Berg Balance Scale - Alat Ukur Menilai Keseimbangan Pasien

What is the Berg Balance Scale?

The Berg Balance Scale (BBS) is a measuring instrument used to assess a patient's balance. BBS is generally used to measure the balance level of the elderly population. BBS can also be used to assess the level of balance in patients with several conditions, such as stroke, spinal injuries, vestibular disorders, pulmonary disease, lower extremity amputation, brain injury, Alzheimer's and progressive dementia, intellectual disability, and Parkinson's.

The Berg Balance Scale (BBS) is a test used to assess functional balance. The BBS was created by Katherine Berg in 1989 to evaluate balance abilities in the elderly, with the initial target population having an average age of 73 years. BBS evaluates dynamic and static balance through 14 tests related to patient mobility. The Berg Balance Scale is useful in predicting a patient's risk of falling. BBS is a short test that can be performed relatively quickly under different environments. This test can be performed by nurses, physical therapists, occupational therapists, and doctors.

Measurement technique

The Berg Balance Scale consists of 14 mobility tests, with the tests varying in difficulty. The BBS test is divided into 3 domains, namely sitting balance, standing balance and dynamic balance. In sitting balance, the test is to evaluate sitting without support. Standing balance consists of standing without support, standing with eyes closed, standing with feet together, standing on one foot, looking back, reaching for an object from the floor, reaching forward with arms outstretched, and placing one foot in front of the other. In the final domain, dynamic balance is evaluated with the individual shifting from sitting to standing, standing to sitting, transferring, turning 360 degrees, placing one foot on a step.

Each task is rated on a 5-point ordinal scale ranging from 0 to 4 with a maximum score of 56. In general, a score of 0 is given when the individual is unable to perform the task, and a score of 4 is given. when able to complete assigned tasks independently. Other factors that influence the points awarded are the time required to complete the task, the time the position can be maintained, and the amount of supervision or assistance required. The more time or supervision required or the need to use assistive devices affects the points awarded.

The 14 tasks each come with specific instructions on how to do them. For example, when testing unsupported standing with eyes closed, the instructions are “close your eyes and stand still for 10 seconds.” If the patient is able to stand for 10 seconds safely, a score of 4 is given, if he is able to stand for 10 seconds with supervision, a score of 3, able to stand for 3 seconds, a score of 2, unable to close his eyes for 3 seconds but still safe gives a score of 1, and a score of 0 given if the patient needs help to prevent falling.

Download the Berg Balance Scale instrument here:

Reliability of the Berg Balance Scale

POPULATION	CRITERIA	MARK
Elderly	Test-retest reliability	ICC = 0.77 (general elderly) ICC = 0.886 (elderly in nursing homes)
	Interater/Intrarater reliability	Community Elderly ITA : ICC = 0.98ITE : ICC = 0.98 Institutional Elderly ITA : ICC = 0.97ITE : ICC = 0.88 Elderly in Nursing Homes ITE : ICC = 0.993 *ITA : intrarater reliability, ITE : interrater reliability
Brain Trauma	Test-retest reliability	ICC = 0.99
Parkinson	Test-retest reliability	ICC = 0.94 (common Parkinson's) ICC = 0.80 (idiopathic Parkinson's in the community)
	Interater/Intrarater reliability	ITE : ICC = 0.84 – 0.95 *ITA : intrarater reliability, ITE : interrater reliability
	Internal consistency	Cronbach Alpha : 0.86 – 0.95
Spinal Injuries	Interater/Intrarater reliability	ITE : ICC = 0.95 *ITA : intrarater reliability, ITE : interrater reliability
	Internal consistency	0.84-0.98, p < 0.001) and for the total score (ICC = 0.95, 95% confident interval = 0.910-0.975)
Stroke	Test-retest reliability	ICC = 0.72 – 0.99
	Interater/Intrarater reliability	ITE : ICC = 0.95 – 0.98 ITA : ICC = 0.97 – 0.98 *ITA : intrarater reliability, ITE : interrater reliability
	Internal consistency	Cronbach alpha : 0.92 – 0.98
Amputation	Interater/Intrarater reliability	ITE : ICC = 0.945 *ITA : intrarater reliability, ITE : interrater reliability
	Internal consistency	Cronbach alpha : 0.26 – 0.27
Intellectual disorder (Adults with learning disabilities)	Test-retest reliability	ICC = 0.98
	Interater/Intrarater reliability	ITE : ICC = 0.99 *ITA : intrarater reliability, ITE : interrater reliability
Alzheimer's and progressive dementia	Test-retest reliability	ICC = 0.995
	Interater/Intrarater reliability	ITE : ICC = 0.83 – 1 *ITA : intrarater reliability, ITE : interrater reliability
	Internal consistency	Cronbach alpha : 0.948

