I’m working on catching up on issues of journals. Being a part of a balance outcomes task force for work made the October 2013 PTJ article Conceptual Limitations of Balance Measures for Community-Dwelling Older Adults catch my eye.
The authors purpose was to “(1) to conduct item-level content analysis of balance measures for community-dwelling elderly people based on task and environmental factors and (2) to develop profiles of individual measures summarizing their task and environment representation.” Using a taxonomy of tasks, they assessed a series of common balance tests with “7 criteria related to task and environment: (1) task role, (2) environmental variation, (3) object interaction, (4) obstacle negotiation, (5) external forces, (6) dual-tasking, and (7) moving people or objects in the environment” (these 7 criteria led to 12 task roles). They found current tests focused on single task assessments in a static situation, and that they lacked items examining “postural control demands in daily-life situations involving dynamic changing environments, person-environment interactions, and multitasking.”
The radar plots of each test and the percentage of items in the test that addressed these 12 task roles was a good reminder that one test cannot measure or address all areas of balance. The most broad was the mini-BEST and the Fullerton Advanced Balance Scale, but as the authors note there are issues with ceiling effects for the mini-BEST and the FAB “has been found to have very few items to assess community-dwelling elderly people with above-average balance ability.” Creating a test large enough to test all areas of balance would be good, but as they point out it creates a burden for the clinician (they gave the BESTest as an example, which has “twenty seven tasks that evaluate the following six functions of balance. 1) BioMechanical Constraints, 2) Stability Limits Verticality, 3) Transitions/ Anticipatory, 4) Reactive, 5) Sensory Orientation, 6) Stability in Gait”).
So where does that leave us? First, no test is broad enough to test all areas, so PT’s will need to select several (based upon history of falls and examination findings). Second, we need to pick tests with good psychometric properties (a good place to find test properties is at Rehabilitation Measures Database. I look forward to seeing what the GeriEDGE balance task force comes out with – unfortunately I missed their presentation at CSM this year. Hopefully the authors of this study are developing a balance test that helps address the deficiencies they noted in our current balance test options.