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A Journal on Physical Medicine and Rehabilitation after Pathological Events

Official Journal of the Italian Society of Physical and Rehabilitation Medicine (SIMFER), European Society of Physical and Rehabilitation Medicine (ESPRM), European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS-PRM), Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM), Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
In association with International Society of Physical and Rehabilitation Medicine (ISPRM)
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Europa Medicophysica 2003 December;39(4):181-9


language: English

Psychometric evaluation of the Italian version of the Berg Balance Scale in rehabilitation inpatients

Ottonello M. 1, Ferriero G. 2, Benevolo E. 1, Sessarego P. 1, Dughi D. 2

1 Unit of Occupational Rehabilitation and Ergonomics “Salvatore Maugeri” Foundation Clinica del Lavoro e della Riabilitazione, IRCCS Scientific Institute, Genoa-Nervi (Genoa), Italy 2 Unit of Occupational Rehabilitation and Ergonomics “Salvatore Maugeri” Foundation Clinica del Lavoro e della Riabilitazione, IRCCS Scientific Institute, Veruno (Novara), Italy


Aim. Balance is impor­tant ­for a suc­cess­ful per­for­mance in ­many ­tasks of dai­ly liv­ing. The Berg Bal­ance ­Scale (­BBS) is per­haps ­the ­most wide­ly ­used ­scale ­for bal­ance eval­u­a­tion in ­the reha­bil­i­ta­tion ­field. The ­aims of ­this ­study ­were: a) to pro­duce an Italian ver­sion of ­the ­BBS (­BBS-it) ­using a val­i­dat­ed pro­ce­dure of ­cross-cul­tu­ral trans­la­tion; b) to ana­lyse ­the ­main psy­cho­met­ric char­ac­ter­is­tics of ­the ­BBS-it (inter­nal con­sis­ten­cy, reli­abil­ity, con­struct ­and con­cur­rent valid­ity ­and respon­sive­ness) in ­patients dur­ing a reha­bil­i­ta­tion ­stay.
Methods. Eighty-­five ­patients, affect­ed by neu­ro­log­ic ­and ortho­pe­dic dis­eas­es, ­were eval­u­at­ed ­using 3 instru­ments: ­the ­BBS-it, ­the Tinetti Bal­ance sub­scale (TBS), ­and ­the Func­tion­al Inde­pen­dence Meas­ure (FIM). The ­BBS-it ­was ­obtained accord­ing to a pro­ce­dure of val­i­dat­ed ­cross-cul­tu­ral trans­la­tion. The inter­nal con­sis­ten­cy ­and con­struct valid­ity of ­BBS-it ­were cal­cu­lat­ed in ­the ­total sam­ple of ­patients, ­while ­the con­cur­rent valid­ity ­and respon­sive­ness of ­the ­scale ­were ana­lysed in ­the ­last 40 ­patients, ­and ­the ­test-­retest ­and ­inter-rat­er reli­abil­ity ­were stud­ied in 13 ­patients, ran­dom­ly cho­sen.
Results. The ­mean ­scores of ­the ­BBS-it, at admis­sion ­and dis­charge, ­were respec­tive­ly 26.02 (SD 13.9) ­and 38.67 (SD 11.4). Cronbach’s coef­fi­cient of ­the ­BBS-it ­was 0.95, ­while ­the cor­re­la­tions ­between ­each ­item ­and ­the ­sum of ­the remain­ing ­items ­gave gen­er­al­ly ­very ­high val­ues of r. A 2-­way ANO­VA ­did ­not ­reveal ­any sig­nif­i­cant dif­fer­ence ­between ­either ­the rat­ers or ­the ­days. For ­the ­inter-rat­er reli­abil­ity, ­the ­ICC ­was 0.99. Factor anal­y­sis ­showed ­that ­all ­the ­items load­ed mean­ing­ful­ly ­onto ­the ­first fac­tor (0.70-0.89) ­except ­the ­item 3 “sit­ting” ­that ­had inter­me­di­ate load­ing (0.43). The ­BBS-it dem­on­strat­ed a sig­nif­i­cant cor­re­la­tion ­with ­the ­TBS (r=0.96, p<0.0001), ­the totFIM (r=0.64, p=0.0001) ­and ­the motFIM (r=0.68, p=0.0001). The ES (respon­sive­ness ­from admis­sion to dis­charge) ­was 1.66 ­for ­BBS-it ­and 1.52 ­for ­TBS.
Conclusion. The ­BBS is per­haps ­the ­most wide­ly ­used bal­ance ­scale. The ­BBS-it ­was ­made accord­ing to val­i­dat­ed pro­ce­dures of ­cross-cul­tu­ral adap­ta­tion ­and trans­la­tors ­did ­not ­find ­any seman­tic dif­fi­cul­ties. The ­test-­retest reli­abil­ity is impor­tant as it ­denotes stabil­ity of ­the ­results. The inter­nal con­sis­ten­cy of ­the ­BBS-it (Cronbach’s α) con­firms ­that ­its ­items ­describe a homo­ge­ne­ous var­i­able. The fac­to­ri­al anal­y­sis indi­cat­ed ­the prev­a­lence of a sin­gle prin­ci­pal fac­tor in ­the ­BBS-it ­scale struc­ture. Regarding ­the valid­ity of ­the ­BBS-it, its ­high cor­re­la­tion ­with ­TBS, motFIM, ­and totFIM on ­the oth­er pro­vides evi­dence of ­the con­struct valid­ity of ­this version. These ­results ­are in agree­ment ­with pre­vi­ous stud­ies show­ing an asso­ci­a­tion ­between pos­tu­ral stabil­ity ­and ­motor ­and func­tion­al per­for­mance. Moreover ­the ­BBS-it ­showed a high­er respon­sive­ness in meas­ur­ing ­change ­over ­time ­for a giv­en out­come ­than ­the ­TBS. In con­clu­sion, as an out­come meas­ure of func­tion­al bal­ance ­with ­known reli­abil­ity, valid­ity ­and respon­sive­ness, ­easy to admin­is­ter ­and requir­ing no spe­cial equip­ment, ­the ­BBS-it ­may rep­re­sent an appro­pri­ate instru­ment ­for bal­ance meas­ure in ­research ­and clin­i­cal prac­tice.

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