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  2. Activities-Specific Balance Confidence Scale

Activities-Specific Balance Confidence Scale

Last Updated

Purpose

The ABC Scale is a self-report measure of balance confidence in performing various activities without losing balance or experiencing a sense of unsteadiness. 

Acronym ABC Scale

Area of Assessment

Balance – Vestibular
Balance – Non-vestibular
Functional Mobility

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Not Free

Cost Description

The paper version of the scale may be reproduced for student training, research and clinical practices in which therapists and assistants use the scale to assess fewer than 1000 patients per year (single assessment). In all other cases, including: larger scale practices (1,000+ patient administrations per year), translation into other languages, any other modifications to the scale itself or instructions, electronic adaptations, use in clinical or multi-centre trials (regardless of sample size), for commercial or marketing purposes, and/or posting the scale on a website, permission must be obtained by the researchers or institution by contacting amyers@uwaterloo.ca. Costs may apply.

CDE Status

NeuroRehab Supplemental-Highly Recommended for trunk control/balance subdomain.

Diagnosis/Conditions

  • Multiple Sclerosis
  • Parkinson's Disease & Movement Disorders
  • Stroke Recovery
  • Vestibular Disorders

Populations

Sensory Disorders
Vestibular Disorders
Stroke
Spinal Injuries
Pulmonary Diseases
Parkinson's Disease
Osteoarthritis
Older Adults and Geriatric Care
Non-Specific Patient Population
Neuromuscular Conditions
Multiple Sclerosis
Limb Loss and Amputation
Cerebral Palsy
Brain Injury

Key Descriptions

  • 16-item self-report measure in which patients rate their balance confidence?for performing activities.
  • This stem is used to lead into each activity considered: "How confident are you that you will not lose your balance or become unsteady when you..."
  • Items are rated on a rating scale?that ranges from 0?- 100.
  • A score of zero represents no confidence, while a score of 100 represents complete confidence.
  • Overall score is calculated by adding item scores and then dividing by the total number of items.

Number of Items

16

Equipment Required

  • Paper survey includes visual analogue scale from 0 - 100%

Time to Administer

5-10 minutes

New Clinician and Experienced Clinician: approximately 5-10 minutes
Can be self-administered or via interview; recommended to administer by face-to-face interview (Powell & Meyers, 1995).

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by Jason Raad, MS and the Rehabilitation Measures Team in 2010; Updated with references from the stroke, PD, elderly, and TBI populations by Julie Hamby, SPT and Ryan Lainez Rivadelo, SPT in 2011; Updated by Phyllis Palma, PT, DPT, Christopher Newman, PT, MPT, NCS, and the SCI EDGE task force of the Neurology Section of the APTA in 2012; Updated by Sue Saliga, PT, MS, DHSc and the TBI EDGE task force of the Neurology Section of the APTA in 2012; Updated with references for the Stroke and Parkinson's Disease populations by Sarah Menhennett, SPT and Jennifer Malwitz Ponce, SPT in 11/2012; Updated by Erin Hussey, PT, DPT, MS, NCS and the PD EDGE task force of the Neurology Section of the APTA in 2013; Updated by Jennifer Fay, PT, DPT, NCS and Tracy Rice, PT, MPH, MCS and the Vestibular EDGE task force of the Neurology Section of the APTA in 2013.

Updated 8/15/2024 by Sophia Alvord, Ann Marie Colavito, Elise Dziko, Rachel Fleischut, Karin E. Johnson, Ryan Klee, and Emily Tormey (Master of Occupational Therapy students) under the direction of faculty mentor Danbi Lee, PhD, OTD, OTR/L, Division of Occupational Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle. 

 

 

 

ICF Domain

Activity

Measurement Domain

Activities of Daily Living
Motor

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit: 

Abbreviations:

 

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

Recommendations for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post)

(Vestibular < 6 weeks post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(Vestibular > 6 weeks weeks post)

SCI EDGE

LS

LS

LS

StrokEDGE

NR

R

R

Vestibular EDGE

R

R

R

Recommendations Based on Parkinson Disease Hoehn and Yahr stage:

 

I

II

III

IV

V

PD EDGE

R

R

R

LS/UR

NR

Recommendations based on level of care in which the assessment is taken:

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

MS EDGE

R

R

R

R

R

StrokEDGE

NR

R

R

R

R

TBI EDGE

LS

LS

LS

LS

LS

Recommendations based on SCI AIS Classification:

 

AIS A/B

AIS C/D

SCI EDGE

NR

LS

Recommendations for use based on ambulatory status after brain injury:

 

Completely Independent

Mildly dependant

Moderately Dependant

Severely Dependant

TBI EDGE

LS

LS

NR

NR

Recommendations based on EDSS Classification:

 

EDSS 0.0 – 3.5

EDSS 4.0 – 5.5

EDSS 6.0 – 7.5

EDSS 8.0 – 9.5

MS EDGE

R

R

R

NR

Recommendations based on vestibular diagnosis

 

Peripheral

Central

Benign Paroxysmal Positional Vertigo (BPPV)

Other

VEDGE

LS

LS

LS

LS

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

MS EDGE

Yes

Yes

Yes

No

PD EDGE

No

No

Yes

Not reported

SCI EDGE

No

No

No

Not reported

StrokEDGE

No

Yes

Yes

Not reported

TBI EDGE

No

Yes

Yes

Not reported

VEDGE

Yes

Yes

Yes

Yes

Considerations

For some clients, need to periodically redirect to ensure they are considering confidence in mobility rather than responding based on their usual level of activity to each of the items listed.

The assessment is available in English and several translations:

  • Turkish version (Karapolat et al., 2010; Paker et al., 2017)
  • Arabic version (Alghwiri et al., 2015; Alghwiri et al., 2020)
  • Italian version (Colnaghi et al., 2017)
  • Spanish version (Montilla-Iba?ez et al., 2017)
  • Japanese version (Ishige et al., 2019)
  • Brazillian version (Freitas, 2021)
  • Persian version (Monjezi, 2021)

Respondents may rate the item on confidence to “walk outside on icy sidewalks” differently based on seasonal and cultural considerations.

