The reliability of balance, mobility and self-care measures in a population of adults with a learning disability known to a physiotherapy service

University of Birmingham, Birmingham, England, United Kingdom
Clinical Rehabilitation (Impact Factor: 2.24). 04/2005; 19(2):216-23. DOI: 10.1191/0269215505cr815oa
Source: PubMed


To estimate the reliability of three measures of balance, mobility and activity for use in clinical and research physiotherapy, with adults with a learning disability.
Prospective study to investigate test-retest and inter-rater reliability.
Participants' homes and day centres.
The Berg Balance Scale (BBS), the Rivermead Mobility Index (RMI) and the Barthel Activities of Daily Living Index (BI).
Of the 181 adults known to the Nottingham Community Physiotherapy Service for Adults with Learning Disabilities, 64 with a known Rivermead Mobility score of less than three were excluded. Of 117 randomized, a further 21 were found to fail this criteria, 27 had acute medical, social or behavioural problems, 22 were unable to participate or refused: therefore 47 entered the study.
Participants were visited in their own homes by two researchers on two occasions, one week apart and rated independently by each rater. Agreement was assessed with the kappa statistic (kappa) and percentage agreement for each item in each scale, and described using standard classification. Intraclass correlation coefficients for inter-rater and test-retest total scores and average differences of total scores, their standard deviations and limits of agreement, were calculated.
For inter-rater observations, the Barthel Index and the Rivermead Mobility Index had almost perfect agreement (kappa = 0.86-1.00 and 0.89-1.00 respectively), with the Berg Balance Scale having substantial to almost perfect agreement (kappa = 0.74-1.00). For test-retest comparisons, both the Barthel Index and the Rivermead Mobility Index demonstrated moderate to almost perfect agreement (kappa = 0.57-1.00 and 0.45-1.00 respectively). Kappa scores for the Berg Balance Scale varied from low to almost perfect agreement (kappa = 0.37-1.00).
The Berg Balance Scale, Rivermead Mobility Index and Barthel Activities of Daily Living Index are all reliable clinical and research tools for physiotherapists working with adults with learning disabilities.

