COSMIN database

Comprehensive clinical sitting balance measures for individuals following stroke: a systematic review on the methodological quality

Birnbaum, M., Hill, K., Kinsella, R., Black, S., Clark, R., and Brock, K.
PURPOSE: The aim of this systematic review was to examine the psychometric properties of published clinical sitting measurement scales containing dynamic tasks in individuals following stroke.

METHOD: Databases, including Cumulative Index of Nursing and Allied Health Literature (CINAHL), MEDLINE, EMBASE, Cochrane, PubMed and Allied and Complementary Medicine Database (AMED) were searched from inception to December 2015. The search strategy included terms relating to sitting, balance and postural control. Two reviewers independently selected and extracted data from the identified articles and assessed the methodological quality of the papers using the COnsensus-based Standards for selection of health status Measurement INstruments (COSMIN) checklist.

RESULTS: Fourteen clinical sitting measurement scales (39 papers) containing dynamic tasks met the inclusion criteria and various measurement properties were evaluated. The methodological quality of the majority of the included studies was rated as poor to fair using the COSMIN checklist, with common limitations including small sample size and inappropriate use of statistical methods.

CONCLUSIONS: This review was unable to identify measures with sufficient psychometric properties to enable recommendation as preferred tools. However, measures were identified that warrant further specific psychometric investigations to fulfil requirements for a high quality measure. Implications for Rehabilitation Fourteen clinical sitting balance scales containing dynamic tasks are available to measure sitting balance with individuals following stroke. No single scale has sufficient psychometric properties to enable recommendation as a preferred tool for measuring sitting balance with stroke survivors. Use of a balance scale or dedicated sitting balance measure containing static and dynamic sitting items should be utilised to monitor progress for individuals following stroke with more severe deficits.
Disabil Rehabil
Publication year:
Biological and physiological variables:
Biological and physiological variables
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
PRO / non-PRO:
Non-patient Reported Outcome
Type of measurement instrument:
4 - Performance-based tests
6 - Clinical rating scales
Balance CAT - Balance Computerized Adaptive Testing (CAT) System
BBA - Brunel Balance Assessment
COVS - Clinical Outcome Variables Scale
Dynamic sitting TELER indicator
FIST - Function In Sitting Test
HBSF - Hierarchical Balance Short Forms
MAS - Motor Assessment Scale   
mFRT - modified Functional Reach Test
PAS - Physical Ability Scale
PCBSS- Postural Control and Balance for Stroke Scale
SAS - Stroke Activity Scale
Sit-and-reach test   
Sitting Balance Scale for hemiplegia
TIS - Trunk Impairment Scale (two different scales; one scale developed by Verheyden et al 2004; one scale developed by Fujiwara et al. 2004 )