RehabMeasures Instrument
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  2. Activities-Specific Balance Confidence Scale

Activities-Specific Balance Confidence Scale

Last Updated

Purpose

The ABC Scale is a self-report measure of balance confidence in performing various activities without losing balance or experiencing a sense of unsteadiness. 

Acronym ABC Scale

Area of Assessment

Balance – Vestibular
Balance – Non-vestibular
Functional Mobility

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Not Free

Cost Description

The paper version of the scale may be reproduced for student training, research and clinical practices in which therapists and assistants use the scale to assess fewer than 1000 patients per year (single assessment). In all other cases, including: larger scale practices (1,000+ patient administrations per year), translation into other languages, any other modifications to the scale itself or instructions, electronic adaptations, use in clinical or multi-centre trials (regardless of sample size), for commercial or marketing purposes, and/or posting the scale on a website, permission must be obtained by the researchers or institution by contacting amyers@uwaterloo.ca. Costs may apply.

Diagnosis/Conditions

  • Multiple Sclerosis
  • Parkinson's Disease & Neurologic Rehabilitation
  • Stroke Recovery
  • Vestibular Disorders

Populations

Vestibular Disorders
Stroke
Parkinson's Disease
Older Adults and Geriatric Care
Non-Specific Patient Population
Multiple Sclerosis
Brain Injury

Key Descriptions

  • 16-item self-report measure in which patients rate their balance confidence for performing activities.
  • This stem is used to lead into each activity considered: "How confident are you that you will not lose your balance or become unsteady when you..."
  • Items are rated on a rating scale that ranges from 0 - 100.
  • Score of zero represents no confidence, a score of 100 represents complete confidence.
  • Overall score is calculated by adding item scores and then dividing by the total number of items.

Number of Items

16

Equipment Required

  • Paper survey includes visual analogue scale from 0 - 100%

Time to Administer

5-10 minutes

New Clinician and Experienced Clinician: approximately 5-10 minutes
Can be self-administered or via interview; recommended to administer by face-to-face interview (Powell & Meyers et al, 1995).

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by Jason Raad, MS and the Rehabilitation Measures Team in 2010; Updated with references from the stroke, PD, elderly, and TBI populations by Julie Hamby, SPT and Ryan Lainez Rivadelo, SPT in 2011; Updated by Phyllis Palma, PT, DPT, Christopher Newman, PT, MPT, NCS, and the SCI EDGE task force of the Neurology Section of the APTA in 2012; Updated by Sue Saliga, PT, MS, DHSc and the TBI EDGE task force of the Neurology Section of the APTA in 2012; Updated with references for the Stroke and Parkinson's Disease populations by Sarah Menhennett, SPT and Jennifer Malwitz Ponce, SPT in 11/2012; Updated by Erin Hussey, PT, DPT, MS, NCS and the PD EDGE task force of the Neurology Section of the APTA in 2013; Updated by Jennifer Fay, PT, DPT, NCS and Tracy Rice, PT, MPH, MCS and the Vestibular EDGE task force of the Neurology Section of the APTA in 2013.

ICF Domain

Activity

Measurement Domain

Activities of Daily Living
Motor

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit: http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

Abbreviations:

 

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

Recommendations for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post)

(Vestibular < 6 weeks post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(Vestibular > 6 weeks weeks post)

SCI EDGE

LS

LS

LS

StrokEDGE

NR

R

R

Vestibular EDGE

R

R

R

Recommendations Based on Parkinson Disease Hoehn and Yahr stage:

 

I

II

III

IV

V

PD EDGE

R

R

R

LS/UR

NR

Recommendations based on level of care in which the assessment is taken:

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

MS EDGE

R

R

R

R

R

StrokEDGE

NR

R

R

R

R

TBI EDGE

LS

LS

LS

LS

LS

Recommendations based on SCI AIS Classification:

 

AIS A/B

AIS C/D

SCI EDGE

NR

LS

Recommendations for use based on ambulatory status after brain injury:

 

Completely Independent

Mildly dependant

Moderately Dependant

Severely Dependant

TBI EDGE

LS

LS

NR

NR

Recommendations based on EDSS Classification:

