Berg Balance Scale (BBS)

Purpose

The Berg Balance Scale (BBS) quantitatively assesses balance in older adults.

In-Depth Review

Purpose of the measure

The Berg Balance Scale (BBS) quantitatively assesses balance in older adults.

Available versions

The BBS was published in 1989 by Berg, Wood-Dauphinee, Williams and Maki.

Features of the measure

Items:
In this 14-item scale, patients must maintain positions and complete moving tasks of varying difficulty. In most items, patients must maintain a given position for a specified time.

Scoring:
Patients receive a score from 0-4 on their ability to meet these balance dimensions. A global score can be calculated out of 56. A score of 0 represents an inability to complete the item, and a score of 56 represents the ability to independently complete the item.

• 0-20 on the BBS represents balance impairment;
• 21-40 on the BBS represents acceptable balance;
• 41-56 on the BBS represents good balance.

Subscales:
None typically reported.

Equipment:
Only simple and easily accessible equipment is needed to complete the BBS. This includes a ruler, stopwatch, chair, and a step or stool. Also, the patients will require enough room to move 360 degrees.

Training:
No special training is required to administer the BBS. It has been deemed highly reliable when administered by individuals with no formal training on the administration of the scale.

However, it is important to note that in order to ensure the safety of the patient, the BBS should only be administered by individuals with knowledge on how to safely manage those with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The BBS is a risky assessment where a patient could fall if not supervised by someone with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. expertise.

Time:
The scale takes approximately 10-15 minutes to complete. The patient must be directly observed to assess whether the task was completed.

Alternative forms of the BBS

• A short form of the BBS (BBS-3P), which is composed of 7 items, has been developed (Chou, Chien, Hsueh, Sheu, Wang, & Hsieh, 2006).
• The BBS-3P was found to be psychometrically similar (including test reliabilityReliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of “true” variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to “noise” in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest .
  , validityThe degree to which an assessment measures what it is supposed to measure.
  , and responsivenessThe ability of an instrument to detect clinically important change over time.
  ) to the original BBS for people with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
• The BBS-3P takes less than 10 minutes to complete and requires only a chair and an object that the patient can retrieve from the floor. The BBS-3P is scored based on 3 levels: unable to complete the task, partially completes task, and able to complete the task. The 7 items included in the BBS-3P are: reaching forward with outstretched arm, standing with eyes closed, standing with one foot in front, turning to look behind, retrieving object from floor, standing on one foot, and changing from a sitting to standing position.
• Compared with the original BBS, the BBS-3P is a quick and simple measure to complete in either a clinical or a research setting.

Client suitability

Can be used with:

• Patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. who understand spoken or written language who will find the items challenging.

The BBS was originally designed as a quantitative measure of balance and risk for falls in community-dwelling elderly patients. It has been shown to be a reliable and valid measure of balance in the elderly client with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Should not be used in:

• More active elderly post-stroke patients.
• Post-stroke patients who are younger.
  There may be a ceiling effectA ceiling effect occurs when test items aren’t challenging enough for a group of individuals. Thus, the test score will not increase for a subsample of people who may have clinically improved because they have already reached the highest score that can be achieved on that test. In other words, because the test has a limited number of difficult items, the most highly functioning individuals will score at the highest possible score. This becomes a measurement problem when you are trying to identify changes – the person may continue to improve but the test does not capture that improvement. Example: A memory test that assesses how many words a participant can recall has a total of five words that each participant is asked to remember. Because most individuals can remember all five words, this measure has a ceiling effect. See also “floor effect.” with these patients, in that the items may not be sufficiently challenging to measure higher-level balance such as walking outdoors.
• Severely affected patients such as patients who cannot leave a seated position.
  There may be a floor effectThe floor effect is when data cannot take on a value lower than some particular number. Thus, it represents a subsample for whom clinical decline may not register as a change in score, even if there is worsening of function/behavior etc. because there are no items or scaling within the test that measure decline from the lowest possible score. See also “ceiling effect.”
  with these patients, as there is only one item assessing balance in the seated position.

