The Berg Balance Scale (BBS) is used to objectively determine a patient’s ability (or inability) to safely balance during a series of predetermined tasks. It is a 14 item list with each item consisting of a five-point ordinal scale ranging from 0 to 4, with 0 indicating the lowest level of function and 4 the highest level of function and takes approximately 20 minutes to complete. It does not include the assessment of gait.
Intended Population
Elderly population with impairment of balance, patients with acute stroke
Method of Use
Equipment required
- A ruler
- 2 standard chairs (one with arm rests, one without
- A footstool or step
- 15 ft walkway
- Stopwatch or wristwatch
The scale
ITEM DESCRIPTION SCORE (0-4)
Sitting to standing ________
Standing unsupported ________
Sitting unsupported ________
Standing to sitting ________
Transfers ________
Standing with eyes closed ________
Standing with feet together ________
Reaching forward with outstretched arm ________
Retrieving object from floor ________
Turning to look behind ________
Turning 360 degrees ________
Placing alternate foot on stool ________
Standing with one foot in front ________
Standing on one foot ________
Total ________
General instructions for completing the scale
Please document each task and/or give instructions as written. When scoring, please record the lowest response category that applies for each item.
In most items, the subject is asked to maintain a given position for a specific time. Progressively more points are deducted if:
- the time or distance requirements are not met
- the subject’s performance warrants supervision
- the subject touches an external support or receives assistance from the examiner
The subject should understand that they must maintain their balance while attempting the tasks. The choices of which leg to stand on or how far to reach are left to the subject. Poor judgment will adversely influence the performance and the scoring.
Equipment required for testing is a stopwatch or watch with a second hand, and a ruler or other indicator of 2, 5, and 10 inches. Chairs used during testing should be a reasonable height. Either a step or a stool of average step height may be used for item # 12.
Interpretation
Cut-off scores for the elderly were reported by Berg et al 1992 [6] as follows :
- A score of 56 indicates functional balance.
- A score of < 45 indicates individuals may be at greater risk of falling.
It has been reported more recently that in the elderly population a change of 4 points is needed to be 95% confident that true change has occurred if a patient scores within 45–56 initially, 5 points if they score within 35–44, 7 points if they score within 25–34 and, finally, 5 points if their initial score is within 0–24 on the Berg Balance Scale [7].
Evidence
Reliability
Studies of various elderly populations (N = 31–101, 60–90 + years of age) have shown high intrarater and interrater reliability (ICC =.98,14,15 ratio of variability among subjects to total = .96–1.0,16 rs =.8817). Test-retest reliability in 22 people with hemiparesis is also high (ICC [2,1]=.98).[8]
Validity
Content validity of the BBS was established in a 3-phase development process involving 32 health care professionals who were experts working in geriatric settings. Criterion-related validity has been supported by moderate to high correlations between BBS scores and other functional measurements in a variety of older adults with disability.
Responsiveness
Increasing age has not been shown to correlate with decreasing BBS scores.
Limitations
In ataxic clients it cannot, however, reflect problems in the performance of daily living activities, which are caused by the effects of ataxia on the upper extremities, because none of the items are designed to do this.