 

EDSS 0.0 – 3.5

EDSS 4.0 – 5.5

EDSS 6.0 – 7.5

EDSS 8.0 – 9.5

MS EDGE

R

R

R

NR

Recommendations based on vestibular diagnosis

 

Peripheral

Central

Benign Paroxysmal Positional Vertigo (BPPV)

Other

VEDGE

LS

LS

LS

LS

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

MS EDGE

Yes

Yes

Yes

No

PD EDGE

No

No

Yes

Not reported

SCI EDGE

No

No

No

Not reported

StrokEDGE

No

Yes

Yes

Not reported

TBI EDGE

No

Yes

Yes

Not reported

VEDGE

Yes

Yes

Yes

Yes

Considerations

For some clients, need to periodically redirect to ensure they are considering confidence in mobility rather than responding based on their usual level of activity to each of the items listed.

Turkish Version (Karapolat et al., 2010)

  • Tested on individuals with unilateral vestibular disease
  • Adequate to Excellent  individual item ICC = 0.67-0.92
  • Adequate to Excellent individual item Cronbach ɑ = 0.67-0.93
  • Excellent whole scale Cronbach ɑ = 0.95
  • Adequate  DHI and ABC correlation r = 0.51-0.54; p < 0.05   

 

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Older Adults and Geriatric Care

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Standard Error of Measurement (SEM)

Community-Dwelling Elderly:

(Nemmers et al., 2008; n = 203; mean age = 77.33 (7.59), Community-Dwelling Elderly)

  • SEM = 1.197

Normative Data

Community Dwelling Older Adults:

(Huang & Wang, 2009; n = 168, mean age = 70.96 (6.91); mean Tinetti mobility score = 23.11 (6.39); mean FES score = 91.85 (16.89); Chinese language sample)

  • Mean (SD) scores = 79.89 (20.59)

Test/Retest Reliability

Elderly Population:

(Powell & Myers, 1995; n = 21; Assessed in two-week intervals, Elderly Population)

  • Excellent test-retest reliability (r = 0.92, p < 0.001)

Internal Consistency

Community Dwelling Older Adults:

(Huang & Wang, 2009, Community Dwelling Older Adults)

  • Excellent internal consistency (Cronbach’s alpha = 0.96)

 

Geriatric Females:

(Talley et al., 2008; n = 272; mean age = 78.7 (4.9) years, Geriatric Females)

  • Excellent internal consistency (Cronbach's alpha = 0.95)

Criterion Validity (Predictive/Concurrent)

Geriatric Females:

(Talley et al., 2008, Geriatric Females)

Correlations between the ABC and Other Clinical Assessments:

 

SAFE

-0.65*

Balance Test

0.57*

Gait Speed

0.51*

TUG

-0.39*

Activity Restrictions

-0.43*

Depression Scale

-0.38*

Fall History

-0.20*

Medical Condition

-0.32*

Assistive Device Use

0.51*

*p < 0.001

 

 

Construct Validity

Community-Dwelling Elderly:

(Wrisley et al., 2010; n = 35 community dwelling older adults; mean age = 72.9 (7.8) years, Community-Dwelling Elderly)

  • Adequate correlation between ABC score and Functional Gait Assessment (r = 0.53, p < 0.001)

(Filiatrault et al., 2007; n = 200 community dwelling seniors involved in an effectiveness study of a falls prevention program; mean age = 73.0 (7.4) years, Community-Dwelling Elderly)

  • Excellent correlation between ABC-S and ABC Scale (r = 0.94, p < 0.001)

(Landers et al., 2011; Part 1, questionnaire development: n = 39 residents of an assisted living facility; mean age = 85.03 (5.1) years; Part 2, psychometric testing; n = 63 community dwelling individuals with varying health conditions; mean age = 72.2 (7.2) years, Community-Dwelling Elderly)

  • Excellent correlation between ABC and Fear of Falling Avoidance Behavior Questionnaire (FFABQ) (r= -0.678, p < 0.01)

(Hatch et al., 2003; n = 50 community dwelling elderly people; mean age = 81.7 (6.7) years, Community-Dwelling Elderly)

  • Excellent correlation between ABC score and Berg Balance Scale (BBS) (r = 0.752, p < 0.01)
  • Excellent correlation between ABC score and Timed Up & Go Test (TUG) (r = 0.698, p < 0.01)

Content Validity

  • Clinicians were asked to "name the 10 most important activities, essential to independent living, that while requiring some position change or walking, would be safe and nonhazardous to most elderly persons."

