Falls in persons with spinal cord injury: validity and reliability of the Berg Balance Scale.
BACKGROUND
Persons with spinal cord injury who are able to walk are at risk for falls.


OBJECTIVE
The objectives were to investigate if the Berg Balance Scale (BBS) can discriminate those with a propensity to fall; to determine whether the BBS is associated with mobility measures, fear of falling, and muscle strength; and to assess interobserver reliability.


METHODS
The measurement tools used were the BBS, the Spinal Cord Independence Measure, the Falls Efficacy Scale (FES-I), the Walking Index for Spinal Cord Injury, the 10-m walk test, and the standard neurological classification including motor scores (MS). Falls were recorded retrospectively for the previous month and prospectively for the subsequent 4 months. To determine interobserver reliability, BBS performance was videotaped and analyzed by additional physical therapists. Associations between BBS and the number of falls, measures of mobility, FES-I, and MS were calculated using Spearman correlations. The interobserver reliability was quantified using Kendall's coefficient of concordance and intraclass correlation coefficients (ICCs).


RESULTS
Forty-two participants were included of whom 26 sustained 1 or more falls. BBS performance correlated with measures of mobility, FES-I, and MS (r(s) = -.83 to .93; P < .001) but not with the number of falls (r(s) = -.17; P = .28). The interobserver reliability was excellent, both for single items (.84-.98, P < .001) and for the total score (ICC = .95; 95% confidence interval = 0.910-0.975).


CONCLUSIONS
The BBS proved to be reliable and to relate well with other mobility measures, fear of falling, and muscle strength. However, it was unable discriminate between people who did fall and people who did not fall.
Wirz
Markus
M
Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland. mwirz@paralab.balgrist.ch
Müller
Roland
R
Bastiaenen
Caroline
C
D000058:Accidental Falls; D000328:Adult; D002908:Chronic Disease; D005239:Fear; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D015588:Observer Variation; D004856:Postural Balance; D011446:Prospective Studies; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012306:Risk; D012720:Severity of Illness Index; D013119:Spinal Cord Injuries / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D016138:Walking