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Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin 2013; 23(03): 135-146
DOI: 10.1055/s-0033-1337977
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Metric Characteristics of the Tests for Dynamic Balance Evaluation

Metrische Eigenschaften von Tests für die Beurteilung der dynamischen Gleichgewichtsfähigkeit
N. Sarabon
1   Ludwig Boltzmann Institute of Electrical Stimulation and Physical Rehabilitation, Vienna, Austria
2   Science and Research Center, Institute for Kinesiology Research, University of Primorska, Koper, Slovenia
3   S2P Ltd., Laboratory for Motor Control and Motor Behaviour, Ljubljana, Slovenia
,
T. Zacirkovnik
2   Science and Research Center, Institute for Kinesiology Research, University of Primorska, Koper, Slovenia
,
J. Rosker
2   Science and Research Center, Institute for Kinesiology Research, University of Primorska, Koper, Slovenia
3   S2P Ltd., Laboratory for Motor Control and Motor Behaviour, Ljubljana, Slovenia
,
S. Loefler
1   Ludwig Boltzmann Institute of Electrical Stimulation and Physical Rehabilitation, Vienna, Austria
› Institutsangaben
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Publikationsverlauf

received 07. Oktober 2012

accepted 21. Februar 2013

Publikationsdatum:
13. Juni 2013 (online)

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Erratum zu diesem Artikel:

Metric Characteristics of the Tests for Dynamic Balance EvaluationPhysikalische Medizin, Rehabilitationsmedizin, Kurortmedizin 2013; 23(04): 246-246
DOI: 10.1055/s-0033-1351293

Abstract

Different dynamic balance tests help to identify specific balance deficits in elderly and various population groups. In addition, dynamic balance tests have proved useful in identifying potential locomotor-system injury risk factors. These tests differ in the quality of their metric characteristics which could influence their applicability to measure balance in different clinical groups. Reliability, validity, sensitivity and objectivity define metric characteristics of an individual test. This paper provides an overview of the available scientific literature regarding measurement characteristics of the most commonly used dynamic balance tests. Reliability (intra-session, inter-session, inter-tester and intra-tester), sensitivity, validity and ability to predict possible balance impairing trauma and disease are presented. Clinical balance tests (balance assessed by analogue scales), functional reach, star excursion tests and out step tests were most frequently studied for their metric characteristics. In general intra-session reliability proved to be slightly higher than inter-session reliability. On the contrary there is a lack of reports on inter-tester and intra-tester reliability, especially for star excursion tests and for the tests performed on an unstable surface. Tests differ in the validity; possibly resulting from use of different reference standards. In addition factors such as age, fatigue, learning, and anthropometric characteristics have been shown to affect dynamic balance. Majority of tests were successfully implemented in the process of identifying fall prone individuals. However the reports on potential of dynamic balance tests to help predict other lower extremity injury or sports performance are sparse. In general dynamic balance measuring tests (not all parameters) proved to have sufficient metric characteristics for their practical application. However individual parameters and goals of balance assessment should be considered, when choosing the most appropriate test.