 

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Older Adults and Geriatric Care

back to Populations

Standard Error of Measurement (SEM)

Community-Dwelling Elderly:

(Nemmers et al., 2008; n = 203; mean age = 77.33 (7.59), Community-Dwelling Elderly)

  • SEM = 1.197

Minimal Detectable Change (MDC)

Older adults: (Wang, et. al., 2018; n = 5012; mean age = 73.6 (5.8); age range = 65-85; patients receiving outpatient therapy in 123 outpatient clinics in 18 U.S. States)

  • MDC (computed) for entire group = 14.89

 

Cut-Off Scores

Community-Dwelling Older Adults: (Freitas et al., 2022; n = 158; median age = 72 years; age range = 65-89 years; female = 57.6%; 33.3% reported falls in the previous year, Brazilian version)

  • Cut-off score for balance impairments = 67%, sensitivity = 81%, specificity = 77.4%, AUC = 0.894

 

Normative Data

Community Dwelling Older Adults:

(Huang & Wang, 2009; n = 168, mean age = 70.96 (6.91); mean Tinetti mobility score = 23.11 (6.39); mean FES score = 91.85 (16.89); Chinese language sample)

  • Mean (SD) scores = 79.89 (20.59)

 

Older adults: (Cleary & Skornyakov, 2014; n = 44; mean age = 84.2 (6.3); age range = 68-95; female = 68%; U.S. sample; 6 months between assessments)

  • Mean scores for Time 1 and Time 2 were 69.3 and 70.8, respectively

 

Community-Dwelling Older Adults: (Freitas et al., 2022)

Mean and median scores by item on Activities-Specific Balance Scale-16 (ABC-16)

ABC-16 Item

Mean (SD)

Median (min-max)

ABC1

89.3 (19.3)

100 (0-100)

ABC2

68.7 (32.2)

80 (0-100)

ABC3

75.7 (27.5)

90 (0-100)

ABC4

90.0 (12.5)

100 (0-100)

ABC5

65.0 (34.7)

80 (0-100)

ABC6

55.6 (35.2)

70 (0-100)

ABC7

89.8 (20.8)

100 (0-100)

ABC8

85.2 (25.9)

100 (0-100)

ABC9

81.4 (24.2)

90 (0-100)

ABC10

71.8 (31.0)

80 (0-100)

ABC11

68.8 (32.4)

80 (0-100)

ABC12

67.9 (31.2)

80 (0-100)

ABC13

54.9 (32.9)

60 (0-100)

ABC14

67.7 (38.0)

80 (0-100)

ABC15

46.4 (36.6)

50 (0-100)

ABC16

42.8 (33.7)

50 (0-100)

 

Test/Retest Reliability

Elderly Population: (Powell & Myers, 1995; n = 21; Assessed in two-week intervals, Elderly Population)

  • Excellent test-retest reliability (r = 0.92, p < 0.001)

Older adults: (Cleary & Skornyakov, 2014; 6 months between assessments)

  • Acceptable test-retest reliability for total score (ICC = 0.879, 95% CI: 0.779-0.934)

Interrater/Intrarater Reliability

Community-Dwelling Older Adults: (Freitas et al., 2022; 2 evaluators, order for two evaluators for evaluation 1 and evaluation 2 was randomly chosen, one week later one of the two evaluators were chosen to assess intrarater reliability with a subset of participants (n = 105))

  • Excellent interrater reliability (Krippendorff’s α = 0.946, 95% CI: 0.902-0.976), n = 158)
  • Excellent intrarater reliability (Krippendorff’s α = 0.946, 95% CI: 0.904-0.965), n = 105)

 

Internal Consistency

Community Dwelling Older Adults:

(Huang & Wang, 2009, Community Dwelling Older Adults)

  • Excellent internal consistency (Cronbach’s alpha = 0.96*)

 

Geriatric Females:

(Talley et al., 2008; n = 272; mean age = 78.7 (4.9) years, Geriatric Females)

  • Excellent internal consistency (Cronbach's alpha = 0.95*)

 

Older adults: (Cleary & Skornyakov, 2014)

  • Excellent internal consistency (Cronbach's α = 0.973* on each of two test days)

 

Older adults: (Wang, et. al., 2018)

  • Excellent internal consistency (reported as 0.93* from Rasch Analysis)

 

Community-Dwelling Older adults: (Freitas et al., 2022)

  • Excellent internal consistency (Cronbach’s α = 0.943*)

 

*Scores higher than 0.9 may indicate redundancy in the scale questions.

 

Criterion Validity (Predictive/Concurrent)

Geriatric Females:

(Talley et al., 2008, Geriatric Females)

Correlations between the ABC and Other Clinical Assessments:

 

SAFE

-0.65*

Balance Test

0.57*

Gait Speed

0.51*

TUG

-0.39*

Activity Restrictions

-0.43*

Depression Scale

-0.38*

Fall History

-0.20*

Medical Condition

-0.32*

Assistive Device Use

0.51*

*p < 0.001

 

 

Construct Validity

Convergent validity:

Community-Dwelling Elderly:

(Wrisley et al., 2010; n = 35 community dwelling older adults; mean age = 72.9 (7.8) years, Community-Dwelling Elderly)

  • Adequate correlation between ABC score and Functional Gait Assessment (r = 0.53, p < 0.001)

(Filiatrault et al., 2007; n = 200 community dwelling seniors involved in an effectiveness study of a falls prevention program; mean age = 73.0 (7.4) years, Community-Dwelling Elderly)

  • Excellent correlation between ABC-S and ABC Scale (r = 0.94, p < 0.001)

(Landers et al., 2011; Part 1, questionnaire development: n = 39 residents of an assisted living facility; mean age = 85.03 (5.1) years; Part 2, psychometric testing; n = 63 community dwelling individuals with varying health conditions; mean age = 72.2 (7.2) years, Community-Dwelling Elderly)

  • Excellent correlation between ABC and Fear of Falling Avoidance Behavior Questionnaire (FFABQ) (r= -0.678, p < 0.01)

(Hatch et al., 2003; n = 50 community dwelling elderly people; mean age = 81.7 (6.7) years, Community-Dwelling Elderly)

  • Excellent correlation between ABC score and Berg Balance Scale (BBS) (r = 0.752, p < 0.01)
  • Excellent correlation between ABC score and Timed Up & Go Test (TUG) (r = 0.698, p < 0.01)

(Freitas et al., 2022)

  • Excellent correlation between ABC and Berg Balance Scale (BBS) (r = 0.649)
  • Excellent correlation between ABC and Falls Efficiency Scale - International (FES-1) (r = -0.779)
  • Poor correlation between ABC and Modified Clinical Test of Sensory Interaction and Balance (mCTSIB) – condition 1 (r = -0.139)
  • Poor correlation between ABC and mCTSIB – condition 2 (r = 0.240)
  • Adequate correlation between ABC and mCTSIB – condition 3 (r = 0.321)
  • Adequate correlation between ABC and mCTSIB – condition 4 (r = 0.346)
  • Adequate correlation between ABC and Unilateral Stance – Eyes Open (r = 0.488)
  • Adequate correlation between ABC and Unilateral Stance – Eyes Closed (r = 0.460)
  • Excellent correlation between ABC and gait speed (r = 0.688)

 

 

Content Validity

  • Clinicians were asked to "name the 10 most important activities, essential to independent living, that while requiring some position change or walking, would be safe and nonhazardous to most elderly persons."
  • A sample of seniors were asked the above question, in addition to the following question: "Are you afraid of falling during any normal daily activities, and if so, which ones?" (Powell & Myers, 1995)

Floor/Ceiling Effects

Community-dwelling Older Adults:

(Huang & Wang, 2009; n = 174 community-dwelling adults aged 60 and older; Taiwanese sample, Community-Dwelling Older Adults)

  • Less-frail participants scoring above 80 on the ABC were unlikely to improve their balance confidence after completing physical activity programs.

