Comparing the short and original versions of the Activities-specific Balance Confidence (ABC) scale in older adults

Abstract Balance confidence assessment in older adults has implications for falls and quality of life. It remains unclear whether the original Activities-specific Balance Confidence (ABC-16) scale or the shortened 6-item (ABC-6) scale is recommended. To further inform the decision-making process of balance confidence tool selection, a secondary analysis of an existing dataset consisting of 77 community-dwelling older adults was performed. ABC-16 and ABC-6 association and agreement, internal consistencies, and relationships with self-rated health (SRH) were assessed. Participants were primarily female (80.5%) between the ages of 60 and 87 years. Results indicated a strong association between the scales [r = .97, p<.001); ICC(2,1) = .80] but limited agreement (95% Limits of Agreement range = 22.1; mean difference of 7.2 points in the direction of the ABC-16). Cronbach’s alphas were .95 (ABC-16) and .89 (ABC-6), suggesting high internal consistency for both scales but possible item redundancy with the ABC-16. Regression model 1 (ABC-6 = primary predictor) explained more of the variance (R2=.36) in SRH compared to model 2 (ABC-16 = primary predictor; R2=.29). Hotelling’s t-test [t(74)=2.4, p=.008] indicated that the correlation coefficient (Multiple R) from the ABC-6 model was significantly higher than the correlation coefficient from the ABC-16 model. In conclusion, despite a high correlation, the two scales did not agree strongly and should not be considered interchangeable. Given that the ABC-16 takes longer to administer, does not relate to SRH as strongly, and could have redundant items, the ABC-6 should be considered for balance confidence assessment in older adults.

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Determinants of Satisfaction With Community Reintegration in Older Adults With Chronic Stroke: Role of Balance Self-Efficacy

Physical Therapy ◽

10.2522/ptj.20060142 ◽

2007 ◽

Vol 87 (3) ◽

pp. 282-291 ◽

Cited By ~ 89

Author(s):

Marco YC Pang ◽

Janice J Eng ◽

William C Miller

Keyword(s):

Older Adults ◽

Self Efficacy ◽

Secondary Analysis ◽

Chronic Stroke ◽

Community Dwelling ◽

Physical Factors ◽

Community Reintegration ◽

Bivariate Correlation ◽

Scale Scores ◽

Abc Scale

Background and Purpose Many people with stroke have a low level of satisfaction with community reintegration. Although previous studies focused on the effect of physical factors on community reintegration, the effect of psychological factors, such as balance self-efficacy, has been ignored. The purpose of this study was to determine the contribution of balance self-efficacy to satisfaction with community reintegration in older adults with chronic stroke. Subjects A sample of 63 community-dwelling older adults (50 years of age or older) with chronic stroke (onset of 1 year or more) participated in this study. Methods This study involved a secondary analysis of data collected from a stroke exercise clinical trial. Satisfaction with community reintegration was measured with the Reintegration to Normal Living (RNL) Index, and balance self-efficacy was measured with the Activities-specific Balance Confidence (ABC) Scale. Results Bivariate correlation analyses showed that the RNL Index scores were moderately correlated with the ABC Scale scores. In a multiple regression analysis, after adjusting for age, sex, depression, and other impairments after stroke, balance self-efficacy remained independently associated with the RNL Index scores, accounting for 6.5% of the variance in the RNL Index scores. Discussion and Conclusion Balance self-efficacy is an independent predictor of satisfaction with community reintegration in older adults with chronic stroke. Improving balance self-efficacy may be instrumental in enhancing community reintegration in this population.

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Interpreting the Need for Initial Support to Perform Tandem Stance Tests of Balance

Physical Therapy ◽

10.2522/ptj.20110283 ◽

2012 ◽

Vol 92 (10) ◽

pp. 1316-1328 ◽

Cited By ~ 13

Author(s):

Elizabeth S. Hile ◽

Jennifer S. Brach ◽

Subashan Perera ◽

David M. Wert ◽

Jessie M. VanSwearingen ◽

...

