COSMIN database

Measurement instruments to assess posture, gait, and balance in Parkinson's disease: Critique and recommendations

Bloem, B. R., Marinus, J., Almeida, Q., Dibble, L., Nieuwboer, A., Post, B., Ruzicka, E., Goetz, C., Stebbins, G., Martinez-Martin, P., and Schrag, A.
BACKGROUND: Disorders of posture, gait, and balance in Parkinson's disease (PD) are common and debilitating. This MDS-commissioned task force assessed clinimetric properties of existing rating scales, questionnaires, and timed tests that assess these features in PD.

METHODS: A literature review was conducted. Identified instruments were evaluated systematically and classified as "recommended," "suggested," or "listed." Inclusion of rating scales was restricted to those that could be used readily in clinical research and practice.

RESULTS: One rating scale was classified as "recommended" (UPDRS-derived Postural Instability and Gait Difficulty score) and 2 as "suggested" (Tinetti Balance Scale, Rating Scale for Gait Evaluation). Three scales requiring equipment (Berg Balance Scale, Mini-BESTest, Dynamic Gait Index) also fulfilled criteria for "recommended" and 2 for "suggested" (FOG score, Gait and Balance Scale). Four questionnaires were "recommended" (Freezing of Gait Questionnaire, Activities-specific Balance Confidence Scale, Falls Efficacy Scale, Survey of Activities, and Fear of Falling in the Elderly-Modified). Four tests were classified as "recommended" (6-minute and 10-m walk tests, Timed Up-and-Go, Functional Reach).

CONCLUSION: We identified several questionnaires that adequately assess freezing of gait and balance confidence in PD and a number of useful clinical tests. However, most clinical rating scales for gait, balance, and posture perform suboptimally or have been evaluated insufficiently. No instrument comprehensively and separately evaluates all relevant PD-specific gait characteristics with good clinimetric properties, and none provides separate balance and gait scores with adequate content validity for PD. We therefore recommend the development of such a PD-specific, easily administered, comprehensive gait and balance scale that separately assesses all relevant constructs. (c) 2016 International Parkinson and Movement Disorder Society.
Mov Disord
1531-8257 (Electronic); 0885-3185 (Linking)
Publication year:
Symptom status:
Emotional state
Physical state
Functional status:
Physical functioning
Adults (18-65)
Seniors (65+)
Diseases of and symptoms related to the nervous system
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
10MWT - 10 Meter Walk Test   
6MWT - 6 Minute Walk Test    |  | also see:
ABC scale - Activities-specific Balance Confidence scale (versions: ABC-6; ABCm)   
BBS - Berg Balance Scale   
BESTest - Balance Evaluation Systems Test (versions: Brief BESTest; Mini BESTest)
DGI - Dynamic Gait Index (versions: DGI-4 or 4DGI)   
DYPAGS - Dynamic Parkinson's Gait Scale
FES - Falls Efficacy Scale
FFM - Fear of Falling Measure (University of Illinois at Chicago)
FGA - Functional Gait Assessment
FOG-Q - Freezing of Gait Questionnaire   
FRT - Functional Reach Test   
GABS - Clinical Gait and Balance Scale
LPA - Lindop Parkinson's Disease Mobility Assessment
Mini BESTest - Mini Balance Evaluation Systems Test   
mSAFFE - modified Survey of Activities and Fear of Falling in the Elderly
NFOG-Q - New Freezing of Gait Questionnaire   
PIDG - Postural Instability and Gait Difficulty (PIDG) score
RAPID - Rapid assessment of postural instability in Parkinson's disease
RSGE - Rating Scale for Gait Evaluation
Tinetti Balance Scale
Tinetti Gait and Balance Test
TIS - Trunk Impairment Scale (two different scales; one scale developed by Verheyden et al 2004; one scale developed by Fujiwara et al. 2004 )   
TUG - Timed Up and Go test   
Walk-12G - Generic Walking Scale