 

Older adults: (Balasubramanian, 2015; n = 40; mean age = 73.4 (6.9); U.S. sample)

  • Adequate ceiling effect of 7.5%

     

Older adults: (Wang, et al., 2018)

  • Adequate ceiling effect of 8.5% (n = 425)
  • Adequate floor effect of 1.3% (n = 67)

Responsiveness

Community Dwelling Older Adults:

(Huang & Wang, 2009; 8 weeks between assessments, Community-Dwelling Older Adults)

  • Mean change scores = -3.58 (6.61); not statistically different (t = 1.894, p = 0.07)

 

Geriatric Females:

(Talley et al., 2008, Geriatric Females)

  • Standardized response means for the ABC were 0.05
  • Participants in a fall prevention group had a mean change score of -1.1 for the ABC

Parkinson's Disease

back to Populations

Standard Error of Measurement (SEM)

Parkinson’s Disease:

(Dal Bello-Haas et al., 2011; n = 24; mean age = 64.9 (8.0) years; mean time since diagnosis = 4.5 (4.3) years; H & Y Stages 1- 3; Stage 1: n = 13, Stage 2: n = 6, Stage 3: n = 5; mean MMSE scores = 27.4 (2.5) points, test retest by same rater at 2-week interval)

  • SEM = 4.01

 

(Jonasson et al., 2014; n = 174 in initial sample, 102 respondents; mean age = 73 (8))

  • SEM (calculated) for entire group (n = 102) = 11.0

 

Minimal Detectable Change (MDC)

Parkinsonism (included 35 PD and 2 Parkinson-plus syndromes):

(Steffen & Seney, 2008; n = 37; mean age = 71 (21); mean disease duration = 14 (6) years; Hoehn and Yahr Stages median score = 2 (range = 1 to 4); Stage 1: n = 3, Stage 2: n = 7, Stage 3: n = 9, Stage 4: n = 8; test retest by same rater at 1 week intervals; mean number of falls in the past 6 monts = 7; administered ABC via participant interview)

  • MDC = 13

(Dal Bello-Haas et al., 2011, Parkinson’s Disease)

  • MDC = 11.12

Cut-Off Scores

Parkinson’s Disease:

(Mak & Pang, 2009; n = 70 with idiopathic PD, 32 reporting 1 or more falls in 12 months; mean age for fallers = 64.1 (6.9) and 62.6 (7.8) years for non-fallers; mean duration of disease nonfallers = 7.2 (4.2) and fallers = 9.4 (5.3); H&Y stage of nonfallers = 2.8 (0.5) and fallers mean = 3.0 (0.3) MMSE > 23)

  • Cut-off score of 69%. Predictive of recurrent falls based on prospective 12-month follow-up (AUC = 0.823, sensitivity = 93%, specificity = 69%)

(Almeida et al., 2016; n = 225 persons with PD in prospective cohort study; 122 (54.2%) male; mean age = 70.7 (6.6); 84 recurrent fallers with 2 or more falls in the 12-month follow-up period; mean age for recurrent fallers = 71.1 (6.3); 141 nonrecurrent fallers with one or no falls in the 12-month follow-up period; mean age for nonrecurrent fallers = 70.4 (6.7))

  • Cut-off score of 55%. Exhibited moderate accuracy for predicting recurrent falls in persons with PD (AUC = 0.73; sensitivity = 0.71; specificity = 0.62)

Normative Data

Parkinson's Disease:

(Mak et al., 2012; n = 57 via convenience sample, mean age = 63.7 (8.5); mean duration PD diagnosis = 7.6 (4.7) years; H&Y Stages: mean = 2.5 (1.0); MMSE > 23/30; able to walk 6 meters x3 without device. All tested during "on" phase of medications; Correlational study completed in one session)

  • Mean ABC score = 73.6% (19.3)

Test/Retest Reliability

Parkinson's Disease:

(Dal Bello-Haas et al., 2011, Parkinson’s Disease)

  • Excellent test-retest reliability (ICC = 0.79)

(Lohnes et al., 2010; n = 89; mean age = 66 (8.9); mean disease duration = 8.2 (5.2); Hoehn & Yahr range 1 - 4 with mean = 2.3 (0.5))

  • Excellent test restest reliability (ICC = 0.96)

 

Parkinson's Disease and Parkinsonism:

(Steffen et al., 2008; n = 37; mean age 71 (12) years; Hoehn and Yahr Median Score = 2 (scores ranged from 1 to 4); mean number of falls in the past 6 months = 7; mean disease duration = 14 (6) years, Parkinsonism)Parkinson’s Disease)

  • Excellent test-retest reliability (ICC = 0.94)

 

Parkinson’s Disease: (Jonasson et al., 2014)

  • Acceptable test retest reliability (n = 68): (ICC = 0.86)

 

Internal Consistency

Parkinson's Disease and Parkinsonism:

(Steffen & Seney, 2008, Parkinson’s Disease)

  • Excellent internal consistency (Cronbach's alpha = 0.95*)

(Dal Bello-Haas et al., 2011, Parkinson’s Disease)

  • Excellent internal consistency (Cronbach’s alpha = 0.92*)

 

Parkinson Disease and High level gait disorders:

(Peretz et al, 2006; Hebrew version of ABC scale; n = 157 subjects in 3 groups, > 24/30 on MMSE; Controls, n =68; High-level gait disorders (HLGD), n = 70; Parkinson Disease, n = 19; Those with PD were H&Y stages 1 - 3; mean disease duration = 7.7 (5.2) years and on Levadopa)

  • Excellent internal consistency (Cronbach's alpha = 0.91*)

 

Parkinson’s Disease: (Jonasson et al., 2014)

  • Excellent: Cronbach's alpha = 0.98*

 

*Scores higher than 0.9 may indicate redundancy in the scale questions.

