Question 2

2. You want to evaluate joe's balance. What tests could you use? What is the reliability and validity of the different test? Cite references to support your answers.

A. I could use the Dynamic Gait Index (DGI) test. This test has been shown to be a valid and reliable tool and it looks beyond static balance and measures dynamic balance during walking tasks. (Betsy)
http://journals.lww.com/jnpt/Fulltext/2004/12000/Reliability_and_Validity_of_the_Dynamic_Gait_Index.39.aspx

B. You could use the BERG balance test. Though the test does not have a high sensitivity, it is helpful as a general guideline to determine balance and fall risk. It does have high specificity. (Denise)
http://physicaltherapyjournal.com/content/76/6/576.short
After reading the BERG balance test, it has tests that I feel would be more functional of Joe's job. For example, it has sit and reach tests, turning to look behind and more. Since Joe is a bus driver, I feel it is necessary to assess his balance when he is sitting and transfering to standing. (Megan)
http://www.fallpreventiontaskforce.org/pdf/BergBalanceScale.pdf

C. I would perform the Star Excursion Balance Test. The purpose of the Star Excursion Balance Test (SEBT) is to determine the function of an individual’s lower extremity while identifying any changes or injury. The SEBT challenges the individual’s stability and balance. Reliability-Intrasession Reliability Estimates between .067 and 0.87, Intratester/Intertester Reliability between 0.82 and 0.96, therefore the SEBT test was shown to be valid. Validity -From the information provided with the articles published on the SEBT there was no information specifically discussing this tests validity. http://pt.unlv.edu/ebpt/tests.html (Carley)

D. Five Time Sit to Stand Test: The pt. crosses their arms over their chest and then go from sitting to standing 5 times as fast as they can. A normal time is 15 seconds or less for a healthy adult. This test will assess both strength in the LE and balance as a whole. According to the Journal of Strength and Conditioning Research this test has a good to high reliability. It would prove to be a valid test as well since we have learned that strength and balance are both important factors in a sit to stand transfer. *http://www.ptproductsonline.com/issues/articles/2008-09_04.asp; http://journals.lww.com/nsca-jscr/Abstract/2011/11000/Test_Retest_Reliability_of_the_Five_Repetition.36.aspx** (Kristen)

E. Tinetti balance test is an easily administered test to measure a patient’s gait and balance ability. The test is used to evaluate the patient’s ability to perform specific tasks and is used as a predictive measure for falls. This test has been shown to have predictive validity and consistently correlate with the berg balance test but may not be significantly sensitive to changes in balance. For this reason this may not be the best test for this patient, but is an option that could be used in conjunction with other tests. http://pt.unlv.edu/ebpt/tests.html (Dani)

F. The Spring Scale Test is a test that have shows reliability and validity in measuring an individual's standing balance. The research done shows a sensitivity 0.93 of and a specificity of 0.97. The Spring Scale Test (SST) is more specifically tests balance by pulling on a rope that is around a patient to assess their balance.
http://journals.lww.com/jgpt/Fulltext/2009/32040/The_Spring_Scale_Test__A_Reliable_and_Valid_Tool.4.aspx (Laura)

Since the Spring Scale Test is based on balance and reactions to movement, I think this would be an appropriate test to perform on Joe. Since he drives a bus, reaction time is key. I would like to assess this to make sure he is safe on the road and isn't putting others, or himself, in danger. (Liz)

G. The One Legged (Single Limb) Stance is a test that is reliable in measuring balance impairments."It has been reported in the literature that individuals increase their chances of sustaining an injury due to a fall by two times if they are unable to perform a One-Legged Stance Test for five seconds." It has an interrater eyes open and eyes closed ICC of 0.99 and a test retest of eyes open ICC of 0.90 and of eyes closed ICC of 0.74. (Marleigh K.)
Magee, David J. Orthopedic Physical Assesment 5th Edition pg 128
http://physical-therapy.advanceweb.com/Article/One-Legged-Single-Limb-Stance-Test.aspx

H. The Activities-specific and Balance Confidence (ABC) Scale is a questionnaire that asks participants to rate their confidence in performing certain activities without losing their balance or becoming unsteady. The scale has a high retest reliability and has good validity, especially in samples of older people with mild balance impairments and people who had fractured their hip (according to the study linked below). The study also found a .84 sensitivity and .87 specificity. (Mandy)
http://ajp.physiotherapy.asn.au/AJP/vol_51/3/AustJPhysiotherv51i3Clinimetrics.pdf