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    • "In the population with ID, the BBS was found to be a reliable instrument (Jonge, Tonino, & Hobbelen, 2010; Sackley et al., 2005) and feasible for older adults with mild to moderate ID who are able to walk for at least 10 m and understand simple instructions (Enkelaar, Smulders, van Schrojenstein Lantman-de Valk, Weerdesteyn, & Geurts, 2013). Validity has not yet been investigated in this group. "
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    ABSTRACT: High incidence of falls and increased risk of fall-related injuries are seen in individuals with intellectual disabilities (ID). The Berg Balance Scale (BBS) is a reliable instrument for balance assessment in the population of (older) adults with ID. The aims of this study were to assess the balance capacities of a large group of older adults with ID with the BBS and look for gender and age effects, as well as reasons for drop-out on separate items, and to identify feasible subtests for subgroups in which the complete BBS is not feasible. The balance capacities of 1050 older clients with borderline to profound ID of three Dutch care-provider services (mean age 61.6 [sd=8.0]) were assessed with the BBS. The participants who completed all items of the BBS (n=508) were the functionally more able part of the study sample. Results showed that even this functionally more able part had poor balance capacities, with a mean BBS score of 47.2, 95% CI [46.3, 48.0], similar to adults in the general population aged around 20 years older. Balance capacities decreased with increasing age and females had poorer balance capacities than males. Difficulties understanding the task and physical limitations were most often the reasons for drop-out. Feasible subtests were identified for the subgroups with very low cognitive levels and wheelchair users. Low balance capacities of older adults with ID show the need for regular screening and the urge for fall prevention programs for individuals with ID.
    Full-text · Article · Jun 2013 · Research in developmental disabilities
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    • "Se pencher en avant bras tendu échelle dénommée « The Balance Scale », en publiant pas moins de cinq papiers entre 1992 et 1995 sur ses propriétés métrologiques [14] [15] [16] [17] [18]. Le « Berg Balance Scale » [112] a par la suite été largement utilisé en gériatrie, en neurologie, en ORL ainsi qu'en pathologie rhumato-orthopédique. La reproductibilité intra et inter examinateur est dans l'ensemble correcte [14] [122], mais pas toujours excellente en particulier chez les hémiplégiques chez qui il faut un gain d'au moins six points sur le score total du BBS pour conclure statistiquement à une amélioration des performances posturales [136]. Cette relative reproductibilité est sans doute expliquée par un nombre impair de niveaux de cotation, une méthodologie de cotation variant selon les items, ainsi que par l'absence de guide de passation/cotation. "
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    ABSTRACT: To analyse the clinical usefulness and metrological properties of the main techniques and indices used to assess balance disorders. More than 4000 abstracts referenced in MEDLINE and dealing with postural control and postural disorders (wide screening) were reviewed to determine the main postural techniques and indices used in a clinical context. We retained abstracts with a high citation frequency and those with interesting findings. Corresponding key words were identified for a specific search of articles that we analysed. Postural assessment tools can be classified as scales of ordinal items, tests based on metric or chronometric measurement, posturography, and verticality perception. These techniques are complementary, and their association is recommended in a clinical context. Regarding generic tools, the Falls-related Efficacy Scale (FES) and the Activities-specific Balance Confidence scale (ABC scale) would be enhanced if comparatively analysed and reworked to allow for a feasible and reliable assessment of the fear of falling. Despite a wide diffusion in numerous postural fields worldwide, the Berg Balance Scale (BBS) and the Functional Reach Test (FRT) do not have the required criteria to remain the gold standards they were in the 1990s. Static posturography should be normalised and yield more reliable indices. The clinical relevance of the subjective assessment of visual, haptic, and postural verticals are questionable, especially to explain postural disability. Regarding specific tools, the Tinetti test (TT) and the Time Up and Go test (TUG) are the most suited to assess postural capacities in very elderly people, in whom the predictive validity of the postural assessment of falls is still modest. In stroke patients, the Postural Assessment Scale for Stroke (PASS), posturography, lateropulsion assessment, and vertically perception are interesting and complementary techniques. Postural assessment relies mainly upon the 5 postural items of the Unified Parkinson Disease Rating Scale (UPDRS) in people with Parkinson disease and upon the Romberg test and posturography in patients with cerebellar or proprioceptive ataxia. Some novel postural scales for patients with multiple sclerosis or spinal cord injury are also emerging. Among numerous tools that contribute to the assessment of postural disorders, only the most recent ones (developed in the last 10 years) have undergone complete validation. It is now crucial to compare these tools, not only in terms of reproducibility and internal consistency, but also overall, in terms of feasibility, responsiveness, and predictive validity for a given population.
    Full-text · Article · Aug 2005 · Annales de Réadaptation et de Médecine Physique
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    ABSTRACT: To investigate the psychometric properties (acceptability, internal consistency reliability, interrater reliability, construct validity) and identify the most challenging items of the Berg Balance Scale (BBS) for elderly people living in the community. A total of 268 community-dwelling adults 65 years of age or older volunteered to participate in this study. Each subject's performance was assessed with the BBS, timed up and go (TUG) test, and usual gait speed. For testing interrater reliability, the other 68 community-dwelling older adults who met the criteria were also recruited. The BBS demonstrated good internal consistency reliability (Cronbach's alpha = 0.77), good interrater reliability (ICC(2,1) = 0.87), and moderate correlation with the TUG and usual gait speed (Spearman's rho = -0.53 and 0.46, respectively). The BBS score of the mobility/IADL (instrumented activities of daily living) able group was also significantly higher than that of the disabled group. Among all items on the BBS, tandem stance (item 13) and one-legged stance (item 14) were found to be the most challenging items for the subjects in the sample. The results of this study suggest that the internal consistency reliability, interrater reliability, and construct validity of the BBS are adequate for measuring balance in community-dwelling older adults. Among all items in the BBS, the tandem stance and one-legged stance are the most challenging items. Further study of their applicability for screening use in the community is warranted.
    No preview · Article · Jan 2007 · Journal of the Formosan Medical Association
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