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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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