title: Measurement instruments to assess posture, gait, and balance in Parkinson's disease: Critique and recommendations.
abstract: Disorders of posture, gait, and balance in Parkinson's disease (PD) are common and debilitating. This MDS-commissioned task force assessed clinimetric properties of existing rating scales, questionnaires, and timed tests that assess these features in PD.
  
  
  
  A literature review was conducted. Identified instruments were evaluated systematically and classified as "recommended," "suggested," or "listed." Inclusion of rating scales was restricted to those that could be used readily in clinical research and practice.
  
  
  
  One rating scale was classified as "recommended" (UPDRS-derived Postural Instability and Gait Difficulty score) and 2 as "suggested" (Tinetti Balance Scale, Rating Scale for Gait Evaluation). Three scales requiring equipment (Berg Balance Scale, Mini-BESTest, Dynamic Gait Index) also fulfilled criteria for "recommended" and 2 for "suggested" (FOG score, Gait and Balance Scale). Four questionnaires were "recommended" (Freezing of Gait Questionnaire, Activities-specific Balance Confidence Scale, Falls Efficacy Scale, Survey of Activities, and Fear of Falling in the Elderly-Modified). Four tests were classified as "recommended" (6-minute and 10-m walk tests, Timed Up-and-Go, Functional Reach).
  
  
  
  We identified several questionnaires that adequately assess freezing of gait and balance confidence in PD and a number of useful clinical tests. However, most clinical rating scales for gait, balance, and posture perform suboptimally or have been evaluated insufficiently. No instrument comprehensively and separately evaluates all relevant PD-specific gait characteristics with good clinimetric properties, and none provides separate balance and gait scores with adequate content validity for PD. We therefore recommend the development of such a PD-specific, easily administered, comprehensive gait and balance scale that separately assesses all relevant constructs. © 2016 International Parkinson and Movement Disorder Society.
authors.affiliation: Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Dept. of Neurology, Nijmegen, The Netherlands. bas.bloem@radboudumc.nl.
authors.forename: Bastiaan R
authors.initials: BR
authors.lastname: Bloem
authors.affiliation: Leiden University Medical Center, Department of Neurology, Leiden, The Netherlands.
authors.forename: Johan
authors.initials: J
authors.lastname: Marinus
authors.affiliation: Sun Life Financial Movement Disorders Research & Rehabilitation Centre; Department of Kinesiology & Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada.
authors.forename: Quincy
authors.initials: Q
authors.lastname: Almeida
authors.affiliation: University of Utah, Department of Physical Therapy, Salt Lake City, Utah, USA.
authors.forename: Lee
authors.initials: L
authors.lastname: Dibble
authors.affiliation: KU Leuven, University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium.
authors.forename: Alice
authors.initials: A
authors.lastname: Nieuwboer
authors.affiliation: Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Dept. of Neurology, Nijmegen, The Netherlands.
authors.forename: Bart
authors.initials: B
authors.lastname: Post
authors.affiliation: 1st Faculty of Medicine and General University Hospital, Dept. of Neurology and Centre of Clinical Neuroscience, Charles University, Prague, Czech Republic.
authors.forename: Evzen
authors.initials: E
authors.lastname: Ruzicka
authors.affiliation: Department of Neurological Services, Rush University School of Medicine, Chicago, Illinois, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Goetz
authors.affiliation: Department of Neurological Services, Rush University School of Medicine, Chicago, Illinois, USA.
authors.forename: Glenn
authors.initials: G
authors.lastname: Stebbins
authors.affiliation: Alzheimer Center Reina Sofia Foundation and CIBERNED, Carlos III Institute of Health, Madrid, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Martinez-Martin
authors.affiliation: UCL Institute of Neurology, University College, London, UK.
authors.forename: Anette
authors.initials: A
authors.lastname: Schrag
mesh_terms: D019937:Diagnostic Techniques and Procedures / Q000592:standards*; D020233:Gait Disorders, Neurologic / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D010300:Parkinson Disease / Q000150:complications / Q000175:diagnosis*; D004856:Postural Balance
keywords: Parkinson's disease; balance; gait; posture; rating scales