Tool Description
- Performance based measure of balance with 14 tasks. Tasks progress in difficulty and include functional activities related to balance while reaching, bending, transferring, and standing.
- Originally developed for use with the elderly, the scale has been used in a variety of populations including stroke, Parkinson’s, multiple sclerosis, and recently SCI. Some researchers have used the BBS as the gold standard for balance in measurement studies.
Clinical Considerations
- The BBS is generally well received among clinicians who specialize in the area of gait and balance training.
- The tool is only applicable to individuals with incomplete SCI who retain some ability to stand and walk.
- It has been found to be an appropriate assessment of standing balance for these individuals as shown by its strong associations with various clinical walking evaluations.
ICF Domain
Activity ▶ Mobility
Administration
- Clinician-administered; observer-rated performance measure
- Time to administer is approximately 20 minutes (in relatively well functioning older adults). In general, the time required is inversely related to the lower extremity ability of the individual.
Number of Items
14
Equipment
- 2 standard chairs (1 with arms and 1 without)
- Stopwatch
- Step or stepstool
- Ruler
Scoring
- Each of the 14 tasks are rated on a 5-point scale from 0 (cannot perform) to 4 (normal performance).
- Task scores are summed to yield a total score.
- Total scores range from 0 (severely impaired balance) to 56 (excellent balance).
- Some tasks are rated according to the quality of the performance of the task, while others are evaluated by the time required to complete the task.
Languages
English, Italian, Turkish, Brazilian-Portuguese, German, Korean, and Dutch.
Training Required
Raters are typically health professionals with knowledge of balance and trained to assign ratings.
Availability
Can be found here.
Measurement Property Summary
Number of studies reporting psychometric properties: 8
Interpretability
- Results from studies of older adults suggest the following cut points: 0-20 = wheelchair bound; 21-40 = walking with assistance; and 41-56 = independent.
- Scores below 41 are suggested to indicate increased risk of falling.
- Change scores >7 are said to be clinically relevant in studies of older adults. This interpretation has not been validated with SCI populations.
- Published data for the SCI population is available for comparison (see the Interpretability section of the Study Details sheet).
MCID: not established for SCI
SEM: not established for the SCI population, but for a stroke population, SEM = 2.93 for individuals who ambulate with assistance (n = 16) [Stevensen 2001, “Detecting change in patients with stroke using the Berg Balance Scale”, n = 48, patients >65 yrs of age admitted to stroke rehabilitation unit after acute stroke]
MDC: not established for the SCI population, but for a stroke population, MDC = 8.1 for individuals who ambulate with assistance (n = 16) [Stevensen 2001, see above for population and article details]
Reliability
Inter-rater consistency is High for the BBS (Intraclass Correlation Coefficient = 0.998) (Srism et al. 2015; n = 83, chronic SCI, mixed injury types, mean time since injury (multiple and non-multiple fallers) = 46.72-58.70 months).
Intra-rater consistency is High for the BBS (Intraclass Correlation Coefficient = 0.97) (Tamburella et al. 2014; n = 23, 14 males, AIS D, time Since Injury (SD): 16.43 (19.03) months).
Internal consistency is High for the BBS (Information Coefficient = 0.94) (Jørgensen et al. 2017; n = 46 (32 males); AIS D = 85%, duration of injury (range): 6.5 years (1-41)).
Validity
Correlations between the BBS and the Walking Index for SCI are High (Pearson’s r = 0.89-0.92).
Correlations between the BBS and the Functional Independence Measure (FIM) are High (Pearson’s r = 0.72-0.77).
Correlations between the BBS and the FIM Locomotor Score are High (Pearson’s r = 0.86-0.89).
(Ditunno et al. 2007: n = 146, 114 males, inpatient, incomplete SCI, within 1 year post-injury)
Correlations between the BBS and the ASIA Motor Scale are low to High (ranging from Pearson’s r = 0.30 – UEMS, to Pearson’s r = 0.79 – LEMS, to Pearon’s r = 0.75 – ASIA Motor Score).
(Harkema et al. 2016: N=152, 123 male; mixed injury type, median (range) time post-SCI = 0.9 (0.1-45.2) years)
Correlations between the BBS and the Mini-BESTest scale are High (Pearon’s r = 0.899, P<0.001).
Correlations between the BBS and the Timed Up and Go (TUG) assessment are High (Pearson’s r = -0.75, P<0.001).
Correlations between the BBS and Spinal Cord Independence Measure version III (SCIM) are High (Pearson’s r = 0.88, P<0.001).
Correlations between the BBS and the Walking Index for Spinal Cord Injury version II (WISCI) are High (Pearson’s r = 0.63, P<0.001).
Correlations between the BBS and the Fall Efficiency Scale – International (FES-I) are High (Pearson’s r = -0.68, P<0.001).
Correlations between the BBS and the participants’ fear of falling are Low (Pearson’s r = -0.32, P=0.83).
Correlations between the BBS and the Quality of Life (QOL) questionnaire are Low (Pearson’s r = -0.75, P = 0.20).
(Jørgensen et al. 2017: n = 46, 32 males; AIS D = 85%, duration of injury (range) = 6.5 years (1-41))
Responsiveness
No values were reported for the responsiveness of the QOLP-PD for the SCI population.
Floor/Ceiling Effect
Significant ceiling effects (37.5% of subjects reached maximal score) and no floor effects have been reported in the Berg Balance Scale for the SCI population (Lemay & Nadeau 2010; N = 32, 25 male, AIS D mixed injury types, mean time since injury (SD) = 77.2 (44.3) days).
Effect Size
Standardized Response Mean:
All individuals: 0.59
AIS-A/B: 0.52
AIS-C: 0.65
AIS-D: 0.91
(Post locomotor training; Harkema et al. 2016; N=152, 123 male; mixed injury type; median (range) time post-SCI = 0.9 (0.1-45.2) years) Number of studies reporting responsiveness data: 2
Reviewers
Dr. Janice Eng, John Zhu, Jeremy Mak, Gita Manhas
Date Last Updated
20 July 2020
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http://online.liebertpub.com/doi/10.1089/neu.2015.4213
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http://www.ncbi.nlm.nih.gov/pubmed/24886312
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