Zusammenfassung

Die Verwendung dynamischer Balance Tests ermöglicht die Identifikation spezieller Gleichgewichtsdefizite bei älteren Personen und verschiedenen Bevölkerungsgruppen. Zusätzlich haben dynamische Balance Tests ihre Fähigkeit potenzielle Verletzungsrisiken des Bewegungs­apparates zu erkennen unter Beweis gestellt. Jedoch gibt es Unterschiede in der Qualität der metrischen Eigenschaften und Anwendbarkeit von Gleichgewichtsmessungen in verschiedenen Altersgruppen. Reliabilität, Validität, Sensitivi­tät und Objektivität definieren die metrischen Eigenschaften von individuellen Tests. Diese Arbeit gibt einen Überblick über die vorhandene Literatur bezüglich der Messeigenschaften der meistverwendeten dynamischen Balance Tests. Reliabilität (Intrasession, Test-Retest, Interrater, Intrarater), Sensitivität, Validität und die Fähigkeit mögliche gleichgewichtsbeeinträchtigende Traumata oder Krankheiten prognostizieren zu können werden vorgestellt. Klinische Gleichgewichtstests (bewertet mit analogen Skalen), „Functional Reach“-Tests, Star-Excursion Tests und Schritt auslösende Tests wurden wegen ihrer metrischen Eigenschaften am häufigsten untersucht. Im Allgemeinen zeigt sich eine leicht höhere Intra- als Intersession Reliabilität. Jedoch fehlen Berichte über die Interrater und Intrarater Reliabilität speziell für Star-Excursion Tests und Tests auf labilen Untergründen. Die Validität der Tests unterscheidet sich. Möglicherweise lässt sich dies durch die Verwendung unterschiedlicher Referenzstandards erklären. Zusätzlich hat sich gezeigt, dass Alter, Ermüdung, Lerneffekte und anthropometrische Eigenschaften die dynamische Balance beeinflussen. Die Mehrheit der Tests konnte mögliche Stürze prognostizieren. Allerdings gibt es wenig Berichte über mögliche andere Prognosen (Verletzungen der unteren Extremitäten, sportliche Leistungen). Generell haben Tests für die Beurteilung der dynamischen Gleichgewichtsfähigkeit (wenn auch nicht alle Para­meter) be­wiesen, dass sie ausreichende metrische Eigenschaften be­sitzen. Es sollten jedoch individuelle Parameter und Ziele der angestrebten Balancemessung bei der Wahl eines geeigneten Tests berücksichtigt werden.

Key words

dynamic balance - metric characteristics - testing - reliability - validity - sensitivity

