Berg Balance Scale

Scales

Tool content

Objective

The Berg Balance Scale (BBS) was developed to measure static and dynamic balance in adults, in order to screen for individuals at risk of falls. (1)

Interpretation

Older adults (4)

41–56: the person walks independently.
21–40: the person requires a walking aid.
0–20: the person requires a wheelchair.

Cutoff scores (2)

≤51 with a history of falls or ≤42 with no history of falls: risk of falling ≥50% (sensitivity = 0.91; specificity = 0.82) (2).
≤40: risk of falling at nearly 100% (2).

Parkinson disease

Cutoff score = 52 (sensitivity = 0.64; specificity = 0.7) (5).

Stroke

Cutoff score = 45 (6).

Execution

The BSS consists of 14 tasks scored from 0 to 4 that assess static and dynamic balance. The total score out of 56 allows the examiner to determine the risk of falling as well as the need for walking aid. (4)

The examiner must:

ensure that the participant is wearing closed-toe shoes;
demonstrate each task to the patient;
inform the patient that they may use either leg for the single-leg and tandem stance portions of the test;
record the lowest score achieved by the patient;
complete the entire form to ensure reliable and valid results.

Static balance (standing without moving the feet) is measured using the following tasks:

feet together;
single-leg stance;
tandem stance (one foot in front of the other);
eyes closed;
trunk rotations.

Dynamic balance is measured using the following tasks:

360° pivot;
picking up an object;
standing up and sitting down;
seated transfer from one chair to another.

(During the test, the patient may not use a walking aid and may not receive assistance from the examiner.)

Duration

15–30 minutes.

Equipment

Stopwatch.
Tape measure.
Two standard-height chairs (one with armrests, one without).
19.5 cm (about 7.7 in) step.

Clinical Value

Validity

Predictive validity: excellent correlation for identifying fall risk in older adults (AUC = 0.762) (3).
Predictive validity: poor correlation for identifying fall risk in patients with Parkinson disease (AUC = 0.69) (5).
Excellent correlation between the BBS and the Balance Evaluation Systems Test, the Mini-BESTest, and the Brief BESTest in individuals at high risk of falls (0.679–0.957) (3).
Excellent correlation between the BBS and the Dynamic Gait Index (r = 0.75 and r = 0.77) in patients with chronic stroke (9).
Adequate correlation between the BBS and the Timed Up and Go (r = -0.52 and r = -0.53) in patients with chronic stroke (9).

Reliability

Excellent test-retest reliability (ICC = 0.89) (3); (ICC = 0.95) (8).
Excellent intra-rater reliability (ICC = 0.98) (4); (ICC = 0.98) (9).
Excellent inter-rater reliability (ICC = 0.98) (4); (ICC = 0.95) (7).

Minimal detectable change (MDC)

Older adults(10):
- Baseline score 0–24 → MDC = 5.
- Baseline score 25–34 → MDC = 7.
- Baseline score 35–44 → MDC = 5.
- Baseline score 45–56 → MDC = 4.
Parkinson disease (11):
- MDC = 5.
Stroke (9):
- MDC = 3.

Bibliography

1. Downs, S., Marquez, J., & Chiarelli, P. (2014). Normative scores on the Berg Balance Scale decline after age 70 years in healthy community-dwelling people: a systematic review. Journal of Physiotherapy, 60(2), 85–89. https://doi.org/10.1016/j.jphys.2014.01.002

2. Shumway-Cook, A., Baldwin, M., Polissar, N. L., & Gruber, W. (1997). Predicting the probability for falls in community-dwelling older adults. Physical Therapy, 77(8), 812–819. https://doi.org/10.1093/ptj/77.8.812

3. Viveiro, L., Gomes, G., Bacha, J., Carvas Junior, N., Kallas, M. E., Reis, M., Jacob Filho, W., & Pompeu, J. E. (2019). Reliability, Validity, and Ability to Identity Fall Status of the Berg Balance Scale, Balance Evaluation Systems Test (BESTest), Mini-BESTest, and Brief-BESTest in Older Adults Who Live in Nursing Homes. Journal of Geriatric Physical Therapy, 42(4), E45–E54. https://doi.org/10.1519/JPT.0000000000000215

4. Berg, K. O., Wood-Dauphinee, S. L., Williams, J. I., & Maki, B. (1992). Measuring balance in the elderly: validation of an instrument. Canadian Journal of Public Health, 83(Suppl. 2), S7–S11.

5. Schlenstedt, C., Brombacher, S., Hartwigsen, G., Weisser, B., Möller, B., & Deuschl, G. (2016). Comparison of the Fullerton Advanced Balance Scale, Mini-BESTest, and Berg Balance Scale to Predict Falls in Parkinson Disease. Physical Therapy, 96(4), 494–501. https://doi.org/10.2522/ptj.20150249

6. Doğan, A., Mengüllüoğlu, M., & Özgirgin, N. (2011). Evaluation of the effect of ankle-foot orthosis use on balance and mobility in hemiparetic stroke patients. Disability and Rehabilitation, 33(15–16), 1433–1439. https://doi.org/10.3109/09638288.2010.533243

7. Leddy, A. L., Crowner, B. E., & Earhart, G. M. (2011). Functional gait assessment and balance evaluation system test: reliability, validity, sensitivity, and specificity for identifying individuals with Parkinson disease who fall. Physical Therapy, 91(1), 102–113. https://doi.org/10.2522/ptj.20100113

8. Hiengkaew, V., Jitaree, K., & Chaiyawat, P. (2012). Minimal detectable changes of the Berg Balance Scale, Fugl-Meyer Assessment Scale, Timed “Up & Go” Test, gait speeds, and 2-minute walk test in individuals with chronic stroke with different degrees of ankle plantarflexor tone. Archives of Physical Medicine and Rehabilitation, 93(7), 1201–1208. https://doi.org/10.1016/j.apmr.2012.01.014

9. Alghadir, A. H., Al-Eisa, E. S., Anwer, S., & Sarkar, B. (2018). Reliability, validity, and responsiveness of three scales for measuring balance in patients with chronic stroke. BMC Neurology, 18(1), 141. https://doi.org/10.1186/s12883-018-1146-9

10. Donoghue, D., Physiotherapy Research and Older People (PROP) group, & Stokes, E. K. (2009). How much change is true change? The minimum detectable change of the Berg Balance Scale in elderly people. Journal of Rehabilitation Medicine, 41(5), 343–346. https://doi.org/10.2340/16501977-0337

11. Steffen, T., & Seney, M. (2008). Test-retest reliability and minimal detectable change on balance and ambulation tests, the 36-item short-form health survey, and the unified Parkinson disease rating scale in people with parkinsonism. Physical Therapy, 88(6), 733–746. https://doi.org/10.2522/ptj.20070214