease Rating Scale (UPDRS; Part III, motor scores) (Fahn and Elton 1987), and the Parkinson's Disease Questionnaire [PDQ-39: a self-report measure of quality of life (QOL)] (Jenkinson et al. 1997), the Berg Balance Scale (BBS: a measure of performance on balance tasks of varying difficulty) (Qutubuddin et al. 2005), and the Beck Depression Inventory (BDI: a selfreport measure of depression) (Beck et al. 1996). The interpretation of improvement is supported by statistical test and previous UPDRS motor score research. "
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    ABSTRACT: In 2001, Dance for Parkinson's disease (DfPD(®)) classes for persons with Parkinson's disease and care partners were developed by Brooklyn Parkinson Group and Mark Morris Dance Group. A previous assessment suggested that individuals experience positive benefits from DfPD(®). The current preliminary uncontrolled study investigated the effects of a dance intervention on several motor and quality of life aspects of PD following 16 sessions (8 weeks; 20 h) taught by professional dancers/teachers. A mixed methods design was used to determine the effects of the class. Assessment instruments administered at baseline and post-intervention included the Hoehn and Yahr, UPDRS (part III), Berg Balance Scale, Beck Depression Inventory, and PDQ-39 and individual interviews after the last class. Hoehn and Yahr scores ranged from 1 to 4. UPDRS III total scores and sub scores of gait and tremor improved following the intervention (P < 0.05). During interviews participants reported physical, emotional, and social benefits. Despite the diversity of baseline measures post-class interview results were consistently positive across the sample. Twelve of 14 subjects (mean age 66.2) with idiopathic PD completed the sessions. After 4 years, four participants regularly attended DfPD(®) classes. The low attrition rate and continued attendance suggest notable adherence to the DfPD(®) class. The importance of the results is both clinical and conceptual, highlighting the value of using both quantitative and qualitative data to evaluate the benefits of dance with PD.
    Journal of Neural Transmission 04/2015; 122(9). DOI:10.1007/s00702-015-1380-x · 2.40 Impact Factor
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    • "After providing informed consent, participants completed falls diaries over a period of 4 weeks, at the end of which they underwent a battery of assessments, including objective and self-reported measures of both motor and non-motor impairment. Relevant to the present analysis, the following data on measures of PD severity, motor function and mobility were extracted from the GABI database, and utilized for the assessment of construct validity of the ACM/PIGD: Items 13, 14, 15, 29, and 30 of the UPDRS [13] to calculate the ACM/PIGD; Hoehn and Yahr state while ON (HYS) as a measure of disease severity [14]; number of falls in the preceding 4 weeks (NOF); Activities Based Confidence Scale (ABC) [15] as a measure of the subjects' confidence in their own ability to ambulate safely; Freezing of Gait Questionnaire (FOG) [16] as a measure of freezing; Five Times Sit-to-Stand (FTSS) [17] [18], Timed Upand Go (TUG) [19] [20], Gait Velocity (GV) [21], as global measures of bradykinesia and overall mobility; and, Berg Balance Scale (BBS) [22] [23] as a measure of balance. Briefly, all objective assessments took place in the ON state, according to standardized protocols. "
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    ABSTRACT: Background: A construct calculated as the sum of items 13-15, 29, 30 of the Unified Parkinson's Disease Rating Scale (UPDRS) has been used as an "Ambulatory Capacity Measure" (ACM in Parkinson disease (PD). Its construct validity has never been examined. A similar construct, consisting of the mean value of the same UPDRS items has been used under the acronym PIGD as a measure of postural instability and gait disorder in PD. Objective: To examine the construct validity of the ACM and PIGD in PD. Methods: We analyzed data in an existing database of 340 PD patients, Hoehn and Yahr stages (HYS) 1-5 who participated in a study of falls. Number of falls (NOF) was recorded over 4 weeks, and UPDRS (mental, ADL, and motor subscales), HYS, Activities Based Confidence Scale (ABC), Freezing of Gait Questionnaire (FOG), Five Times Sit-to-Stand (FTSS), Timed Up-and Go (TUG), Gait Velocity (GV), and Berg Balance Scale (BBS) evaluations were performed. Internal consistency was assessed by Cronbach's alpha. Construct validity was assessed through correlations of the ACM and PIGD to these measures and to their summed-ranks. A coefficient of determination was calculated through linear regression. Results: Mean age was 71.4, mean age at diagnosis 61.4 years; 46% were women; mean UPDRS subscale scores were: Mental 3.7; ADL 15.7; motor: 27.1; mean ACM was 6.51, and mean PIGD 1.30. Cronbach's alpha was 0.78 for both ACM and PIGD. Spearman correlation coefficients between the ACM/PIGD and ABC, FOG, TUG, GV and BBS were 0.69, 0.72, 0.67, 0.58, and 0.70 respectively. Correlation between the ACM/PIGD and summed-ranks of HYS, NOF, ABC, FOG, FTSS, TUG, GV and BBS was high (Spearman r = 0.823, p < 0.0001); 68% of the variability in the summed-ranks was explained by ACM/PIGD. Conclusion: The ACM and the PIGD are valid global measures and accurately reflect the combined effects of the various components of ambulatory capacity in PD patients with HY stages 1-4.
    Journal of Parkinson's Disease 10/2014; 5(1). DOI:10.3233/JPD-140405 · 1.91 Impact Factor
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