Yadav Sunita. Correlation of Balance Tests Scores With Modified Physical Performance Test in Indian...

8/2/2019 Yadav Sunita. Correlation of Balance Tests Scores With Modified Physical Performance Test in Indian Community-D

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Vol.1 No.2 2012 Scientific Research Journal of India 12

http://www.srji.co.cc

Correlation of Balance Tests Scores with Modified Physical

Performance Test in Indian Community-Dwelling Older Adults

Sunita Yadav* MPT (Neuro), Deepti Dhar** MPT (Paediatrics)

INTRODUCTION

The number of persons above the

age of 60 years is fast growing, especially

in India. India is the second most populous

country in the world has 76.6 million

people at or over the age of 60,

constituting above 7.7% of total

population. Recurrent falls are an

important cause of morbidity and mortality

Abstract: Background and Objective: There is sufficient evidence which shows significant

relationship between balance tests and other functional tests but there is lack of literature

regarding the relationship between balance tests (BBS, MDRT, BPOMA) and Modified

Physical Performance Test in different age groups of older adults. Design: An Observational

Study Subjects: 58 subjects were divided into three different age groups, having the mean age

of 65.33.0 (Group-A), 73.72.4 (Group-B), 82.61.4 (Group-C), mean height of 161.45.6

(Group-A), 164.910.2 (Group-B), 160.35.9 (Group-C) & mean weight of 68.44.8 (Group-

A), 72.76.9 (Group-B), 63.67.7 (Group-C) were recruited in this study from old age home

and local community. Methods: Subjects in each group performed the tests in the following

sequence: BBS (Berg Balance Scale), MDRT (Multi-Directional Reach Test), Modified-PPT

(Physical Performance Test) & BPOMA (Balance Performance-Oriented Mobility Assessment

of Tinetti) with rest period of 5-10 minutes between each scale. Result: The results suggested

that there was a significant positive correlation between balance tests and Modified Physical

Performance Test in different age groups of older adults. Conclusion: The current studyconcluded that Modified physical performance test is a efficient tool to assess static and

dynamic balance and also physical function and ambulation in different age groups of older

adults. It was also observed that out of these balance tests used in the study, MDRT was the

most difficult to understand and perform by subjects above 70 years and the subjects above 80

years found it really hard to understand the procedure.

Keywords: BBS, MDRT, BPOMA, Modified PPT, Balance, Physical Function.


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in the elderly and are a marker of poor

physical and cognitive status.2

Impaired balance and physical

function are the main causes of fall among

the older adults. Stability and orientation

are to distinct goals of the postural control

system. Postural control for stability and

orientation requires both perception and

action. Thus, postural control requires the

complex interaction of neural and

musculoskeletal systems.4

Several researchers show that as

the age increases, the changes in the neural

and musculoskeletal systems disturb the

balance and physical activities.6

As age

increases the physical activities and

physical function also decreases due to

decreased muscular power and strength.11

Both balance problems and physical

inactivity affect the quality of life of older

adults. Therefore the assessment of both

balance and physical function is necessary

for older adults in order to help establish

appropriate treatment goals, increase

awareness of fall risk and assign

appropriate assistive device and to

decrease the disability. Several such

instrument have shown satisfactory

reliability and validity in identifying olderpeople with balance and physical

functional problems, discriminating older

adults by their needs for different assistive

device to maintain balance or predicting

their likelihood of falls and to enhance

physical function.

The Berg Balance Scale was

developed by Kathy Berg (a Canadian

physical therapist) in1993, as a means of

measuring balance in the elderly.

Multi-directional Reach Test

(MDRT) is developed by Roberta A.

Newton in 2001. It allows for analysis of

the patient voluntary postural control.

The Performance Oriented

Mobility Assessment (POMA) scale was

originally developed by Dr. Mary E.

Tinetti and first published in 1986, is a

widely used tool for assessing mobility

and fall risk in older people. In this study

balance subscale of Tinetti assessment is

used to assess the balance of older adults.15

Brown, M, Sinacore, D.R.

developed the modified physical

performance test in 2005 to provide more

focus on gross motor function by

substituting a chair rise task and a balance

task for the writing and stimulated eating

tasks described in the original PPT. The

tool was more useful in identifying deficits

in physical function than the self- report

comparison measure, the functional status

questionnaire. The authors concluded thatthe performance based measure could

assist in early identification of minor

problems in physical functioning, and

allow for opportunity for early intervention

for the patients.16


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Several researchers found that

balancing exercises improve physical

function and previous studies also found

significant correlation between balance

scales and other functional tests.17,18,13,19

Therefore it is clear that there is a

relationship between balance and physical

function.

