Postural Assessment Scale for Stroke Patients (PASS)

Purpose of the measure

The PASS is comprised of 12 items of increasing difficulty that measure balance in lying, sitting and standing. It was designed specifically for patients with stroke, regardless of postural competence (Barros de Oliveira et al., 2008; Mao et al., 2002). The PASS measures the patient’s ability to maintain stable postures as well as equilibrium in changes of position (Di Monaco et al., 2010). It includes items not assessed by the Berg Balance Scale (Blum & Korner-Bitensky, 2008) and demonstrates better psychometric properties than the Berg Balance Scale and the Fugl-Meyer Assessment modified balance subscale (Mao et al., 2002).

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.

Features of the measure

Items
The PASS consists of 12 items of graded difficulty:

Maintaining a posture

  • Sitting without support (sitting on the edge of a 50cm-high examination table with feet touching the floor)
  • Standing with support (feet position free, no other constraints)
  • Standing without support (feet position free, no other constraints)
  • Standing on nonparetic leg (no other constraints)
  • Standing on paretic leg (no other constraints)

Changing Posture

  • Supine to affected side lateral
  • Supine to nonaffected side lateral
  • Supine to sitting up on edge of table
  • Sitting on edge of table to supine
  • Sit-to-stand (without any support, no other constraints)
  • Stand-to-sit (without any support, no other constraints)
  • Standing, picking up a pencil from the floor (without any support, no other constraints) (Barros de Oliveira et al., 2008)

Scoring
The PASS consists of a 4-point scale where items are scored from 0 – 3. The total score ranges from 0 – 36 (Barros de Oliveira et al., 2008).

Item 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

Item 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

Item 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

Items 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

Items 6 – 10
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

Description of tasks
Items are graded by difficulty, whereby lying and sitting items are easier than standing items. Items 6 (supine to the affected side lateral) and 7 (supine to nonaffected side lateral) are the easiest items; item 5 (standing on the paretic leg) is the most difficult item of the assessment (Benaim et al., 1999).

What to consider before beginning

Time
The PASS takes 1 to 10 minutes to administer (Benaim et al., 1999).

Training requirements
No special training is required, although clinicians should have an understanding of balance impairment and related safety issues following stroke.

Chien et al. (2007b) note that the different scoring criteria for several items of the PASS may pose difficulties for less-trained assessors, and recommends the simpler SFPASS as an alternative.

Equipment

  • 50cm-high examination table (e.g. Bobath plane)
  • Chronometer
  • Pen
Alternative forms of the PASS

Chien et al. (2007b) developed a short form PASS (SFPASS) by conducting an item analysis of the PASS in a sample of 278 patients with stroke, and selecting items with the best measurement properties (i.e. highest internal consistency and greatest responsiveness). The SFPASS focuses on assessment of bed mobility and sit-to-stand. The SFPASS comprises 5 items (Liaw et al., 2012):

  • Standing on the nonparetic leg
  • Supine to sitting up on the edge of the table
  • Sitting on the edge of the table to supine
  • Sitting to standing up
  • Standing up to sitting down

SFPASS items are scored on a 3-point scale and total scores range from 0 to 15. The SFPASS is simpler and quicker to administer than the PASS (Liaw et al., 2012).

Persson et al. (2011) developed a Swedish version of the PASS (SwePASS) in response to perceived need to clarify scoring criteria and item descriptions. The SwePASS defines the scoring criteria “much help” as “support from 2 persons”, and “little help” as “support from 1 person”. Items 4, 7 and 10 have been clarified or modified. The SwePASS comprises the same 12 items as the PASS, and the same ordinal scale scoring (0-3), with a maximum score of 36.

Client suitability

Can be used with:

  • Patients with stroke, regardless of postural competencies.

Should not be used in:

  • None reported
In what languages is the measure available?
  • French
  • English
  • Swedish