Criterion Validity (Predictive/Concurrent)

Parkinson Disease:

(Mak & Pang, 2009; n = 70 with idiopathic PD, 32 reporting 1 or more falls in 12 months; Mean age nonfallers = 62.6 (7.8) and fallers = 64.1 (6.9); mean duration of disease nonfallers = 7.2 (4.2) and fallers = 9.4 (5.3) HY stage of Nonfallers = 2.8 (0.5) and fallers mean 3.0 (0.3) MMSE > 23)

  • Regression analysis: Most significant predictor of recurrent falls was 1) fall history (F = 32.57; p < 0.001); 2) UPDRS motor (F = 25.23, p < 0.001), and 3) ABC score (F = 18.84, p < 0.001)
  • Previous fall history, UPDRS-motor score and ABC score accurately predict recurrent falls (prospective 12 mo) based on regression analysis (accuracy = 87%, sensitivity = 93% and specificity = 86%)
  • Recurrent fallers had higher HY stage (p < 0.05), Higher UPDRS motor scores (p < 0.01) and lower ABC scores (p < 0.001) than nonfallers

 

Parkinson Disease:

(Mak et al., 2012)

  • Adequate correlation between ABC score and knee muscle strength (r = 0.301,P = 0.029)
  • Excellent inverse correlation between ABC score with the UPDRS-Posture & Gait (PG) score (r = ?0.661, P < 0.001)

 

Parkinson's Disease: 

(Lohnes & Earhart et al, 2010)

Poor to Adequate Correlation ABC and other clinical measures

Correlation *significant

p value reported

Berg Balance Score (Adequaqte)

0.505*

< 0.001

Functional Reach Test (Poor)

0.184

= 0.184

Single Limb Stance (Poor)

0.263*

< 0.05

Tandem Stance (Adequate)

0.357*

< 0.05

6 minute walk test (Adequate)

0.458

< 0.001

TUG (Adequate)

-0.372* inverse

< 0.001

PIGD (Adequate)

-0.387* inverse

< 0.001

UPDRS-III (Poor)

-0.221* inverse

< 0.05

Construct Validity

Parkinson Disease:

(Peretz et al., 2006)

  • Distinguish those with Parkinson Disease vs. Control group (sensitivity = 58%; specificity = 96%)
  • Distinguish high level gait disorders (HLGD) vs. those with Parkinson Disease (sensitivity = 97%; specificity = 32%)
  • Distinguish those with HLGDs vs. Controls (sensitivity = 96%; specificity = 96%)

(Dal Bello Haas et al, 2011; identifies scale best at distinguishing stage 1 from stage 3 since only that reached significance at p = 0.007)

  • ABC scores distinguish those in HY stage 1 and stage 3, 13.90 (95% CI: 3.67 - 23.14, (p = 0.007))

 (Mak et al., 2009)

  • PD fallers significantly lower ABC scores (p < 0.05), compared to PD non-fallers; PD non-fallers significantly lower ABC scores (p < 0.05) than control
  • ABC of > 80 signif associated with lower falls risk (after accounting for age, gender, disease duration, depression); OR=0.06, CI = 0.01, 0.65, p = 0.02. Whereas, moderate ABC scores (50 - 80%) were not significantly associated with reduced fall risk (OR= 0.10, CI 0.01, 1.29; p = 0.078)

Stroke

back to Populations

Standard Error of Measurement (SEM)

Stroke:

(Botner et al., 2005; n = 77; mean age = 67 (8.8) years; average time since stroke = 4.0 (3.1) years, Chronic Stroke)

  • SEM = 6.81

(Salbach et al., 2006; n = 86; mean age (ABC) = 73 (10) years, (ABC-CF) = 70 (12) years, Stroke)

  • SEM for ABC = 5.05
  • SEM for ABC-CF = 5.13

Chronic Stroke: (Ishige, et al., 2020; n = 88 completed initial ABC-J, n = 69 completed ABC-J after 1-2 weeks; mean age = 66.5 (9.5) years; IQR = 61-73; mean time since stroke = 4.8 (4.2) years; Japanese translation: ABC-J)

  • SEM for total ABC-J (n = 69) = 7.14
  • SEM item range (n = 69) = 11.16 - 17.88

 

 

Minimal Detectable Change (MDC)

Chronic Stroke: (Ishige, et al., 2020)

  • MDC total score (n = 69) = 19.79 
  • MDC item score range (n = 69) = 30.93 - 49.56

Cut-Off Scores

Stroke:

(Beninato et al., 2009; n = 27; mean age for fallers = 61.2 (13.5) and 55.2 (11.6) years for non-fallers, Chronic Stroke)

  • Cut-off score of 81.1 can provide relative certainty that the individual did not have a history of multiple falls

Normative Data

Chronic Stroke:

(Botner et al., 2005)

ABC Item and Total Score Descriptive Data:

 

 

 

 

 

Activity

Mean (SD)

Median

Range

ICC

95% CI

Walk around the house

83.3 (18.6)

90

30 – 100

0.89

0.76 – 0.95

Walk up and down stairs

76.3 (17.7)

77.5

50 – 100

0.53

0.17 – 0.77

Pick up a slipper from the floor

74.1 (25.5)

80

10 – 100

0.88

0.74 – 0.95

Reach at eye level

79.4 (20.9)

85

40 – 100

0.57

0.22 – 0.79

Reach while standing on your tiptoes

57.3 (29.3)

60

0 – 100

0.64

0.33 – 0.83

Stand on a chair to reach

38.1 (30.0)

40

0 – 95

0.81

0.61 – 0.92

Sweep the floor

70.0 (28.7)

80

10 – 100

0.59

0.25 – 0.80

Walk outside to nearby car

82.3 (19.4)

90

40 – 100

0.69

0.41 – 0.85

Get in and out of a car

84.2 (18.3)

95

40 – 100

0.73

0.47 – 0.87

Walk across a parking lot

78.8 (19.3)

80

40 – 100

0.75

0.50 – 0.88

Walk up and down a ramp

71.9 (22.8)

70

15 – 100

0.93

0.84 – 0.97

Walk in a crowded mall

72.9 (20.7)

70

40 – 100

0.69

0.41 – 0.85

Walk in a crowd or get bumped

65.4 (21.4)

62.5

25 – 100

0.58

0.23 – 0.79

Ride an escalator holding the rail

70.6 (26.0)

70

0 – 100

0.58

0.24 – 0.79

Ride an escalator not holding the rail

46.3 (30.5)

45

0 – 100

0.70

0.41 – 0.86

Walk on icy sidewalks

41.7 (28.7)

50

0 – 100

0.79

0.58 – 0.90

Total ABC score

68.3 (17.5)

64.5

40.6 – 98.8

0.85

0.68 – 0.93

 

Chronic Stroke: (Ishige, et al., 2020)

  • Mean ABC-J score: 57.5 (24.1)
  • Median value: 58

 

Summary statistics for the ABC-J Scale by individual item and total (n = 88)

Item Number

Mean

Standard Deviation

Median

1

74.4

25.7

80

2

59.7

30.4

60

3

72.4

27.0

80

4

76.3

25.2

80

5

49.8

33.6

50

6

31.6

35.5

20

7

52.8

35.8

50

8

79.7

26.0

90

9

77.7

25.1

80

10

75.3

29.3

80

11

60.7

32.4

65

12

48.6

33.7

50

13

37.5

32.5

35

14

64.2

38.0

80

15

29.7

34.9

15

16

29.1

32.2

20

Total ABC-J Score

57.5

24.1

58

 

 
 

Test/Retest Reliability

Stroke:

(Botner et al., 2005, Chronic Stroke)

  • Adequate 4-week total score test-retest reliability (ICC = 0.85; 95% CI: 0.68 – 0.93)
  • Adequate to excellent item level test-retest reliability (ICC ranged from 0.53 to 0.93)

Chronic Stroke: (Ishige, et al., 2020; n = 69, administered 1-2 weeks after initial assessment)

  • Excellent test-retest reliability (ICC = 0.92)

 

 

Internal Consistency

Stroke: (Salbach et al., 2006)

  • Excellent internal consistency for ABC (Cronbach’s alpha = 0.94*) and ABC-CF (Cronbach’s alpha = 0.93*)

Chronic Stroke: (Ishige, et al., 2020; n = 88)

  • Excellent: Cronbach’s alpha = 0.95*

     

*Scores higher than .9 may indicate redundancy in the scale questions.