Instead, you may wish to consider the Postural Assessment Scale for StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Patients (PASS), which was designed as a balance assessment for patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. that is applicable for all patients, even those with the most severe postural performance (Benaim, Pérennou, Villy, Rousseaux, & Pelissier, 1999).

Mao, Hsueh, Tang, Sheu, and Hsieh (2002) compared the psychometrics of the BBS to those of the balance subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
of the Fugl-Meyer Assessment and the Postural Assessment Scale for StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Patients in 123 patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. up to 180 days after strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. onset and found that the FM-B and BBS showed a significant floor or ceiling effectA ceiling effect occurs when test items aren't challenging enough for a group of individuals. Thus, the test score will not increase for a subsample of people who may have clinically improved because they have already reached the highest score that can be achieved on that test. In other words, because the test has a limited number of difficult items, the most highly functioning individuals will score at the highest possible score. This becomes a measurement problem when you are trying to identify changes - the person may continue to improve but the test does not capture that improvement. Example: A memory test that assesses how many words a participant can recall has a total of five words that each participant is asked to remember. Because most individuals can remember all five words, this measure has a ceiling effect. See also "floor effect." at some days after strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. points, whereas the PASS did not show these effects.

In what languages is the measure available?

• Translated and validated in Portuguese (Miyamoto, Lombardi, Berg, Ramos, & Natour, 2004).
• Translated and validated in French (Institut de réadaptation de Montréal).
• Translated (not yet validated) in: Iceland, Norway, Sweden, Denmark, Finland, Italy, the Netherlands, Poland, Korea, Japan, Spain, and Hong Kong and Germany.

Summary

What does the tool measure?	Balance in older adults
What types of clients can the tool be used for?	The BBS was developed for use with community-dwelling elderly individuals. It can also be used in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Is this a screeningTesting for disease in people without symptoms. or assessment tool?	Assessment.
Time to administer	Approximately 10-15 minutes to complete by direct observation.
Versions	Short form of the BBS (BBS-3P)
Other Languages	Translated and validated in Portuguese, French. Translated (not yet validated) in the following countries: Iceland, Norway, Sweden, Denmark, Finland, Italy, the Netherlands, Poland, Korea, Japan, Spain, and Hong Kong and Germany.
Measurement Properties
ReliabilityReliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of “true” variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to “noise” in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest .	Internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency.: One study has reported excellent internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency.. Test-retest: One study has reported excellent test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society). . Intra-rater: One study has reported excellent intra-rater reliabilityThis is a type of reliability assessment in which the same assessment is completed by the same rater on two or more occasions. These different ratings are then compared, generally by means of correlation. Since the same individual is completing both assessments, the rater’s subsequent ratings are contaminated by knowledge of earlier ratings. . Inter-rater: Two studies have reported excellent inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept. .
ValidityThe degree to which an assessment measures what it is supposed to measure.	Content: The items were selected based on interviews with 12 geriatric clients and 10 professionals. The list of items was revised following a pretest of all preliminary items. Criterion: Concurrent: Excellent correlations with the Fugl-Meyer balance subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society). , Postural Assessment Scale for StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Patients, Functional Reach, Tinetti Balance Scale, Timed Up and Go test and Single-Leg Stance; adequate to excellent correlations with the Motor Assessment Scale sitting section and Rivermead Mobility Index (although poor correlations with the weight shift test and step-up tests); adequate correlations with the Barthel Index mobility subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society). , dynamic Balance Master measures, and postural sway. Predictive: Predicted risk of falling over next 12 months, moderately predictive of length of stay in rehabilitation unit, predicted motor ability 180 days after strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.; not a significant predictor of mean steps per day. Construct: Convergent/Discriminant: Excellent correlations with the Barthel Index, and Fugl-Meyer balance subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society). ; adequate to excellent correlations with the Functional Independence Measure. Known Groups: One study reported that the BBS is able to differentiate between patients according to level of functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second. .
Floor/Ceiling Effects	Significant floor and ceiling effects have been detected in the BBS.
SensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also “Specificity.” / SpecificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).	No studies have reported on the sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also “Specificity.” /specificity of the BBS with patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Does the tool detect change in patients?	One study reports general sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also “Specificity.” to change and two studies report large responsivenessThe ability of an instrument to detect clinically important change over time. to change. Two studies indicate moderate responsivenessThe ability of an instrument to detect clinically important change over time. to change 6 weeks to 3 months post-stroke, but poor responsivenessThe ability of an instrument to detect clinically important change over time. following these times. One study reported a minimum absolute change score of 6 points represents genuine change.
Acceptability	This direct observation test is not suitable for severely affected patients as it assesses only one item related to balance while sitting. Active individuals will find it too simple. The scale is not suitable for use by proxy.
Feasibility	The BBS requires no specialized training to administer, however, the BBS should only be administered by individuals with knowledge on how to safely manage those with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. as the BBS is a risky assessment where a patient could fall if not supervised by someone with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. expertise. Relatively little equipment or space is required.
How to obtain the tool?	Click here to find a copy of the BBS.