  • A sample of seniors were asked the above question, in addition to the following question: "Are you afraid of falling during any normal daily activities, and if so, which ones?" (Powell & Myers, 1995)

Floor/Ceiling Effects

Community-dwelling Older Adults:

(Huang & Wang, 2009; n = 174 community-dwelling adults aged 60 and older; Taiwanese sample, Community-Dwelling Older Adults)

  • Less-frail participants scoring above 80 on the ABC were unlikely to improve their balance confidence after completing physical activity programs.

Responsiveness

Community Dwelling Older Adults:

(Huang & Wang, 2009; 8 weeks between assessments, Community-Dwelling Older Adults)

  • Mean change scores = -3.58 (6.61); not statistically different (t = 1.894, p = 0.07)

 

Geriatric Females:

(Talley et al., 2008, Geriatric Females)

  • Standardized response means for the ABC were 0.05
  • Participants in a fall prevention group had a mean change score of -1.1 for the ABC

Parkinson's Disease

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Standard Error of Measurement (SEM)

Parkinson’s Disease:

(Dal Bello-Haas et al., 2011; n = 24; mean age = 64.9 (8.0) years; mean time since diagnosis = 4.5 (4.3) years; H & Y Stages 1- 3; Stage 1: n = 13, Stage 2: n = 6, Stage 3: n = 5; mean MMSE scores = 27.4 (2.5) points, test retest by same rater at 2-week interval)

SEM = 4.01

Minimal Detectable Change (MDC)

Parkinsonism (included 35 PD and 2 Parkinson-plus syndromes):

(Steffen & Seney, 2008; n = 37; mean age = 71 (21); mean disease duration = 14 (6) years; Hoehn and Yahr Stages median score = 2 (range = 1 to 4); Stage 1: n = 3, Stage 2: n = 7, Stage 3: n = 9, Stage 4: n = 8; test retest by same rater at 1 week intervals; mean number of falls in the past 6 monts = 7; administered ABC via participant interview)

  • MDC = 13

(Dal Bello-Haas et al., 2011, Parkinson’s Disease)

  • MDC = 11.12

Cut-Off Scores

Parkinson’s Disease:

(Mak & Pang, 2009; n = 70 with idiopathic PD, 32 reporting 1 or more falls in 12 months; mean age for fallers = 64.1 (6.9) and 62.6 (7.8) years for non-fallers; mean duration of disease nonfallers = 7.2 (4.2) and fallers = 9.4 (5.3); H&Y stage of nonfallers = 2.8 (0.5) and fallers mean = 3.0 (0.3) MMSE > 23)

  • Cut-off score of 69%. Predictive of recurrent falls based on prospective 12-month follow-up (AUC = 0.823, sensitivity = 93%, specificity = 69%)

(Almeida et al., 2016; n = 225 persons with PD in prospective cohort study; 122 (54.2%) male; mean age = 70.7 (6.6); 84 recurrent fallers with 2 or more falls in the 12-month follow-up period; mean age for recurrent fallers = 71.1 (6.3); 141 nonrecurrent fallers with one or no falls in the 12-month follow-up period; mean age for nonrecurrent fallers = 70.4 (6.7))

  • Cut-off score of 55%. Exhibited moderate accuracy for predicting recurrent falls in persons with PD (AUC = 0.73; sensitivity = 0.71; specificity = 0.62)

Normative Data

Parkinson's Disease:

(Mak et al., 2012; n = 57 via convenience sample, mean age = 63.7 (8.5); mean duration PD diagnosis = 7.6 (4.7) years; H&Y Stages: mean = 2.5 (1.0); MMSE > 23/30; able to walk 6 meters x3 without device. All tested during "on" phase of medications; Correlational study completed in one session)

