Validation of a Russian version of the Berg Balance Scale

Objective: linguistic and cultural adaptation of the original version of Berg Balance Scale (BBS) and assessment its psychometric properties.

Patients and methods. The staff of the Validation Center of International Scales and Questionnaires of the Research Center of Neurology received consent from Katherine Berg to validate the BSS in Russia. We carried out the linguocultural ratification during the validation study and prepared a Russian version of the scale. To assess the psychometric properties of the scale (reliability, validity, and sensitivity), we evaluated 55 patients (30 females and 25 males) aged 22–88 years with different neurological disorders (vascular and demyelinating diseases of the central nervous system, peripheral neuropathy, and movement disorders). We analyzed the differences of the total BBS score and the number of patients with high and low risk of falls at the end of rehabilitation compared to baseline to assess the dynamics of changes.

Results and discussion. We successfully performed the translation and linguocultural adaptation of the BBS. The scale represents a high level of validity (expert score: 8.6 out of 10 points), reliability (Pearson's correlation coefficient r=0.98, р<0.0001; Cronbach's alpha α=0.94 р<0.001; Cohen's kappa κ=0.71, p<0.0001) and sensitivity (р<0.0001). After a two-week rehabilitation course, the risk of falls significantly decreased (χ2 =4.42; р=0.035); however, the level of independence of movement did not change significantly (F=0.94; р=0.636).

Conclusion. The Russian version of the BBS was officially adapted based on the results of the accomplished validation study and is recommended for use both in routine clinical practice and in clinical trials by neurologists and rehabilitologists. The scale is available for downloading by QR code and on the website of Validation Center of International Scales and Questionnaires of the Research Center of Neurology.

1. Sackley CM, Baguley BI, Gent S, Hodgson P. The use of a balance performance monitor in the treatment of weight-bearing and weight transference problems after stroke. Physiotherapy. 1992;78:907-13. doi: 10.1016/S0031-9406(10)60498-1

2. Lin H, Bhattacharyya N. Balance disorders in the elderly: epidemiology and functional impact. Laryngoscope. 2012 Aug;122(8):1858- 61. doi: 10.1002/lary.23376. Epub 2012 May 29.

3. Rubenstein L, Josephson K. The epidemiology of falls and syncope. Clin Geriatr Med. 2002 May;18(2):141-58. doi: 10.1016/s0749-0690(02)00002-2

4. Romanova MV, Kubryak OV, Isakova EV, et al. Objectivization of equilibrium and stability changes in patients with stroke in the early restorative period. Annaly klinicheskoy i eksperimental'noy nevrologii = Annals of Clinical and Experimental Neurology. 2014;8(2):12-5 (In Russ.).

5. Suslina ZA, Varakin YuA, Vereshchagin NV. Sosudistyye zabolevaniya golovnogo mozga. Epidemiologiya. Patogeneticheskiye mekhanizmy. Profilaktika [Vascular diseases of the brain. Epidemiology. Pathogenetic mechanisms]. 2nd ed. Moscow: MEDpress-inform; 2009. 325 p. (In Russ.).

6. Berg K, Wood-Dauphine S, Williams JI, Gayton D. Measuring balance in the elderly: preliminary development of an instrument. Physiotherapy Canada. 1989;41:304-11. doi: 10.3138/ptc.41.6.304

7. Korner-Bitensky N, Wood-Dauphinee SL, Teasell R, et al. Best versus actual practices in stroke rehabilitation: results of the Canadian National Survey [abstract]. Stroke. 2006;37:631.

8. Major MJ, Fatone S, Roth EJ. Validity and reliability of the Berg Balance Scale for community-dwelling persons with lowerlimb amputation. Arch Phys Med Rehabil. 2013 Nov;94(11):2194-202. doi: 10.1016/j.apmr.2013.07.002. Epub 2013 Jul 13.

