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EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
A Journal on Physical Medicine and Rehabilitation after Pathological Events
Official Journal of the , , , ,
In association with
Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 2,063
Europa Medicophysica 2003 December;39(4):181-9
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.