  • Mean ABC score = 73.6% (19.3)

Test/Retest Reliability

Parkinson's Disease:

(Dal Bello-Haas et al., 2011, Parkinson’s Disease)

  • Excellent test-retest reliability (ICC = 0.79)

(Lohnes et al., 2010; n = 89; mean age = 66 (8.9); mean disease duration = 8.2 (5.2); Hoehn & Yahr range 1 - 4 with mean = 2.3 (0.5))

  • Excellent test restest reliability (ICC = 0.96)

 

Parkinson's Disease and Parkinsonism:

(Steffen et al., 2008; n = 37; mean age 71 (12) years; Hoehn and Yahr Median Score = 2 (scores ranged from 1 to 4); mean number of falls in the past 6 months = 7; mean disease duration = 14 (6) years, Parkinsonism)Parkinson’s Disease)

  • Excellent test-retest reliability (ICC = 0.94)

Internal Consistency

Parkinson's Disease and Parkinsonism:

(Steffen & Seney, 2008, Parkinson’s Disease)

  • Excellent internal consistency (Cronbach's alpha = 0.95)

(Dal Bello-Haas et al., 2011, Parkinson’s Disease)

  • Excellent internal consistency (Cronbach’s alpha = 0.92)

 

Parkinson Disease and High level gait disorders:

(Peretz et al, 2006; Hebrew version of ABC scale; n = 157 subjects in 3 groups, > 24/30 on MMSE; Controls, n =68; High-level gait disorders (HLGD), n = 70; Parkinson Disease, n = 19; Those with PD were H&Y stages 1 - 3; mean disease duration = 7.7 (5.2) years and on Levadopa)

  • Excellent internal consistency (Cronbach's alpha = 0.91)

Criterion Validity (Predictive/Concurrent)

Parkinson Disease:

(Mak & Pang, 2009; n = 70 with idiopathic PD, 32 reporting 1 or more falls in 12 months; Mean age nonfallers = 62.6 (7.8) and fallers = 64.1 (6.9); mean duration of disease nonfallers = 7.2 (4.2) and fallers = 9.4 (5.3) HY stage of Nonfallers = 2.8 (0.5) and fallers mean 3.0 (0.3) MMSE > 23)

  • Regression analysis: Most significant predictor of recurrent falls was 1) fall history (F = 32.57; p < 0.001); 2) UPDRS motor (F = 25.23, p < 0.001), and 3) ABC score (F = 18.84, p < 0.001)
  • Previous fall history, UPDRS-motor score and ABC score accurately predict recurrent falls (prospective 12 mo) based on regression analysis (accuracy = 87%, sensitivity = 93% and specificity = 86%)
  • Recurrent fallers had higher HY stage (p < 0.05), Higher UPDRS motor scores (p < 0.01) and lower ABC scores (p < 0.001) than nonfallers

 

Parkinson Disease:

(Mak et al., 2012)

  • Adequate correlation between ABC score and knee muscle strength (r = 0.301,P = 0.029)
  • Excellent inverse correlation between ABC score with the UPDRS-Posture & Gait (PG) score (r = −0.661, P < 0.001)

 

Parkinson's Disease: 

(Lohnes & Earhart et al, 2010)

Poor to Adequate Correlation ABC and other clinical measures

Correlation *significant

p value reported

Berg Balance Score (Adequaqte)

0.505*

< 0.001

Functional Reach Test (Poor)

0.184

= 0.184

Single Limb Stance (Poor)

0.263*

< 0.05

Tandem Stance (Adequate)

0.357*

< 0.05

6 minute walk test (Adequate)

0.458

< 0.001

TUG (Adequate)

-0.372* inverse

< 0.001

PIGD (Adequate)

-0.387* inverse

< 0.001

UPDRS-III (Poor)

-0.221* inverse

< 0.05

Construct Validity

Parkinson Disease:

(Peretz et al., 2006)

