Balance Outcome Measure for Elder Rehabilitation

Last Updated

March 27, 2015

Purpose

The BOOMER assesses standing balance and functional mobility in the elderly population. A global multi-item static, dynamic, and functional balance measure throughout all settings of elder rehabilitation. Collaboration of 4 test scores used to measure balance, mobility and perceived confidence in the geriatric population.

Link to Instrument

Instrument Details

Acronym BOOMER

Cost

Not Free

Older Adults and Geriatric Care

Four assessments include:
1) Timed Up-and-Go (TUG)
2) Functional Reach Test (FRT)
3) Step test
4) Test of static standing with feet together and eyes closed
Scores range from 0 to 16.
To scale each item, 4 cutoff points were selected creating 5 ordinal categories (scores range 0-4).
An overall score was created by summing the scores for each item (scores range 0-16).

Number of Items

stopwatch
chair with armrests
ruler or tape measurer
duct tape
cone
yard stick
7.5 cm high step

5-10 minutes

May vary with patient's abilities

Required Training

No Training

Instrument Reviewers

Initially reviewed by Kartik Srinivasan, PT, MHS; Evan Papa, DPT, PhD for The University of North Texas Health Science Center, DPT Class of 2015 in June 2014.

ICF Domain

Activity

Considerations

Quick and easy to administer, is able to be used at bedside, and appears to be able to differentiate between patients requiring inpatient rehabilitation as well as those hospitalized following a fall. (Kuys et al, 2014) Recommended as a tool to guide referral for rehabilitation or determine patients who could be safely discharged from an acute care setting to their usual residence. (Kuys et al, 2014)The study only considered existing standing balance measures. (Haines et al, 2007)The Boomer has not been investigated for its use as a falls prediction tool. The BOOMER utilizes a composite of several clinical balance measures. Links to the instructions for using these instruments can be found as follows:

Step Test: http://www.rehabmeasures.org/Lists/RehabMeasures/DispForm.aspx?ID=1107
Functional Reach Test: http://www.rehabmeasures.org/PDF%20Library/Functional%20Reach%20Test.pdf
Static stance feet together eyes closed: http://www.rehabmeasures.org/Lists/RehabMeasures/PrintView.aspx?ID=1173
TUG: http://www.cdc.gov/homeandrecreationalsafety/pdf/steadi/timed_up_and_go_test.pdf

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Standard Error of Measurement (SEM)

Older adults with dementia: (Fox et al. 2014; n=12; male: 1; female: 11; mean age = 83.25 + 9.94 years)

The SEM for the components of BOOMER are as follows:

Step test R foot (steps): 2.654
Step test L foot (steps): 2.192
TUG (s): 5.959 Functional Reach (cm): 6.080
Static Timed Standing (s): 24.462

Minimally Clinically Important Difference (MCID)

Elderly: (Haines et al., 2007; n =1769; mean age=74 (13.5) years; data from several rehabilitation units including various diagnoses: stroke, neurologic, orthopedic etc.)

3 points on the 0-16 point scale

Cut-Off Scores

Elderly: (Haines et al., 2007)

4 cut off points were selected allowing for 5 categories

Test	0	1	2	3	4
Step Test (average number of steps)	Unable	>0-5	>5-8	>8-12	>12
TUG test (s)	Unable	>/= 30	<30-20	<20-10	<10
FRT (cm)	0	>0-15	>15-20	>20-30	>30
Static Standing eyes closed (s)	Unable	>0-30	>30-60	>60-<90	90

An overall score is created by summing the scores for each item (ranging from 0-16)

Test/Retest Reliability

Older adults with dementia (Fox et al. 2014; n =12; female = 11, male = 1; mean age: 83.25 + 9.94 years)

Component	ICC
ST R foot	0.696 (Adequate)
ST L foot	0.790 (Excellent)
TUG	0.857 (Excellent)
FR	0.384 (Poor)
Static Timed Standing	0.469 (Adequate)

Excellent test-retest reliability - TUG and ST L foot

Adequate test-retest reliability – ST R foot and Static Timed Standing

Poor test-retest reliability - FR

Internal Consistency

Elderly:

Excellent internal consistency (Cronbach’s alpha 0.87 to 0.89) for admission and discharge assessments (Haines et al, 2007).