Criterion Validity (Predictive/Concurrent)

Concurrent validity:

Chronic Stroke: (Ishige, et al., 2020)

  • Excellent  concurrent validity of the ABC-J with the BBS (r = 0.61, p < 0.001)
  • Adequate  concurrent validity of the ABC-J with the 10MWT and TUG-T (r = -0.51, -0.55 respectively, p < 0.001)
  • Poor  concurrent validity of the ABC-J with Geriatric Depression Scale-Short Version-Japanese (GDS-S-J) (r = -0.27)

 

Construct Validity

Convergent validity:

Stroke: (Salbach et al., 2006, Stroke)

Spearman (95% CI)

 

 

Measure (unit or scoring)

ABC (n = 51)

ABC CF (n = 35)

SF-36 PF Scale (range, 0-100)

0.60 (0.39-0.76)

0.56 (0.29-0.76)

EQ VAS (range, 0-100)

0.52 (0.28 to 0.69)

0.68 (0.44 to 0.82)

BBS (range, 0-56)

0.42 (0.16 to 0.62)

0.49 (0.19 to 0.71)

Maximum walking speed (m/s)

0.43 (0.18 to 0.63)

0.53 (0.24 to 0.74)

Comfortable walking speed (m/s)

0.42 (0.16 to 0.62)

0.48 (0.17 to 0.70)

6MWT (m)

0.40 (0.13 to 0.61)

0.48 (0.18 to 0.70)

Barthel Index (range, 0-100)

0.37 (0.11 to 0.59)

0.45 (0.14 to 0.68)

TUG (s)

-0.34 (-0.07 to -0.56)

-0.52 (-0.22 to -0.73)

GDS (range, 0-30)

-0.30 (-0.03 to -0.53)

-0.61 (-0.34 to -0.79)

 

Chronic Stroke:

(Botner et al., 2005, Chronic Stroke)

  • Adequate correlation between the ABC total score and the BBS score (r = 0.36, p < 0.001)
  • Adequate correlation between the ABC total score and gait speed (r = 0.48, p < 0.001)

(Ishige, et al., 2020)

  • Excellent  correlation between the ABC-J and the Falls Efficacy Scale-International (FES-I) (r = -0.77)

 

Floor/Ceiling Effects

Stroke:

(Salbach et al., 2006, Stroke)

  • 75% of subjects scored between 20% and 80% out of 100%, which would suggest no floor or ceiling effects for the total score of the ABC scale

Chronic Stroke:

(Botner et al., 2005)

  • More than 80% of the sample scored between 40 and 80 suggesting there were minimal floor or ceiling effects

(Ishige, et al., 2020)

  • Adequate  ceiling effect of 2.3% was found for the total ABC-J score
  • Adequate  floor effect of 1.1% was found for the total ABC-J score
  • Poor  ceiling effect of > 20% was found in 8 individual ABC-J items (range = 21.6-42.0)
  • Poor  floor effect of > 20% was found in 4 individual ABC-J items (range = 27.3-45.5)

 

Brain Injury

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Construct Validity

Traumatic Brain Injury:

(Inness et al., 2011; n = 35 patients with Traumatic Brain Injury (TBI) (13 in-patient/22 out-patient); mean age = 28.7(10.6) years, TBI)

  • Excellent correlation between Community Balance and Mobility Scale (CB & M) and ABC scores (r = 0.60, p = 0.011)

Vestibular Disorders

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Minimally Clinically Important Difference (MCID)

Vestibular Disorders: (Wellons et al., 2022; n = 222; mean age = 60.41 (13.60) years; age range = 27-92 years; female = 61.3%; duration of symptoms = 93.55 (237.66) weeks; Vestibular diagnoses (% of total): Benign Paroxysmal Positional Vertigo (21.17%), Unspecified Unilateral Vestibular Hypofunction (20.72%), Acoustic Neuroma after surgical intervention (12.61%), Unspecified Central Vestibular Disorder (11.71%), Meniere’s Disease (11.71%), Vestibular Migraine (8.4%), Vestibular Neuritis/Labyrinthitis (6.76%), Unspecified mixed peripheral and central vestibular disorder (5.41%), Bilateral Vestibular Hypofunction (3.15%), Other peripheral vestibular disorders (15.77%), Other central vestibular disorders (8.10%))

  • MCID = 18.1% (sensitivity = 0.69, specificity = 0.70, accuracy = 0.73)

 

Cut-Off Scores

Fallers and Non-fallers:

(Lajoie & Gallagher, 2003; n = 125; mean age for fallers = 75.50 (3.14) and 73.80 (2.75) years for non-fallers, Fallers and Non-fallers)

  • Scores < 67% indicates a risk for falling; can accurately classify people who fall 84% of the time.

Normative Data

Vestibular Disorders: (Alghwiri et al., 2016; n = 82; mean age = 43 (14); Jordan and Saudi Arabia sample; Arabic translation of ABC: A-ABC; 1 week between assessments)

  • Mean score at first trial: 62.7, SD = 20.6 (range = 11.9 – 98)
  • Mean score at second trial: 62.2, SD = 19 (range = 15.4 – 92.5)

 

Test/Retest Reliability

Vestibular Disorders: (Alghwiri et al., 2016)

  • Excellent test-retest reliability (ICC = 0.95)

 

Vestibular Disorders: (Colnaghi et al., 2017; patients referred to outpatient vertigo services with central or peripheral vestibular disorder; age range = 18-75; test-retest reliability subgroup: n = 30; male = 17; mean age = 45.8 (18.5); mean symptom duration = 2 (4.5) years; 2 weeks between assessments)

  • Excellent test-retest reliability (ICC = 0.978)

 

Vestibular Disorders: (Montilla-Ibá?ez et al., 2017; n = 8; age = 53.02?(15.48) years; age range = 19–84; Spanish translation of ABC scale: ABC-S) 

  • Adequate test-retest reliability (ICC = 0.86)

 

 

Internal Consistency

Vestibular Disorders: (Colnaghi et al., 2017; n = 316; mean age = 53.5 (15.6) years; female = 61%; mean symptom duration = 1.6 (3) years; Italian sample)

  • Excellent: Cronbach's alpha = 0.954*

 

Vestibular Disorders: (Montilla-Ibá?ez et al., 2017)

  • Excellent: Cronbach’s alpha = 0.916*

 

*Scores higher than 0.9 may indicate redundancy in the scale questions.

