COSMIN database

How to measure balance in clinical practice. A systematic review of the psychometrics and clinical utility of measures of balance activity for neurological conditions

Tyson, S. F. and Connell, L. A.
Objective: To identify psychometrically robust and clinically feasible measurement tools of balance activity in people with neurological conditions to recommend for use in clinical practice. Data sources: MEDLINE, CINAHL, EMBASE, PEDro and AMED. Review methods: Independent reviewers selected and extracted data from articles that assessed the reliability, validity, sensitivity to change and clinical utility of measures of balance activity in adult neurological conditions. Quality assessment was based on Jorstad et al. Measures with ‘good’ psychometrics and 9/10 clinical utility scores were recommended. Results: Nineteen measurement tools were selected. Of these, the Brunel Balance Assessment, Berg Balance Scale, Trunk Impairment Scale, arm raise and forward reach tests in sitting and standing, weight shift, step/tap and step-up tests reached the required standards and are usable in clinical practice. The Brunel Balance Assessment and its associated functional performance tests have the additional advantages of being a hierarchical scale with established lack of redundancy. Conclusion: The measurement tools identified above are psychometrically robust and feasible to use in clinical practice. Future objective measure development should consider the theoretical construct of the measure, the minimal detectable change and use in clinical populations other than stroke.
<Go to ISI>://WOS:000269345700006
Clinical Rehabilitation
Publication year:
Functional status:
Physical functioning
Adults (18-65)
Seniors (65+)
Diseases of and symptoms related to the circulatory system
Diseases of and symptoms related to the nervous system
Injury, poisoning and certain other consequences of external causes
Mental and behavioural disorders and related symptoms
PRO / non-PRO:
Non-patient Reported Outcome
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
4 - Performance-based tests
6 - Clinical rating scales
7 - Observations
BBA - Brunel Balance Assessment
BBS - Berg Balance Scale   
FMA - Fugl-Meyer Motor Assessment (versions: S-FA)   
MAS - Motor Assessment Scale   
Romberg Test
Sandin Sitting Balance
SBS - Standing Balance Scale
Sitting arm raise
Sitting forward reach
Standing bending forward reach
Standing + physical task
Tandem Stance [alias: sharpened Romberg] (versions: Tandem and Unipedal Stance; semi-tandem; parallel)
Tap test
Timed standing balance tests
TIS - Trunk Impairment Scale (two different scales; one scale developed by Verheyden et al 2004; one scale developed by Fujiwara et al. 2004 )   
Weight shift