Psychometric Properties of the Persian Version of the Berg Balance Scale in People with Lower Amputations

Document Type : Original article

Authors

1 MSc, Motor Behavior, Alzahra University, Tehran, Iran

2 Assistant Professor, Motor Behavior, Alzahra University, Tehran, Iran

Abstract

Background and Aims: The purpose of the present study was to evaluate the psychometric properties of the Berg balance scale instrument in Tehran's people lower limb amputations.
 Materials and Methods: A descriptive and cross-sectional study was conducted on 83 individuals (38 athlete and 45 non-athlete amputees) (age: 38±5 years) with lower limb amputation who were selected using convenience sampling based on inclusion criteria. The instruments of the present study were Berg balance test, artificial intelligence (mobility section) questionnaire, two-minute walk test, L functional mobility test, and digital scales to determine body mass index. For data analysis, we used Cronbach's alpha, intra-class correlation coefficient, Pearson correlation, and independent test
Results: Internal consistency was obtained for Berg  balance scale (α = 0/89) and Cronbach's alpha variability in Berg balance subscales (0/73 to 0/76). The Intraclass correlation coefficient (ICC) was greater than 90% for all substructures. Also, the Intraclass correlation coefficients (ICC) for evaluating intra-rater reliability and inter-rater reliability was greater than %90 for all leaf balance subscales. Content Validity Index (CVI) was evaluated to be  0/94. Correlation coefficients related to the reliability of the Berg balance test constructs with each of the artificial limb assessment tests (r = 0/57), two-minute walking test (r = -0/25), functional mobility test (r=-0/48), and activity specific balance test (r = 0/59) were found. Independent test-retest results showed that the Berg balance test between athlete and non-athlete lower limb amputation had a discriminant validity (p < 0/05).
Conclusion: Given the validity and reliability of the Berg balance test, this instrument can be used to evaluate lower amputee individuals in Tehran.