9. Telenius EW, Engedal K, Bergland A. Long-term effects of a 12 weeks high-intensity functional exercise program on physical function and mental health in nursing home residents with dementia: a single blinded randomized controlled trial. BMC Geriatr. 2015 Dec 3;15:158. doi: 10.1186/s12877-015-0151-8

10. Muir-Hunter SW, Graham L, Montero Odasso M. Reliability of the Berg Balance Scale as a Clinical Measure of Balance in Community-Dwelling Older Adults with Mild to Moderate Alzheimer Disease: A Pilot Study. Physiother Can. 2015 Aug;67(3):255-62. doi: 10.3138/ptc.2014-32

11. Babaei-Ghazani A, Mohammadi H, Shahidi GA, et al. Reliability and validity of the Persian translation of Berg Balance Scale in Parkinson disease. Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran. Aging Clin Exp Res. 2017 Oct;29(5):857-62. doi: 10.1007/s40520-016-0682-7

12. Matsushima M, Yabe I, Uwatoko H, et al. Reliability of the Japanese version of the Berg balance scale. Department of Neurology, Hokkaido University Graduate School of Medicine, Japan. Intern Med. 2014;53(15):1621-4. doi: 10.2169/internalmedicine.53.2662

13. Miyamoto ST, Lombardi Junior I, Berg KO, et al. Brazilian version of the Berg balance scale. Braz J Med Biol Res. 2004 Sep;37(9):1411-21. doi: 10.1590/s0100-879x2004000900017. Epub 2004 Aug 24.

14. Gordt K, Mikolaizak AS, Nerz C, et al. German version of the Community Balance and Mobility Scale: Translation and evaluation of measurement properties. Z Gerontol Geriatr. 2019 Feb;52(1):28-36. doi: 10.1007/s00391-018-1374-z. Epub 2018 Feb 12.

15. Sahin F, Yilmaz F, Ozmaden A, et al. Reliability and validity of the Turkish version of the Berg Balance Scale. J Geriatr Phys Ther. 2008;31(1):32-7. doi: 10.1519/00139143-200831010-00006

16. Covotta A, Gagliardi M, Berardi A, et al. Physical Activity Scale for the Elderly: Translation, Cultural Adaptation, and Validation of the Italian Version. Curr Gerontol Geriatr Res. 2018 Aug 8;2018:8294568. doi: 10.1155/2018/8294568. eCollection 2018.

17. Belova AN, editor. Shkaly, testy i oprosniki v meditsinskoy reabilitatsii [Scales, tests and questionnaires in medical rehabilitation.]. Moscow: Antidor; 2002. P. 27 (In Russ.).

18. Karpova EA, Ivanova-Smolenskaya IA, Chernikova LA, et al. Clinical and stabilometric analysis of postural instability in Parkinson’s disease. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova = S.S. Korsakov Journal of Neurology and Psychiatry. 2004;104(1):37-41 (In Russ.).

19. Sidorovich E, Likhachev S, Klishevskaya N, et al. Subclinical postural instability detected by stabiloplatform examination in the patients with vascular mild cognitive impairment – Part 1. Wiad Lek. 2014;67(2 Pt 1):64-70.

20. Santos GM, Souza ACS, Virtuoso JF, et al. Predictive values at risk of falling in physically active and no active elderly with Berg Balance Scale. Rev Bras Fisioter. Mar-Apr 2011;15(2):95-101. doi: 10.1590/s1413-35552011000200003

21. Scholtes VA, Terwee CB, Poolman RW. What makes a measurement valid and reliable? Injury. 2011 Mar;42(3):236-40. doi: 10.1016/j.injury.2010.11.042. Epub 2010 Dec 9.

22. Park S-H, Lee Y-S. The Diagnostic Accuracy of the Berg Balance Scale in Predicting Falls. West J Nurs Res. 2017 Nov;39(11):1502-25. doi: 10.1177/0193945916670894. Epub 2016 Oct 26.

23. Bogle T, Newton RA. Use of the Berg Balance Test to predict falls in elderly persons. Phys Ther. 1996 Jun;76(6):576-83; discussion 584-5. doi: 10.1093/ptj/76.6.576

24. Medley A, Thomson M, French J. Predicting the probability of falls in community dwelling persons with brain injury: A pilot study. Brain Injury. 2006 Dec;20(13-14):1403-8. doi: 10.1080/02699050601082057

25. Kadam P, Bhalerao S. Sample size calculation. Int J Ayurveda Res. 2010 Jan;1(1):55-7. doi: 10.4103/0974-7788.59946