Psychometric Properties

Overview

Berg, Wood-Dauphinee, Williams, and Maki (1992), and Berg, Wood-Dauphinee, and Williams (1995) examined both the validityThe degree to which an assessment measures what it is supposed to measure.
and reliabilityReliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of "true" variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to "noise" in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest .
of the BBS. Following these psychometric studies, current research on the BBS has focused mainly on comparing the psychometrics of the BBS to other balance measures (eg. Mao, Hsueh, Tang, Sheu, & Hsieh, 2002) and on testing the psychometrics of the short form of the BBS, the BBS-3P (Chou et al., 2006).

Floor/Ceiling Effects

In a study by Mao et al. (2002), three common balance scales (BBS, the Balance subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
of the Fugl-Meyer Assessment, and the Postural Assessment Scale for StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Patients) were compared. A significant floor effectThe floor effect is when data cannot take on a value lower than some particular number. Thus, it represents a subsample for whom clinical decline may not register as a change in score, even if there is worsening of function/behavior etc. because there are no items or scaling within the test that measure decline from the lowest possible score. See also "ceiling effect."
was detected in the BBS and the balance subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
of the Fugl- Meyer 14 days after strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. onset. One possible explanation for this effect is that the least demanding item in these two tests is to sit independently. As patients with severe impairments may be unable to do any of the other activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
– for example, stand on one foot, step up on a stool etc. – even as they improve, the result is a floor effectThe floor effect is when data cannot take on a value lower than some particular number. Thus, it represents a subsample for whom clinical decline may not register as a change in score, even if there is worsening of function/behavior etc. because there are no items or scaling within the test that measure decline from the lowest possible score. See also "ceiling effect."
(the score does not show change for those with severe impairments). Thus, in those with severe impairments, you may wish to consider using another scale such as the Postural Assessment Scale for StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Patients, which is applicable to all strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. patients. The BBS also had a significant ceiling effectA ceiling effect occurs when test items aren't challenging enough for a group of individuals. Thus, the test score will not increase for a subsample of people who may have clinically improved because they have already reached the highest score that can be achieved on that test. In other words, because the test has a limited number of difficult items, the most highly functioning individuals will score at the highest possible score. This becomes a measurement problem when you are trying to identify changes - the person may continue to improve but the test does not capture that improvement. Example: A memory test that assesses how many words a participant can recall has a total of five words that each participant is asked to remember. Because most individuals can remember all five words, this measure has a ceiling effect. See also "floor effect." at 90 and 180 days after strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. onset for those with higher-level function, suggesting that the BBS may not be able to discriminate balance function after 90 days, the point at which people typically reintegrate into leisure and community activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
.

Reliability

Internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. :
Berg et al. (1995) conducted a study to assess the internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. of the BBS in both elderly long-term care residents and patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The BBS was administered to elderly residents (n=113) at baseline, and at 3, 6 and 9 months, and to patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. (n=70) at 2, 4, 6 and 12 weeks post-stroke onset. At each evaluation, Cronbach’s alphas were greater than 0.83 and 0.97 for the elderly residents and patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. respectively, showing that the BBS has excellent internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency..

