Berg Balance Scale

{{Short description|Clinical test of balance}} {{cs1 config|name-list-style=vanc}} {{Infobox diagnostic | name = Berg Balance Scale | image = | alt = | caption = | pronounce = | purpose =test of a person's static and dynamic balance abilities | test of = | based on = | synonyms = BBS | reference_range = | calculator = | DiseasesDB =  | ICD10 =  | ICD9 = | ICDO = | MedlinePlus =  | eMedicine =  | MeshID = | OPS301 =  | LOINC =  }} The '''Berg Balance Scale''' (or '''BBS''') is a widely used clinical test of a person's static and dynamic balance abilities,<ref name="Blum2008">{{cite journal | title = Usefulness of the Berg Balance Scale in Stroke Rehabilitation: A Systematic Review | journal = Physical Therapy | first1=Lisa |last1 = Blum | first2= Nicol | last2= Korner-Bitensky | date=May 2008 | volume = 88 | issue = 5 | pages=559–566 | doi=10.2522/ptj.20070205 | pmid=18292215| doi-access=free }}</ref> named after Katherine Berg, one of the developers.<ref name=berg>{{cite journal | journal=Physiotherapy Canada | title=Measuring balance in the elderly: preliminary development of an instrument | volume=41 | issue=6 | year=1989 | pages=304–311 | url=http://utpjournals.metapress.com/content/T30N37061661184R | archive-url=https://archive.today/20130128220509/http://utpjournals.metapress.com/content/T30N37061661184R | url-status=dead | archive-date=2013-01-28 | first1=Katherine | last1=Berg | first2=Sharon | last2=Wood-Dauphinėe | first3=J.I. | last3=Williams | first4=David | last4=Gayton | access-date=2012-02-12 | doi=10.3138/ptc.41.6.304 | url-access=subscription }}</ref> For functional balance tests, the BBS is generally considered to be the gold standard.<ref name=Langley>Langley, F.A. & Mackintosh, S.F.H. (2007). [http://ijahsp.nova.edu/articles/vol5num4/pdf/langley.pdf Functional balance assessment of older community dwelling adults: A systematic review of the literature]. The Internet Journal of Allied Health Sciences and Practice, 5(4).</ref>

The test takes 15–20 minutes and comprises a set of 14 simple balance related tasks, ranging from standing up from a sitting position, to standing on one foot. The degree of success in achieving each task is given a score of zero (unable) to four (independent), and the final measure is the sum of all of the scores.<ref>{{cite web | url = http://www.csp.org.uk/outcome-measures/berg-balance-scale-bbs | title= Berg Balance Scale (BBS) | work= The Chartered Society of Physiotherapy | access-date=2012-02-12}}</ref><ref name="stroke">{{cite web | url = http://www.strokecenter.org/wp-content/uploads/2011/08/berg.pdf | title = Berg Balance Scale | work = Internet Stroke Center | access-date = 2012-02-12 | archive-date = 2012-05-03 | archive-url = https://web.archive.org/web/20120503182409/http://www.strokecenter.org/wp-content/uploads/2011/08/berg.pdf | url-status = dead }}</ref>

The BBS has been shown to have excellent inter-rater (ICC = 0.98) and intra-rater relative reliability (ICC = 0.97), with an absolute reliability varying between 2.8/56 and 6.6/56, with poorer reliability near the middle of the scale,<ref name=Downs>{{cite journal | pmid = 23663794 | volume=59 | issue=2 | title=The Berg Balance Scale has high intra- and inter-rater reliability but absolute reliability varies across the scale: a systematic review | year=2013 |vauthors=Downs S, Marquez J, Chiarelli P | journal=Journal of Physiotherapy | pages=93–99 | doi=10.1016/s1836-9553(13)70161-9| doi-access=free | hdl=1959.13/1295036 | hdl-access=free }}</ref> and is internally consistent (0.96).<ref name=berg /> The BBS correlates satisfactorily with laboratory measures, including postural sway, and has good concurrent criterion, predictive criterion, and construct validity.<ref name=BergWood>{{cite journal | pmid = 1468055 | volume=83 | title=Measuring balance in the elderly: validation of an instrument | year=1992 |vauthors=Berg KO, Wood-Dauphinee SL, Williams JI, Maki B | journal=Can J Public Health | issue=Suppl 2 | pages=S7–11}}</ref> Considerable evidence indicates that the BBS is also a valid measure of standing balance in post-stroke patients, but only for those who ambulate independently, due to the tasks that are required of the patient.<ref>{{cite journal | pmid=11552860 | volume=47 | issue=1 | title=Detecting change in patients with stroke using the Berg Balance Scale | year=2001 | author=Stevenson TJ | journal=Aust J Physiother | pages=29–38 | doi=10.1016/s0004-9514(14)60296-8 | doi-access=free }}</ref> The BBS was recently identified as the most commonly used assessment tool across the continuum of stroke rehabilitation and it is considered a sound measure of balance impairment. <ref name="Blum2008"/>

