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RehabMeasures Instrument

Fullerton Advanced Balance Scale

Last Updated

Purpose

Test of both static and dynamic balance under varying sensory conditions. Designed to measure balance in higher-functioning active older adults.

Link to Instrument

Instrument Details

Acronym FAB Scale

Area of Assessment

Balance – Non-vestibular

Cost

Free

Diagnosis/Conditions

  • Brain Injury
  • Parkinson's Disease & Neurologic Rehabilitation

Key Descriptions

  • 10 performance-based activities in the test.
  • Score of 0-40 points possible (higher scores are better).
  • Items scored on a 5-point ordinal scale (0-4).
  • Administration instructions can be found at the above link.

Number of Items

10

Time to Administer

10-12 minutes

Required Training

No Training

ICF Domain

Activity

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

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

MS EDGE

UR

UR

UR

UR

UR

TBI EDGE

LS

LS

LS

LS

LS

Recommendations for use based on ambulatory status after brain injury:

 

Completely Independent

Mildly dependant

Moderately Dependant

Severely Dependant

TBI EDGE

LS

LS

LS

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

UR

UR

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)

MS EDGE

No

No

No

Yes

TBI EDGE

No

No

No

Not reported

 

The Academy of Oncologic Physical Therapy of the American Physical Therapy Association (APTA) formed the Cancer Evaluation Database to Guide Effectiveness (EDGE) Task Force to provide recommendations for outcome measures to use in patients affected by cancer. Below is the recommendation for use of the Fullerton Advanced Balance Scale. Recommendations were developed by research and clinical experts by critically appraising the literature to assess the psychometric properties and clinical utility of the outcome measure. Outcome measures were ranked using the Cancer EDGE Rating Scale.

Detailed information on recommendations for measures of balance in adult cancer survivors can be found at:

  • Huang MH, Hile E, Croarkin E, Wampler-Kuhn M,  Blackwood J, Colon G, Pfalzer L. Academy of Oncologic Physical Therapy EDGE Task Force: A Systematic Review of Measures of Balance in Adult Cancer Survivors. Rehabilitation Oncology. 2019;37:92-103.

 

Cancer EDGE Rating Scale:

 

4

Highly recommended

The outcome measure has excellent psychometric properties (reliability and validity AND have available data to guide interpretation) in condition of interest and excellent clinical utility (≤20 min, equip in clinic, no copyright payments, easy to score); the measure is free or reasonably accessible to a broad range of providers.

3

Recommended

The outcome measure has good psychometric properties (may lack some info about reliability, validity, responsiveness) in the population of interest and good clinical utility (>20 min, some equip, training, copyright fee); OR has excellent psychometric properties but is not free and may require access to specialized testing equipment that is beyond the means of many clinicians or clinics.

2

Reasonable to use

Limited study in the target group; the outcome measure has good or excellent psychometric properties and clinical utility in a related population, but insufficient study in the target population to support higher recommendation.

1

Not recommended

The outcome measure has poor psychometric properties and/or poor clinical utility.

 

Recommendation for use of the Fullerton Advanced Balance Scale in adult cancer survivors:

4          Highly Recommended

Considerations

  • Fairly new measure, with limited psychometric data and testing in populations other than older adults (Langley and Mackintosh, 2007)

Fullerton Advanced Balance Scale translations:

German:
http://link.springer.com/article/10.1007%2Fs00391-011-0236-8

These translations, and links to them, are subject to the Terms and Conditions of Use of the Rehab Measures Database. RIC is not responsible for and does not endorse the content, products or services of any third-party website, and does not make any representations regarding its quality, content or accuracy. If you would like to contribute a language translation to the RMD, please contact us at rehabmeasures@ric.org.

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Chronic Pain

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Criterion Validity (Predictive/Concurrent)

Fibromyalgia: (Cherry et al, 2012, = 68; mean age=59.54(7.50) years)

Predictive validity:

  • FAB predicting cognitive function:
    • Poor but significant correlation with attention/executive function (beta = 0.38, = 0.34), processing (beta = 0.44, = 0.37), and problem solving (beta=0.47, = 0.39)
    • Poor correlation with inhibition (beta = -0.21)

Cancer

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Test/Retest Reliability

Breast cancer (post chemotherapy): (Wampler et al, 2007; n=40, 20 with breast cancer, 20 healthy controls; mean age for sick = 50.35 (9.34) years; mean age for healthy = 49.60(9.08) years; treated with taxane chemotherapy)

  • Excellent test-retest reliability (ICC=0.98)

Interrater/Intrarater Reliability

Breast Cancer: (Wampler et al, 2007)

