Functional Balance Assessment of Older Community Dwelling Adults: A Systematic Review of the Literature

A Peer Reviewed Publication of the College of Allied Health & Nursing at Nova Southeastern University Dedicated to allied health professional practice and education http://ijahsp.nova.edu Vol. 5 No. 4 ISSN 1540-580X Functional Balance Assessment of Older Community Dwelling Adults: A Systematic Review of the Literature Felicity Anne Langley Shylie F.H. Mackintosh, PhD, MSc, B.ApplSc University of South Australia, City East Campus, North Terrace, Adelaide, South Australia CITATION: Langley, FA., Mackintosh, SFH. Functional balance assessment of older community dwelling adults: a systematic review of the literature. The Internet Journal of Allied Health Sciences and Practice. Oct 2007, Volume 5 Number 4. ABSTRACT Background: For allied health professionals wishing to assess the functional balance of older adults living in the community, the vast number of functional balance tests available makes it difficult to decide which assessment is most appropriate. Objective: To identify the reliability, concurrent validity and clinical practicality of functional balance tests with community dwelling older adults. Methods: A systematic review of published literature relevant to 17 functional balance tests was undertaken. The 17 functional balance tests were identified by a preliminary literature search and through consultation with an expert in the field of functional balance assessment. Studies published in English before January 2007, assessing the use of these functional balance tests with community dwelling adults aged 65 years or above were included. The CINAHL, MEDLINE, Ageline, Amed, PubMed, Cochrane library, PEDro and Joanna Briggs Institute databases were searched. The methodological quality of studies was assessed using a checklist criteria adapted from the Cochrane Working Group for Screening and Diagnostic Tests. Results: Eight databases were searched and 21 studies were included. The majority of studies demonstrated low to moderate methodological quality scores. Despite limitations reported for clinical application with community dwelling older adults, the Berg Balance Scale and the Timed Up and Go Test have been most rigorously tested. Reliability and concurrent validity of the Balance Screening Tool and the Fullerton Advanced Balance Scale had also been established in this population, however only one study was retrieved for each. Conclusion: The Berg Balance Scale and Timed Up and Go Test have published reliability and validity with community dwelling older adults. Further testing of other functional balance tests is required to establish their reliability and validity in this target population. BACKGROUND The performance of all activities of daily living requires good balance control while at rest or when moving from one position to another.1,2 Maintenance of balance requires the coordination of sensory, neural and musculoskeletal systems. 1,2 Many of these systems undergo deterioration as people age. 3,4 This has the potential to affect balance, restrict safe mobility, increase the likelihood of a fall and adversely affect quality of life. 3,5 Therefore, the assessment of balance with older people is important to direct appropriate interventions to improve balance performance and to monitor changes in balance over time. 6 Various approaches to measure balance have been developed. 3,7 Questionnaires such as the Rivermead Mobility Index and the Activities Specific Balance Scale provide self-report information regarding functional status. 8 Laboratory measures such as computerized force platforms provide accurate measurements of postural sway. 3,9 Functional performance-based tests such as the Berg Balance Scale and the Timed Up and Go Test may be defined as tests which objectively measure a person performing balance or walking tasks.7,10,11 An advantage of functional balance tests is their practicality for assessment in a variety of settings because of their low cost, lack of complex equipment and time efficiency. 10,11 © The Internet Journal of Allied Health Sciences and Practice, 2007 Functional balance assessment of older community dwelling adults: a systematic review of the literature. 2 To substantiate the clinical use of a functional balance test, it must be established to be reliable and valid when used with the target population.9 A reliable test should provide similar results when performed on the same person and under the same conditions both on different occasions and by different raters. 3 Results of a test with concurrent validity should correlate with results of another “gold standard” test when performed on the same person. 3 For functional balance tests, the Berg Balance Scale has been reported to be the “gold standard”, and will be considered the gold standard for this systematic review. 7, 21 To detect balance impairments of older adults, functional balance tests should also challenge the various sensory, neural and musculoskeletal systems required for postural control. To be a useful outcome measure, functional balance tools also need to be sensitive to change in the elderly community dwelling population. 3,9 As there are a vast number of functional balance assessment tests available, it is often difficult for a therapist or researcher to decide which to use. Psychometric properties and the practical application of some tests have been summarized in previous literature reviews and a systematic review for people with stroke. 7,11,12 Such reviews include results of studies involving a wide range of populations. To date, no systematic reviews have been conducted to assess the psychometric properties and practical application of functional balance tests in community dwelling older people. Such a review would aid therapists and researchers to make decisions about which tool may be most useful when assessing functional balance in this target population. Therefore, the aims of the following systematic review were; to determine the reliability, concurrent validity and the reported practicality for application of functional balance measures when used with community dwelling older adults. METHOD FOR REVIEW Study eligibility criteria Functional Balance Assessment Tools A preliminary search and consultation with an expert in balance assessment identified 33 tests of functional balance for older adults. Assessment tools were included for review if they fulfilled each of the following criteria; · · A test of functional balance appropriate for people living in the community (includes standing tasks). Practical and able to be tested in a variety of settings (requires minimal and easily accessible equipment and take less then 20 minutes to administer). · Challenges at least two of the following balance components; § Static balance § Dynamic balance § Change in sensory conditions (visual, vestibular, somatosensory) Seventeen of the 33 functional balance tests identified met these criteria. Each of these tests are listed in table 1 as search terms. Types of (...truncated)