Tinetti test

 Tinetti-test (POMA)

Purpose
the tinetti-test was published by Mary Tinetti (Yale University) to assess the gait and balance in older adults. It is therefore also called: performance-oriented mobility assessment (POMA).4 Besides giving information on maneuverability it also is a very good indicator of the fall risk of the tested person. It has better test-retest, discriminative and predictive validities concerning fall risk than other tests like: Timed Up and Go test (TUG), one-leg stand and functional reach test.5
Procedure
The patient is to sit in a hard armless chair and will be asked to rise up and stay standing. The patient will then turn 360° and then sit back down.3 This is to test the patients balance. Testing this, the evaluator will look at several key points. These are: how does the patient rise from and sits down on his/her chair, whether or not the patient stays upright while sitting and standing, what happens when the patients eyes are closed or when the patient gets a small push against the sternum.4 Next the patient will have to walk a few meters at normal speed, followed by turning and walking back at a “fast but safe” speed. The patient will then sit back down.3 As well as in the first part of the test there are some points the evaluator has to look at. These are: the length and height of the steps, the symmetry and continuity of the steps and straightness of the trunk.1 During this test the patient can use any assistive devices (walking stick, crutches, zimmer frame, …) he/she would normally use.4
http://vimeo.com/5390494

Interpretation


Gait and balance
If the patient needs to rise in stages, it is possible that there is a problem with proprioception or cerebellar problems.
A shuffling gait, abnormal knee extension, high stepping, toe dragging and an inability to stop or turn are all sings of abnormalities during walking. These sings need to be further evaluated because they could indicate several health problems such as: partial vision loss, lowered strength in knee or hip joints, problems with proprioception, frontal lobe dysfunction or even vascular claudicatio.
When the patient falls into his/her chair upon returning it is indicative of poor knee and/or hip flexion.1


Fall risk
Testing the fall risk works with a check list. On this check list the evaluator must give points from 0 (meaning the function is most impaired) to 2 (meaning the function is normal). The scores are put in three different measures: the gait assessment (POMA-G), the balance assessment (POMA-B) and gait and balance score (POMA-T). The maximum score for gait is 12, the maximum score for balance is 16. This off course means that the overall gait and balance score has a maximum of 28. A score below 26 usually means there might be a problem with the patient’s ability to stay upright, meaning off course he/she has a higher risk of falling. A person with a score below 19 has a highly increased risk.3


Clinimetric properties
The test and retest values for the POMA-T, POMA-B en POMA-G all varied between .72 and .86. The interrater reliability values all varied between .80 and .93.6
People with a score lower than 26 will have a higher chance of falling. This test has a sensitivity of 70% and a specificity of 52%. This means that 70% of the people with a higher fall risk will have a test score lower than 26. It also means that 52% of the people who have a test score lower than 26 have a higher fall risk and will have a fall within a year. The people who have a score of 26 or lower have a two-fold risk of falling.2

Search strategy
Database: pubmed
keywords: tinetti, performance-oriented mobility assessment, fall risk

Database: google books
keywords: tinetti, POMA
References
ABCDEF: evidence levels

1. http://www.webmanmed.com/disorders/disorders_files/neurologic/12123495.html: D
2. The Lancet, Volume 356, Issue 9234, 16 September 2000 “screening older adults at risk of falling with the Tinetti balance scale”: B
3. Functional testing in human performance ,Michael P. Reiman,Robert C. Manske, Human kinetics : D
4. Motor control: translating research into clinical practice, Anne Shumway-Cook,Marjorie H. Woollacott: D
5. J Am Geriatr Soc. 2004 Aug;52(8):1343-8. Psychometric comparisons of the timed up and go, one-leg stand, functional reach, and Tinetti balance measures in community-dwelling older people.: B

6. Phys Ther. 2006 Jul;86(7):944-54. Clinimetric properties of the performance-oriented mobility assessment.: B


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