Advertisement

Neurological Sciences

, Volume 39, Issue 12, pp 2175–2181 | Cite as

Psychometric properties of the Berg balance scale in idiopathic Parkinson’ disease in the drug off-phase

  • Ghorban Taghizadeh
  • Pablo Martinez-Martin
  • Seyed-Mohammad Fereshtehnejad
  • Seyed Amirhasan Habibi
  • Negar Nikbakht
  • Naeeme Haji Alizadeh
  • Sheyda Salehi
  • Maryam Mehdizadeh
Original Article

Abstract

Background

Having an appropriate tool for assessment of the balance status during the drug off-phase in idiopathic Parkinson’s disease (PD) is relevant for clinical and research settings. Our objective was to assess the clinimetric properties of the Berg balance scale (BBS) during drug off-phase in PD.

Method

Balance of 98 PD patients (mean age ± SD, 59.19 ± 10.88 years) was evaluated with the BBS. Other assessments in the study included the Fall Efficacy Scale-International (FES-I), Functional Reach Test (FRT), Section II of the Unified Parkinson’s Disease Rating Scale-3.0, Parkinson’s Disease Questionnaire-39 (PDQ-39), and Schwab and England Activities of Daily Living Scale. All evaluations took place during the drug off-phase. Internal consistency and inter- and intra-rater reliability were evaluated by Cronbach’s alpha coefficient and intraclass correlation coefficient, respectively. Dimensionality was explored by factor analysis. Discriminative validity was tested by comparing BBS score between PD patients with and without a history of falling.

Results

Internal consistency was high (α = 0.98), as were intra- and inter-rater reliability (ICC = 0.98 and 0.95, respectively). Factor analysis identified only one dimension for the BBS, whose convergent validity with FES-I, FRT, and domain mobility of the PDQ-39 were moderate or high (rS = |0.60–0.74|). Correlation of BBS with functional scales and PDQ-39 Summary Index was moderate (rS = |0.45–0.62|). Finally, the BBS showed a moderate strength to discriminate between PD patients with and without a history of falling.

Conclusion

Our study suggests that BBS has satisfactory internal consistency, reliability, and construct validity for measuring functional balance in people with PD during the drug off-phase.

Keywords

Psychometric properties Berg balance scale Parkinson’ disease Drug off-phase 

Notes

Acknowledgments

This research was funded by Student Research Center of Iran University of Medical Sciences, Tehran, Iran. We have to express our appreciation to the patients and their family for their participation and cooperation through this study.

Compliance with ethical standards

This study was approved by the ethics committee of the Student Research Center at Iran University of Medical Sciences (number, IR.IUMS.REC.1394.94-01-19-25617). All patients signed an informed consent for participation to the study.

Conflict of interest

The authors declare that there is no conflict of interest.

