Center for Smart Use of Technologies to Assess Real World Outcomes (C-STAR)
May 9–10
Live and Online
Offered by Academy, Shirley Ryan AbilityLab
The CB&M detects ‘high level’ balance and mobility deficits based on tasks that are commonly encountered in community environments.
13
20-30 minutes
Adolescent
13 - 17
yearsAdult
18 - 64
yearsInitially reviewed by the Rehabilitation Measures Team; Updated with references from the TBI population by Tammie Keller Johnson, PT, DPT, MS and the TBI EDGE task force of the Neurology Section of the APTA in 2012; Updated by Minu M. Nair, PT in 10/2012.
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
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Abbreviations: |
|
HR |
Highly Recommend |
|
R |
Recommend |
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LS / UR |
Reasonable to use, but limited study in target group / Unable to Recommend |
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NR |
Not Recommended |
Recommendations based on level of care in which the assessment is taken:
|
|
Acute Care |
Inpatient Rehabilitation |
Skilled Nursing Facility |
Outpatient Rehabilitation |
Home Health |
|
TBI EDGE |
R |
R |
R |
R |
R |
Recommendations for use based on ambulatory status after brain injury:
|
|
Completely Independent |
Mildly dependant |
Moderately Dependant |
Severely Dependant |
|
TBI EDGE |
R |
R |
NR |
NR |
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) |
|
TBI EDGE |
Yes |
Yes |
Yes |
Not reported |
In patients with mild to moderate neurologic deficits secondary to stroke, the CB&M was superior to either the TUG or BBS five months after stroke onset
Designed for ambulatory individuals living in the community.
The CB&M is a valid outcome measure for detecting dynamic instability and for evaluating the ability of patients of TBI to successfully return to community living (Inness, 2011)
“Clinical feedback and preliminary evidence indicates that the scale is also appropriate for clients with diagnoses other than traumatic brain injury. The items of the CB&M encompass challenging balance and mobility tasks and, therefore, the CB&M may be more appropriate for patients in the rehabilitation and community setting rather than acute care.” (Toronto rehab CB&M pdf document)
Since the tool has not been specifically studied in community dwelling elderly population, the psychometric properties of the other studies can be considered which have included the age group of more than 60 years of age.
The studies which have taken the community dwelling elderly group into consideration are as follows:
Knorr et al, 2010: For community dwelling elderly group with stroke, the available psychometric properties include convergent validity, sensitivity to change, and floor and ceiling effects as detailed above.
Clegg et al, 2009 (healthy individuals aged 20-79 years: normative data): The age related reference values for community dwelling elderly show that the CB&MS score decline after the age of 50 indicating that balance is affected significantly in healthy elderly population.
Do you see an error or have a suggestion for this instrument summary? Please e-mail us!
Traumatic Brain Injury (TBI): (Howe et al, 2006; phase 1: n=36; mean age(SD)= 31(9) years; mean time post-injury (SD)= 11(23) months; phase 2: n=32; mean age(SD)=34(12) years; mean time post-injury (SD)= 4(6) months) • SEM = 4.1 (calculated using Cronbach’s α value 0.96) • SEM = 3.2 (calculated using test-retest ICC 0.975)
Traumatic Brain Injury (TBI): (Howe et al, 2006)
Acquired Brain Injury in school-aged children and adolescents: (Wright et al, 2010)
Traumatic Brain Injury: (Howe, 2006; n = 32; participants were able to ambulate with or without aid, participants drawn from 3 locations including acute care, inpatient, day hospital and outpatient; 5 days between assessments)
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Care Setting Norms*: |
|
Population |
Mean |
Standard Deviation |
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Acute care |
30.39 |
11.7 |
|
Outpatients |
41.69 |
18.0 |
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Inpatient rehabilitation |
53.59 |
21.2 |
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Day hospital setting |
