Article

Impaired balance has a significant negative impact on mobility,
functional independence, and fall risk in older adults. Although several,
well-respected balance measures are currently in use, there is limited evidence
regarding the most appropriate measure to assess change in community-dwelling
older adults. The aim of this study was to compare floor and ceiling
effects, sensitivity to change, and responsiveness across the following balance
measures in community-dwelling elderly people with functional limitations: Berg
Balance Scale (BBS), Performance-Oriented Mobility Assessment total scale
(POMA-T), POMA balance subscale (POMA-B), and Dynamic Gait Index (DGI). DESIGN:
Retrospective data from a 16-week exercise trial were used. Secondary analyses
were conducted on the total sample and by subgroups of baseline functional
limitation or baseline balance scores. METHODS: Participants were 111
community-dwelling older adults 65 years of age or older, with functional
limitations. Sensitivity to change was assessed using effect size, standardized
response mean, and paired t tests. Responsiveness was assessed using minimally
important difference (MID) estimates. RESULTS: No floor effects were noted.
Ceiling effects were observed on all measures, including in people with moderate
to severe functional limitations. The POMA-T, POMA-B, and DGI showed
significantly larger ceiling effects compared with the BBS. All measures had low
sensitivity to change in total sample analyses. Subgroup analyses revealed
significantly better sensitivity to change in people with lower compared with
higher baseline balance scores. Although both the total sample and lower baseline
balance subgroups showed statistically significant improvement from baseline to
16 weeks on all measures, only the lower balance subgroup showed change scores
that consistently exceeded corresponding MID estimates. LIMITATIONS: This study
was limited to comparing 4 measures of balance, and anchor-based methods for
assessing MID could not be reported. CONCLUSIONS: Important limitations,
including ceiling effects and relatively low sensitivity to change and
responsiveness, were noted across all balance measures, highlighting their
limited utility across the full spectrum of the community-dwelling elderly
population. New, more challenging measures are needed for better discrimination
of balance ability in community-dwelling elderly people at higher functional
levels.

Langue : ANGLAIS