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Usefulness of the Berg Balance Scale to Predict Falls in the Elderly

Neuls, Patrick D. PT, DPT1; Clark, Tammie L. PT, DPT2; Van Heuklon, Nicole C. PT, DPT3; Proctor, Joy E. PT4; Kilker, Barbra J. PT, DPT5; Bieber, Mallory E. PT6; Donlan, Alice V. PT, DPT, MBA7; Carr-Jules, Suchitha A. PT, DPT8; Neidel, William H. PT, DPT9; Newton, Roberta A. PT, PhD5

Journal of Geriatric Physical Therapy: January/March 2011 - Volume 34 - Issue 1 - p 3–10
doi: 10.1097/JPT.0b013e3181ff2b0e
Systematic Review

Objective: The purpose of this systematic review was to complete a comprehensive search and review of the literature to determine the ability of the Berg Balance Scale (BBS) to predict falls in the elderly with and without pathology. Specifically, the cutoff score that is most predictive of falls in the older adults and the sensitivity and specificity of the BBS in predicting falls.

Methods: A search of English-language–based literature with relevant search terms using the OVID, CINAHL, PubMed, and MEDLINE search engines from 1985 to March 2009.

Results: Nine studies warranted inclusion in this systematic review after evaluation for article objectives, inclusion criteria, and scoring 5 or more out of 10 on the Physiotherapy Evidence Database scale. Five studies addressed the elderly population ( = 65 years) without pathology. The remaining 4 studies addressed elderly participants with neurological disorders. All 9 studies reported sensitivity and specificity of the BBS in predicting falls. Sensitivity and specificity results varied greatly depending on the cutoff score and the author's objectives. Eight of the 9 studies recommended specific cutoff scores.

Discussion and Conclusion: The BBS alone is not useful for predicting falls in the older adults with and without pathological conditions. Given the varied recommended cutoff scores and psychometric values, clinicians should use the BBS in conjunction with other tests/measures considering unique patient factors to quantify the chances of falls in the older adults. This study recommends research to formulate a scoring algorithm that can further enhance the clinician's ability to predict falls in the older adults.

1HealthSouth Rehabilitation Hospital, Toms River, New Jersey.

2Nash Community College, Rocky Mount, North Carolina.

3UW Hospital and Clinics, Madison, Wisconsin.

4Susquehanna Health Neuroscience Center, Williamsport, Pennsylvania.

5Temple University, Philadelphia, Pennsylvania.

6The Reading Hospital and Medical Center, Reading, Pennsylvania.

7Phoebe Services, Allentown, Pennsylvania.

8Odenton, Maryland.

9Gaylord Hospital, Wallingford, Connecticut.

Address correspondence to: Patrick D. Neuls, PT, DPT, Healthsouth Rehabilitation Hospital, 14 Hospital Drive, Toms River, NJ 08755 (Patrick.Neuls@healthsouth.com).

We thank Temple University, and Dr Roberta Newton for her guidance in the writing and editing of this paper.

Copyright © 2011 the Section on Geriatrics of the American Physical Therapy Association
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