Intra-rater:
Flansbjer, Blom & Brogardh (2012) conducted an intra-rater test-retest reproducibility study whereby 50 patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. were assessed with the BBS on 2 occasions, 7 days apart, by one rater. Test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
was excellent (ICC=0.88). The mean difference of test scores, measured by the Bland and Altman technique, was high and positive (d=0.72), indicating a learning effect.
Note: When performing a Bland and Altman analysis, a mean difference close to zero indicates higher agreement between measurements.

Inter-rater and intra-rater:
Berg et al. (1995) also assessed inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
. Therapists administered the BBS to 35 patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. within 24 hours of the independent rater. Similarly, caregivers were asked to test the elderly residents within one week of the independent rater. To assess intra-rater reliabilityThis is a type of reliability assessment in which the same assessment is completed by the same rater on two or more occasions. These different ratings are then compared, generally by means of correlation. Since the same individual is completing both assessments, the rater's subsequent ratings are contaminated by knowledge of earlier ratings.
, 18 residents and 6 strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. patients were assessed one week apart by the same rater. There was agreement between the raters (ICC = 0.98) and the same rater was consistent at two points in time (ICC = 0.97).

Stevenson (2001) examined inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
of the BBS among 48 patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. assessed by two different raters at initial assessment (T1) and second assessment within 24 hours (T2). Agreement between T1 and T2 data was excellent (ICC = 0.92).

Validity

Content:
The items were selected based on interviews with 12 geriatric clients and 10 professionals. The list of items was revised following a pretest of all preliminary items.

Criterion:
Concurrent:
Flansbjer, Blom & Brogardh (2012) reported excellent relationships between the BBS and the Single-Leg Stance (SLS) in 50 patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. (r=0.65 – 0.79, p<0.001), using Pearson product moment correlationThe most commonly used method of computing a correlation coefficient between variables that are linearly related. Pearson’s r is a measure of association which varies from -1 to +1, with 0 indicating no relationship (random pairing of values) and 1 indicating perfect relationship
coefficients.

Liston and Brouwer (1996) showed that BBS scores related to dynamic Balance Master measures (r ? 0.48) in 20 ambulatory hemiparetic subjects.

Mao et al. (2002) reported excellent relationships between BBS scores and the balance subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
of the Fugl-Meyer (r = 0.90 to 0.92), and Postural Assessment Scale for StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Patients (r = 0.92 to 0.95) at 4 assessment times (14, 30, 90, and 180 days post-stroke).

Tyson and DeSouza (2004) tested the concurrent validities of the sitting section of the Motor Assessment Scale, the Berg Balance Scale and Rivermead Mobility Index using Spearman’s rho and found that BBS scores correlated with the the appropriate comparator tests (r = 0.32 to 0.74), except the weight shift test and step-up tests which did not form significant relationship with Berg Balance Scale (r = 0.26 and 0.19 respectively).

Smith, Hembree, and Thompson (2004) found that the BBS correlated with Functional Reach (r = 0.78). When the relationship between the two measures for subjects with similar motor impairments were examined (based on the four categories of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. severity from the motor section of the Fugl-Meyer as suggested by Duncan et al. (1992)), correlations differed according to patient severity, with the lowest correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
being for those with moderately severe motor impairmentLoss of strength and coordination, decrease in arm or leg movement
(a score of 36-55 on the Fugl-Meyer; r = 0.24), and the highest correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
for those with moderate motor impairments (a score of 56-79 on the FM; r = 0.80).