  • Excellent interrater reliability (ICC=0.98)

Construct Validity

Breast cancer (post chemotherapy): (Wampler et al, 2007)

  • Adequate correlation with SOT composite score (= 0.581)
  • Adequate correlation with COP velocity:
    • Eyes open/head straight (r = -0.581)
    • Eyes open/head back (r = -0.541)
    • Eyes closed/head straight (r = -0.523)
    • Eyes closed/head back (r = -0.496)

Older Adults and Geriatric Care

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Cut-Off Scores

Older adults (>=65 years): (Hernandez and Rose, 2008; n=192; mean age=77(6.5) years, independently, healthy functioning adults, n= 133 without fall in previous 12 months / n= 59 reported falling 2 or more times previous 12 months)

  • Score of 25/40 produces highest sensitivity (74.6%) and specificity (52.6%) in predicting fall risk
  • In 7 out of 10 cases an individual who scores 25 or lower is at a high risk for falls

Test/Retest Reliability

Older Adults: (Rose et al, 2006; = 46, mean age = 75(6.2) years; with (= 31) and without balance problems (= 15)); subset of = 31 for test-retest, mean age 75 (6.2) years, community dwelling healthy adults)

  • Excellent test re-test reliability (= 0.96) for total score
  • Adequate to excellent for individual test items (= 0.52 – 0.82)

Interrater/Intrarater Reliability

Older Adults: (Klein et al, 2010, = 480 community dwelling adults; mean age = 76.4(7.1) years; 20% reported >= 2 falls in past 12 months)

  • Excellent interrater reliability (ICC=0.955 – 0.999)

 

Older Adults: (Rose et al, 2006; subset of =31 for test-retest reliability; mean age = 75 (6.2) years)

  • Excellent interrater reliability for total score when administered by trained raters (= 0.94-0.97)
  • Excellent interrater reliability for total score (r = 0.93-1.00)

Internal Consistency

Older adults: (Rose et al, 2006)

  • Excellent internal consistency (H coefficients >0.75) for all 10 items

 

Older adults: (Klein et al, 2010)

  • Excellent internal consistency (Cronbach’s alpha=0.805)

Criterion Validity (Predictive/Concurrent)

Older adults: (Rose and Lucchese, 2006)

Concurrent validity:

  • Excellent correlation with BBS scores (= .75)

 

Older adults:(Hernandez and Rose, 2008)

Predictive validity:

  • Using retrospective self-report fall history and logistic regression, a cutoff  score of 25/40 predicts fallers
  • In 7 out of 10 cases an individual who scores 25 or lower is at a high risk for falls

Construct Validity

Older adults: (Rose et al, 2006; subset of n=31, mean age 75 (6.2) years)

Convergent validity:

  • Excellent with BBS (r = 0.75)

Content Validity

Older adults: (Rose et al, 2006)

  • Established through literature review, administration of test items to 15 older adults, reviewed by 4 experienced physical therapists

Floor/Ceiling Effects

Older adults: (Rose et al, 2006)

  • Item 1 may have a ceiling effect for independent functioning older adults

 

Older adults: (Hernandez and Rose, 2008)

  • Excellent (no ceiling effect, no participants achieved highest score of 40/40, only one participant (n = 192) achieved 38/40)

Bibliography

Cherry, B. J., Zettel-Watson, L., et al. (2012). "Positive associations between physical and cognitive performance measures in fibromyalgia." Arch Phys Med Rehabil 93(1): 62-71. Find it on PubMed

Hernandez, D. and Rose, D. J. (2008). "Predicting which older adults will or will not fall using the Fullerton Advanced Balance scale." Archives of Physical Medicine & Rehabilitation 89(12): 2309-2315. Find it on PubMed

Klein, P. J., Fiedler, R. C., et al. (2011). "Rasch Analysis of the Fullerton Advanced Balance (FAB) Scale." Physiother Can 63(1): 115-125. Find it on PubMed

Langley, F. A. and Mackintosh, S. F. H. (2007). "Functional balance assessment of older community dwelling adults: a systematic review of the literature." Internet Journal of Allied Health Sciences & Practice 5(4): 11p. Find it on PubMed

Rose, D. J., Lucchese, N., et al. (2006). "Development of a multidimensional balance scale for use with functionally independent older adults." Archives of Physical Medicine and Rehabilitation 87(11): 1478-1485. Find it on PubMed

Wampler, M. A., Topp, K. S., et al. (2007). "Quantitative and clinical description of postural instability in women with breast cancer treated with taxane chemotherapy." Arch Phys Med Rehabil 88(8): 1002-1008. Find it on PubMed

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