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Published on: April 12, 2016
A comparison of two balance measures to predict discharge performance from inpatient stroke rehabilitation
Michael W O'Dell1, Jessica Au, Eric Schwabe
1Division of Rehabilitation Medicine, Weill Cornell Medical College, New York, NY; Department of Rehabilitation Medicine, Weill Cornell Medical Center, 525 East 68th Street, Box 142, Room F1600, New York, NY 10065, USA. mio2005@med.cornell.edu
Objective:
To compare the admission Berg Balance Scale (BBS) and Postural Assessment Scale for Stroke (PASS) in predicting outcomes at discharge from an inpatient rehabilitation unit (IRU). We hypothesized that discharge outcomes would be better predicted by (1) the PASS compared with the BBS, and (2) by the PASS changing position subscore compared with the PASS maintain posture subscore.
Design:
A retrospective study.
Setting:
An IRU in an academic medical center.
Participants:
Fifty-five subjects with stroke and mean (standard deviation [SD]) age of 71.5 ± 13.8 years, admission functional independence measures (FIM) of 57.2 ± 17.2 points, and IRU length of stay of 17.3 ± 9.7 days. METHODOLOGY/MAIN OUTCOME MEASUREMENTS: Admission and discharge BBS and PASS scores, gait velocity (GV) at discharge, and selected FIM items at discharge were measured. GV was analyzed both as a continuous and categorical variable.
Results:
The Spearman rank correlation coefficient (r) was strong between admission BBS and PASS (r = 0.90, P < .0001). Correlations between admission BBS and PASS and discharge GV were 0.32 (P = .03) and 0.28 (P = .06), respectively. Analysis of variance was significant for both balance measures when grouped by the discharge gait speed category (P < .0001). Pairwise comparisons were significant between GV-A and the other 2 categories but not between GV-B and GV-C. The magnitude of the observed correlation with discharge GV was greater for PASS maintain posture subscore (r = 0.35, P = .02) than for PASS changing position subscore (r = 0.23, P = .13). Both subscores were significantly associated with both toileting and transfers (r = 0.43-0.56, all at least P ≤ .001).
Conclusions:
Contrary to our hypotheses, the BBS and PASS performed equally well in our study sample and were best at predicting patients discharged in the slowest GV category. There were few differences between the PASS subscores. Further research should compare how well admission BBS and PASS predict gait velocity, falls, and other functional parameters in the community after IRU discharge.