Schlüsselwörter

metrische Eigenschaften - Reliabilität - Validität - Sensitivität
 

  • References

  • 1 Hrysomallis C. Balance ability and athletic performance. Sports Med 2011; 41: 221-232
    CrossrefPubMedGoogle Scholar
  • 2 Missaoui B, Portero P, Bendaya S et al. Posture and equilibrium in orthopedic and rheumatologic diseases. Neurophysiol Clin 2008; 38: 447-457
    CrossrefPubMedGoogle Scholar
  • 3 Marigold DS, Misiaszek JE. Whole-body responses: neural control and implications for rehabilitation and fall prevention. Neuroscientist 2009; 15: 36-46
    PubMedGoogle Scholar
  • 4 Bloem BR, Grimbergen YAM, Van Dijk JG et al. The “posture second” strategy: a review of wrong priorities in Parkinson’s disease. J Neurol Sci 2006; 248: 196-204
    CrossrefPubMedGoogle Scholar
  • 5 Maki BE, McIlroy WE. Control of rapid limb movements for balance recovery: age-related changes and implications for fall prevention. Age Ageing 2006; 35 (Suppl 2): ii12-ii18
    CrossrefPubMedGoogle Scholar
  • 6 Maki BE, McIlroy WE. Postural control in the older adult. Clin Geriatr Med 1996; 12: 635-658
    PubMedGoogle Scholar
  • 7 Gage W, Winter D, Frank J et al. Kinematic and kinetic validity of the inverted pendulum model in quiet standing. Gait & Posture 2004; 19: 124-132
    CrossrefPubMedGoogle Scholar
  • 8 Winter D. Human balance and posture control during standing and walking. Gait & Posture 1995; 3: 193-214
    CrossrefPubMedGoogle Scholar
  • 9 Benvenuti F. Physiology of Human Balance. Advances in Neurology 2001; 87: 41-51
    PubMedGoogle Scholar
  • 10 Allen NE, Sherrington C, Paul SS et al. Balance and falls in Parkinson’s disease: a meta-analysis of the effect of exercise and motor training. Mov Disord 2011; 26: 1605-1615
    CrossrefPubMedGoogle Scholar
  • 11 Weerdesteyn V, De Niet M, Van Duijnhoven HJR et al. Falls in individuals with stroke. J Rehabil Res Dev 2008; 45: 1195-1213
    CrossrefPubMedGoogle Scholar
  • 12 Howells BE, Ardern CL, Webster KE. Is postural control restored following anterior cruciate ligament reconstruction? A systematic review. Knee Surg Sports Traumatol Arthrosc 2011; 19: 1168-1177
    CrossrefPubMedGoogle Scholar
  • 13 McKeon PO, Hertel J. Systematic review of postural control and lateral ankle instability, part I: can deficits be detected with instrumented testing. J Athl Train 2008; 43: 293-304
    CrossrefPubMedGoogle Scholar
  • 14 Ruhe A, Fejer R, Walker B. Center of pressure excursion as a measure of balance performance in patients with non-specific low back pain compared to healthy controls: a systematic review of the literature. Eur Spine J 2011; 20: 358-368
    CrossrefPubMedGoogle Scholar
  • 15 Maki BE, Sibley KM, Jaglal SB et al. Reducing fall risk by improving balance control: development, evaluation and knowledge-translation of new approaches. J Safety Res 2011; 42: 473-485
    CrossrefPubMedGoogle Scholar
  • 16 Emery CA, Cassidy JD, Klassen TP et al. Development of a clinical static and dynamic standing balance measurement tool appropriate for use in adolescents. Phys Ther 2005; 85: 502-514
    PubMedGoogle Scholar
  • 17 Horak FB, Henry SM, Shumway-Cook A. Postural perturbations: new insights for treatment of balance disorders. Phys Ther 1997; 77: 517-533
    PubMedGoogle Scholar
  • 18 Broadstone BJ, Westcott SL, Deitz JC. Test-retest reliability of two tiltboard tests in children. Phys Ther 1993; 73: 618-625
    PubMedGoogle Scholar
  • 19 Sarabon N, Mlaker B, Markovic G. A novel tool for the assessment of dynamic balance in healthy individuals. Gait & Posture 2010; 31: 261-264
    CrossrefPubMedGoogle Scholar
  • 20 Panjabi MM. Clinical spinal instability and low back pain. J Electromyogr Kinesiol 2003; 13: 371-379
    CrossrefPubMedGoogle Scholar
  • 21 Wikstrom EA, Naik S, Lodha N et al. Bilateral balance impairments after lateral ankle trauma: a systematic review and meta-analysis. Gait Posture 2010; 31: 407-414