Thirty-one elderly clients were measured on the BBS, and on lab measures of postural sway and clinical measures of balance and mobility including the Tinetti Balance SubscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
, the Barthel mobility subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
, and the Timed Up and Go Test. Postural sway correlated adequately with the BBS (r = -0.55), and clinical measure correlations ranged from poor (r = -0.46) to excellent (r = -0.67) and were negatively correlated (note: low scores on postural sway and clinical measures indicate normal function, whereas a high score on the BBS indicates normal function, resulting in a negative correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
). CorrelationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
with the Tinetti Balance SubscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
was excellent (r = 0.91), and the BBS adequately correlated with the Barthel mobility subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
(r = 0.67). CorrelationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
with the Timed Up and Go Test was excellent and negative (r = -0.76), meaning that a low score on the Timed Up and Go Test (a low score suggests normal functioning) corresponds to a high score on the BBS (a high score indicates balance is intact) (Berg et al., 1992).

In this same study, correlations between scores on the BBS and ratings of 113 residents of a home for the elderly and their caregivers ranged from poor to adequate (elderly: r=0.39 to r=0.41; caregivers: r=0.47 to r=0.61) (Berg et al., 1992).

Predictive:
One hundred thirteen elderly individuals were followed for 12 months, and were classified as having 0, 1, and > 2 falls during that time. The relative risk of falling over the next 12 months was 2.7 times more likely in patients who obtained a BBS score < 45 (Berg et al., 1992).

Admission BBS was adequately predictive of length of stay (LOS) in rehabilitation unit (r = -0.39) (this negative relationship suggests that a higher BBS score results in a shorter length of stay) (Juneja et al., 1998).

In Mao et al. (2002), the predictive validityA form of criterion validity that examines a measure’s ability to predict some subsequent event. Example: can the Berg Balance Scale predict falls over the following 6 weeks? The criterion standard in this example would be whether the patient fell over the next 6 weeks.
of the BBS was assessed by comparing the results of the BBS at 14, 30, and 90 days after strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. with that of the Motor Assessment Scale at 180 days after strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. by use of Spearman’s correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
coefficient. The scores of the BBS at the earlier 3 days after strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. points were highly correlated with the MAS scores on evaluations on 180 days after strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. (r > 0.8), indicating excellent predictive validityA form of criterion validity that examines a measure’s ability to predict some subsequent event. Example: can the Berg Balance Scale predict falls over the following 6 weeks? The criterion standard in this example would be whether the patient fell over the next 6 weeks.
.

Fulk, Reynolds, Mondal & Deutsch (2010) examined the predictive validityA form of criterion validity that examines a measure’s ability to predict some subsequent event. Example: can the Berg Balance Scale predict falls over the following 6 weeks? The criterion standard in this example would be whether the patient fell over the next 6 weeks.
of the 6MWT and other widely used clinical measures (FMA LE, self-selected gait-speed, SIS and BBS) in 19 patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The BBS was found to not be a significant predictor of mean steps per day (r = 0.54; P = 0.016). Although gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
speed and balance were related to walking activity, only the 6MWT was found to be a predictor of community ambulation in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Construct:
Convergent/Discriminant:
Seventy acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. clients were tested on the BBS, the Barthel Index, and the balance subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
of the Fugl-Meyer Assessment at 4, 6 and 12 weeks post-stroke. Correlations between the BBS and the Barthel Index were excellent (ranging from r = 0.80 to r=0.94, and correlations between the BBS and the balance subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
of the Fugl-Meyer ranged from adequate to excellent (ranging from r = 0.62 to r = 0.94) (Berg et al., 1992).

BBS scores were also reported to correlate with the Functional Independence Measure (r = 0.57 to 0.70) (Juneja, Czyrny, & Linn, 1998) and r = 0.76 (Wee, Bagg, & Palepu, 1999).

Known Groups:
Stevenson (2001) examined the known groups validityKnown groups validity is a form of construct validation in which the validity is determined by the degree to which an instrument can demonstate different scores for groups know to vary on the variables being measured.
of the BBS among 48 patients with acute strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain., using Dunn’s method. Patients were grouped according to Functional AmbulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
Category (FAC) scores: ASSIST (FAC score ? 2, requiring physical assistance, n=16), SBA (FAC score = 3, requiring stand-by assistance, n=17) or INDEP (FAC score ? 4, independently ambulant, n=15). There was a significant difference between the INDEP and ASSIST groups (Q = 4.47, p<0.05) and the INDEP and SBA groups (Q = 3.07, p<0.05), but not between the SBA and ASSIST groups.

