Examining the Reliability, Correlation, and Validity of Commonly Used Assessment Tools to Measure Balance

Overview

Journal Health Sci Rep

Specialty General Medicine

Date 2019 Jan 10

PMID 30623052

Citations 32

Authors

Nicole Dawson

Darcy Dzurino

Melissa Karleskint

Jennifer Tucker

Affiliations

Soon will be listed here.

Abstract

Objectives: The Biodex SD Stability System has been shown to be a reliable assessment tool for postural stability. However, its ability to provide an accurate representation of balance has not been compared with functional performance measures such as the four-square step test (FSST) and timed-up-and-go test (TUG). The purpose of this study was to investigate reliability, internal consistency, and construct validity of FSST, TUG, and Biodex SD (limits of stability [LOS] and modified Clinical Test of Sensory Organization and Balance [m-CTSIB]).

Methods: An observational reliability and validity study was conducted. A convenience sample of 105 healthy adults, 77 females and 28 males, mean age 24.5 years old (± 4.66 SD) performed balance assessments including the FSST, TUG, Biodex SD LOS, and m-CTSIB. For LOS, the overall percentage and test duration were recorded. For m-CTSIB, the overall Sway Index was recorded. Condition 1 of the m-CTSIB represented simple postural stability.

Results: The Biodex SD LOS overall percentage, TUG, and FSST showed strong to excellent test-retest reliability (ICC [3, 1] = .83 [mean 1: 58.14, mean 2: 60.54], .88 [mean 1: 6.98 seconds, mean 2: 6.91 seconds], .92 [mean 1: 6.29 seconds, mean 2: 6.14 seconds], respectively), while the Biodex SD m-CTSIB overall percentage demonstrated strong test-retest reliability (ICC [3, 1] = .75 [mean 1: 1.18, mean 2: 1.18]). The LOS test duration showed moderate test-retest reliability (ICC [3, 1] = .58 [mean 1: 38.55 seconds, mean 2: 37.10 seconds]), while the m-CTSIB condition 1 showed poor test-retest reliability (ICC [3, 1] = .24 [mean 1: 0.63, mean 2: 0.66]). Weak construct validity was found between TUG, FSST, and Biodex SD measures of LOS and m-CTSIB ( values = -0.15-0.22).

Conclusion: It is suggested that clinicians use more than one measure to assess different aspects of a patient's balance deficits to better guide treatment and intervention.

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References

Duncan R, Earhart G . Four square step test performance in people with Parkinson disease. J Neurol Phys Ther. 2013; 37(1):2-8. DOI: 10.1097/NPT.0b013e31827f0d7a. View

Podsiadlo D, Richardson S . The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991; 39(2):142-8. DOI: 10.1111/j.1532-5415.1991.tb01616.x. View

Sousa A, Silva A, R S Tavares J . Biomechanical and neurophysiological mechanisms related to postural control and efficiency of movement: a review. Somatosens Mot Res. 2012; 29(4):131-43. DOI: 10.3109/08990220.2012.725680. View

Blanca M, Alarcon R, Arnau J, Bono R, Bendayan R . Non-normal data: Is ANOVA still a valid option?. Psicothema. 2017; 29(4):552-557. DOI: 10.7334/psicothema2016.383. View

Dite W, Connor H, Curtis H . Clinical identification of multiple fall risk early after unilateral transtibial amputation. Arch Phys Med Rehabil. 2007; 88(1):109-14. DOI: 10.1016/j.apmr.2006.10.015. View

Dite W, Temple V . A clinical test of stepping and change of direction to identify multiple falling older adults. Arch Phys Med Rehabil. 2002; 83(11):1566-71. DOI: 10.1053/apmr.2002.35469. View

Berg K, Wood-Dauphinee S, Williams J . The Balance Scale: reliability assessment with elderly residents and patients with an acute stroke. Scand J Rehabil Med. 1995; 27(1):27-36. View

Almeida G, Oliveira Monteiro I, Marizeiro D, Maia L, Lima P . Y balance test has no correlation with the Stability Index of the Biodex Balance System. Musculoskelet Sci Pract. 2017; 27:1-6. DOI: 10.1016/j.msksp.2016.11.008. View

Brandmeir N, Brandmeir C, Kuzma K, McInerney J . A Prospective Evaluation of an Outpatient Assessment of Postural Instability to Predict Risk of Falls in Patients with Parkinson's Disease Presenting for Deep Brain Stimulation. Mov Disord Clin Pract. 2019; 3(2):151-155. PMC: 6353327. DOI: 10.1002/mdc3.12257. View

10.

Shumway-Cook A, Horak F . Assessing the influence of sensory interaction of balance. Suggestion from the field. Phys Ther. 1986; 66(10):1548-50. DOI: 10.1093/ptj/66.10.1548. View

11.

Emery C, Cassidy J, Klassen T, Rosychuk R, Rowe B . Development of a clinical static and dynamic standing balance measurement tool appropriate for use in adolescents. Phys Ther. 2005; 85(6):502-14. View

12.

Talbot L . Defining and measuring balance in adults. Biol Res Nurs. 2001; 1(4):321-31. DOI: 10.1177/109980040000100408. View

13.

Rose D, Lucchese N, Wiersma L . Development of a multidimensional balance scale for use with functionally independent older adults. Arch Phys Med Rehabil. 2006; 87(11):1478-85. DOI: 10.1016/j.apmr.2006.07.263. View

14.

Haran F, Keshner E . Sensory reweighting as a method of balance training for labyrinthine loss. J Neurol Phys Ther. 2009; 32(4):186-91. PMC: 2678881. DOI: 10.1097/NPT.0b013e31818dee39. View

15.

Whitney S, Marchetti G, Morris L, Sparto P . The reliability and validity of the Four Square Step Test for people with balance deficits secondary to a vestibular disorder. Arch Phys Med Rehabil. 2007; 88(1):99-104. DOI: 10.1016/j.apmr.2006.10.027. View

16.

Blennerhassett J, Jayalath V . The Four Square Step Test is a feasible and valid clinical test of dynamic standing balance for use in ambulant people poststroke. Arch Phys Med Rehabil. 2008; 89(11):2156-61. DOI: 10.1016/j.apmr.2008.05.012. View

17.

Shumway-Cook A, Woollacott M . Attentional demands and postural control: the effect of sensory context. J Gerontol A Biol Sci Med Sci. 2000; 55(1):M10-6. DOI: 10.1093/gerona/55.1.m10. View

18.

Pickerill M, Harter R . Validity and reliability of limits-of-stability testing: a comparison of 2 postural stability evaluation devices. J Athl Train. 2012; 46(6):600-6. PMC: 3418936. DOI: 10.4085/1062-6050-46.6.600. View

19.

Clark S, Rose D, Fujimoto K . Generalizability of the limits of stability test in the evaluation of dynamic balance among older adults. Arch Phys Med Rehabil. 1997; 78(10):1078-84. DOI: 10.1016/s0003-9993(97)90131-3. View

20.

Arifin N, Abu Osman N, Wan Abas W . Intrarater test-retest reliability of static and dynamic stability indexes measurement using the Biodex Stability System during unilateral stance. J Appl Biomech. 2013; 30(2):300-4. DOI: 10.1123/jab.2013-0130. View