 

Criterion Validity (Predictive/Concurrent)

Vestibular Disorders:

(Horak et al., 2009; n = 22 subjects with and without balance disorders including vestibular (5), PD (3), and peripheral neuroopathy; mean age = 63 (10) years, Vestibular Disorders)

  • Excellent correlation between the Balance Evaluation Systems Test (BESTest) and the ABC Scale (r = 0.636, p < 0.01)

(Legters et al 2005; n = 137 adults diagnosed with peripheral vestibular disorder; mean age 60.8 years)

  • Adequate correlation between the Dynamic Gait Index (DGI) and the ABC scale (r = 0.58, p<0.001) in total sample.
  • Excellent correlation between the DGI and the ABC Scale in patients with mild or moderate caloric weakness (r = 0.65)
  • Adequate correlation between ABC Scale and the DGI for patients with severe or total weakness (r = 0.48)

(Morgan et al., 2013; n = 53 individuals with dizziness and imbalance)

  • Excellent correlation between ABC and FES-I (r = -0.84)

(Marchetti et al., 2011; n = 95 adults older than 65 years with signs and symptoms of vestibular dysfunction)

  • Adequate correlation between ABC and TUG (r = -0.40; p < 0.01)
  • Adequate correlation between ABC and DGI (r = 0.37; p < 0.01)
  • Adequate correlation between ABC and SF-36 (r = 0.41; p < 0.01)

Construct Validity

Vestibular Disorders:

(Whitney et al., 1999; n = 71 adults from a local Balance and Vestibular Clinic)

  • Excellent correlation between the Dizziness Handicap Inventory (DHI) and the ABC Nonparametric Spearman Rank Order Correlation Coefficient rs = -0.6751 for patients ≤ 64 years p < 0.0005.
  • Excellent correlation between the Dizziness Handicap Inventory (DHI) and the ABC Nonparametric Spearman Rank Order Correlation Coefficient rs = -0.6359 for patients ≥ 64 years p < 0.0005.
  • Excellent correlation between the Dizziness Handicap Inventory (DHI) and the ABC Nonparametric Spearman Rank Order Correlation Coefficient rs = -0.6350 for patients total sample p < 0.0005.

 

(Alghwiri et al., 2016)

  • Adequate correlation between the A-ABC Scale and the Arabic Berg Balance Scale (A-BBS) (r = 0.54, p < 0.05). 
  • Excellent correlation between the A-ABC Scale and the Arabic Dizziness Handicap Inventory (A-DHI) (r = ?0.76, p < 0.05)

 

(Colnaghi et al., 2017)

  • Poor correlation between the A-ABC Scale and age (r = -0.197, p = 0.003)
  • Adequate correlations between the A-ABC Scale and the Dizziness Handicap Inventory (DHI) physical and functional subscales (r = 0.320 and 0.353, respectively, both p < 0.001)
  • Poor correlation between the A-ABC Scale and the DHI emotional subscale (r = 0.242, p < 0.001)
  • Adequate correlation between the A-ABC Scale and the Situational Vertigo Questionnaire (r = -0.493, p < 0.001)

 

 

Responsiveness

Vestibular Disorders (Friscia et al., 2014; n = 45; mean age = 56 (15); age range = 18-79; female = 29 (64%))

  • Adequate correlation between the A-ABC Scale and the Global Rating of Change Scale (r = 0.50, p = 0.001)
  • Adequate area under the curve (AUC) from ROC analysis = 0.72, p = 0.011

Non-Specific Patient Population

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Cut-Off Scores

Fallers and Non-fallers:

(Lajoie & Gallagher, 2004; n = 125; mean age for fallers = 75.50 (3.14) and 73.80 (2.75) years for non-fallers, Fallers and Non-fallers)

  • Scores < 67% indicates a risk for falling; can accurately classify people who fall 84% of the time.

Normative Data

High school adolescents: (Alsalaheen et al., 2014; n = 91; male = 47; mean age = 15.5 (1.1) for males and 15.7 (0.9) for females; U.S. sample)

Percentile scores for the Activities-Specific Balance Scale

Percentile

5

25

50

75

95

Score

79

91

95

98

99

 

Floor/Ceiling Effects

High school adolescents: (Alsalaheen et al., 2014)

  • Poor ceiling effect: scores for 50th, 75th, 95th percentile on the ABC Scale were similar: 95, 98, and 99, respectively.

 

Pulmonary Diseases

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Minimal Detectable Change (MDC)

COPD: (Beauchamp, et al., 2016; n = 55; mean age = 71.2 (7.1); mean FEV1 = 39.2 (15.8)% predicted; Canadian sample)

  • MDC95 for entire group (n = 55): 18.9

 

Minimally Clinically Important Difference (MCID)

COPD: (Beauchamp, et al., 2016)

  • MCID overall range = 14.2 to 18.9, based on:
    • Mean change rated as “A little better” = 14.2
    • Mean change rated as “Much better” = 18.5
    • MDC95 = 18.9

 

Cut-Off Scores

COPD: (Alsubheen, 2022; n = 223, male = 123; mean age = 72(9) years; classified as ‘fallers’ if one or more fall occurred and ‘non fallers’ if no falls occurred in past 12 months)

  • 58% discriminates fallers from non-fallers (sensitivity 88%; specificity 63%)

 

Normative Data

COPD: (Alsubheen, 2022) 

 

Mean Scores and 95% confidence intervals on ABC by group

Variable 

N (%) 

Mean (SD) of the ABC Scale 

95% CI 

Age (years) 

 

 

 

50-65 

47 (21) 

               71 (21) 

65-77 

> 65 

176 (79) 

               72 (21) 

69-75 

Sex 

 

 

 

Male 

123 (55) 

               77 (19) 

73-80 

Female 

100 (45) 

               66 (21) 

62-70 

Oxygen use 

 

 

 

Yes 

34 (15) 

               72 (21) 

64-79 

No 

189 (85) 

               72 (21) 

69-75 

Rollator walker use 

 

 

 

Yes 

28 (13) 

               59 (20) 

51-67 

No 

195 (87) 

               74 (20) 

71-77 

Fall status* 

 

 

 

Fallers 

112 (50 

               66 (23) 

62-70 

Non-fallers 

111 (50) 

               78 (17) 

74-81 

*Fallers = 1 or more falls in past 12 months; Non-fallers = no falls in past 12 months.