Yet there is no study to show

relationship between these scales or tests

in different age groups. Therefore the main

purpose of my study is to find out the

relationship between balance tests and

Modified physical performance test.

Second purpose is, the Modified physical

performance test assesses both balance and

physical function in older adults no other

tool is required because it measure the

both static and dynamic balance and also

physical function. It tells about fall risk,

need of assistance device and functional

limitations; additionally it takes less time

to administer as compared to other scale.

METHODOLOGY

This observational study recruited

58 subjects from old age homes and local

community of Delhi and Dehradun

meeting the inclusion criteria. InclusionCriteria: Age - 60 to 89 year old healthy

subjects; Gender- Both male and female;

Ability to abduct and flex the shoulder up

to 90 degrees; Ability to stand for

minimum 10 min. without any assistance;

Ability to walk at least 50 feet before

sitting to rest; Minimal use of rail or cane

while climbing. Exclusion Criteria: Use

of any assistive prosthetic device; History

of any cardiac problem confirmed by

physician; Any history of fainting spells or

extended dizziness due to unknown

reasons History of neurological; vestibular

or auditory deficit confirmed by physician;

History of any visual disorder which will

not be corrected by optical glasses as

confirmed by physician; MMSE score

below 23; History of postural hypotension;

History of recent fractures and severe

arthritic conditions; History of any major

surgeries during last 6 month; History of

any previous balance training; Moderate to

severe hypertensions

Measurement Tools

Berg Balance Scale (BBS)

The BBS was developed to measure

balance among older people with

impairment in balance function by

assessing the performance of 14 functional

tasks. The results are based on how long it

takes to complete specific tasks and how

well the tasks are performed. Each task is

measured on a five point ordinal scaleranging from 0 to 4 (0 = unable to

perform, 4 = independent) so that the

aggregate score ranges from 0 to 56.

Multidirectional Reach Test (MDRT)


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The MDRT is an inexpensive, reliable and

valid screening tool to measure the limits

of postural stability in four directions

(forward, backward, right & left) during

standing. The distance of each reach is

measured in centimetres or inches.

Balance Performance Oriented Mobility

Assessment (BPOMA)

The Tinetti assessment is a physical task-

oriented scale which measures the gait and

balance activities of older adults. In this

study BPOMA was used to assess the

balance of the community dwelling older

adults; it consists 9 tasks. 6 tasks are

measured on a three point ordinal scale

ranging from 0 to 2 and remaining three

tasks are measured on a two point ordinal

scale ranging from 0 to 1 ( 0 = unable to

perform, 1 & 2 = independent). The

maximum score is 16.

Physical Performance Test (Modified-

PPT)

An objective evaluation of overall physical

function was obtained by using modified

PPT. The severity of physical frailty in

physical functioning was assessed using a

modified PPT. It consists of 9 tasks; each

task is measured on a five point ordinal

scale ranging from 0 to 4 ( 0 = unable toperform, 4 = independent) except 7th task

(turning 360 degrees) which ranges from 0

to 1 (0 = unsteady, 1 = steady). The

maximum score is 36.

Procedure

The subjects were recruited based on

inclusion and exclusion criteria the

subjects of different age groups 60 to 69

years of age (Group- A), 70 to 79 years of

age (Group- B), and 80 to 89 years of age

(Group- C). Subjects in each group

performed the tests in a sequence i.e. BBS,

MDRT, Modified-PPT, POMA. The whole

procedure was explained to each subject

and the subject signed a consent form

before performing the study. Description

data was collected which included age,

gender, height, weight and number of falls

in the past 6 months. MMSE score was

also assessed. All subjects were assessed

by all four scales or tests in the following

order BBS, MDRT, Modified-PPT and

BPOMA. All components of each scale

were demonstrated to all the subjects and

one practice session was done for all the

components of four scales by all the

subjects, after that reading was taken. Each

test or scale was administered by myself.

All subjects were offered rest breaks and

water during the session and completed the

approximately 60 minute testing protocol

without complaint of fatigue or

discomfort. The resting period of 5 to 10minute was given after performing each

scale. As a precautionary measure, blood

pressure was checked prior to beginning of

the test session and it was again taken at

the end of the last test performed. One


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person was always nearby vicinity of the

subject.

Data Analysis

The data analysis was done on SPSS 11.5

software. The arithmetical mean and

standard deviation of age, height and

weight in demographic data were

evaluated. Karl pearsons correlation test

was done to analyse the correlation

between balance tests (BBS, MDRT &

POMA) with physical performance test

(modified) among elderly people.

Statistical significance level was set at

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