Criterion Validity (Predictive/Concurrent)

Concurrent Validity:

Geriatric rehab setting: (Kuys et al, 2011; n = 134, mean age = 78 (11) years)

Excellent correlation between BOOMER and BBS (ρ = .91, P < .01 at admission; ρ = .89 P < .01 at discharge)
Excellent correlation between BOOMER and gait speed (ρ = .67, P < .01 at admission; ρ = .68, P < .01 at discharge)

Geriatric rehab setting: (Haines et al., 2007)

Excellent concurrent validity of the BOOMER with the motor FIM (admission data, ρ = .73; discharge data, ρ =.72) and the Modified Elderly Mobility Scale (MEMS) (admission data, ρ =.88; discharge data, ρ =.83). Each of these associations was statistically signiﬁcant (P<.001).

Acute Inpatient setting: (Kuys et al 2014, n = 44; mean age= 77 (7) years)

Excellent correlation with BBS (ρ =.93, p<0.001)
Excellent correlation with de Morton Mobility Index (ρ =.89, p<0.001)
Adequate correlation with Activities-Specific Balance Confidence scale (ρ =.52, p<0.001)

Elderly: (Lindenberg et al. 2014; n=227; age > 60 years; mean age = 79(9) years)

Adequate correlation of discharge total BOOMER score < 4 to discharge to Residential Aged Care Facility (RACF) (r = -0.47)

Outcome Measure	Correlation with discharge to RACFa
BOOMER total score	-0.33b
Boomer Total score < 4	-0.47
10MWT	0.07
10MWT (unable to perform)	0.34b
Age	0.15b
Rehabilitation LOS	0.37b

^a Spearman rank correlation

^b Significant when P < 0.05

Construct Validity

Elderly population: (Haines et al. 2007; Phase 3; n=272; mean age = 75 (14) years)

Excellent correlation between BOOMER, the Modified Elderly Mobility Scale (MEMS – admission data, ρ=.88; discharge data, ρ=.83), and the Functional independence measure (FIM – admission data, ρ=.73; discharge data, ρ=.72) motor score across scores at admission and discharge.

Content Validity

Items were selected by an expert panel made up of 8 senior clinical physiotherapists with 5 to 20 years of clinical experience. (Haines et al., 2007)
The expert panel deemed that items encompassed a range of static and dynamic tasks incorporating a range of functional activities including both motor and sensory challenges to balance.
The panel further determined that the four tests selected adequately sampled the range of balance domains while preserving the desire for the tool to be practically applicable.

Floor/Ceiling Effects

Floor/Ceiling Effects Elderly: (Haines et al., 2007)

Small floor effects at admission (6.5%)

Bibliography

Fox B., Henwood T., et al. (2014). “Relative and absolute reliability of functional performance measures for older adults with dementia living in residential aged care.” Int Psychogeriatr 26(10): 1659-1667.

Haines, T., Kuys, S., et al. (2007). “Development and validation of the Balance Outcome Measure for Elder Rehabilitation.” Arch Phys Med Rehabil 88: 1614-21.

Kuys S.S., Morrison G., et al. (2011). “Further validation of the Balance Outcome Measure for Elder Rehabilitation.” Arch Phys Med Rehabil. 92(1):101-105.

Kuys S.S., Crouch T., et al. (2014). “Use and validation of the Balance Outcome Measure for Elder Rehabilitation in acute care.” New Zealand Journal of Physiotherapy 42(1): 16-21.

Lindenberg K., Nitz J.C., et al. (2014). “Predictors of discharge destination in a geriatric population after undergoing rehabilitation.” J Geriatr Phys Ther 37(2): 92-98.