  • Distinguish those with Parkinson Disease vs. Control group (sensitivity = 58%; specificity = 96%)
  • Distinguish high level gait disorders (HLGD) vs. those with Parkinson Disease (sensitivity = 97%; specificity = 32%)
  • Distinguish those with HLGDs vs. Controls (sensitivity = 96%; specificity = 96%)

(Bello Haas et al; identifies scale best at distinguishing stage 1 from stage 3 since only that reached significance at p = 0.007)

  • ABC scores distinguish those in HY stage 1 and stage 3, 13.90 (95% CI: 3.67 - 23.14, (p = 0.007))

 (Mak et al., 2009)

  • PD fallers significantly lower ABC scores (p < 0.05), compared to PD non-fallers; PD non-fallers significantly lower ABC scores (p < 0.05) than control
  • ABC of > 80 signif associated with lower falls risk (after accounting for age, gender, disease duration, depression); OR=0.06, CI = 0.01, 0.65, p = 0.02. Whereas, moderate ABC scores (50 - 80%) were not significantly associated with reduced fall risk (OR= 0.10, CI 0.01, 1.29; p = 0.078)

Stroke

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Standard Error of Measurement (SEM)

Stroke:

(Botner et al., 2005; n = 77; mean age = 67 (8.8) years; average time since stroke = 4.0 (3.1) years, Chronic Stroke)

  • SEM = 6.81

(Salbach et al., 2006; n = 86; mean age (ABC) = 73 (10) years, (ABC-CF) = 70 (12) years, Stroke)

  • SEM for ABC = 5.05
  • SEM for ABC-CF = 5.13

Cut-Off Scores

Stroke:

(Beninato et al., 2009; n = 27; mean age for fallers = 61.2 (13.5) and 55.2 (11.6) years for non-fallers, Chronic Stroke)

  • Cut-off score of 81.1 can provide relative certainty that the individual did not have a history of multiple falls

Normative Data

Stroke:

(Botner et al., 2005, Chronic Stroke)

ABC Item and Total Score Descriptive Data:

 

 

 

 

 

Activity

Mean (SD)

Median

Range

ICC

95% CI

Walk around the house

83.3 (18.6)

90

30 – 100

0.89

0.76 – 0.95

Walk up and down stairs

76.3 (17.7)

77.5

50 – 100

0.53

0.17 – 0.77

Pick up a slipper from the floor

74.1 (25.5)

80

10 – 100

0.88

0.74 – 0.95

Reach at eye level

79.4 (20.9)

85

40 – 100

0.57

0.22 – 0.79

Reach while standing on your tiptoes

57.3 (29.3)

60

0 – 100

0.64

0.33 – 0.83

Stand on a chair to reach

38.1 (30.0)

40

0 – 95

0.81

0.61 – 0.92

Sweep the floor

70.0 (28.7)

80

10 – 100

0.59

0.25 – 0.80

Walk outside to nearby car

82.3 (19.4)

90

40 – 100

0.69

0.41 – 0.85

Get in and out of a car

84.2 (18.3)

95

40 – 100

0.73

0.47 – 0.87

Walk across a parking lot

78.8 (19.3)

80

40 – 100

0.75

0.50 – 0.88

Walk up and down a ramp

71.9 (22.8)

70

15 – 100

0.93

0.84 – 0.97

Walk in a crowded mall

72.9 (20.7)

70

40 – 100

0.69

0.41 – 0.85

Walk in a crowd or get bumped

65.4 (21.4)

62.5

25 – 100

0.58

0.23 – 0.79

Ride an escalator holding the rail

70.6 (26.0)

70

0 – 100

0.58

0.24 – 0.79

Ride an escalator not holding the rail

46.3 (30.5)

45

0 – 100

0.70

0.41 – 0.86

Walk on icy sidewalks

41.7 (28.7)

50

0 – 100

0.79

0.58 – 0.90

Total ABC score

68.3 (17.5)

64.5

40.6 – 98.8

0.85

0.68 – 0.93

Test/Retest Reliability

Stroke:

(Botner et al., 2005, Chronic Stroke)

  • Excellent 4-week total score test-retest reliability (ICC = 0.85; 95% CI 0.68 – 0.93)
  • Adequate to excellent item level test-retest reliability (ICC ranged from 0.53 to 0.93)