The BBS has been strongly established as valid and reliable but there are still several factors which may indicate that the BBS should be used in conjunction with other balance measures.<ref name="Blum2008"/> For example, there are a few tasks in the BBS to test dynamic balance, which may limit its ability to challenge older adults who live independently in the community.<ref name=Langley /> A ceiling effect and floor effect has been reported for the BBS when used with community dwelling older adults. <ref name="Blum2008"/> The use of the BBS as an outcome measure is compromised when participants score high on initial trials.<ref name=Langley /> In initial development of the BBS, the authors noted that a limitation to the scale was the lack of items requiring postural response to external stimuli or uneven support surfaces.<ref name=berg /> This indicates that the BBS may be more appropriate for use with frail older adults rather than community-dwellers.<ref name=Langley /> In addition, the BBS has been shown to be a poor predictor of falls.<ref>{{cite journal | url=http://ptjournal.apta.org/content/83/4/328.full.pdf+html | pmid=12665404 | volume=83 | issue=4 | title=Use of clinical and impairment-based tests to predict falls by community-dwelling older adults | date=April 2003 | vauthors=Boulgarides LK, McGinty SM, Willett JA, Barnes CW | journal=Phys Ther | pages=328–39 | doi=10.1093/ptj/83.4.328 | doi-access=free | access-date=2012-05-05 | archive-url=https://web.archive.org/web/20120808201231/http://ptjournal.apta.org/content/83/4/328.full.pdf+html | archive-date=2012-08-08 | url-status=dead | url-access=subscription }}</ref>

The interpretation of the result is:<ref name="stroke"/> {| class="wikitable" | ≤20 | wheelchair user |- | >20≤40 | walking with assistance |- | >40≤56 | independent |}

Alternatively, the BBS can be used as a multilevel tool, with the risk of multiple falls increasing below a score of 45 and a significant increase below 40.<ref>{{cite journal | pmid = 18218822 | doi=10.2522/ptj.20070251 | volume=88 | issue=4 | title=Use of the Berg Balance Scale for predicting multiple falls in community-dwelling elderly people: a prospective study |date=April 2008 |vauthors=Muir SW, Berg K, Chesworth B, Speechley M | journal=Phys Ther | pages=449–59| doi-access=free }}</ref> In the original study, the value of 45 points was used to calculate relative risk estimates to demonstrate predictive validity,<ref name=berg /> and a score of 45 has been shown to be an appropriate cut-off for safe independent ambulation and the need for assistive devices or supervision.<ref name=BergWood /> An instrumented version of BBS is recently proposed to avoid observer bias and to facilitate objective assessment of Balance in home environments for periodic or long term monitoring.<ref>{{Cite journal|last1=Shahzad|first1=A.|last2=Ko|first2=S.|last3=Lee|first3=S.|last4=Lee|first4=J. A.|last5=Kim|first5=K.|date=October 2017|title=Quantitative Assessment of Balance Impairment for Fall-Risk Estimation Using Wearable Triaxial Accelerometer|journal=IEEE Sensors Journal|volume=17|issue=20|pages=6743–6751|doi=10.1109/jsen.2017.2749446|issn=1530-437X|bibcode=2017ISenJ..17.6743S|s2cid=30818100 }}</ref>

==Outcome measures== The Berg Balance Scale is used by clinical exercise physiologists, physiotherapists and occupational therapists to determine the functional mobility of an individual. This test can be administered prior to treatment for elderly individuals and patients with a history of but not limited to stroke, <ref name="Blum2008"/> Multiple sclerosis, Parkinson's disease, Ataxia, vertigo, cardiovascular disease and respiratory disease. The Berg Balance Scale Test can be administered every few months of treatment to determine if the treatment was effective for increasing the patient's functional mobility (a difference of 8 points is considered a significant change).<ref>{{cite journal |author1=Steffen T. M. |author2=Hacker T. A. |author3=Mollinger L. | year = 2002 | title = Age- and Gender-Related Test Performance in Community-Dwelling Elderly People: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and Gait Speeds | journal = Journal of Physical Therapy | volume = 82 | issue = 2| pages = 128–137 |doi=10.1093/ptj/82.2.128 |pmid=11856064 | doi-access = free }}</ref>

==See also== {{Portal|Medicine}} * Timed Up and Go test * Tinetti Test

==References== {{reflist}}

==External links== * [https://medicalcalculatorhub.com/physical-therapy/berg-balance-scale Berg Balance Scale Calculator – complete 14-task scoring with MDC tracking and EMR documentation] – MedicalCalculatorHub.com

Category:Diagnostic neurology Category:Medical scales Category:Geriatrics