Recommendations for a Core Outcome Set for Measuring Standing Balance in Adult Populations: A Consensus-Based Approach

Abstract

BackgroundStanding balance is imperative for mobility and avoiding falls. Use of an excessive number of standing balance measures has limited the synthesis of balance intervention data and hampered consistent clinical practice.ObjectiveTo develop recommendations for a core outcome set (COS) of standing balance measures for research and practice among adults.MethodologyA combination of scoping reviews, literature appraisal, anonymous voting and face-to-face meetings with fourteen invited experts from a range of disciplines with international recognition in balance measurement and falls prevention. Consensus was sought over three rounds using pre-established criteria.Data sourcesThe scoping review identified 56 existing standing balance measures validated in adult populations with evidence of use in the past five years, and these were considered for inclusion in the COS.ResultsFifteen measures were excluded after the first round of scoring and a further 36 after round two. Five measures were considered in round three. Two measures reached consensus for recommendation, and the expert panel recommended that at a minimum, either the Berg Balance Scale or Mini Balance Evaluation Systems Test be used when measuring standing balance in adult populations.LimitationsInclusion of two measures in the COS may increase the feasibility of potential uptake, but poses challenges for data synthesis. Adoption of the standing balance COS does not constitute a comprehensive balance assessment for any population, and users should include additional validated measures as appropriate.ConclusionsThe absence of a gold standard for measuring standing balance has contributed to the proliferation of outcome measures. These recommendations represent an important first step towards greater standardization in the assessment and measurement of this critical skill and will inform clinical research and practice internationally.

Components of Standing Postural Control Evaluated in Pediatric Balance Measures: A Scoping Review

“…24 It was recently recommended by an international expert panel as suitable for a core outcome set or minimum data set for research and practice in adult populations. 69 Neither of these pediatric studies reported any adverse events in using either version of the BESTest. Given their inclusion of missing components in existing pediatric balance measures, comprehensiveness, and endorsed use in adult populations, one or both represent good candidates for initial validation in pediatric populations.…”

The Mini-BESTest: a review of psychometric properties

“…The ability to measure outcomes using a shorter instrument has many practical advantages over long-form instruments, for example better acceptability for the study population and better feasibility for the administering staff (Pollock et al, 2011;Rolstad et al, 2011). For these reasons, the MiniBESTest has increasingly been used and validated to assess balance impairments in several conditions (including a series of neurological diseases), and has recently been identified as the most comprehensive balance measure by different research groups (Pardasaney et al, 2013;Sibley et al, 2015aSibley et al, , 2015b.…”

Is the Effect of a High-Intensity Functional Exercise Program on Functional Balance Influenced by Applicability and Motivation among Older People with Dementia in Nursing Homes?

“…Three of every 10 (29.6%) participants had sustained previous hip fractures, and four of every five (81.5%) used mobility devices, such as wheelchairs and walkers ( Table 1). The median [interquartile range (IQR)] number of attended sessions was 34 (30)(31)(32)(33)(34)(35)(36)(37). The participants performed high-intensity strength exercises at a median (IQR) of 16 (3.5-27.0) sessions and high-intensity balance exercises at a median (IQR) of 24 (11.0-31.5) sessions.…”

“…Another consideration is whether the selected measure (the BBS) actually captured the effect of exercise for all participants. A review, however, confirmed the suggested use of the BBS as a core measure of functional balance outcomes in adults (37). Furthermore, the dichotomization of outcome variables has disadvantages; data variety is lost, and participants with deteriorated balance are equalized with those with balance improvement below the MDC.…”

“…Given that the ability to perform functional activities is multifaceted, the BBS also reflects aspects other than balance, such as lower-limb strength and dynamic movements, which are important for mobility. The BBS is a valid, reliable instrument for the measurement of balance function and evaluation of intervention effects, and it is recommended as a core outcome measure in clinical settings and for research in adult populations (37). Individual differences in BBS scores between follow-up and baseline testing were dichotomized to define two groups -responders (≥5 point increase) and non-responders (<5 point increase, including no change or decrease) -according to the minimal detectable change (MDC).…”