Internal Consistency

Stroke:

(Salbach et al., 2006, Stroke)

  • Excellent internal consistency for ABC (Cronbach’s alpha = 0.94) and ABC-CF (Cronbach’s alpha = 0.93)

Construct Validity

Stroke:

(Salbach et al., 2006, Stroke)

Spearman (95% CI)

 

 

Measure (unit or scoring)

ABC (n=51)

ABC CF (n=35)

SF-36 PF Scale (range, 0-100)

0.60 (0.39-0.76)

0.56 (0.29-0.76)

EQ VAS (range, 0-100)

0.52 (0.28 to 0.69)

0.68 (0.44 to 0.82)

BBS (range, 0-56)

0.42 (0.16 to 0.62)

0.49 (0.19 to 0.71)

Maximum walking speed (m/s)

0.43 (0.18 to 0.63)

0.53 (0.24 to 0.74)

Comfortable walking speed (m/s)

0.42 (0.16 to 0.62)

0.48 (0.17 to 0.70)

6MWT (m)

0.40 (0.13 to 0.61)

0.48 (0.18 to 0.70)

Barthel Index (range, 0-100)

0.37 (0.11 to 0.59)

0.45 (0.14 to 0.68)

TUG (s)

-0.34 (-0.07 to -0.56)

-0.52 (-0.22 to -0.73)

GDS (range, 0-30)

-0.30 (-0.03 to -0.53)

-0.61 (-0.34 to -0.79)

 

(Botner et al., 2005, Chronic Stroke)

  • Adequate correlation between the ABC total score and the BBS score (r = 0.36, p < 0.001)
  • Adequate correlation between the ABC total score and gait speed (r = 0.48, p < 0.001)

Floor/Ceiling Effects

Stroke:

(Salbach et al., 2006, Stroke)

  • 75% of subjects scored between 20% and 80% out of 100%, which would suggest no floor or ceiling effects for the total score of the ABC scale

(Botner et al., 2005, Chronic Stroke)

  • More than 80% of the sample scored between 40 and 80 suggesting there were minimal floor or ceiling effects

Brain Injury

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Construct Validity

Traumatic Brain Injury:

(Inness et al., 2011; n = 35 patients with Traumatic Brain Injury (TBI) (13 in-patient/22 out-patient); mean age = 28.7(10.6) years, TBI)

  • Excellent correlation between Community Balance and Mobility Scale (CB & M) and ABC scores (r =0.60, p = 0.011)

Vestibular Disorders

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Cut-Off Scores

Fallers and Non-fallers:

(Lajoie & Gallagher, 2003; n = 125; mean age for fallers = 75.50 (3.14) and 73.80 (2.75) years for non-fallers, Fallers and Non-fallers)

  • Scores < 67% indicates a risk for falling; can accurately classify people who fall 84% of the time.

Criterion Validity (Predictive/Concurrent)

Vestibular Disorders:

(Horak et al., 2009; n = 22 subjects with and without balance disorders including vestibular (5), PD (3), and peripheral neuroopathy; mean age = 63 (10) years, Vestibular Disorders)

  • Excellent correlation between the Balance Evaluation Systems Test (BESTest) and the ABC Scale (r = 0.636, p < 0.01)

(Legters et al 2005; n = 137 adults diagnosed with peripheral vestibular disorder; mean age 60.8 years)

  • Adequate correlation between the Dynamic Gait Index (DGI) and the ABC scale (r = 0.58, p<0.001) in total sample.
  • Excellent correlation between the DGI and the ABC Scale in patients with mild or moderate caloric weakness (r = 0.65)
  • Adequate correlation between ABC Scale and the DGI for patients with severe or total weakness (r = 0.48)

(Morgan et al., 2013; n = 53 individuals with dizziness and imbalance)

  • Excellent correlation between ABC and FES-I (r = -0.84)

(Marchetti et al., 2011; n = 95 adults older than 65 years with signs and symptoms of vestibular dysfunction)

  • Adequate correlation between ABC and TUG (r = -0.40; p < 0.01)
  • Adequate correlation between ABC and DGI (r = 0.37; p < 0.01)
  • Adequate correlation between ABC and SF-36 (r = 0.41; p < 0.01)

Construct Validity

Vestibular Disorders:

(Whitney et al., 1999; n = 71 adults from a local Balance and Vestibular Clinic.

