Table 1.
Measurement properties of balance assessment tools: Summary results with overall quality ratings: Summary results of measurement properties of tools with quality ratings
| Instrument | Reference | Reliability | Validity | |||
|---|---|---|---|---|---|---|
| Reliability | Measurement error | Internal consistency | Criterion validity | Hypothesis testing for construct validity | ||
| The Balance Evaluation Systems Test (BESTest) | Anson, 2019 [19] Marques, 2016 [20] O’Hoski, 2015 [21] Viveiro, 2019 [22] Wang-Hsu, 2018 [23] Yingyongyudha, 2016 [24] |
ICC = 0.77–0.99 (+) | MIC not defined (?) | N/R | r ≥ 0.70 (+) |
Hypotheses confirmed (+) |
| The Spanish version of the BESTest (Spanish BESTest) | Dominguez-Olivan, 2020 [25] | ICC = 0.97 (+) |
MIC not defined (?) | Criteria not met (?) |
r < 0.70 (−) |
r > 0.50 (+) |
| The Mini-Balance Evaluation Systems Test (Mini-BESTest) |
Anson, 2019 [19] Marques, 2016 [20] O’Hoski, 2015 [21] Viveiro, 2019 [22] Yingyongyudha, 2016 [24] |
ICC = 0.71–0.99 (+) |
MIC not defined (?) | N/R | r ≥ 0.83 (+) |
(±), for discriminative validity (+), for convergent validity |
| The Spanish version of the Mini-BESTest (Spanish Mini-BESTest) | Dominguez-Olivan, 2020 [25] | ICC = 0.79 (+) |
MIC not defined (?) | Criteria not met (?) |
r = 0.18 (−) |
Hypothesis confirmed (+) |
| The modified Clinical test of Sensory Interaction in Balance (mCTSIB) of the Balance Platform Biodex Balance System (BBS) | Antoniadou, 2020 [26] | ICC = 0.628 (−) |
N/R | N/R | N/R | r > 0.50 (+) |
| The Berg Balance Scale (BBS) | Berg, 1992a [27] Berg, 1992b [28] Bogle Thorbahn, 1996 [29] Harada, 1995 [30] Holbein-Jenny, 2005 [31] Marques, 2016 [20] Muir, 2008 [32] Pelicioni, 2022 [33] Viveiro, 2019 [22] Wang, 2006 [34] Yingyongyudha, 2016 [24] |
ICC = 0.77–0.99 (+) |
MIC not defined (?) | Criteria not met (?) |
Indeterminate (?) |
Hypotheses confirmed (+) |
| The Brazilian version of the Berg balance scale (Brazilian BBS) | Miyamoto, 2004 [35] | ICC ≥ 0.99 (+) |
N/R | N/R | N/R | N/R |
| The Lateral Reach (LR) Test | Brauer, 1999 [36] | ICC = 0.999 (+) |
N/R | N/R | r < 0.70 (−) |
N/R |
| The Six-Spot Step Test | Brincks, 2021 [37] | ICC = 0.94–0.96 (+) |
MIC not defined (?) | N/R | N/R | r > 0.50 (+) |
| The Functional reach (FR) test | Brooks, 2006 [38] Galhardas, 2020 [39] Giorgetti, 1998 [40] Lin, 2004 [41] |
ICC ≥ 0.73 (+) |
MIC not defined (?) | N/R | Indeterminate (?) |
(+), for discriminative validity (−), for convergent validity |
| Gait Initiation Assessment | Chang, 1999 [42] | N/R | N/R | N/R | N/R | Hypothesis confirmed (+) |
| The modified Wii Fit balance board | Chang, 2013 [43] | ICC ≥ 0.93 (+) |
N/R | N/R | N/R | N/R |
| The Stepping Threshold Test (STT) | Adams, 2021 [44] | N/R | N/R | N/R | N/R | Hypotheses not confirmed (−) |
| The Unstable board (DYJOC BOARD, SAKAI Medical Co., Ltd.) |
Akizuki, 2018 [45] | N/R | N/R | N/R | N/R | Hypothesis not confirmed (−) |
| The limits of stability (LOS) test | Clark, 1997 [46] | ICC not reported (?) |
MIC not defined (?) | N/R | N/R | N/R |