    CrossrefPubMedGoogle Scholar
  • 22 Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Phys Ther 2000; 80: 896-903
    PubMedGoogle Scholar
  • 23 Demura S, Yamada T, Shin S. Age and sex differences in various stepping movements of the elderly. Geriatr Gerontol Int 2008; 8: 180-187
    CrossrefPubMedGoogle Scholar
  • 24 Ng SS, Hui-Chan CW. The timed up & go test: its reliability and association with lower-limb impairments and locomotor capacities in people with chronic stroke. Arch Phys Med Rehabil 2005; 86: 1641-1647
    Google Scholar
  • 25 Liston RA, Brouwer BJ. Reliability and validity of measures obtained from stroke patients using the Balance Master. Arch Phys Med Rehabil 1996; 77: 425-430
    CrossrefPubMedGoogle Scholar
  • 26 Yelnik A, Bonan I. Clinical tools for assessing balance disorders. Neurophysiol Clin 2008; 38: 439-445
    CrossrefPubMedGoogle Scholar
  • 27 Howe TE, Rochester L, Neil F et al. Exercise for improving balance in older people. Cochrane Database Syst Rev 2011; CD004963
    PubMedGoogle Scholar
  • 28 Duncan PW, Studenski S, Chandler J et al. Functional reach: predictive validity in a sample of elderly male veterans. J Gerontol 1992; 47: M93-M98
    CrossrefPubMedGoogle Scholar
  • 29 King MB, Judge JO, Wolfson L. Functional base of support decreases with age. J Gerontol 1994; 49: M258-M263
    CrossrefPubMedGoogle Scholar
  • 30 Newstead A, Hinman M, Tomberlin J. Reliability of the Berg Balance Scale and balance master limits of stability tests for individuals with brain injury. Journal of Neurologic Physical Therapy 2005; 29: 18-23
    CrossrefPubMedGoogle Scholar
  • 31 Dodd K, Hill K, Haas R et al. Retest reliability of dynamic balance during standing in older people after surgical treatment of hip fracture. Physiother Res Int 2003; 8: 93-100
    CrossrefPubMedGoogle Scholar
  • 32 Altman D. Practical statistics for medical research. London: Chapman & Hall; 1991
    Google Scholar
  • 33 Mergner T. Modeling sensorimotor control of human upright stance. Progress in Brain Research 2007; 165: 283-297
    PubMedGoogle Scholar
  • 34 Mazaheri M, Coenen P, Parnianpour M et al. Low back pain and postural sway during quiet standing with and without sensory manipulation: A systematic review. Gait Posture 2013; 37: 12-22
    CrossrefPubMedGoogle Scholar
  • 35 Amiridis IG, Hatzitaki V, Arabatzi F. Age-induced modifications of static postural control in humans. Neurosci Lett 2003; 350: 137-140
    CrossrefPubMedGoogle Scholar
  • 36 Bartlett D, Birmingham T. Validity and reliability of a pediatric reach test. Pediatr Phys Ther 2003; 15: 84-92
    CrossrefPubMedGoogle Scholar
  • 37 Duncan PW, Weiner DK, Chandler J et al. Functional reach: a new clinical measure of balance. J Gerontol 1990; 45: M192-M197
    CrossrefPubMedGoogle Scholar
  • 38 Katz-Leurer M, Fisher I, Neeb M et al. Reliability and validity of the modified functional reach test at the sub-acute stage post-stroke. Disabil Rehabil 2009; 31: 243-248
    CrossrefPubMedGoogle Scholar
  • 39 Lynch SM, Leahy P, Barker SP. Reliability of measurements obtained with a modified functional reach test in subjects with spinal cord injury. Phys Ther 1998; 78: 128-133
    PubMedGoogle Scholar
  • 40 Kage H, Okuda M, Nakamura I et al. Measuring methods for functional reach test: comparison of 1-arm reach and 2-arm reach. Arch Phys Med Rehabil 2009; 90: 2103-2107
    CrossrefPubMedGoogle Scholar
  • 41 Behrman AL, Light KE, Flynn SM et al. Is the functional reach test useful for identifying falls risk among individuals with Parkinson’s disease?. Arch Phys Med Rehabil 2002; 83: 538-542
    CrossrefPubMedGoogle Scholar
  • 42 Sherrington C, Lord SR. Reliability of simple portable tests of physical performance in older people after hip fracture. Clin Rehabil 2005; 19: 496-504
    CrossrefPubMedGoogle Scholar