References

  1. 1.
    Šumec R et al (2015) Psychological benefits of nonpharmacological methods aimed for improving balance in Parkinson’s disease: a systematic review. Behav Neurol:2015Google Scholar
  2. 2.
    Rahman S, Griffin HJ, Quinn NP, Jahanshahi M (2008) Quality of life in Parkinson’s disease: the relative importance of the symptoms. Mov Disord 23(10):1428–1434CrossRefPubMedGoogle Scholar
  3. 3.
    Rodríguez-Molinero A, Samà A, Pérez-López C, Rodríguez-Martín D, Alcaine S, Mestre B, Quispe P, Giuliani B, Vainstein G, Browne P, Sweeney D, Quinlan LR, Moreno Arostegui JM, Bayes À, Lewy H, Costa A, Annicchiarico R, Counihan T, Laighin GÒ, Cabestany J (2017) Analysis of correlation between an accelerometer-based algorithm for detecting Parkinsonian gait and UPDRS subscales. Front Neurol 8:431CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    McNeely ME, Duncan RP, Earhart GM (2012) Medication improves balance and complex gait performance in Parkinson disease. Gait Posture 36(1):144–148CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Foreman KB, Addison O, Kim HS, Dibble LE (2011) Testing balance and fall risk in persons with Parkinson disease, an argument for ecologically valid testing. Parkinsonism Relat Disord 17(3):166–171CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Yardley L, Beyer N, Hauer K, Kempen G, Piot-Ziegler C, Todd C (2005) Development and initial validation of the Falls Efficacy Scale-International (FES-I). Age Ageing 34(6):614–619CrossRefPubMedGoogle Scholar
  7. 7.
    Nisenzon AN, Robinson ME, Bowers D, Banou E, Malaty I, Okun MS (2011) Measurement of patient-centered outcomes in Parkinson’s disease: what do patients really want from their treatment? Parkinsonism Relat Disord 17(2):89–94CrossRefPubMedGoogle Scholar
  8. 8.
    Morris S, Morris ME, Iansek R (2001) Reliability of measurements obtained with the timed “up & go” test in people with Parkinson disease. Phys Ther 81(2):810–818CrossRefPubMedGoogle Scholar
  9. 9.
    Bloem BR, Marinus J, Almeida Q, Dibble L, Nieuwboer A, Post B, Ruzicka E, Goetz C, Stebbins G, Martinez-Martin P, Schrag A, for the Movement Disorders Society Rating Scales Committee (2016) Measurement instruments to assess posture, gait, and balance in Parkinson’s disease: critique and recommendations. Mov Disord 31(9):1342–1355CrossRefPubMedGoogle Scholar
  10. 10.
    Berg K et al (1989) Measuring balance in the elderly: preliminary development of an instrument. Physiother Can 41(6):304–311CrossRefGoogle Scholar
  11. 11.
    Nova IC, Perracini MR, Ferraz HB (2004) Levodopa effect upon functional balance of Parkinson’s disease patients. Parkinsonism Relat Disord 10(7):411–415CrossRefPubMedGoogle Scholar
  12. 12.
    Landers MR, Backlund A, Davenport J, Fortune J, Schuerman S, Altenburger P (2008) Postural instability in idiopathic Parkinson’s disease: discriminating fallers from nonfallers based on standardized clinical measures. J Neurol Phys Ther 32(2):56–61CrossRefPubMedGoogle Scholar
  13. 13.
    Scalzo PL, Nova IC, Perracini MR, Sacramento DRC, Cardoso F, Ferraz HB, Teixeira AL (2009) Validation of the Brazilian version of the Berg balance scale for patients with Parkinson’s disease. Arq Neuropsiquiatr 67(3B):831–835CrossRefPubMedGoogle Scholar
  14. 14.
    Babaei-Ghazani, A., et al. (2016) Reliability and validity of the Persian translation of Berg balance scale in Parkinson disease. Aging clinical and experimental researchGoogle Scholar
  15. 15.
    Hughes AJ, Daniel SE, Kilford L, Lees AJ (1992) Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 55(3):181–184CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Godefroy O, Fickl A, Roussel M, Auribault C, Bugnicourt JM, Lamy C, Canaple S, Petitnicolas G (2011) Is the Montreal cognitive assessment superior to the mini-mental state examination to detect poststroke cognitive impairment? Stroke 42(6):1712–1716CrossRefPubMedGoogle Scholar
  17. 17.
    Behrman AL, Light KE, Flynn SM, Thigpen MT (2002) Is the functional reach test useful for identifying falls risk among individuals with Parkinson’s disease? Arch Phys Med Rehabil 83(4):538–542CrossRefPubMedGoogle Scholar
  18. 18.
    Baharlouei H, Salavati M, Akhbari B, Mosallanezhad Z, Mazaheri M, Negahban H (2013) Cross-cultural validation of the Falls Efficacy Scale International (FES-I) using self-report and interview-based questionnaires among Persian-speaking elderly adults. Arch Gerontol and Geriatr 57 (3):339–344Google Scholar
  19. 19.
    Jonasson SB, Nilsson MH, Lexell J (2017) Psychometric properties of the original and short versions of the Falls Efficacy Scale-International (FES-I) in people with Parkinson’s disease. Health Qual Life Outcomes 15(1):116CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Fereshtehnejad S-M, Naderi N, Rahmani A, Shahidi G, Delbari A, Lökk J (2014) Psychometric study of the Persian short-form eight-item Parkinson’s disease questionnaire (PDQ-8) to evaluate health related quality of life (HRQoL). Health Qual Life Outcomes 12(1):78CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Martinez-Martin, P., et al., (2013) Expanded and independent validation of the Movement Disorder Society–Unified Parkinson’s Disease Rating Scale (MDS-UPDRS). J Neurol p. 1–9Google Scholar
  22. 22.
    Martínez-Martín P, Benito-León J, Alonso F, Catalán MJ, Pondal M, Tobías A, Zamarbide I (2003) Patients’, doctors’, and caregivers’ assessment of disability using the UPDRS-ADL section: are these ratings interchangeable? Mov Disord 18(9):985–992CrossRefPubMedGoogle Scholar
  23. 23.
    McHorney CA, Tarlov AR (1995) Individual-patient monitoring in clinical practice: are available health status surveys adequate? Qual Life Res 4(4):293–307CrossRefPubMedGoogle Scholar
  24. 24.
    Hays R, Anderson R, Revicki D (1993) Psychometric considerations in evaluating health-related quality of life measures. Qual Life Res 2(6):441–449CrossRefPubMedGoogle Scholar
  25. 25.
    Lohr KN (2002) Assessing health status and quality-of-life instruments: attributes and review criteria. Qual Life Res 11(3):193–205CrossRefPubMedGoogle Scholar
  26. 26.
    Piedmont, R. L. (2014) Inter-item correlations, in Encyclopedia of quality of life and well-being research. Springer. p. 3303–3304Google Scholar
  27. 27.
    Clark LA, Watson D (1995) Constructing validity: basic issues in objective scale development. Psychol Assess 7(3):309–319CrossRefGoogle Scholar
  28. 28.
    Streiner DL, Norman GR, Cairney J (2008) Health measurement scales: a practical guide to their development and use, 4th edn. Oxford University Press, USAGoogle Scholar
  29. 29.
    Terwee CB, Bot SDM, de Boer MR, van der Windt DAWM, Knol DL, Dekker J, Bouter LM, de Vet HCW (2007) Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 60(1):34–42CrossRefGoogle Scholar
  30. 30.
    Landis, J. R. and G. G. Koch (1977) The measurement of observer agreement for categorical data. Biometrics p. 159–174Google Scholar
  31. 31.
    Wyrwich KW, Bullinger M, Aaronson N, Hays RD, Patrick DL, Symonds T (2005) Estimating clinically significant differences in quality of life outcomes. Qual Life Res 14(2):285–295CrossRefPubMedGoogle Scholar
  32. 32.
    Gorsuch RL (1997) Exploratory factor analysis: its role in item analysis. J Pers Assess 68(3):532–560CrossRefPubMedGoogle Scholar
  33. 33.
    Rooney, R. (2006) Statistical evidence in medical trials: what do the data really tell us? Stephen D. Simon. OUP, 2006.£ 65. ISBN 0 19 856760 X, Oxford University PressGoogle Scholar
  34. 34.
    Husted JA, Cook RJ, Farewell VT, Gladman DD (2000) Methods for assessing responsiveness: a critical review and recommendations. J Clin Epidemiol 53(5):459–468CrossRefPubMedGoogle Scholar
  35. 35.
    Gibbons JD and Chakraborti S (2011) Nonparametric statistical inference, in International encyclopedia of statistical science. Springer. p. 977–979Google Scholar
  36. 36.
    Leddy AL, Crowner BE, Earhart GM (2011) Functional gait assessment and balance evaluation system test: reliability, validity, sensitivity, and specificity for identifying individuals with Parkinson disease who fall. Phys Ther 91(1):102–113CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Franchignoni F, Martignoni E, Ferriero G, Pasetti C (2005) Balance and fear of falling in Parkinson’s disease. Parkinsonism Relat Disord 11(7):427–433CrossRefPubMedGoogle Scholar
  38. 38.
    Lim L et al (2005) Measuring gait and gait-related activities in Parkinson’s patients own home environment: a reliability, responsiveness and feasibility study. Parkinsonism Relat Disord 11(1):19–24CrossRefPubMedGoogle Scholar
  39. 39.
    Steffen T, Seney M (2008) Test-retest reliability and minimal detectable change on balance and ambulation tests, the 36-item short-form health survey, and the unified Parkinson disease rating scale in people with parkinsonism. Phys Ther 88(6):733–746CrossRefPubMedGoogle Scholar
  40. 40.
    Qutubuddin AA, Pegg PO, Cifu DX, Brown R, McNamee S, Carne W (2005) Validating the Berg balance scale for patients with Parkinson’s disease: a key to rehabilitation evaluation. Arch Phys Med Rehabil 86(4):789–792CrossRefPubMedGoogle Scholar
  41. 41.
    Brusse KJ et al (2005) Testing functional performance in people with Parkinson disease. Phys Ther 85(2):134–141PubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2018

