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The Accuracy of Individual Berg Balance Scale Items Compared with the Total Berg Score for Classifying People with Chronic Stroke According to Fall History

Alzayer, Lamia PT, MS; Beninato, Marianne PT, DPT, PhD; Portney, Leslie G. PT, DPT, PhD, FAPTA

Journal of Neurologic Physical Therapy: September 2009 - Volume 33 - Issue 3 - pp 136-143
doi: 10.1097/NPT.0b013e3181b51307

Background and Purpose: To determine whether individual Berg Balance Scale (BBS) items or a group of items would have greater accuracy than the total BBS in classifying community-dwelling people with stroke with a history of multiple falls.

Methods: The subjects were 44 community-dwelling individuals with chronic stroke; 34 had one or no falls in the past six months, and 10 had multiple falls. Each BBS item was dichotomized at three points along the scoring scale of 0-4: between scores of 1 and 2, 2 and 3, and 3 and 4. Sensitivity (Sn), specificity (Sp), and positive (+LR) and negative (−LR) likelihood ratios were calculated for all items for each scoring dichotomy based on their accuracy in classifying subjects with a history of multiple falls. These findings were compared with the total BBS score where the cutoff score was derived from receiver operating characteristic curve analysis.

Results: Dichotomized point 3-4 for items B11 (turning 360 degrees), B12 (alternate foot on stool), B13 (tandem stance), and B14 (standing on one leg) all revealed Sn greater than 60%. B14 had the best Sn and Sp (0.90 and 0.50). Combining B11, B12, or B13 with B14 did not improve Sn. Total BBS receiver operating characteristic curve revealed a cutoff score of 52 (Sn = 90% and Sp = 41%).

Conclusion: Using selected items from the BBS may be more time efficient and accurate than the total BBS score for classifying people with chronic stroke living in the community with a history of multiple falls. Prospective study is needed to validate these findings relative to fall prediction.

Rehabilitation Services Unit (L.A.), Saudi Aramco Medical Services Organization (SAMSO), Dhahran, Saudi Arabia; Graduate Programs in Physical Therapy (M.B., L.G.P.), MGH Institute of Health Professions, CNY, Boston, Massachusetts.

Address correspondence to: Marianne Beninato, E-mail:

© 2009 Academy of Neurologic Physical Therapy, APTA