62.49 |
17.1 |
|
*Statistically different across all settings (p < 0.03) |
Traumatic Brain Injury: (Howe, 2006)
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Test-retest Reliability: |
|
Item |
Test-retest (5 days apart) |
Test-retest (Immediate) |
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Unilateral stance left |
0.81 |
0.76 |
|
Unilateral stance right |
0.44 |
0.8 |
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Tandem walking |
0.59 |
0.85 |
|
1808 tandem pivot |
0.53 |
0.9 |
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Lateral foot scooting left |
0.54 |
0.74 |
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Lateral foot scooting right |
0.58 |
0.92 |
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Hopping forward left |
0.68 |
0.85 |
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Hopping forward right |
0.6 |
0.87 |
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Crouch and walk |
0.45 |
0.92 |
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Lateral dodging |
0.61 |
0.61 |
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Walking & looking left |
0.3 |
0.86 |
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Walking & looking right |
0.35 |
0.87 |
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Running with controlled stop |
0.58 |
0.85 |
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Forward to backward walking |
0.64 |
0.77 |
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Walk, look & carry left |
0.69 |
N/A |
|
Walk, look & carry right |
0.77 |
N/A |
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Descending stairs |
0.77 |
0.96 |
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Step-ups X 1 step left |
0.6 |
0.98 |
|
Step-ups X 1 step right |
0.51 |
0.94 |
Acquired Brain Injury in school-aged children and adolescents: (Wright et al, 2010)
Excellent test re-test reliability (3–10-day re-test interval) (ICC=0.90)
Traumatic Brain Injury: (Howe, 2006; n = 13 Physical Therapist raters, mean practice experience = 5.89 (4.4) years)
Inter-rater = 0.977 (CI = 0.972-0.988)
Inter and Intra-rater Reliability: |
|
Item |
Intra-rater |
Inter-rater |
|
Unilateral stance left |
0.89 |
0.87 |
|
Unilateral stance right |
0.92 |
0.98 |
|
Tandem walking |
0.71 |
0.85 |
|
1808 tandem pivot |
0.64 |
0.59 |
|
Lateral foot scooting left |
0.84 |
0.78 |
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Lateral foot scooting right |
0.62 |
0.88 |
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Hopping forward left |
0.81 |
0.81 |
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Hopping forward right |
0.76 |
0.86 |
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Crouch and walk |
0.64 |
0.7 |
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Lateral dodging |
0.53 |
0.78 |
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Walking & looking left |
0.34 |
0.53 |
|
Walking & looking right |
0.72 |
0.64 |
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Running with controlled stop |
0.78 |
0.67 |
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Forward to backward walking |
0.76 |
0.71 |
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Walk, look & carry left |
0.58 |
0.75 |
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Walk, look & carry right |
0.71 |
0.8 |
|
Descending stairs |
0.85 |
0.78 |
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Step-ups X 1 step left |
0.71 |
0.84 |
|
Step-ups X 1 step right |
0.82 |
0.85 |
Acquired Brain Injury in school-aged children and adolescents: (Wright et al, 2010)
Excellent interrater reliability (ICC=0.93)
Traumatic Brain Injury: (Howe, 2006; n = 32; participants were able to ambulate with or without aid, participants drawn from 3 locations including acute care, inpatient, day hospital, and outpatient; 5 days between assessments)
Acquired Brain Injury in school-aged children and adolescents: (Wright et al, 2010)
Traumatic Brain Injury: (Howe, 2006)
Traumatic Brain Injury : (Inness, 2011 n= 35 patients with TBI; 13 in-patients, 22 outpatients)
TBI patients and clinicians experienced in neurorehabilitation were involved in item generation. A group of PT's then rated items for relevance (Howe, 2006).