| The Four Square Step Test (FSST) | Cleary, 2017 [48] Işik, 2015 [49] Dite, 2002 [47] |
ICC ≥ 0.98 (+) |
N/R | N/R | Inconsistent (±) |
(±), for convergent validity (+), for discriminative validity |
| The mediolateral balance assessment (MELBA) tool | Cofré Lizama, 2015 [50] | N/R | N/R | N/R | r < 0.70 (−) |
N/R |
| The Spring Scale Test (SST) | DePasquale, 2009 [51] | ICC = 0.94 (+) |
MIC not defined (?) | N/R | N/R | Hypotheses confirmed (+) |
| The Microsoft Xbox One Kinect (Kinect v2) | Eltoukhy, 2018 [52] | ICC > 0.75 (+) |
MIC not defined (?) | N/R | r not reported (?) |
N/R |
| The TURN 180 test | Fitzpatrick, 2005 [53] Ranji, 2020 [54] |
ICC = 0.828 (+) |
MIC not defined (?) | N/R | r not reported (?) |
Hypothesis confirmed (+) |
| The Lower Quarter Y-Balance Test (LQ-YBT) | Freund, 2019 [55] | ICC ≥ 0.98 (+) |
MIC not defined (?) | N/R | N/R | Hypothesis not confirmed (−) |
| The Narrow Path Walking Test (NPWT) | Gimmon, 2013 [56] |
ICC = 0.77–0.92 (+) |
MIC not defined (?) | N/R | N/R | Inconsistent (±) |
| One leg standing (OLS) | Giorgetti, 1998 [40] Lin, 2004 [41] |
ICC ≥ 0.75 (+) |
N/R | N/R | Indeterminate (?) |
(+), for discriminative validity (−), for convergent validity |
| Tandem Gait (TG) | Giorgetti, 1998 [40] | ICC = 0.31 (−) |
N/R | N/R | N/R | N/R |
| The five-times-sit-to-stand test (FTSST) | Goldberg, 2012 [57] | ICC = 0.95 (+) |
MIC not defined (?) | N/R | N/R | Inconsistent (±) |
| The Maximum Step Length (MSL) test | Goldberg, 2010 [58] | ICC = 0.90–0.96 (+) |
MIC not defined (?) | N/R | N/R | Inconsistent (±) |
| The Thirty Rapid-Step test (30-RST) | Goldberg, 2015 [59] | ICC = 0.85 (+) |
MIC not defined (?) | N/R | N/R | Inconsistent (±) |
| The Community Balance and Mobility Scale (CBM) | Weber, 2018 [60] | ICC ≥ 0.97 (+) |
N/R | Criteria not met (?) |
N/R | Inconsistent (±) |
| The German-Community Balance and Mobility Scale (German CBM) | Gordt, 2019 [61] | ICC ≥ 0.99 (+) |
N/R | Criteria not met (?) |
r > 0.70 (+) |
Hypothesis confirmed (+) |
| The Shortened version of the Community Balance and Mobility Scale (s-CBM) | Gordt, 2020 [62] | N/R | N/R | Criteria met (+) |
N/R | Inconsistent (±) |
| The ‘Step-Ex’ (New Development Technologies [NDT], Stockholm, Sweden) |
Halvarsson, 2012 [63] | ICC = 0.71–0.87 (+) |
MIC not defined (?) | N/R | N/R | N/R |
| Tinetti’s POMA balance subscale | Harada, 1995 [30] Lin, 2004 [41] |
ICC ≥ 0.93 (+) |
N/R | N/R | Indeterminate (?) |
(+), for discriminative validity (−), for convergent validity |
| The Short Berg Balance Scale (BBS-9) | Hohtari-Kivimaki, 2012 [64] | N/R | N/R | Criteria met (+) |
r < 0.70 (−) |
N/R |
| The Multi-Directional Reach Test (MDRT) | Holbein-Jenny, 2005 [31] Newton, 2001 [65] |
ICC = 0.83–0.98 (+) |
N/R | Criteria not met (?) |
Inconsistent (±) |
(±), for convergent validity (−), for discriminative validity |
| The Kinect system (Kinect for Xbox 360™, Microsoft Corp, Seattle, WA, USA) | Hsiao, 2018 [66] | ICC ≥ 0.775 (+) |
N/R | N/R | r < 0.70 (−) |
rS > 0.50 (+) |