Responsiveness

Flansbjer, Blom & Brogardh (2012) examined the responsivenessThe ability of an instrument to detect clinically important change over time.
of the BBS among 50 patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. who were assessed on 2 occasions, 7 days apart. The standard error of measurement (SEM), i.e. the smallest change that indicates a real improvement for a group of individuals, was 3%. The smallest real difference (SRD) for a single individual was 8%.

Stevenson (2001) examined the responsivenessThe ability of an instrument to detect clinically important change over time.
of the BBS among 48 patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. assessed by different raters over three intervals – initial assessment (T1), second assessment within 24 hours (T2), and third assessment after approximately 1 to 2 weeks of intervention (T3). Patients were categorized into one of three groups according to Functional AmbulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
Category (FAC) scores: ASSIST (FAC score ≤ 2, requiring physical assistance); SBA (FAC score = 3, requiring stand-by assistance); and INDEP (FAC score ≤ 4, independently ambulant). All groups demonstrated statistically significant increases in BBS performance from T1 to T3 (Wilcoxon Signed Rank Test, W = 77.4 – 106, p ≤ 0.002), but not from T1 to T2. Minimal Detectable Change (MDC)Minimal Detectable Change (MDC) refers to the minimal amount of change outside of error that reflects true change by a patient between two time points (rather than a variation in measurement). from T1 to T2 = 5.8 (90% CI) indicating that a minimum absolute change score of 6 points represents change in a patient’s BBS performance when assessed by two different raters within 24 hours (all patients ± 6; INDEP group ± 6; SBA group ± 5; ASSIST group ± 7).

Mao et al. (2002) assessed the responsivenessThe ability of an instrument to detect clinically important change over time.
of the BBS, the Balance subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
of the Fugl-Meyer Test, and the Postural Assessment Scale for StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Patients by calculating effect sizeEffect size (ES) is a name given to a family of indices that measure the magnitude of a treatment effect. Unlike significance tests, these indices are independent of sample size. The ES is generally measured in two ways: as the standardized difference between two means, or as the correlation between the independent variable classification and the individual scores on the dependent variable. This correlation is called the “effect size correlation”.
(ES) (dividing the mean change scores by the standard deviation of the change score in the same subjects). The ES showed that the BBS was moderately responsive in detecting changes before 90 days after strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The ES for the BBS were greatest in the interval between 14 and 30 days (0.80) and diminished the further one moved through time from the strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. event (30 to 90 days after strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., ES = 0.69). The ES for the BBS was considered poor at 90-100 days after strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. (ES = 0.40). The changes in the BBS at each stage were significant.

To determine whether the responsivenessThe ability of an instrument to detect clinically important change over time.
of the measures varied depending on the initial stroke-induced deficits, patients were stratified into 1 of the following 3 groups on the basis of their Balance subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
of the Fugl-Meyer Test scores: 0 to 35, severe; 36 to 79, moderate; and 80, mild. The responsivenessThe ability of an instrument to detect clinically important change over time.
of the BBS at different stages for subjects with different levels of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. severity (ES = 0.21) suggested that the BBS is generally sensitive to change over time after a strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. However, the BBS was found to be less responsive than the Balance subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
of the Fugl-Meyer Test and Postural Assessment Scale for StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Patients for severe patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., at 14 to 30 days after strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The reason for this finding might be that the BBS was not originally designed for patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., and only one item of the scale assesses balance ability in the sitting position. Because sitting balance is one of the first postures to be restored after a strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., it seems that the BBS is lacking items to detect change in patients who are unable to stand independently.

Wood-Dauphinee, Berg, Bravo, and Williams (1997) reported an ES of 0.66 for initial 6-week post-stroke evaluation period, ES = 0.25 for 6-12 weeks post-stroke, and an overall ES = 0.97.