Keywords

Main Subjects


1. Stevens J, Corso P, Finkelstein E, Miller T. The cost of fatal and non-fatal falls among older adults. Inj Prev 2006; 12: 290–295.##
2. Ziegler-Graham K, MacKenzie E, Ephraim P, Travison T, BrookmeyerR. Estimating the prevalence of limb loss in the UnitedStates: 2005 to 2050. Arch Phys Med Rehabil 2008; 89: 422–429. ##
3. Miller W, Deathe A, Speechley M, Koval J. The influence of falling,fear of falling, and balanceconfidence on prosthetic mobility andsocial activity among individuals with a lower extremity amputation.Arch Phys Med Rehabil 2001; 82: 1238–1244. ##
4. Christopher Kevin Wong, Christine C. Chen, Wren M. Blackwell, Rana T. Rahal, and Stephany A. Benoy. Balance ability measured with the Berg Balance Scale: a determinant of fa ll history in community-dwelling adults with leg amputation. J Rehabil Med 2015; 47: 80–86. ##
5. van Velzen JM, van Bennekom CA, PolomskiW, et al. Physical capacity and walkingability' after lower limb amputation: a systematicreview. Clin Rehabil. 2006;20:999-1016. ##
6.  Miller WC, Speechley M, Deathe B. The prevalence and risk factorsof falling and fear of falling among lower extremity amputees. ArchPhys Med Rehabil 2001;82:1031-7. ##
7. Kulkarni J, Wright S, Toole C, Morris J, Hirons R. Falls in patientswith lower limb amputations: prevalence and contributing factors.Physiotherapy 1996;82:130-6. ##
8. Pauley T, Devlin M, Heslin K. Falls sustained during inpatientrehabilitation after lower limb amputation: prevalence and predictors.Am J Phys Med Rehabil 2006;85:521-32; quiz 33-5. ##
9. Blake AJ, Morgan K, Bendall MJ, et al. Falls by elderly people athome: prevalence and associated factors. Age Ageing 1988;17:365-72. ##
10. Campbell AJ, Reinken J, Allan BC, Martinez GS. Falls in old age:a study of frequency and related clinical factors. Age Ageing 1981;10:264-70. ##
11. Norvell DC, Turner AP, Williams RM, Hakimi KN, Czerniecki JM.Defining successful mobility after lower extremity amputation forcomplications of peripheral vascular disease and diabetes. J VascSurg 2011;54:412-9. ##
12.  Pedrinelli A, Saito M, Coelho RF, Fontes RB, Guarniero R.Comparative study of the strength of the flexor and extensor musclesof the knee through isokinetic evaluation in normal subjects andpatients subjected to trans-tibial amputation. Prosthet Orthot Int2002;26:195-205. ##
13. Nadollek H, Brauer S, Isles R. Outcomes after trans-tibialamputation: the relationship between quiet stance ability,strength of hip abductor muscles and gait. Physiother Res Int2002;7:203-14. ##
14. Kavounoudias A, Tremblay C, Gravel D, Iancu A, Forget R. Bilateralchanges in somatosensory sensibility after unilateral below-kneeamputation. Arch Phys Med Rehabil 2005;86:633-40. ##
15. Geurts AC, Mulder TW, Nienhuis B, Rijken RA. Postural reorganizationfollowing lower limb amputation: possible motor and sensorydeterminants of recovery. Scand J Rehabil Med 1992;24:83-90. ##
16. Quai TM, Brauer SG, Nitz JC. Somatosensation, circulation andstance balance in elderly dysvascular transtibial amputees. ClinRehabil 2005;19:668-76. ##
17. Jayakaran P, Johnson GM, Sullivan SJ, NitzJC. Instrumented measurement of balanceand postural control in individuals withlower limb amputation: a critical review.Int J Rehabil Res. 2012;35:187–196. ##
18. Franchignoni F, Giordano A, Ferriero G, et al. Measuring mobility in people with lowerlimb amputation: Rasch analysis of the mobility section of the prosthesis evaluationquestionnaire. J Rehabil Med, 2007;39:138-144. ##
19. Gailey RS, Roach KE, Applegate EB, et al. The Amputee Mobility Predictor: aninstrument to assess determinants of the lower-limb amputee ability to ambulate. Arch PhysMed Rehabil, 2002;83:613-627. ##
20. Hislop HJ, Montgomery J. Daniels and Worthingham’s muscletesting: techniques of manual examination. 8th ed. St. Louis: Saunders;1995. ##
21. Norkin CC, White DJ. Measurement of joint motion: a guide togoniometry. 3rd ed. Philadelphia: F.A. Davis Company; 2003. ##
22. Deathe AB, Wolfe DL, Devlin M, Hebert JS, Miller WC,Pallaveshi L. Selection of outcome measures in lower extremityamputation rehabilitation: ICF activities. Disabil Rehabil 2009;31:1455-73. ##
23. Tyson SF, Connell LA: How to measure balance in clinical practice. A systematic reviewof thepsychometrics and clinical utility of measures of balance activity for neurologicalconditions. Clin Rehabil2009; 23: 824-40. ##
24. Berg KO, Maki BE, Williams JI, et al.: Clinical and laboratory measures of posturalbalance in an elderly population. Arch Phys Med Rehabil 1992; 73: 1073-80##
25. Gosselin S, Desrosiers J, Corriveau H, et al.: Outcomes during and after inpatientrehabilitation: comparison between adults and older adults. J Rehabil Med 2008; 40: 55-60. ##