  • 43 Takahashi T, Ishida K, Yamamoto H et al. Modification of the functional reach test: analysis of lateral and anterior functional reach in community-dwelling older people. Arch Gerontol Geriatr 2006; 42: 167-173
    CrossrefPubMedGoogle Scholar
  • 44 Brauer S, Burns Y, Galley P. Lateral reach: a clinical measure of medio-lateral postural stability. Physiother Res Int 1999; 4: 81-88
    CrossrefPubMedGoogle Scholar
  • 45 Nitz JC, Choy NLL, Isles RC. Medial-lateral postural stability in community-dwelling women over 40 years of age. Clin Rehabil 2003; 17: 765-767
    CrossrefPubMedGoogle Scholar
  • 46 Newton RA. Validity of the multi-directional reach test: a practical measure for limits of stability in older adults. J Gerontol A Biol Sci Med Sci 2001; 56: M248-M252
    CrossrefPubMedGoogle Scholar
  • 47 Holbein-Jenny MA, Billek-Sawhney B, Beckman E et al. Balance in personal care home residents: a comparison of the Berg Balance Scale, the Multi-Directional Reach Test, and the Activities-Specific Balance Confidence Scale. J Geriatr Phys Ther 2005; 28: 48-53
    CrossrefPubMedGoogle Scholar
  • 48 Eechaute C, Vaes P, Duquet W. Functional performance deficits in patients with CAI: validity of the multiple hop test. Clin J Sport Med 2008; 18: 124-129
    CrossrefPubMedGoogle Scholar
  • 49 Kinzey SJ, Armstrong CW. The reliability of the star-excursion test in assessing dynamic balance. J Orthop Sports Phys Ther 1998; 27: 356-360
    CrossrefPubMedGoogle Scholar
  • 50 Plisky PJ, Rauh MJ, Kaminski TW et al. Star Excursion Balance Test as a predictor of lower extremity injury in high school basketball players. J Orthop Sports Phys Ther 2006; 36: 911-919
    CrossrefPubMedGoogle Scholar
  • 51 Cho B, Scarpace D, Alexander NB. Tests of stepping as indicators of mobility, balance, and fall risk in balance-impaired older adults. J Am Geriatr Soc 2004; 52: 1168-1173
    CrossrefPubMedGoogle Scholar
  • 52 Goldberg A, Schepens S, Wallace M. Concurrent validity and reliability of the maximum step length test in older adults. J Geriatr Phys Ther 2010; 33: 122-127
    PubMedGoogle Scholar
  • 53 Punakallio A. Trial-to-trial reproducibility and test-retest stability of two dynamic balance tests among male firefighters. International Journal of Sports Medicine 2004; 25: 163-169
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 54 Clark S, Rose DJ. Evaluation of dynamic balance among community-dwelling older adult fallers: a generalizability study of the limits of stability test. Arch Phys Med Rehabil 2001; 82: 468-474
    CrossrefPubMedGoogle Scholar
  • 55 Clark S, Rose DJ, Fujimoto K. Generalizability of the limits of stability test in the evaluation of dynamic balance among older adults. Arch Phys Med Rehabil 1997; 78: 1078-1084
    CrossrefPubMedGoogle Scholar
  • 56 Munro AG, Herrington LC. Between-session reliability of the star excursion balance test. Phys Ther Sport 2010; 11: 128-132
    CrossrefPubMedGoogle Scholar
  • 57 Gribble PA, Tucker WS, White PA. Time-of-day influences on static and dynamic postural control. J Athl Train 2007; 42: 35-41
    PubMedGoogle Scholar
  • 58 Hoch MC, Staton GS, McKeon PO. Dorsiflexion range of motion significantly influences dynamic balance. J Sci Med Sport 2011; 14: 90-92
    CrossrefPubMedGoogle Scholar
  • 59 Robinson R, Gribble P. Kinematic predictors of performance on the Star Excursion Balance Test. J Sport Rehabil 2008; 17: 347-357
    PubMedGoogle Scholar
  • 60 Herrington L, Hatcher J, Hatcher A et al. A comparison of Star Excursion Balance Test reach distances between ACL deficient patients and asymptomatic controls. Knee 2009; 16: 149-152
    CrossrefPubMedGoogle Scholar
  • 61 Olmsted LC, Carcia CR, Hertel J et al. Efficacy of the Star Excursion Balance Tests in Detecting Reach Deficits in Subjects With Chronic Ankle Instability. J Athl Train 2002; 37: 501-506
    PubMedGoogle Scholar