Salbach et al. (2001) used standardized response meanThe standardized response mean (SRM) is calculated by dividing the mean change by the standard deviation of the change scores.
(SRM = mean change/standard deviation of change) to estimate the responsivenessThe ability of an instrument to detect clinically important change over time.
of the 5-metre walk test, the 10-metre walk test, the BBS, the Barthel Index , the StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Rehabilitation Assessment of Movement, and the Timed Up and Go in 50 subjects with residual gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
deficits after a first-time strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The SRM from 8-38 days post-stroke for the BBS was 1.04. The BBS was rated as the second most responsive measure (the 5-metre walk test was the most responsive measure) and was recommended for use in patients who have suffered a severe strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

English, Hillier, Stiller, and Warden-Flood (2006) investigated the sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also “Specificity.”
of gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
speed, the BBS and the Motor Assessment Scale in 78 subjects receiving inpatient rehabilitation following a first or recurrent strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to detect change over time. Subjects were assessed within one week of admission and one week of discharge. The BBS was sensitive to change (only two patients showed no change) and demonstrated a large ES (d = 1.01).

References

• Benaim, C., Pérennou, D. A., Villy, J., Rousseaux, M., Pelissier J. Y. (1999). Validation of a Standardized Assessment of Postural Control in Stroke Patients: The Postural Assessment Scale for Stroke Patients (PASS). Stroke, 30, 1862-1868.
• Berg, K.O., Wood-Dauphinee, S., Williams, J. L., Maki, B. (1989). Measuring balance in the elderly: Validation of an instrument. Physiotherapy Canada, 41(6), 304-311.
• Berg, K., Wood-Dauphinee, S. L., Williams, J. I., Maki, B. E. (1992). Measuring balance in the elderly: Validation of an instrument. Canadian Journal of Public Health, 83(S2), S7-S11.
• Berg, K., Wood-Dauphinee, S. L., Williams, J. I. (1995). The Balance Scale: reliability assessment with elderly residents and patients with an acute stroke. Sc and J Rehabil Med, 27(1), 27-36.
• Chou, C. Y., Chien, C. W., Hsueh, I. P., Sheu, C. F., Wang, C. H., Hsieh, C. L. (2006). Developing a Short Form of the Berg Balance Scale for People With Stroke. Physical Therapy, 86(2), 195-204.
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• Mao, H. F., Hsueh, I. P., Tang, P. F., Sheu, C. F., Hsieh, C. L. (2002). Analysis and comparison of the psychometric properties of three balance measures for stroke patients. Stroke, 33, 1022.
• Miyamoto, S. T., Lombardi, I. J., Berg, K. O., Ramos, L. R., Natour, J. (2004). Brazilian version of the Berg balance scale. Braz J Med Biol Res, 37(9), 1411-1421.
• Salbach, N. M., Mayo, N. E., Higgins, J., Ahmed, S., Finch, L. E., Richards, C. L. (2001). Responsiveness and predictability of gait speed and other disability measures in acute stroke. Arch Phys Med Rehabil, 82, 1204-1212.
• Scherfer, E., Bohls, C., Freiberger, E., Heise, K. F., Hogan, D. (2006). Berg-Balance-Scale – German Version – Translation of a standardized instrument for the assessment of balance and risk of falling. Physioscience, 2, 59-66.
• Smith, P. S., Hembree, J. A., Thompson, M. E. (2004). Berg Balance Scale and Functional Reach: Determining the best clinical tool for individuals post acute stroke. Clin Rehabil, 18, 811-818.
• Stevenson, T.J. (2001). Detecting change in patients with stroke using the Berg Balance Scale. Australian Journal of Physiotherapy, 47, 29-38.
• Tyson, S. F., De Souza, L. H. (2004). Reliability and validity of functional balance tests post stroke. Clin Rehabil, 18, 916-923.
• Wee, J. Y. M., Bagg, S. D., Palepu, A. (1999). The Berg Balance Scale as a predictor of length of stay and discharge in an acute stroke rehabilitation setting. Arch Phys Med Rehabil, 80, 448-452.
• Wood-Dauphinee, S., Berg, K. O., Bravo, G., Williams, J. L. (1997). The Balance Scale: responsiveness to clinically meaningful changes. Can J Rehab, 10, 35-50.

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