Quantification of Static and Dynamic Balance While Maintaining and Changing Body Position

Use of a Short Version of the Activities-specific Balance Confidence Scale in Multiple Sclerosis

BACKGROUND

Multiple sclerosis (MS) is a neurologic disease that results in balance and mobility impairments that are associated with elevated fall risk. One common patient-reported outcome measure of balance is the 16-item Activities-specific Balance Confidence (ABC) scale. The ABC scale is valid and reliable in assessing balance confidence in people with MS. However, a shorter, six-question version of the ABC scale, the ABC-6 scale, has been proposed to save time in a clinical setting. Thus, we assessed the convergent validity and internal consistency reliability of the ABC-6 scale in people with MS.

METHODS

A total of 221 participants were included in this secondary analysis to compare the ABC-6 scale with the ABC scale. Convergent validity and internal consistency reliability were applied to participants based on fall history and physiological fall risk.

RESULTS

Statistical analysis indicated a main effect of group of the ABC and ABC-6 scales (P < .001). Both scales showed good to very good internal consistency (Cronbach α range, 0.832-0.975) and good reliability (intraclass correlation coefficient score range, 0.888-0.941). Furthermore, both versions had moderate convergent validity. Sensitivity ranged from 30% to 97%, and specificity ranged from 64% to 100% across groups tested.

CONCLUSIONS

The ABC and ABC-6 scales demonstrated good internal consistency reliability and moderate convergent validity in predicting balance confidence in people with MS. However, poor sensitivity of both versions in distinguishing between MS groups at risk for falls may call into question the usefulness of this self-report measure.

Dual-task training effects on motor and cognitive functional abilities in individuals with stroke: a systematic review

Objective:

This systematic review aimed to examine the effects of dual-task balance and mobility training in people with stroke.

Methods:

An extensive electronic databases literature search was conducted using MEDLINE, PubMed, EBSCO, The Cochrane Library, Web of Science, SCOPUS, and Wiley Online Library. Randomized controlled studies that assessed the effects of dual-task training in stroke patients were included for the review (last search in December 2017). The methodological quality was evaluated using the Cochrane Collaboration recommendation, and level of evidence was determined according to the criteria described by the Oxford Center for Evidence-Based Medicine.

Results:

About 13 articles involving 457 participants were included in this systematic review. All had substantial risk of bias and thus provided level IIb evidence only. Dual-task mobility training was found to induce more improvement in single-task walking function (standardized effect size = 0.14–2.24), when compared with single-task mobility training. Its effect on dual-task walking function was not consistent. Cognitive-motor balance training was effective in improving single-task balance function (standardized effect size = 0.27–1.82), but its effect on dual-task balance ability was not studied. The beneficial effect of dual-task training on cognitive function was provided by one study only and thus inconclusive.

Conclusion:

There is some evidence that dual-task training can improve single-task walking and balance function in individuals with stroke. However, any firm recommendation cannot be made due to the weak methodology of the studies reviewed.

Reconceptualizing balance: attributes associated with balance performance

Balance tests are commonly used to screen for impairments that put older adults at risk for falls. The purpose of this study was to determine the attributes that were associated with balance performance as measured by the Frailty and Injuries: Cooperative Studies of Intervention Techniques (FICSIT) balance test. This study was a cross-sectional secondary analysis of baseline data from a longitudinal cohort study, the Boston Rehabilitative Impairment Study of the Elderly (Boston RISE). Boston RISE was performed in an outpatient rehabilitation research center and evaluated Boston area primary care patients aged 65 to 96 (N=364) with self-reported difficulty or task-modification climbing a flight of stairs or walking 1/2 of a mile. The outcome measure was standing balance as measured by the FICSIT-4 balance assessment. Other measures included: self-efficacy, pain, depression, executive function, vision, sensory loss, reaction time, kyphosis, leg range of motion, trunk extensor muscle endurance, leg strength and leg velocity at peak power. Participants were 67% female, had an average age of 76.5 (±7.0) years, an average of 4.1 (±2.0) chronic conditions, and an average FICSIT-4 score of 6.7 (±2.2) out of 9. After adjusting for age and gender, attributes significantly associated with balance performance were falls self-efficacy, trunk extensor muscle endurance, sensory loss, and leg velocity at peak power. FICSIT-4 balance performance is associated with a number of behavioral and physiologic attributes, many of which are amenable to rehabilitative treatment. Our findings support a consideration of balance as multidimensional activity as proposed by the current International Classification of Functioning, Disability, and Health (ICF) model.