26. Yazicioglu K, Taskaynatan M, Guzelkucuk U, et al.: Effect of playing football (soccer) onbalance, strength, and quality of life in unilateral below-knee amputees. Am JPhys MedRehabil2007; 86: 800-5. ##
27. Ülger Ö, Topus S, Bayramlar K. Effects of a hydraulic knee joint on energy consumption,gait and patient satisfaction in trans-femoral amputees. Fizyoter Rehabil2009; 20: 169-77. ##
28. Cowley A, Kerr K. Amputees and tightropes: a pilot study to measure postural controlpost-amputation. Phys Ther Reviews2001; 6: 5-15##
29. Berg K, Wood-Dauphinee S, Williams JI, Gayton D. Measuringbalance in the elderly: validation of an instrument. PhysiotherCanada 1989;41:304-11. ##
30. Berg KO, Maki BE, Williams JI, Holliday PJ, Wood-Dauphinee SL.Clinical and laboratory measures of postural balance in an elderlypopulation. Arch Phys Med Rehabil 1992;73:1073-80. ##
31. Sahin F, Yilmaz F, Ozmaden A, Kotevolu N, Sahin T, Kuran B.Reliability and validity of the Turkish version of the Berg BalanceScale. J Geriatr Phys Ther 2008;31:32-7. ##
32. Halsaa KE, Brovold T, Graver V, Sandvik L, Bergland A. Assessmentsof interrater reliability and internal consistency of theNorwegian version of the Berg Balance Scale. Arch Phys MedRehabil 2007;88:94-8. ##
33. Wirz M, Muller R, Bastiaenen C. Falls in persons with spinal cordinjury: validity and reliability of the Berg Balance Scale. NeurorehabilNeural Repair 2010;24:70-7. ##
34. Lemay JF, Nadeau S. Standing balance assessment in ASIA Dparaplegic and tetraplegic participants: concurrent validity of theBerg Balance Scale. Spinal Cord 2010;48:245-50. ##
35. Ditunno JF Jr, Barbeau H, Dobkin BH, et al. Validity of the walkingscale for spinal cord injury and other domains of function ina multicenter clinical trial. Neurorehabil Neural Repair 2007;21:539-50. ##
36. Rougier PR, Bergeau J. Biomechanical analysis of postural control ofpersons with transtibial or transfemoral amputation. Am J Phys MedRehabil 2009;88:896-903. ##
37. Hermodsson Y, Ekdahl C, Persson BM, Roxendal G. Standingbalance in trans-tibial amputees following vascular disease ortrauma: a comparative study with healthy subjects. Prosthet OrthotInt 1994;18:150-8. ##
38. Vanicek N, Strike S, McNaughton L, Polman R. Postural responses todynamic perturbations in amputee fallers versus nonfallers:a comparative study with able-bodied subjects. Arch Phys MedRehabil 2009;90:1018-25 . ##
39. Christopher K. Wong. Interrater Reliability of the Berg Balance Scale When Used by Clinicians of Various Experience Levels to Assess People With Lower Limb Amputations. American Physical Therapy Association. 2014;94:371-378. ##
40. Matthew J. Major, Stefania Fatone, BPO(Hons),Elliot J. Roth, MD. Validity and Reliability of the Berg Balance Scale for Community-Dwelling Persons With Lower-Limb Amputation. Physical Medicine and Rehabilitation 2013;94:2194-202. ##
41. Christopher Kevin Wong, Christine C. Chen, Jenna Welsh. Preliminary Assessment of BalanceWith the Berg Balance Scale in Adults Who Have a Leg Amputation and Dwell in the Community: Rasch Rating Scale Analysis.. American Physical Therapy Association. 2013;93:1520–1529. ##
42. Legro MW, Reiber GD, Smith DG, et al.: Prosthesis evaluation questionnaire for persons with lower limb amputations: assessing prosthesis-related quality of life. Arch Phys Med Rehabil, 1998, 79: 931–938. ##
43. Deathe AB, Miller WC. The L test of functional mobility:measurement properties of a modified version of the timed “up & go”test designed for people with lower-limb amputations. Phys Ther2005;85:626-35. ##
44. Brooks D, Parsons J, Hunter JP, Devlin M, Walker J. The 2- minute walk test as a measure of functional improvement in persons with lower limb amputation. Arch Phys Med Rehabil 2001;82:1478-83. ##
45. Solway S, Brooks D, Lacasse Y, Thomas S. A qualitative systematic review of the measurement properties of functional walk tests used in the cardiorespiratory domain. Chest 2001;119:256-70. ##
46. Hunter SW, Batchelor F, Hill KD, Hill A-M, Mackintosh S, Payne M. Risk factors for falls in people with a lower limb amputation: a systematic review. PM R. 2017;9:170-180. ##
47. Kimberly Vu, Michael W.C. Payne, Susan W. Hunter, PT, Ricardo Viana. Risk Factors for Falls in Individuals With Lower Extremity Amputations During the Pre-Prosthetic Phase: A Retrospective Cohort Study. American Academy of Physical Medicine and Rehabilitation 2019, 6: 1-6. https://dx.doi.org/10.1002/pmrj.12046. ##
Volume 9, Issue 4
January 2021
Pages 183-195
  • Receive Date: 27 September 2019
  • Revise Date: 20 December 2019
  • Accept Date: 25 March 2020
  • First Publish Date: 21 December 2020