  • 62 Hertel J, Braham RA, Hale SA et al. Simplifying the star excursion balance test: analyses of subjects with and without chronic ankle instability. J Orthop Sports Phys Ther 2006; 36: 131-137
    CrossrefPubMedGoogle Scholar
  • 63 Demura S, Sohee S, Yamaji S. Sex and age differences of relationships among stepping parameters for evaluating dynamic balance in the elderly. J Physiol Anthropol 2008; 27: 207-215
    CrossrefPubMedGoogle Scholar
  • 64 Fujisawa H, Takeda R. A new clinical test of dynamic standing balance in the frontal plane: the side-step test. Clin Rehabil 2006; 20: 340-346
    CrossrefPubMedGoogle Scholar
  • 65 Melzer I, Shtilman I, Rosenblatt N et al. Reliability of voluntary step execution behavior under single and dual task conditions. J Neuroeng Rehabil 2007; 4: 16
    CrossrefPubMedGoogle Scholar
  • 66 Dite W, Temple VA. A clinical test of stepping and change of direction to identify multiple falling older adults. Arch Phys Med Rehabil 2002; 83: 1566-1571
    CrossrefPubMedGoogle Scholar
  • 67 Whitney SL, Marchetti GF, Morris LO et al. The reliability and validity of the Four Square Step Test for people with balance deficits secondary to a vestibular disorder. Arch Phys Med Rehabil 2007; 88: 99-104
    CrossrefPubMedGoogle Scholar
  • 68 Godi M, Franchignoni F, Caligari M et al. Comparison of Reliability, Validity, and Responsiveness of the Mini-BESTest and Berg Balance Scale in Patients With Balance Disorders. Phys Ther. 2012
    PubMedGoogle Scholar
  • 69 Conradsson M, Lundin-Olsson L, Lindelöf N et al. Berg balance scale: intrarater test-retest reliability among older people dependent in activities of daily living and living in residential care facilities. Phys Ther 2007; 87: 1155-1163
    CrossrefPubMedGoogle Scholar
  • 70 Cattaneo D, Regola A, Meotti M. Validity of six balance disorders scales in persons with multiple sclerosis. Disabil Rehabil 2006; 28: 789-795
    CrossrefPubMedGoogle Scholar
  • 71 Cattaneo D, Jonsdottir J, Repetti S. Reliability of four scales on balance disorders in persons with multiple sclerosis. Disabil Rehabil 2007; 29: 1920-1925
    CrossrefPubMedGoogle Scholar
  • 72 Franjoine MR, Gunther JS, Taylor MJ. Pediatric balance scale: a modified version of the berg balance scale for the school-age child with mild to moderate motor impairment. Pediatr Phys Ther 2003; 15: 114-128
    CrossrefPubMedGoogle Scholar
  • 73 Botner EM, Miller WC, Eng JJ. Measurement properties of the Activities-specific Balance Confidence Scale among individuals with stroke. Disabil Rehabil 2005; 27: 156-163
    CrossrefPubMedGoogle Scholar
  • 74 Leddy AL, Crowner BE, Earhart GM. Functional gait assessment and balance evaluation system test: reliability, validity, sensitivity, and specificity for identifying individuals with Parkinson disease who fall. Phys Ther 2011; 91: 102-113
    CrossrefPubMedGoogle Scholar
  • 75 Wrisley DM, Marchetti GF, Kuharsky DK et al. Reliability, internal consistency, and validity of data obtained with the functional gait assessment. Phys Ther 2004; 84: 906-918
    PubMedGoogle Scholar
  • 76 Lin M-R, Hwang H-F, Hu M-H et al. Psychometric comparisons of the timed up and go, one-leg stand, functional reach, and Tinetti balance measures in community-dwelling older people. J Am Geriatr Soc 2004; 52: 1343-1348
    CrossrefPubMedGoogle Scholar
  • 77 Cipriany-Dacko LM, Innerst D, Johannsen J et al. Interrater reliability of the Tinetti Balance Scores in novice and experienced physical therapy clinicians. Arch Phys Med Rehabil 1997; 78: 1160-1164
    CrossrefPubMedGoogle Scholar
  • 78 Kegelmeyer DA, Kloos AD, Thomas KM et al. Reliability and validity of the Tinetti Mobility Test for individuals with Parkinson disease. Phys Ther 2007; 87: 1369-1378
    CrossrefPubMedGoogle Scholar
  • 79 Horak FB, Wrisley DM, Frank J. The Balance Evaluation Systems Test (BES­Test) to differentiate balance deficits. Phys Ther 2009; 89: 484-498
    CrossrefPubMedGoogle Scholar