  • Excellent correlation between the Dizziness Handicap Inventory (DHI) and the ABC Nonparametric Spearman Rank Order Correlation Coefficient rs = -0.6751 for patients ≤ 64 years p < 0.0005.
  • Excellent correlation between the Dizziness Handicap Inventory (DHI) and the ABC Nonparametric Spearman Rank Order Correlation Coefficient rs = -0.6359 for patients ≥ 64 years p < 0.0005.
  • Excellent correlation between the Dizziness Handicap Inventory (DHI) and the ABC Nonparametric Spearman Rank Order Correlation Coefficient rs = -0.6350 for patients total sample p < 0.0005.

Non-Specific Patient Population

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Cut-Off Scores

Fallers and Non-fallers:

(Lajoie & Gallagher, 2003; n = 125; mean age for fallers = 75.50 (3.14) and 73.80 (2.75) years for non-fallers, Fallers and Non-fallers)

  • Scores < 67% indicates a risk for falling; can accurately classify people who fall 84% of the time.

Bibliography

Alghwiri, A. A., Marchetti, G. F., et al. (2011). "Content comparison of self-report measures used in vestibular rehabilitation based on the international classification of functioning, disability and health." Physical Therapy 91(3): 346-357.

Almeida, L. R. S., Valenca, G. T., et al. (2016). "Comparison of self-report and performance-based balance measures for predicting recurrent falls in people with Parkinson Disease: A cohort study." Physical Therapy 96 (7): 1074-1084.

Beninato, M., Portney, L. G., et al. (2009). "Using the International Classification of Functioning, Disability and Health as a framework to examine the association between falls and clinical assessment tools in people with stroke." Phys Ther 89(8): 816-825. Find it on PubMed

Botner, E. M., Miller, W. C., et al. (2005). "Measurement properties of the Activities-specific Balance Confidence Scale among individuals with stroke." Disability and Rehabilitation 27(4): 156-163. Find it on PubMed

Clendaniel, R. A. (2000). "Outcome measures for assessment of treatment of the dizzy and balance disorder patient." Otolaryngologic Clinics of North America 33(3): 519-533.

Dal Bello-Haas, V., Klassen, L., et al. (2011). "Psychometric Properties of Activity, Self-Efficacy, and Quality-of-Life Measures in Individuals with Parkinson Disease." Physiother Can 63(1): 47-57. Find it on PubMed

Duracinsky, M., Mosnier, I., et al. (2007). "Literature review of questionnaires assessing vertigo and dizziness, and their impact on patients' quality of life." Value in health 10(4): 273-284.

Filiatrault, J., Gauvin, L., et al. (2007). "Evidence of the psychometric qualities of a simplified version of the Activities-specific Balance Confidence scale for community-dwelling seniors." Archives of Physical Medicine and Rehabilitation 88(5): 664-672. Find it on PubMed

Hatch, J., Gill-Body, K. M., et al. (2003). "Determinants of balance confidence in community-dwelling elderly people." Physical Therapy 83(12): 1072-1079. Find it on PubMed

Horak, F. B., Wrisley, D. M., et al. (2009). "The Balance Evaluation Systems Test (BESTest) to differentiate balance deficits." Physical Therapy 89(5): 484-498. Find it on PubMed

Huang, S. L., Hsieh, C. L., et al. (2011). "Minimal detectable change of the timed "up & go" test and the dynamic gait index in people with Parkinson disease." Physical Therapy 91(1): 114-121.