 

 
 
 

Test/Retest Reliability

COPD: (Mkacher, et al., 2017; n = 60; mean age = 61.2 (3.2))

  • Excellent test retest reliability (ICC = 0.91)

 

Criterion Validity (Predictive/Concurrent)

Predictive validity:

COPD: (Alsubheen, 2022) 

  • Poor predictive ability of the ABC scale to distinguish fallers from non-fallers (AUC = 0.64, 95% CI: 0.57-0.72, p = 0.001)

 

Construct Validity

Convergent validity:

COPD: (Alsubheen, 2022) 

  • Adequate convergent validity with Berg Balance Scale (BBS) (r = 0.58) 
  • Adequate convergent validity with Balance Evaluation Systems Test (BESTest) (r = 0.58) 
  • Adequate convergent validity with 6-Minute Walk Test (6-MWT) (r = 0.54) 
  • Adequate convergent validity with Baseline Dyspnea (BDI) (r = 0.49) 
  • Adequate convergent validity with 30-s Chair Stand Test (30-s CST) (r = 0.44) 
  • Adequate convergent validity with European Quality of Life-Visual Analogue Scale (EQ-VAS) (r = 0.42) 
  • Poor convergent validity with age (r = -0.13) 
  • Poor convergent validity with sex (r = -0.26) 
  • Poor convergent validity with use of rollator walker (r = -0.23) 
  • Poor convergent validity with fall status (r = -0.27) 

 

Discriminant validity: 

COPD: (Alsubheen, 2022)

  • Significant ability of the ABC scale to discriminate between known groups:
    • Sex: lower scores for females (mean difference (MD) = 10%, p < 0.001)
    • Rollator walker use: lower scores for rollator walker users (MD = 15%, p < 0.001)
    • Fall status: lower scores for fallers (MD = 12%, p < 0.001)
  • Excellent discriminant validity with Body Mass Index (BMI) (r = -0.09) 
  • Excellent discriminant validity with smoking history (r = -0.07) 
  • Excellent discriminant validity with Forced Expiratory Volume in 1 second (FEV1%) predicted (r = 0.03)

 

Limb Loss and Amputation

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Standard Error of Measurement (SEM)

Lower Limb Loss: (Hafner et al., 2016; n = 201, mean age = 60.2 (11.4))

  • SEM for entire group (n = 201) = 0.21

 

Minimal Detectable Change (MDC)

Lower Limb Loss: (Hafner et al., 2016)

  • MDC95 for entire group (n = 201) = 0.58

 

Test/Retest Reliability

Lower Limb Loss: (Hafner et al., 2016)

  • Excellent test-retest reliability (ICC = 0.95)

 

Construct Validity

Convergent validity:

Lower Limb Loss (Hafner et al., 2017; n = 199; mean age = 55.4 (14.3); male = 71.4%; current lower-limb prosthetic users assessed prior to receiving a replacement prosthesis, prosthetic socket, and/or prosthetic knee)

  • Adequate correlation with Prosthetic Limb Users Survey of Mobility (PLUS-M) (ρ = 0.81, p < 0.001)

 

Spinal Injuries

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Standard Error of Measurement (SEM)

Chronic Incomplete Spinal Cord Injury (iSCI): (Shah, et al, 2017; n = 26 community-dwelling, ambulatory w/chronic iSCI; mean age = 59.7 (18.9) years; male = 20; 5 AIS C and 21 AIS D)

  • SEM (calculated) for entire group (n = 26) = 5.37%

 

Minimal Detectable Change (MDC)

Chronic iSCI: (Shah, et al, 2017)

  • MDC (calculated) for entire group (n = 26) = 14.87%

 

Test/Retest Reliability

Chronic iSCI: (Shah, et al, 2017; n = 23 (3 excluded from analysis), mean weeks between administrations 2.4 (0.7)

  • Excellent test-retest reliability (ICC = 0.93, 95% CI: 0.85-0.97)

 

Construct Validity

Convergent validity:

Chronic iSCI: (Shah, et al, 2017; n = 26)

  • Excellent correlations with scores on clinical measures of balance, gait and lower extremity strength (ρ = 0.60-0.80, p < 0.01).
  • Poor correlations with clinical measures of proprioception and cutaneous pressure sensitivity (ρ = 0.26-0.08).
  • Excellent correlation with the total MiniBESTest scores (ρ = 0.76, p < 0.001)
  • Excellent correlation with the 10mWT-fast scores (r = 0.80, p < 0.001)
  • Excellent correlation with the SCI-FAP test scores (ρ = -0.67 to -0.76, p < 0.001, with the strongest correlation shown with the Step Task (ρ = -0.76)
  • Excellent correlations with overall center of pressure (COP) velocity (ρ = -0.69, p < 0.001) and COP velocity in the anterior-posterior direction (ρ = - 0.71, p < 0.001). As the ABC score increased, the velocity of the COP decreased.

 

Discriminative validity:

Chronic iSCI: (Shah, et al, 2017; n = 26)

  • Excellent ability of the ABC scale to discriminate between persons with iSCI and able-bodied persons, Z = -4.381, p < 0.001, AUC = 0.95 (95% CI = 0.89-1.00)

 

 

 

Neuromuscular Conditions

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Cut-Off Scores

Dystonia: (Boyce et. al., 2017; n = 122; mean age 52 (12.4); age range = 18-76; Australian sample)

  • A cutoff at the value of 71.3 yielded a sensitivity of 66% and a specificity of 36% to predict falls history

 

Normative Data

Dystonia: (Boyce et al., 2017)

  • Mean score: 67.4 (27.2)

 

Internal Consistency

GNE Myopathy: (Slota, et al, 2018; n = 35, mean age = 41; age range = 25-65, female = 20 (57%); history of falls = 32(91.4%))

  • Excellent Cronbach's alpha range from 0.94* (baseline) to 0.9 (6 month retest)

 

*Scores higher than 0.9 may indicate redundancy in the scale questions.

 

Construct Validity

Convergent validity:

GNE Myopathy: (Slota, et al, 2018)

  • Excellent convergent validity with AMAT Functional subscale scores (r = 0.63, p < 0.001) and AMAT Endurance subscale scores (r = 0.69, p < 0.001).

 

Osteoarthritis

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Test/Retest Reliability

Symptomatic knee osteoarthritis: (Paker, et al., 2017; n = 49, mean age = 64.7 (9.2); age range = 46-84; female = 85%; mean symptom duration = 79 (85.7) months; Turkish translation of ABC: ABC-T)

  • Excellent test-retest reliability: (ICC = 0.95)

 

Internal Consistency

Symptomatic knee osteoarthritis: (Paker, et al., 2017)

  • Excellent: Cronbach’s alpha = 0.97*

 

*Scores higher than 0.9 may indicate redundancy in the scale questions.