Validitas Berg Balance Scale

POPULATION	CRITERIA	MARK
Elderly	Criterion Validity (Predictive/Concurent	Predictive validity : r = 0.67 Specificity = 96% (prediction at low fall risk Sensitivity = 53 % (positive fall prediction results) Predictive validity : AUC = 0.762 (Elderly in nursing homes)
	Construct Validity	Excellent correlation of the BBS compared with the Balance Evaluation Systems Test, Mini-BESTest, and Brief BESTest (individuals with fall risk, r = 0.679-0.957 Poor BBS correlation compared with individuals without fall risk, r = 0.135-0.143)
Parkinson	Criterion Validity (Predictive/Concurent	ROC-AUC (95% CI) Poor AUC (0.69 (0.56, 0.82)) Sensitivity (95% CI) 0.64 (0.47, 0.78) Specificity (95% CI) .67 (0.50, 0.80) LR+ (95% CI) . 91 (1.11, 3.30) LR- (95% CI) 0.55 (0.33, 0.91) *AUC= area under the curve, CI= confidence interval, LR+= positive likelihood ratio, LR-= negative likelihood ratio
Spinal Injuries	Criterion Validity (Predictive/Concurent)	Excellent correlation of BBS compared to WISCI = Walking Index for Spinal Cord Injury, FES-I = Falls Efficacy Scale-International, AIS = ASIA Impairment Scale, SCIM = Spinal Cord Injury Independence Measure, r = 0.62-0.93
	Construct Validity	Excellent correlation of BBS compared to 50FW-S = 50 foot walking speed, LFIM = Locomotor Functional Independence Measure, FIM = Functional Independence Measure, WISCI = Walking Index for Spinal Cord Injury, r = 0.72-0.92
Stroke	Criterion Validity (Predictive/Concurent)	Concurrent validity Very good correlation with the balance subscale of the Fugl-Meyer (r= 0.90 – 09.2) Very good correlation with the Postural Assessment Scale for Stroke patients (PASS) (r = 0.92 to 0.95) Predictive validity Very good correlation with the Motor Assessment Scale (MAS) scores at 180 days post stroke (r = 0.82, 0.84, 0.91) Very good correlation of BBs with Bhartel Index (r = 0.76 and 0.81)
	Construct Validity	Excellent correlation between BBS and Mini-BESTest (r = 0.720)
Vestibular disorders	Criterion Validity (Predictive/Concurent)	Adequate correlation with Dynamic Gait Index (r = 0.71)
Amputation	Construct Validity	Very good correlation with Timed Up and Go test (r = -0.66) Adequate correlation with use of walking aids (r = -0.56) Adequate correlation with 6MWT (r = 0.57)
Intellectual disorder (Adults with learning disabilities)	Construct Validity	Very good correlation between Barthel Activities of Daily Living Index (BI) and Berg Balance Scale (BBS) (r = 0.83 – 0.84) Very good correlation between Rivermead Mobility Index (RMI) and BBS (r = 0.88 – 0, 93)

Reference :

Miranda-Cantellops N, Tiu TK. Berg Balance Testing. [Updated 2023 Feb 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK574518/

Shirley Ryan Ability Lab. diakses pada 13 Agustus 2023 pada https://www.sralab.org/rehabilitation-measures/berg-balance-scale