Objective: This study explores the accuracy of bedside examinations used to screen for imbalance, using the Berg Balance Scale (BBS) as gold standard(cut-off point:45).

Background: Balance and gait disorders are prevalent in general population, and increase fall risk. The accuracy and reliability (test characteristics) of bedside examination of balance is largely unknown, making it difficult to differentiate in the clinic between patients versus those not prone to falling. Although the BBS is a well-validated and popular tool among physical therapists, it is lengthy and not commonly used in general practice. Therefore, a fast, accurate bedside test for imbalance could be useful.

Methods: 65 subjects (47 females, 72.3%), 44 with balance complains, and 21 controls participated in the study. The average age was 69.37 years old (±9.508). Subjects were evaluated using multiple bedside balance examination tests (truncal sway, UPDRS-raising (from the Unified Parkinson’s Disease Rating Scale, UPDRS part 3), stance base, standing with feet close or separated, with eyes open or closed, line of ambulation, tip-toe walking, tandem walking, UPDRS-pull test (multiple cut-off), 3-, 5- and 10-hop unipodal jumping, BARS-gait (from Brief Ataxia Rating Scale, 0=normal), and others.) Then the BBS was administered by blinded physical therapists. The screening ability of each bedside tests (alone or in combinations) was measured using the BBS as gold standard.

Results: 46 participants had a normal balance performance by BBS, while 19 had balance impairment. High-sensitivity tests (over 90%) included: stance base, standing with feet apart eyes closed, standing with feet close eyes open, standing with feet close eyes closed, general gait, pull test(0=normal), 10-hop unipodal jump. High-specificity tests (over 90%): truncal sway, UPDRS-raising, and the pull test(0,1=normal). The combined procedure of 3-hop unipodal jumping and pull test(0,1=normal; failed in either one counted as balance impairment) showed 89% sensitivity and 83% specificity.

Conclusions: The best imbalance screening tests were the UPDRS-pull test(0=normal), the BARS-gait, standing with feet apart-eyes closed, and the 10-hop unipodal jump (each with a sensitivity over 95%). Those with decent specificities, such as truncal sway, raising and UPDRS-pull test (0,1=normal), could rule in people with balance impairment. 

References: Berg, K., Maki, B., Williams, J., Hollida, P., & Wood=Dauphinee, S. (1992, Nov). Clinical and laboratory measures of postural balance in an elderly population. Arch Phys Med Rehabil, 73(11), 1073-80.

TM Steffen, TA Hacker, L Mollinger. 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. Physical Therapy. Volume 82. Num 2:128-137. February 2002. 

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MDS Abstracts - https://www.mdsabstracts.org/abstract/accuracy-measures-of-imbalance-bedside-examination/