Keyword(s):

Older Adults ◽

Support Group ◽

Hold Time ◽

Secondary Analysis ◽

Community Dwelling ◽

Cross Sectional ◽

Balance Confidence ◽

Initial Support ◽

The Impact ◽

Community Dwelling Older Adults

Background Geriatric rehabilitation reimbursement increasingly requires documented deficits on standardized measures. Tandem stance performance can characterize balance, but protocols are not standardized. Objective The purpose of this study was to explore the impact of: (1) initial support to stabilize in position and (2) maximum hold time on tandem stance tests of balance in older adults. Design A cross-sectional secondary analysis of observational cohort data was conducted. Methods One hundred seventeen community-dwelling older adults (71% female, 12% black) were assigned to 1 of 3 groups based on the need for initial support to perform tandem stance: (1) unable even with support, (2) able only with support, and (3) able without support. The able without support group was further stratified on hold time in seconds: (1) <10 (low), (2) 10 to 29, (medium), and (3) 30 (high). Groups were compared on primary outcomes (gait speed, Timed “Up & Go” Test performance, and balance confidence) using analysis of variance. Results Twelve participants were unable to perform tandem stance, 14 performed tandem stance only with support, and 91 performed tandem stance without support. Compared with the able without support group, the able with support group had statistically or clinically worse performance and balance confidence. No significant differences were found between the able with support group and the unable even with support group on these same measures. Extending the hold time to 30 seconds in a protocol without initial support eliminated ceiling effects for 16% of the study sample. Limitations Small comparison groups, use of a secondary analysis, and lack of generalizability of results were limitations of the study. Conclusions Requiring initial support to stabilize in tandem stance appears to reflect meaningful deficits in balance-related mobility measures, so failing to consider support may inflate balance estimates and confound hold time comparisons. Additionally, 10-second maximum hold times limit discrimination of balance in adults with a higher level of function. For community-dwelling older adults, we recommend timing for at least 30 seconds and documenting initial support for consideration when interpreting performance.

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Multidirectional Overground Robotic Training Leads to Improvements in Balance in Older Adults

Robotics ◽

10.3390/robotics10030101 ◽

2021 ◽

Vol 10 (3) ◽

pp. 101

Author(s):

Lara A. Thompson ◽

Mehdi Badache ◽

Joao Augusto Renno Brusamolin ◽

Marzieh Savadkoohi ◽

Jelani Guise ◽

...

Keyword(s):

Older Adults ◽

Healthy Aging ◽

Robotic System ◽

Control Group ◽

Support Surface ◽

Training Methods ◽

Robotic Training ◽

Balance Confidence ◽

Balance Ability ◽

Abc Scale

For the rapidly growing aging demographic worldwide, robotic training methods could be impactful towards improving balance critical for everyday life. Here, we investigated the hypothesis that non-bodyweight supportive (nBWS) overground robotic balance training would lead to improvements in balance performance and balance confidence in older adults. Sixteen healthy older participants (69.7 ± 6.7 years old) were trained while donning a harness from a distinctive NaviGAITor robotic system. A control group of 11 healthy participants (68.7 ± 5.0 years old) underwent the same training but without the robotic system. Training included 6 weeks of standing and walking tasks while modifying: (1) sensory information (i.e., with and without vision (eyes-open/closed), with more and fewer support surface cues (hard or foam surfaces)) and (2) base-of-support (wide, tandem and single-leg standing exercises). Prior to and post-training, balance ability and balance confidence were assessed via the balance error scoring system (BESS) and the Activities specific Balance Confidence (ABC) scale, respectively. Encouragingly, results showed that balance ability improved (i.e., BESS errors significantly decreased), particularly in the nBWS group, across nearly all test conditions. This result serves as an indication that robotic training has an impact on improving balance for healthy aging individuals.

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Validation of a Laser Ranged Scanner-Based Detection of Spatio-Temporal Gait Parameters Using the aTUG Chair

Sensors ◽

10.3390/s21041343 ◽

2021 ◽

Vol 21 (4) ◽

pp. 1343

Author(s):

Sebastian Fudickar ◽

Jörn Kiselev ◽

Christian Stolle ◽

Thomas Frenken ◽

Elisabeth Steinhagen-Thiessen ◽

...