 

Multiple Sclerosis

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Standard Error of Measurement (SEM)

Multiple sclerosis: (Alghwiri et al., 2020; n = 89; mean age = 37.6 (10.1); age range = 18-59; 83 (93.3%) participants have remitting type of MS, 4 (4.5%) participants have secondary progressive, and 2 (2.2%) participants have primary progressive type of MS; Arabic translation of ABC: A-ABC)

  • SEM for entire group (n = 89): 4.07

Multiple sclerosis: (Monjezi et al., 2021; n = 153; mean age = 35.95 (8.57) years; mean time since disease = 6.35 (4.84) years; participants have a confirmed MS diagnosis by a neurologist, are able to walk with or without assistive devices, and an Expanded Disability Status Scale of 0 to 6.5; Persian translation of ABC)

  • SEM (n = 50): 5.03

 

Minimal Detectable Change (MDC)

Multiple sclerosis: (Alghwiri et al., 2020)

  • MDC95 for entire group (n = 89): 11.28

Multiple sclerosis: (Monjezi et al., 2020)

  • MDC for sample group (n = 50): 9.86

Minimally Clinically Important Difference (MCID)

Multiple sclerosis: (Monjezi et al., 2021)

  • MCID = 10.5 score points

 

Cut-Off Scores

Multiple sclerosis: (Monjezi et al., 2021)

  • >10.5 indicates favorable outcome

 

Normative Data

Multiple sclerosis: (Alghwiri et al., 2020; n = 52; test completed twice within one week)

Means and standard deviations by activity over two administrations of the A-ABC

Activity

Mean (SD)

95% CI

Walk around the house

79.2 (28.5)

0.81–0.94

Walk up and down stairs

71.8 (31.8)

0.94–0.98

Pick up a slipper from the floor

71.8 (35.1)

0.82–0.94

Reach at eye level

75.9 (34.1)

0.86–0.96

Reach while standing on your tiptoes

57.6 (38.2)

0.96–0.99

Stand on a chair to reach

49.4 (40.9)

0.98–0.99

Sweep the floor

69.4 (39.1)

0.93–0.98

Walk outside to nearby car

83.5 (27.7)

0.87–0.96

Get in and out of a car

87.5 (21.8)

0.94–0.98

Walk across a parking lot

75.3 (34.1)

0.83–0.95

Walk up and down a ramp

52.9 (35.9)

0.91–0.97

Walk in a crowded mall

55.8 (35.8)

0.82–0.94

Walk in a crowd or get bumped

54.5 (38.7)

0.90–0.97

Ride an escalator holding the rail

76.2 (31.9)

0.89–0.96

Ride an escalator not holding the rail

52.0 (40.7)

0.90–0.97

Walk on icy sidewalks

34.7 (40.9)

0.92–0.97

Total

63.67 (27.81)

0.96–0.99

 

Test/Retest Reliability

Multiple sclerosis: (Alghwiri et al., 2020; test completed twice within one week)

  • Excellent  test-retest reliability (ICC = 0.98)

Multiple sclerosis: (Monjezi et al., 2021; n = 50; tested 2-7 days after first visit)

  • Excellent test-retest reliability (ICC = 0.96)

 

Internal Consistency

Multiple sclerosis: (Alghwiri et al., 2020)

  • Excellent: Cronbach’s alpha = 0.96* (95% CI: 0.94-0.97)

Multiple sclerosis: (Monjezi et al., 2021)

  • Excellent internal consistency for total score (Cronbach’s alpha = 0.96*)

 

*Scores higher than 0.9 may indicate redundancy in the scale questions.

 

Construct Validity

Convergent validity:

Multiple sclerosis: (Alghwiri et al., 2020)

  • Excellent convergent validity between the Arabic Activities Specific Balance Confidence Scale (A-ABC) and other scales (all p < 0.001):
    • Berg Balance Scale (BBS) in older adults (r = 0.76)
    • Dynamic Gait Index (DGI) (r = 0.65)
    • Barthel Index (BI) (r = 0.63)

 

Floor/Ceiling Effects

Multiple sclerosis: (Monjezi et al., 2021) 

  • Adequate ceiling effect of 0.7%

 

Responsiveness

Multiple sclerosis: (Monjezi et al., 2021; n = 50; 4-week balance-specific exercises (3 times per week, 40 min) completed ABC questionnaire before and after the intervention) 

  • Adequate responsiveness supported: AUC = 0.75 (95% CI: 0.62-0.89)

 

Cerebral Palsy

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Standard Error of Measurement (SEM)

Adults with Cerebral Palsy: (Levin, 2019; n = 20, mean age = 32.7 (9.3) years; Gross Motor Function Classification Scale-Extended & Revised Level I (able to walk in all settings with some balance and coordination impairments, n = 5) and Level II (walking is limited in some settings, n = 15))

  • SEM for entire group = 6.53

 

Minimal Detectable Change (MDC)

Adults with Cerebral Palsy: (Levin, 2019)

  • MDC95 for entire group = 18.0

 

Normative Data

Adults with Cerebral Palsy: (Levin, 2019)

  • Test 1 mean ABC score: 68.3 (17.9)
  • Test 2 mean ABC score: 68.7 (16.1)

 

Test/Retest Reliability

Adults with Cerebral Palsy: (Levin, 2019; average of 10 days between assessments, range = 6-23 days)

  • Acceptable test-retest reliability (ICC = 0.86; 95% CI: 0.68-0.94)

 

Sensory Disorders

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Normative Data

Youth with Visual Impairments: (Pennell, 2022; n = 101; mean age = 13.91 (2.82) years; male = 56%; U.S. Association for Blind Athletes Vision Classification Scale levels: B4 visual level (highest acuity), n = 8; B3 visual level, n = 33; B2 visual level, n = 28; B1 visual level (lowest acuity), n = 32) 

 

Total and Item-Level Results for the ABC Scale in Youth with Visual Impairments (n = 101)

? ABC Scale Total Score/Subtest

Mean (SD) 

Median 

Total Score 

82.72 (11.24) 

85 

ABC1 

92.87 (16.02) 

100 

ABC2 

89.11 (17.73) 

90 

ABC3 

94.36 (11.87) 

100 

ABC4 

92.38 (17.67) 

100 

ABC5 

75.84 (22.19) 

80 

ABC6 

67.33 (27.05) 

70 

ABC7 

91.39 (18.00) 

100 

ABC8 

95.15 (13.83) 

100 

ABC9 

96.34 (8.33) 

100 

ABC10 

92.97 (16.77) 

100 

ABC11 

93.86 (14.49) 

100 

ABC12 

80.99 (20.27) 

80 

ABC13 

66.63 (27.07) 

70 

ABC14 

83.96 (24.42) 

100 

ABC15 

60.40 (32.77) 

60 

ABC16 

49.70 (29.98) 

50 

? 

 

Test/Retest Reliability

Youth with Visual Impairments: (Pennell, 2022; subset of n = 8, mean age of subset = 14.14 (1.13) years; male = 50%; B3 visual level = 4; B2 visual level = 2, B3 visual level = 2; evaluated 6 weeks after initial test administration) 

  • ICC = 0.87

 

Internal Consistency

Youth with Visual Impairments: (Pennell, 2022) 

  • Excellent internal consistency (Cronbach’s α = 0.83)

 

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