Huang, T. T. and Wang, W. S. (2009). "Comparison of three established measures of fear of falling in community-dwelling older adults: psychometric testing." International Journal of Nursing Studies 46(10): 1313-1319. Find it on PubMed

Inness, E. L., Howe, J. A., et al. (2011). "Measuring Balance and Mobility after Traumatic Brain Injury: Validation of the Community Balance and Mobility Scale (CB&M)." Physiotherapy Canada 63(2): 199-208. Find it on PubMed

Karapolat, H., Eyigor, S., et al. (2010). "Reliability, validity, and sensitivity to change of Turkish Activities-specific Balance Confidence Scale in patients with unilateral peripheral vestibular disease." Int J Rehabil Res 33(1): 12-18. Find it on PubMed

Lajoie, Y. and Gallagher, S. P. (2004). "Predicting falls within the elderly community: comparison of postural sway, reaction time, the Berg balance scale and the Activities-specific Balance Confidence (ABC) scale for comparing fallers and non-fallers." Archives of Gerontology and Geriatrics 38(1): 11-26. Find it on PubMed

Landers, M. R., Durand, C., et al. (2011). "Development of a scale to assess avoidance behavior due to a fear of falling: the Fear of Falling Avoidance Behavior Questionnaire." Physical Therapy 91(8): 1253-1265. Find it on PubMed

Legters, K., Whitney, S. L., et al. (2005). "The relationship between the Activities-specific Balance Confidence Scale and the Dynamic Gait Index in peripheral vestibular dysfunction." Physiotherapy Research International 10(1): 10-22. Find it on PubMed

Lohnes, C. A. and Earhart, G. M. (2009). "External validation of abbreviated versions of the activities‐specific balance confidence scale in Parkinson's disease." Movement Disorders 25(4): 485-489.

Mak, M. K. and Pang, M. Y. (2009). "Balance confidence and functional mobility are independently associated with falls in people with Parkinson's disease." J Neurol 256(5): 742-749. Find it on PubMed

Mak, M. K. and Pang, M. Y. (2009). "Fear of falling is independently associated with recurrent falls in patients with Parkinson's disease: a 1-year prospective study." J Neurol 256(10): 1689-1695. Find it on PubMed

Mak, M. K., Pang, M. Y., et al. (2011). "Gait Difficulty, Postural Instability, and Muscle Weakness Are Associated with Fear of Falling in People with Parkinson's Disease." Parkinson's disease 2012.

Marchetti, G. F., Whitney, S. L., et al. (2011). "Factors associated with balance confidence in older adults with health conditions affecting the balance and vestibular system." Archives of physical medicine and rehabilitation 92(11): 1884-1891.

Morgan, M. T., Friscia, L. A., et al. (2013). "Reliability and validity of the Falls Efficacy Scale-International (FES-I) in individuals with dizziness and imbalance." Otology and Neurotology.

Nemmers, T. M. and Miller, J. W. (2008). "Factors influencing balance in healthy community-dwelling women age 60 and older." J Geriatr Phys Ther 31(3): 93-100. Find it on PubMed

Peretz, C., Herman, T., et al. (2006). "Assessing fear of falling: Can a short version of the Activities‐specific Balance Confidence scale be useful?" Movement disorders 21(12): 2101-2105.

Powell, L. E. and Myers, A. M. (1995). "The Activities-specific Balance Confidence (ABC) Scale." Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 50A(1): M28-34. Find it on PubMed

Salbach, N. M., Mayo, N. E., et al. (2006). "Psychometric evaluation of the original and Canadian French version of the activities-specific balance confidence scale among people with stroke." Archives of Physical Medicine and Rehabilitation 87(12): 1597-1604. Find it on PubMed

Steffen, T. and 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. Find it on PubMed

Talley, K. M., Wyman, J. F., et al. (2008). "Psychometric properties of the activities-specific balance confidence scale and the survey of activities and fear of falling in older women." Journal of the American Geriatrics Society 56(2): 328-333. Find it on PubMed

Whitney, S., Hudak, M., et al. (1999). "The activities-specific balance confidence scale and the dizziness handicap inventory: a comparison." Journal of Vestibular Research 9(4): 253-259.

Wrisley, D. M. and Kumar, N. A. (2010). "Functional gait assessment: concurrent, discriminative, and predictive validity in community-dwelling older adults." Physical Therapy 90(5): 761-773. Find it on PubMed

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