| The Turkish version of Fullerton Advanced Balance (FAB-T) scale | Iyigun, 2018 [67] | ICC = 0.96 (+) |
N/R | N/R | rS = 0.70 (+) |
N/R |
| The Fullerton Advanced Balance (FAB) Scale |
Klein, 2011 [68] Rose, 2006 [69] |
ICC not reported (?) |
N/R | N/R | r ≥ 0.70 (+) |
N/R |
| The parallel walk test | Lark, 2009 [70] | N/R | N/R | N/R | N/R | Hypotheses not confirmed (−) |
| The Timed Up and Go (TUG) test | Galhardas, 2020 [39] Lin, 2004 [41] Nightingale, 2019 [71] Pelicioni, 2022 [33] Yingyongyudha, 2016 [24] |
ICC ≥ 0.83 (+) |
MIC not defined (?) |
N/R | r not reported (?) |
Hypotheses confirmed (+) |
| The Balance Computerised Adaptive Testing (Balance CAT) | Lu, 2015 [72] | N/R | MIC not defined (?) |
N/R | r = 0.90 (+) |
Hypothesis confirmed (+) |
| The MyBalance test | Mansson, 2021 [73] | N/R | N/R | N/R | N/R | r not reported (?) |
| The Brief-Balance Evaluation Systems Test (Brief-BESTest) | Marques, 2016 [20] O’Hoski, 2015 [21] Viveiro, 2019 [22] |
ICC = 0.82–0.99 (+) |
MIC not defined (?) |
N/R | rS ≥ 0.83 (+) |
(±), for discriminative validity (+), for convergent validity |
| The Functional Gait Assessment-Brazil (FGA- Brazil) |
Marques, 2021 [74] Kirkwood, 2021 [75] |
ICC > 0.90 (+) |
MIC not defined (?) |
Criteria not met (?) |
rS = 0.80 (+) |
Hypothesis confirmed (+) |
| The ‘Get-up and Go’ Test | Mathias, 1986 [76] | ICC not reported (?) |
N/R | N/R | r < 0.70 (−) |
N/R |
| The apparatus for assessment of postural responses | Matjacic, 2010 [77] |
N/R | N/R | N/R | r < 0.70 (−) |
Hypothesis confirmed (+) |
| A comprehensive set of inertial sensor measures of postural sway (The Balance Score (BS) & The Weighted Balance Score (WBS)) |
Mcmanus, 2022 [78] | ICC ≥ 0.75 (+) |
N/R | N/R | N/R | Inconsistent (±) |
| The Modified Version of the Community Balance and Mobility Scale (CBMS-Home) | Ng, 2021 [79] | ICC = 0.95 (+) |
MIC not defined (?) |
Criteria not met (?) |
N/R | Inconsistent (±) |
| The Pavia Instrumented Tinetti Test (PITT) | Panella, 2008 [80] | N/R | N/R | Criteria not met (?) |
r not reported (?) |
Hypotheses confirmed (+) |
| The Dynamic Gait Index (DGI) | Pelicioni, 2022 [33] | ICC ≥ 0.85 (+) |
N/R | N/R | N/R | r > 0.50 (+) |
| The Danish Version of the Dynamic Gait Index (Danish DGI) | Jønsson, 2011 [98] | ICC = 0.82–0.89 (+) |
MIC not defined (?) | N/R | N/R | N/R |
| The Functional Gait Assessment (FGA) |
Pelicioni, 2022 [33] Wrisley, 2010 [99] Beninato, 2016 [100] $ |
ICC ≥ 0.80 (+) |
N/R | N/R | r = 0.84 (+) |
Hypotheses confirmed (+) |
| The NIH Toolbox® Standing Balance Test | Peller, 2022 [81] | ICC = 0.84 (+) |
MIC not defined (?) |
N/R | r < 0.70 (−) |
N/R |
| The Biodex SD (Biodex Medical Systems, Shirley NY) | Riemann, 2017 [82] | ICC = 0.74–0.86 (+) |
MIC not defined (?) |
N/R | N/R | N/R |
| The Balance Scale (by Roberts) | Roberts, 1987 [83] | N/R | N/R | Cronbach’s α not reported (?) | N/R | N/R |
| The Turkish Version of the Berg Balance Scale (BBS) | Sahin, 2008 [84] | ICC = 0.97–0.98 (+) |
N/R | Criteria not met (?) |
N/R | r > 0.50 (+) |