I. I would use the Timed "Up and Go" Test. The Timed "Up and Go" (TUG) Test is a reliable test of basic functional mobility for frail, elderly individuals. The test requires the person to stand up from a chair, walk 10 feet (3 meters), turn around, and walk back and sit down. The score is the time taken to complete the task. People who complete the task in less than 20 seconds have been shown to be independent in activities of daily living. In contrast, those requiring 30 seconds or more to complete the task are more likely to be dependent in activities of daily living and generally require assistive devices for ambulation. Recent research suggests that the TUG test has the ability to identify individuals with hip fractures at risk for new falls.10 This is important considering the fact that following the first hip fracture, less than 50% of patients will regain their prior level of function following the fracture and are three times more likely to be functionally dependent, and four times less likely than those who have not fallen to return to walking in the community.11 Currently, 10% to 13% of patients will later sustain a second hip fracture that will further impact their mobility and social independence.12 The TUG test is very brief and takes only minutes to complete. http://www.ptproductsonline.com/issues/articles/2008-09_04.asp (Colby)

J. The four step square test (FSST) could be performed to assess Joe's ability to change direction while stepping. Four canes are set-up like a cross on the floor with the tips of the canes facing together. The patient stands on the upper left square to start and completes this sequence: (clockwise):Square 1, square 2, square 4, square 3, return to square 1
Then (counterclockwise): Back to square 3, square 4, square 2, and end in square 1. I would ask Joe to "try to complete the sequence as fast as possible without touching the sticks. Both feet must make contact with the floor in each square. If possible, face forward during the entire sequence.” I'd ask Joe to repeat the sequence if he makes contact with the canes or loses his balance. The FSST has good reliability and good correlations with other gait measures. Overall, the FSST is a reliable and valid tool for measuring the ability to perform multidirectional movements in people with balance deficits due to vestibular disorders.
http://www.rehabmeasures.org/Lists/RehabMeasures/DispForm.aspx?ID=900 (Erin)
Measure of stepping speed. The FSST test can be cognitively challenging having to do certain sequences. Second, combinations of movements are necessary to complete the test. Patients are required to weight shift from one foot to the other while changing direction. The FSST is an "all-or-nothing" test, in that a score cannot be given to a patient or client who does not complete the test. The patient or client must complete the test in order to get a score or measurement on speed and stepping sequence accuracy. (Amanda)

K. I would use the Romberg test. The Romberg test is performed with the patient standing with their feet together, with their eyes open and while looking at a fixed point straight ahead. They try and keep their balance without swaying or falling. If they pass this part of the test, they close their eyes and perform the same test. If they do sway or fall then they have a positive Romberg test. The Romberg test tests for myelopathies and neuropathies associated with sensory dysfunction. If a patient displays a positive Romberg sign then the physician can conclude that the ataxia is sensory related and not cerebellar related. There was limited evidence available that detailed the reliability and validity of the Romberg test. However, in a test-retest reliability study, consisting of 37 subjects, they were able to derive that the Romberg test performed with the eyes open had an Intraclass Correlation Coefficient (ICC) of .86, and an ICC of .84 when eyes were closed.
http://pt.unlv.edu/ebpt/tests/Callegari_Romberg_Balance_Test.doc (Amber)

L. We could use the Functional Reach Test. This tests the patient's stability while leaning forward and reaching as far as possible with arms stretched out and parallel to the floor out in front of their body. A normal reach is at least six inches, measured from the distance the fist has traveled during the reach.The reliability for this test is .89, the specificity is 34%, and the sensitivity is 76%. (Melissa)
http://www.injuryresearch.bc.ca/publications/repository/functional%20reach%20test.pdf
http://www.enotes.com/balance-coordination-tests-reference/balance-coordination-tests-171755

QUESTIONS:
1. For the FSST, is there a time limit for completion of the test?
This test should take less than 5 minutes to complete. The patient should be given this test twice, and then the faster time is used for the score on the test. A trial should be re-started of the patient loses his/her balance, makes contact with one of the canes on the floor, or doesn't perform the sequence correctly. (Britt)

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