Keyword(s):

Correlation Coefficient ◽

Measurement Accuracy ◽

Dynamic Balance ◽

Step Length ◽

Berg Balance Scale ◽

Walking Ability ◽

Functional Requirements ◽

Balance Confidence ◽

Gait Parameters ◽

Abc Scale

This article covers the suitability to measure gait-parameters via a Laser Range Scanner (LRS) that was placed below a chair during the walking phase of the Timed Up&Go Test in a cohort of 92 older adults (mean age 73.5). The results of our study demonstrated a high concordance of gait measurements using a LRS in comparison to the reference GAITRite walkway. Most of aTUG’s gait parameters demonstrate a strong correlation coefficient with the GAITRite, indicating high measurement accuracy for the spatial gait parameters. Measurements of velocity had a correlation coefficient of 99%, which can be interpreted as an excellent measurement accuracy. Cadence showed a slightly lower correlation coefficient of 96%, which is still an exceptionally good result, while step length demonstrated a correlation coefficient of 98% per leg and stride length with an accuracy of 99% per leg. In addition to confirming the technical validation of the aTUG regarding its ability to measure gait parameters, we compared results from the GAITRite and the aTUG for several parameters (cadence, velocity, and step length) with results from the Berg Balance Scale (BBS) and the Activities-Specific Balance Confidence-(ABC)-Scale assessments. With confidence coefficients for BBS and velocity, cadence and step length ranging from 0.595 to 0.798 and for ABC ranging from 0.395 to 0.541, both scales demonstrated only a medium-sized correlation. Thus, we found an association of better walking ability (represented by the measured gait parameters) with better balance (BBC) and balance confidence (ABC) overall scores via linear regression. This results from the fact that the BBS incorporates both static and dynamic balance measures and thus, only partly reflects functional requirements for walking. For the ABC score, this effect was even more pronounced. As this is to our best knowledge the first evaluation of the association between gait parameters and these balance scores, we will further investigate this phenomenon and aim to integrate further measures into the aTUG to achieve an increased sensitivity for balance ability.

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Urdu Translation and Validation of Activities-Specific Balance Confidence (ABC) Scale

10.53350/pjmhs2115123505 ◽

2021 ◽

Vol 15 (12) ◽

pp. 3505-3508

Author(s):

Noor Ul Ain Fatima ◽

Qurat-Ul- Ain ◽

Fareeha Kausar ◽

Mian Ali Raza ◽

Misbah Waris ◽

...

Keyword(s):

Older Adults ◽

Construct Validity ◽

Correlation Coefficient ◽

Content Validity ◽

Assessment Tool ◽

Test Reliability ◽

Validity And Reliability ◽

A Value ◽

Abc Scale ◽

Translation And Validation

Objective: To translate and validate the ABC-Scale in Urdu language to predict risk of fall in older population. Study design: Cross-cultural Translation and validation Place and Duration: Study was conducted in older adult community of Sialkot from March 2020 to December 2020. Methodology: Translation of ABC in Urdu was conducted by using Beaton et al guidelines. Two bilingual translators translated the original version into Urdu language step wise, correction process was followed. Then two backward translations were done by language expert. After all this process, the translated version was reviewed by the professionals and the final version was applied on 15 individuals. Its reliability and validity was tested on 60 older adults. Results: For test re test reliability, intra class correlation coefficient ICC was measured with a value of 0.984 Which shows good test re-test reliability. The internal consistency and reliability of ABC was calculated by Cronbach’s alpha for total score with a value of 0.985. Content validity was good with values of CVI ranging from 0.767 to 0.955. To test the discriminative validity, independent t test was used to show the difference between the healthy and unhealthy adults. Factor analysis of UABC showed total variance 81.277 and cumulative variance was also 81.277. To calculate construct validity of U-ABC Pearson’s correlation coefficient was used and measured as 0.558. Conclusion: It was concluded that Urdu version of UABC is a valid assessment tool for older adults with fear of fall. It has good content validity, construct validity and reliability. Keywords: activities specific balance scale, validation, Urdu translation, reliability, tool translation

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90 Falls Efficacy Related Instruments for Community-Dwellig Older Adults – Development and Content Validity: A Cosmin-Based Systematic Review

Age and Ageing ◽

10.1093/ageing/afz164.90 ◽

2019 ◽

Vol 48 (Supplement_4) ◽

pp. iv18-iv27 ◽

Cited By ~ 1

Author(s):

Shawn Leng-Hsien Soh ◽

Chee-Wee Tan ◽

Lane Judith ◽

Nigel Gleeson ◽

Tim Xu

Keyword(s):

