Comparison of the Validity of the Timed Up and Go Test (TUG) and Activities-specific Balance Confidence Questionnaire (ABC) to the ‘Gold Standard’ Berg Balance Scale (BBS) in Assessing Fall Risk in the Elderly Population

Abstract

Background: Falls are ranked as the leading cause of death from unintentional injury among older adults in the United States. Approximately 25% of the older adults in the U.S. experience a fall each year, which leads to excessive healthcare costs. Falls lead to serious injuries such as broken bones and head injuries hospitalizing 800,000 patients a year [1]. Based on those statistics, identifying fall risk accurately and efficiently using balance assessments is pertinent to fall prevention in the geriatric population. Therefore, the purpose of this study is to compare the validity of the Timed Up and Go Test (TUG) and Activities-Specific Balance Confidence Questionnaire (ABC) to the Berg Balance Scale (BBS) in assessing the risk of falls in the elderly population. Methods: The systematic review was conducted to highlight balance assessments including the Berg Balance Scale, Timed Up and Go Test, and Activities-specific Balance Confidence Questionnaire. Databases used in the electronic search were PubMed, Google Scholar, MedlinePlus, PTNow, PEDro, and EBSCOhost, and parameters were set at studies published from 2010 to 2021. All relevant studies were reviewed by assessing abstracts for inclusion. Studies in which participants completed and were scored on the three balance assessments were included. All participants completing the tests were required to be 65 years of age or older in order for the respective study to be included. Results: 62 studies were identified for further review after the initial search. After a more extensive screening process, several studies were excluded for reasons such as study design, age of participants, or insufficient testing measures. 16 studies were included for data analysis with a total of 1,376 participants. The validity of the BBS, TUG, and ABC were measured in the 16 studies with strong negative correlation between BBS and TUG (rho (22) = -.756, p < .01), and moderate positive correlation between BBS and ABC (rho (22) = .591, p < .01). Conclusions: The Timed Up and Go test may be an effective and valid tool assessing balance and a participant’s fall risk. It has been shown to have a strong correlation with the Berg Balance Scale. Meanwhile, the Activities-specific Balance Confidence Questionnaire, a subjective measure, has a moderate correlation with the Berg Balance Scale indicating that it is capable of identifying fall risk but not as accurately or efficiently as the Timed Up and Go Test. This research advocates for the appropriateness of the TUG test and ABC questionnaire, and therefore widens clinicians’ choices of valid balance assessment tools during fall risk examinations.