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Conceptual limitations of balance measures for community-dwelling older adults
Poonam K Pardasaney1, Mary D Slavin, Robert C Wagenaar
1P.K. Pardasaney, PT, DPT, ScD, RTI International, 1440 Main St, Suite 337, Waltham, MA 02451 (USA). At the time of the study, Dr Pardasaney was affiliated with the Department of Rehabilitation Sciences, Sargent College of Health & Rehabilitation Sciences, and Health & Disability Research Institute, School of Public Health, Boston University, Boston, Massachusetts.
Background:
Psychometric limitations of balance measures for community-dwelling elderly may be related to gaps in task and environmental representation.
Objective:
The purposes of this study were: (1) to conduct item-level content analysis of balance measures for community-dwelling elderly people based on task and environmental factors and (2) to develop profiles of individual measures summarizing their task and environment representation.
Design:
A systematic content analysis was conducted.
Methods:
A literature search was conducted to identify balance measures. Item-level content analysis was based on 7 criteria related to task and environment: (1) task role, (2) environmental variation, (3) object interaction, (4) obstacle negotiation, (5) external forces, (6) dual-tasking, and (7) moving people or objects in the environment.
Results:
Twenty-six measures, containing 167 items, were identified. Task role was fairly evenly distributed, with the majority of items examining gait tasks (32.3%), followed by dynamic body stability (29.9%) and static body stability (25.1%). The majority of items involved no environmental variation (58.1%), followed by variation of support surfaces (20.4%), visual conditions (13.2%), and both support and visual conditions (8.4%). Limited task role variability was seen within measures, with 73.1% of measures examining only one task role. Environmental variation was present in 65.3% of measures, primarily during static body stability tasks. Few measures involved object interaction (23.1%), obstacle negotiation (38.5%), external forces (11.5%), dual-tasking (7.7%), or moving people or objects (0%).
Limitations:
The classification framework was not externally validated.
Conclusions:
Existing measures focus on single-task assessment in static environments, underrepresenting postural control demands in daily-life situations involving dynamic changing environments, person-environment interactions, and multitasking. New items better reflecting postural control demands in daily-life situations are needed for more ecologically valid balance assessment. Individual balance measure profiles provided can help identify the most appropriate measure for a given purpose.
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