21:- Balance and gait assessment tools Functional reach Turn 180 Berg Dynamic gait Performance assessment Timed get up and go Tool test Reference Simpson et al, 2002 Berg et al, 1992 Shumway-Cook, 1997 Duncan et al, 1990 Tinetti et al, 1986 Hospital and Setting community All All All All All Population Over 75s Ambulatory elderly Ambulatory elderly Ambulatory elderly Ambulatory elderly Ambulatory elderly 14 everyday movements Stand, and on assessed, including Assessment on ability to Assessment of Assessment of balance while request, turn 180 picking an object up perform 6 actions difference between performing actions including Stand, walk 3m, turn degrees without from the bed to including stepping over arms length and reaching object from high around, return to chair Test using supports chair transfer objects, stair climbing maximum shelf, standing and sitting and sit down Time needed Test is not timed 15 minutes 15 minutes 1 to 2 minutes 10 minutes 1 to 3 minutes Observer grades each Counting steps Scale of 0 to 56, with test 0 to 3, total score Time and observer Assessment taken to turn 180 sub-scales out of 24 Distance reached Short scale 0-28, long 0-40 assessment of fall risk Equipment Stopwatch, chair, bed, Force platform or Stopwatch, chair, 5lb object, Stopwatch, chair, 3m needed None ruler, stool Stairs yardstick high shelf, 15ft walkway walkway Training None Yes Yes Yes Yes Yes 12.7% experienced Acceptability a fear of falling Not known Not known Not known Not known Not known More than 4 is Score of 45 stated to Less than 6in or associated with indicate independently Less than 19 indicates 15cm indicates falls over 18 on short scale Various - 10 to 16 Cut-off increased falls risk safe risk risk predicts falls, seconds Appears to have clinical Detailed, extensively Lack of testing, full gait Assesses balance and utility based on time No evaluations tested, but time assessment, time perfomance, burden to and burden to assessor Conclusions identified consuming consuming Only assesses reach patients and patient Seems most Not appropriate - Could be carried out in Not appropriate - appropriate for limited use in primary care setting, limited and needs primary care data – younger but likely to be costly Not appropriate - specialist Not appropriate - from ProFaNE PHW populations to implement stairs equipment equipment needs indicate cut off Source:- NICE, 2004
21:- Balance and gait assessment tools Tool Turn 180 Berg Dynamic gait Functional reach test Performance assessment Timed get up and go Reference Simpson et al, 2002 Berg et al, 1992 Shumway-Cook, 1997 Duncan et al, 1990 Tinetti et al, 1986 Setting Hospital and community All All All All All Population Over 75s Ambulatory elderly Ambulatory elderly Ambulatory elderly Ambulatory elderly Ambulatory elderly Test Stand, and on request, turn 180 degrees without using supports 14 everyday movements assessed, including picking an object up from the bed to chair transfer Assessment on ability to perform 6 actions including stepping over objects, stair climbing Assessment of difference between arms length and maximum Assessment of balance while performing actions including reaching object from high shelf, standing and sitting Stand, walk 3m, turn around, return to chair and sit down Time needed Test is not timed 15 minutes 15 minutes 1 to 2 minutes 10 minutes 1 to 3 minutes Assessment Counting steps taken to turn 180 Scale of 0 to 56, with sub-scales Observer grades each test 0 to 3, total score out of 24 Distance reached Short scale 0-28, long 0-40 Time and observer assessment of fall risk Equipment needed None Stopwatch, chair, bed, ruler, stool Stairs Force platform or yardstick Stopwatch, chair, 5lb object, high shelf, 15ft walkway Stopwatch, chair, 3m walkway Training None Yes Yes Yes Yes Yes Acceptability 12.7% experienced a fear of falling Not known Not known Not known Not known Not known Cut-off More than 4 is associated with increased falls risk Score of 45 stated to indicate independently safe Less than 19 indicates risk Less than 6in or 15cm indicates falls risk over 18 on short scale predicts falls, Various - 10 to 16 seconds Conclusions No evaluations identified Detailed, extensively tested, but time consuming Lack of testing, full gait assessment, time consuming Only assesses reach Assesses balance and perfomance, burden to patients Appears to have clinical utility based on time and burden to assessor and patient PHW Not appropriate - limited use in younger populations Could be carried out in primary care setting, but likely to be costly to implement Not appropriate - stairs Not appropriate - limited and needs specialist equipment Not appropriate - equipment needs Seems most appropriate for primary care – data from ProFaNE indicate cut off Source:- NICE, 2004