|
Traumatic Brain Injury: (Howe, 2006; n = 32; participants were able to ambulate with or without aid, participants drawn from 3 locations including acute care, inpatient, day hospital and outpatient; 5 days between assessments)
|
Acute Stroke: (Knorr et al, 2010)
|
Chedoke McMaster Stroke Assessment (CMSA) and Lower-Limb Strength Results across measures~: |
|
Variables |
CB&M (n = 44) |
BBS (n = 44) |
TUG (n = 42) |
|
CMSA leg |
0.63* |
0.54* |
-0.70* |
|
CMSA foot |
0.61* |
0.50† |
-0.69* |
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Paretic limb |
0.67* |
0.50* |
-0.71* |
|
Nonparetic limb |
0.46† |
0.28 |
-0.44† |
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~Spearman correlation coefficients |
Acute Stroke: (Knorr et al, 2010; n = 44; time post stroke (baseline assessment) 98.6 (52.6) days; Mean FIM scores, Motor = 82.0 (range = 20 to 91) Cog = 33.0 (range = 23 to 35) points)
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Floor and Ceiling Effects: |
|
Baseline (n = 44) |
Follow-Up (n = 44) |
| Scale |
Floor Effect |
Ceiling Effect |
Floor Effect |
Ceiling Effect |
| CB&M |
4 (9.1) |
0 (0.0) |
3 (6.8) |
0 (0.0) |
| BBS |
0 (0.0) |
15 (34.1)* |
0 (0.0) |
21 (47.7)* |
| TUG |
2 (4.5) |
10 (22.7)* |
0 (0.0) |
16 (36.4)* |
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*Significant effect (> 20%) |
|
|
Acute Stroke: (Knorr et al, 2010)
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Standardized Response Mean Across Measures: |
|
Variable |
Metric |
Baseline* |
Follow-Up* |
p |
SRM |
|
CB&M |
96 points |
42.7 (22.6) |
51.3 (24.6) |
<.001 |
0.83 |
|
BBS |
56 points |
48.9 (12.4) |
50.4 (11.0) |
<.010 |
0.42 |
|
TUG |
Seconds |
16.7 (17.1) |
13.7 (16.0) |
<.010 |
0.34 |
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*Mean (SD) |
Cerebral Palsy: (Bien et al, 2011; n = 4; mean age = 16 (2.25) years; The study span 5 days and used a 90 minute virtual reality balance intervention)
Older Women With Low Bone Mass: (Liu-Ambrose et al, 2006; n = 98; mean age = 79.3 (2.7) years)
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CB&M Norms: |
|
Measure |
Scale |
Mean (SD) |
Range |
|
CB & M |
max. 85 pts |
42 (19) |
0–81 |
|
MMSE |
max. 30 pts |
29 (2) |
24–30 |
|
ABC |
max. 100 pts |
77 (20) |
5–100 |
|
PASE |
85.8 (40.6) |
17.9–224.1 |
|
|
Fast-paced gait (m/s) |
1.38 (0.30) | 0.51–2.24 |
|
MMSE = Mini-Mental State Examination |
Healthy individuals aged 20-79 years (Clegg et al, 2009; n=54)
|
Age group |
N |
Mean* |
SD |
95% CI |
|
20-29 |
24 |
88.71 |
3.53 |
87.2-90.2 |
|
30-39 |
27 |
86.33 |
5.78 |
84.1-88.6 |
|
40-49 |
23 |
84.35 |
4.03 |
82.6-86.1 |
|
50-59** |
26 |
77.43 |
6.55 |
75.0-79.9 |
|
60-69** |
17 |
64.94 |
8.22 |
60.7-69.2 |
|
70-79** |
4 |
49.75 |
6.95 |
38.7-60.8 |
Community-dwelling persons after stroke: (Knorr et al, 2010)
Brien, M. and Sveistrup, H. (2011). "An intensive virtual reality program improves functional balance and mobility of adolescents with cerebral palsy." Pediatr Phys Ther 23(3): 258-266. Find it on PubMed
Clegg, H., Fernande, S., et al. (2009). "Community balance and mobility scale: age-related reference values."
Howe, J. A., Inness, E. L., et al. (2006). "The Community Balance and Mobility Scale--a balance measure for individuals with traumatic brain injury." Clin Rehabil 20(10): 885-895. 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.
Knorr, S., Brouwer, B., et al. (2010). "Validity of the Community Balance and Mobility Scale in community-dwelling persons after stroke." Arch Phys Med Rehabil 91(6): 890-896. Find it on PubMed
Liu-Ambrose, T., Khan, K. M., et al. (2006). "Falls-related self-efficacy is independently associated with balance and mobility in older women with low bone mass." J Gerontol A Biol Sci Med Sci 61(8): 832-838. Find it on PubMed
Wright, F. V., Ryan, J., et al. (2010). "Reliability of the Community Balance and Mobility Scale (CB&M) in high-functioning school-aged children and adolescents who have an acquired brain injury." Brain Inj 24(13-14): 1585-1594. Find it on PubMed
We have reviewed more than 500 instruments for use with a number of diagnoses including stroke, spinal cord injury and traumatic brain injury among several others.