Older Adults ◽

Content Validity ◽

Community Dwelling ◽

High Quality ◽

Structural Validity ◽

Balance Confidence ◽

High Quality Evidence ◽

Community Dwelling Older Adults ◽

Quality Evidence ◽

Selection Of

Abstract Background Falls efficacy is a widely-studied latent construct in community-dwelling older adults. Various self-reported instruments have been used to measure falls efficacy. Empirical evidence is needed to justify the selection of a specific instrument to measure the intended construct. Objectives To summarize evidence on the development, content validity and structural validity of instruments measuring falls efficacy in community-dwelling older adults using Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. Study Design and Setting MEDLINE, Web of Science, PsychINFO, SCOPUS, CINAHL were searched (May 2019). Records on development of instruments and studies assessing content validity or structural validity of falls efficacy related scales were included. COSMIN methodology guided the review of eligible studies and methodological quality. Evidence of content validity: relevance, comprehensiveness and comprehensibility and unidimensionality for structural validity were synthesized. A modified GRADE approach was applied to evidence synthesis. Results 35 studies on 18 instruments were included in the review. High quality evidence showed that modified Falls-Efficacy Scale (FES)–13 items (mFES-13) is relevant but not comprehensive for measuring falls efficacy. Moderate quality evidence supported the FES-10 had sufficient relevance and the mFES-14 had sufficient comprehensibility. Only the Activities-specific Balance Confidence (ABC) Scale–Simplified (ABC-15) had sufficient relevance of moderate quality evidence to measure balance confidence. Low to very low quality evidence underpinned content validity of other instruments. High quality evidence supported sufficient unidimensionality for eight instruments (FES-10, mFES-14, ABC-6, ABC-15, ABC-16, Iconographical FES (Icon-FES), FES–International (FES-I) and Perceived Ability to Prevent and Manage Fall Risks (PAPMFR)). Conclusion Content validity of the instruments to measure falls efficacy is understudied. Structural validity is sufficient for a number of widely-used instruments. Measuring balance confidence is a subset of falls efficacy. Further work is needed to investigate the broader continuum of falls efficacy.

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Chinese Martial Art Training Failed to Improve Balance or Inhibit Falls in Older Adults

Perceptual and Motor Skills ◽

10.1177/0031512518824945 ◽

2019 ◽

Vol 126 (3) ◽

pp. 389-409 ◽

Cited By ~ 1

Author(s):

Ada W. W. Ma ◽

Hsing-Kuo Wang ◽

Duan-Rung Chen ◽

Ya-Mei Chen ◽

Yvonne T. C. Chak ◽

...

Keyword(s):

Older Adults ◽

Outcome Measures ◽

Muscle Activation ◽

Community Dwelling ◽

Peak Force ◽

Control Group ◽

Balance Performance ◽

Balance Confidence ◽

Martial Art ◽

Knee Flexors

This randomized controlled trial explored the effects of a Ving Tsun (VT) Chinese martial art training program on reactive standing balance performance, postural muscle reflex contraction latency, leg muscle performance, balance confidence and falls in community-dwelling older adults. We randomly assigned 33 healthy older adults to either a VT group (mean age = 67.5 years) or a control group (mean age = 72.1 years). The VT group received two 1-hour VT training sessions per week for three months (24 sessions). Primary outcome measures collected before and after the intervention period were electromyographic muscle activation onset latencies of the hamstring and gastrocnemius and the center of pressure path, length and movement velocity in standing (reactive balance performance). Secondary outcome measures included isometric peak force and time to isometric peak force of the knee extensors and flexors, the Activities-Specific Balance Confidence Scale score, and fall history. Results revealed that the mean gastrocnemius muscle activation onset latency was significantly longer (22.53 ms) in the VT group after the intervention. The peak force of the knee flexors significantly increased (by 1.58 kg) in the control group over time but not in the VT group. The time to reach peak force in the knee flexors was significantly longer (by 0.51 s) in the control group (but not the VT group) at posttest compared with the pretest value. No other significant group, time, or group-by-time interaction effects were noted. We discussed possible reasons for the failure of three months of martial art training to benefit fall risks among these older adults.