Authors and Affiliations

  • Ghorban Taghizadeh
    • 1
    • 2
  • Pablo Martinez-Martin
    • 3
  • Seyed-Mohammad Fereshtehnejad
    • 4
    • 5
  • Seyed Amirhasan Habibi
    • 6
  • Negar Nikbakht
    • 7
  • Naeeme Haji Alizadeh
    • 8
  • Sheyda Salehi
    • 9
  • Maryam Mehdizadeh
    • 8
    • 10
  1. 1.Department of Occupational Therapy, School of Rehabilitation SciencesIran University of Medical SciencesTehranIran
  2. 2.Rehabilitation Research Center, School of Rehabilitation SciencesIran University of Medical SciencesTehranIran
  3. 3.National Center of Epidemiology and CIBERNEDCarlos III Institute of HealthMadridSpain
  4. 4.Department of Neurology and NeurosurgeryMcGill UniversityMontrealCanada
  5. 5.Division of Clinical Geriatrics, Department of NeurobiologyCare Sciences and Society (NVS), Karolinska InstitutetStockholmSweden
  6. 6.Department of Neurology, Rasoul Akram HospitalIran University of Medical SciencesTehranIran
  7. 7.Department of Occupational Therapy, School of Rehabilitation SciencesShahid Beheshti University of Medical Sciences and Health ServicesTehranIran
  8. 8.Department of Neurosciences, Faculty of Advance Technologies in MedicineIran University of Medical SciencesTehranIran
  9. 9.Department of Occupational Therapy, School of Rehabilitation SciencesUniversity of Social Welfare and Rehabilitation SciencesTehranIran
  10. 10.Student Research Center, School of Rehabilitation SciencesIran University of Medical SciencesTehranIran

Personalised recommendations