Discriminative and evaluative properties of the activities-specific balance confidence (ABC) scale.

BACKGROUND: Balance confidence is an important indicator of functional mobility and independence in older adults. Preliminary psychometric evidence for the Activities-specific Balance Confidence (ABC) Scale is promising, with a series of four studies adding information on the discriminative and evaluative properties of this tool. METHODS: The original validation sample was reinterviewed one year later. In the second study, the ABC was administered to 475 older adults ranging from home care clients to highly functioning individuals in community exercise programs. The third study compared 31 residents of retirement homes given a 10-week balance control exercise program and fall education with 32 residents who received only fall education. The fourth study examined balance confidence preoperatively and postoperatively for 27 patients undergoing hip or knee replacement. RESULTS: ABC scores remained stable over 12 months in higher functioning elders, but deteriorated in retirement home residents over 26 weeks. Ten weeks of balance training significantly improved balance confidence, as did hip or knee replacement with standard physical therapy. ABC scores lower than 50 indicated a low level of physical functioning characteristic of home care clients. ABC scores above 50 and lower than 80 indicated a moderate level of functioning characteristic of elders in retirement homes and persons with chronic health conditions. ABC scores above 80 are indicative of highly functioning, usually physically active older adults, and are achievable through exercise and rehabilitative therapies. CONCLUSIONS. Balance confidence is amenable to change and able to distinguish between elders at various levels of functional mobility. These results provide comparative benchmarks for researchers and clinicians working with different groups of older adults.

Psychological indicators of balance confidence: relationship to actual and perceived abilities.

BACKGROUND: This study compares several psychological indicators of balance confidence in relation to physical performance, past and current experience, gender bias, and other perceptions of daily functioning. METHODS: Sixty community-dwelling ambulatory elders (aged 65-95) were administered the Falls Efficacy Scale (FES), the Activities-Specific Balance Confidence Scale (ABC), and three dichotomous questions on fear of falling, activity avoidance, and perceived need for personal assistance to ambulate outdoors. Performance measures on walking (average speed) and balance (static posturography) were obtained on a subsample of 21 subjects. RESULTS: Balance confidence assessed by the ABC and self-perceived need for personal assistance with outdoor ambulation were the only indicators significantly associated with the performance measures. As expected, perceived balance capabilities were more strongly related to current behavior (frequency of doing specific activities) than to past experience (fall history). Gender differences in self-report emerged for the global fear-of-falling indicator but not for the two efficacy ratings. CONCLUSIONS: Psychological indicators of balance confidence are important to measure both in conjunction with balance test performance and as a legitimate focus of rehabilitation. Of the various indicators assessed here, the dichotomous fear-of-falling question appears to have the least utility. Perceived need for personal assistance to ambulate outdoors has merit as an initial clinical screening question for discriminating persons on the basis of both physical ability and confidence. The ABC scale appears to have the greatest utility as an evaluative index for older persons at a moderate to high level of functioning.