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The role of attentional focus on walking efficiency among older fallers and non-fallers

Age and Ageing ◽

10.1093/ageing/afz113 ◽

2019 ◽

Vol 48 (6) ◽

pp. 811-816 ◽

Cited By ~ 3

Author(s):

Toby C T Mak ◽

William R Young ◽

Wing-Kai Lam ◽

Andy C Y Tse ◽

Thomson W L Wong

Keyword(s):

Older Adults ◽

Behavioural Change ◽

Attentional Focus ◽

Community Dwelling ◽

Thigh Muscle ◽

Balance Confidence ◽

Functional Balance ◽

History Of ◽

And Control ◽

Community Dwelling Older Adults

Abstract Background This study evaluated the effect of attentional focus instructions on movement efficiency during a level-ground walking task in older adults with and without a history of falls. Methods One hundred and thirty-four community-dwelling older adults were categorised into older fallers (OF) (n = 37) and older non-fallers (ONF) (n = 97). Each participant was instructed to walk at a self-selected pace along a 6 m walkway under three attentional focus conditions (i.e. internal, goal-directed and control) for a total of nine trials. Average muscle activity indices of lower limb co-contractions were measured using surface electromyography. Results Both shank and thigh muscle co-contractions were higher in OF than in ONF in all three conditions. OF also demonstrated higher shank muscle co-contraction under the internal relative to the goal-directed condition, with no such change observed in ONF. Conclusion Despite no significant between-group differences in functional balance and balance confidence, relative walking inefficiencies were observed in OF compared with ONF. This finding demonstrates the debilitating consequences of falling that can occur with relative independence from various physiological or psychological factors that are commonly associated with falling and used to rationalise behavioural change. We also provide evidence that OF are more susceptible to conditions that provoke them to allocate attention internally. Therefore, in clinical contexts (e.g. gait rehabilitation), verbal instructions that refer to body movements (internal focus) might serve to compromise movement efficiency in older adults with a history of falls. Such changes will, theoretically, lessen the ability to react efficiently to changing environments experienced in daily life.

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Validity and reliability testing of the Spanish version of the BESTest and mini-BESTest in healthy community-dwelling elderly

BMC Geriatrics ◽

10.1186/s12877-020-01724-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Pilar Dominguez-Olivan ◽

Angel Gasch-Gallen ◽

Esmeralda Aguas-Garcia ◽

Ana Bengoetxea

Keyword(s):

Psychometric Properties ◽

Correlation Coefficient ◽

Internal Consistency ◽

Elderly Women ◽

Pearson Correlation ◽

Strong Association ◽

Intraclass Correlation ◽

Community Dwelling ◽

Validity And Reliability ◽

Convenience Sample

Abstract Background The Balance Evaluation Systems Test (BESTest) and its abbreviated version, the Mini-BESTest are clinical examination of balance impairment, but its psychometric properties have not yet been tested in European Spanish. We aimed to assess the psychometric properties of BESTest and Mini-BESTest in Spanish in community-dwelling elderly people. Methods We designed a cross-sectional transcultural adaptation and validation study. Convenience sample of thirty (N-30) adults aged 65 to 89 years old without balance problems were recruited. Two physiotherapists assessed participants at the same time. Internal consistency of Spanish BESTest and Mini-BESTest was carried out by obtaining the Cronbach Alpha. The reproducibility between raters was studied with the Intraclass Correlation Coefficient. The Pearson correlation coefficient was calculated by comparing the relationship between the BESTest, mini-BESTest, Berg Balance Scale (BBS) and Falls Efficacy Scale-International (FES-I). Results BESTest and Mini-BESTest showed good internal consistency. BESTest and Mini-BESTest total scores showed an excellent inter-rater agreement. There was a significant correlation between total score of the BESTest and the Mini-BESTest (r = 0.65; p < 0.001). BESTest had a moderate association with BBS and a strong association with FES-I. Mini-BESTest had a fair correlation with BBS and FES-I. Total scores obtained by women at BESTest and at Mini-BESTest were significantly lower than those reached by men. The differences observed in all the test when disaggregating data by sex require further research. Conclusions Spanish versions of BESTest and Mini-BESTest are comprehensible for new raters. They are reliable tools to provide information on which particular balance systems show impairment in community dwelling older adults. Elderly women had a worse quality of balance and a greater perception of their risk of falling. Trial registration This study was registered in ClinicalTrials.gov with NCT 03403218 on 2018/01/17.

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