| The Persian version of the Berg Balance Scale (BBS) | Salavati, 2012 [85] | ICC = 0.93–0.95 (+) |
N/R | Criteria not met (?) |
N/R | r > 0.50 (+) |
| The Nintendo Wii Fit exergame | Sato, 2021 [86] | N/R | N/R | N/R | N/R | r > 0.50 (+) |
| The Wii Stillness (WST) Test | Simms, 2020 [88] | N/R | N/R | N/R | r < 0.70 (−) |
N/R |
| The short form of the Fullerton Advanced Balance (SF-FAB) scale | Sinaei, 2021 [89] | ICC = 0.92–0.99 (+) |
MIC not defined (?) |
Criteria not met (?) |
r not reported (?) |
Hypothesis confirmed (+) |
| The ‘balance meter’ | Stokes, 1998 [90] |
ICC not reported (?) |
MIC not defined (?) |
N/R | N/R | Inconsistent (±) |
| The AMTI Accusway system for balance and postural sway measurement (Advanced Mechanical Technology, Inc., Watertown, Massachusetts) |
Swanenburg, 2008 [91] | ICC = 0.52–0.89 (+) |
MIC not defined (?) |
N/R | N/R | N/R |
| A dual-task computer game-based platform (TGP) | Szturm, 2015 [92] | ICC = 0.55–0.7 (+) |
MIC not defined (?) |
N/R | N/R | N/R |
| The Modified Bathroom Scale | Vermeulen, 2012 [93] | N/R | N/R | N/R | N/R | Inconsistent (±) |
| The instrumented modified Clinical Test of Sensory Interaction on Balance (i-mCTSIB) utilising the Neurocom Very Simple Rehab (VSR) Sport force plate (Natus Medical Incorporated, Pleasanton, California). |
Watson, 2021 [94] | ICC = 0.898 (+) |
MIC not defined (?) |
N/R | N/R | N/R |
| Models for estimating decline in balance using accelerometry-based gait features | Simila, 2017 [95] | N/R | N/R | N/R | r not reported (?) |
r not reported (?) |
| The FICSIT Balance Scales (FICSIT-3 and FICSIT-4) | Rossiter-Fornoff, 1995 [96] | ICC not reported (?) |
N/R | N/R | N/R | Hypothesis confirmed (+) |
| The Wii Balance Board™ (WBB) | Olvera-Chavez, 2013 [97] Scaglioni-Solano, 2014 [87] |
ICC = 0.64–0.85 (+) |
MIC not defined (?) |
N/R | r not reported (?) |
Hypothesis confirmed (+) |
| The Balance Tracking System (BTrackS) | Levy, 2018 [101] | ICC = 0.83 (+) |
MIC not defined (?) |
Criteria not met (?) |
r ≥ 0.82 (+) |
N/R |
| The NeuroCom Smart Equitest Research System (Natus Medical Inc, Pleasanton, California) | Harro, 2019 [102] | ICC ≥ 0.71 (+) |
MIC not defined (?) |
N/R | N/R | Hypotheses not confirmed (−) |
$Only structural validity assessed.
Measurement property rating: sufficient (+), insufficient (−), inconsistent (±), indeterminate (?)
ABC, The Activities-specific Balance Confidence Scale; DSE, direction-sensitive evaluation (new strategy proposed by the authors in this study); 8LBS, The 8-level balance scale; APSI, anteroposterior stability index; MLSI, mediolateral stability index; PABAK, prevalence-adjusted bias-adjusted kappa; PASE, Physical Activity Scale for the Elderly; FAB, The Fullerton Advanced Balance scale; 3MTW, The three meter tandem walk; SRD, Smallest Real Difference; Falls Efficacy Scale-International (FES-I); SEM, Standard Error of Measurement; MDC, minimum detectable change; SD, standard deviation; CTSIB, Clinical Test of Sensory Interaction on Balance; FRT, The Functional Reach Test; SLS, single leg stance; N/R, not reported