Berg Balance Scale (BBS)


Berg Balance Scale (BBS) Evaluation Summary

  What does the tool measure? Balance in older adults
  What types of clients can the tool be used for? The BBS was developed for use with community-dwelling elderly individuals. It can also be used in patients with stroke.
  Is this a screening or assessment tool? Assessment
Time to administer Approximately 10-15 minutes to complete by direct observation.
  Versions Short form of the BBS (BBS-3P)
Other Languages Translated and validated in Portuguese, French. Translated (not yet validated) in the following countries: Iceland, Norway, Sweden, Denmark, Finland, Italy, the Netherlands, Poland, Korea, Japan, Spain, and Hong Kong and Germany.
Measurement Properties
  Reliability – One study has reported excellent internal consistency.
– Two studies have reported excellent inter-rater reliability.
– One study has reported excellent intra-rater reliability.
– One study has reported excellent test-retest reliability.

Content validity:
The items were selected based on interviews with 12 geriatric clients and 10 professionals. The list of items was revised following a pretest of all preliminary items.

Predicted risk of falling over next 12 months, moderately predictive of length of stay in rehabilitation unit, predicted motor ability 180 days after stroke; not a significant predictor of mean steps per day.

Excellent correlations with the Fugl-Meyer balance subscale, Postural Assessment Scale for Stroke Patients, Functional Reach, Tinetti Balance Scale, Timed Up and Go test and Single-Leg Stance; adequate to excellent correlations with the Motor Assessment Scale sitting section and Rivermead Mobility Index (although poor correlations with the weight shift test and step-up tests); adequate correlations with the Barthel Index mobility subscale, dynamic Balance Master measures, and postural sway.

Excellent correlations with the Barthel Index, and Fugl-Meyer balance subscale; adequate to excellent correlations with the Functional Independence Measure.

Known Groups:
One study reported that the BBS is able to differentiate between patients according to level of functional ambulation.

  Floor/Ceiling effect Significant floor and ceiling effects have been detected in the BBS.
  Sensitivity/ Specificity No studies have reported on the sensitivity/specificity of the BBS with patients with stroke.
  Does the tool detect change in patients? One study reports general sensitivity to change and two studies report large responsiveness to change. Two studies indicate moderate responsiveness to change 6 weeks to 3 months post-stroke, but poor responsiveness following these times. One study reported a minimum absolute change score of 6 points represents genuine change.
  Acceptability This direct observation test is not suitable for severely affected patients as it assesses only one item related to balance while sitting. Active individuals will find it too simple. The scale is not suitable for use by proxy.
Feasibility The BBS requires no specialized training to administer, however, the BBS should only be administered by individuals with knowledge on how to safely manage those with stroke as the BBS is a risky assessment where a patient could fall if not supervised by someone with stroke expertise. Relatively little equipment or space is required.
How to obtain the tool? Click here to find a copy of the BBS.