PASS is a postural assessment scale specifically designed to assess and monitor postural control after stroke. It contains 12 four-level items of varying difficulty for assessing ability to maintain or change a given lying, sitting, or standing posture.
Intended Population
Stroke patients
Available Versions
The PASS was developed in 1999 by Benaim et al. as an adaptation of the Fugl-Meyer Assessment balance subscale (Benaim et al., 1999). It was originally developed in French and has since been translated into English and Swedish (SwePASS). Short forms of the PASS, with fewer items (5-item SFPASS) and/or smaller scoring scales (PASS-3P), have also been developed.[1]
Method of Use
The PASS consists of 2 sections with a 4-point scale to describe each task. The total score ranges from 0 – 36 and is as follows:[2]
Maintaining Posture
1: Sitting without support
0 = cannot sit
1 = can sit with slight support (e.g. by 1 hand)
2 = can sit for more than 10 seconds without support
3 = can sit for 5 minutes without support
2: Standing with support
0 = cannot stand, even with support
1 = can stand with strong support of 2 people
2 = can stand with moderate support of 1 person
3 = can stand with support on only 1 hand
3: Standing without support
0 = cannot stand without support
1 = can stand without support for 10 seconds or leans heavily on 1 leg
2 = can stand without support for 1 minute or stands slightly asymmetrically
3 = can stand without support for more than 1 minute and at the same time perform arm movements above the shoulder level
4 and 5: Standing on the nonparetic / paretic leg
0 = cannot stand on the leg
1 = can stand on the leg for a few seconds
2 = can stand on the leg for more than 5 seconds
3 = can stand on the leg for more than 10 seconds
Changing a Posture
Scoring of items 6 to 12 is as follows (items 6 to 11 are to be performed with a 50-cm-high examination table, like a Bobath plane; items 10 to 12 are to be performed without any support; no other constraints):
6. Supine to affected side lateral
7. Supine to non-affected side lateral
8. Supine to sitting up on the edge of the table
9. Sitting on the edge of the table to supine
10. Sitting to standing up
11. Standing up to sitting down
12. Standing, picking up a pencil from the floor
Items 6 – 12
0 = cannot perform the activity
1 = can perform the activity with much help
2 = can perform the activity with little help
3 = can perform the activity without help
Training requirements
No special training is required, although clinicians should have an understanding of balance impairment and related safety issues following stroke.[1]
Evidence
Reliability
PASS is one of most reliable clinical assessment scale.Mao et al. (2002) examined the inter-rater reliability of the PASS using α-coefficient for individual item reliability and Pearson product moment correlation for total score reliability. Two clinicians assessed patients at 14 days post-stroke on the same day, with a total sample of 112 patients. Inter-rater reliability for individual items was adequate to excellent (median α=0.88, range 0.61-0.96) and inter-rater reliability for the total score was excellent (ICC=0.97, 95% CI 0.95-0.98).
Benaim et al. (1999) measured inter-rater reliability of the PASS using α-coefficient for individual item reliability and Pearson product moment correlation for total score reliability. Two clinicians assessed patients with stroke on the same day, with a total sample of 12 patients. The authors reported adequate to excellent inter-rater reliability for individual items (average α=0.88, range 0.64-1) and excellent inter-rater reliability for the total score (r=0.99, p<0.001). [1]
Validity
PASS is one of the most valid clinical assessments of postural control in stroke patients during the first 3 months after stroke[2]
Mao et al. (2002)[3] examined the predictive validity of the PASS, Berg Balance Scale and the Fugl-Meyer Assessment modified balance scale at 14, 30 and 90 days post-stroke by comparison with the Motor Assessment Scale walking subscale score at 180 days post-stroke, in a sample of 123 patients. The PASS demonstrated excellent predictive validity at all time points (α=0.86-0.90), as measured using Spearman’s p correlation coefficient.[2]
Sensitivity
The high sensitivity of the scale during the acute stages of a stroke is excellent and is shown by its’ ability to discriminate between patients with right and left brain damage[4]
