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'''Original Editor '''- [[User:Sinead Greenan|Sinead Greenan]]  
'''Original Editor '''- [[User:FULLNAME|Brecht Haex]] as part of the [[Vrije Universiteit Brussel Evidence-based Practice Project|Vrije Universiteit Brussel's Evidence-based Practice project]].


'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} &nbsp;
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}
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== Objective<br>  ==
== Introduction ==
[[File:Community engagement.jpeg|thumb|416x416px|Used to assess balance in elderly]]
The Tinetti-test, also called Performance-Oriented Mobility Assessment (POMA) assesses a person's perception of balance and stability during [[Activities of Daily Living|activities of daily living]] and their fear of [[Falls in elderly|falling.]]<ref name=":0">Shumway-Cook A, Woollacott MH. Motor control: translating research into clinical practice. Philadelphia : Wolters Kluwer, 2016. level of evidence D</ref><ref>Tinetti ME, Williams TF, Mayewski R, Fall Risk Index for elderly patients based on number of chronic disabilities. Am J Med 1986:80:429-434</ref> It is a very good indicator of the fall risk of an individual.


The&nbsp;'''Tinetti Falls Efficacy Scale''' is used to assess perception of balance and stability during activities of daily living and fear of falling in the elderly population, along with those diagnosed with Multiple Sclerosis
* The test comprises two short sections that contain one examining static balance abilities in a chair and then standing, and the other gait


== Intended Population<br>  ==
* It has better test-retest, discriminative and predictive validities concerning fall risk than other tests including Timed Up and Go test ([http://www.physio-pedia.com/index.php/Timed_Up_and_Go_Test_(TUG) TUG]), [[Single Leg Stance Test|one-leg stand]] and [[Functional Reach Test (FRT)|functional reach test]].<ref>Lin MR, Hwang HF, Hu MH, Wu HD, Wang YW, Huang FC. Psychometric comparisons of the timed up and go, one-leg stand, functional reach, and Tinetti balance measures in community-dwelling older people.Journal of the American Geriatric Society, 2004; 52(8):1343-8. level of evidence B
</ref>
View this 3-minute video to visualise the test.
{{#ev:youtube|v=N88_W845nz8|300}}<ref>Jeff James. Tinetti test. Available from: https://www.youtube.com/watch?v=N88_W845nz8 [last accessed 6/6/2009]</ref>


Community and hospital inpatients with acquired brain injury, multiple sclerosis, spinal cord injury, stroke and the elderly population.  
Access [https://www.thecalculator.co/health/Tinetti-Balance-Test-Calculator-1031.html here] to see how to calculate a Tinetti test score.
=== Intended Population ===
It is used in various settings eg those diagnosed with [[Multiple Sclerosis (MS)]], [[Parkinson's - Clinical Presentation|Parkinson's]], [[Overview of Traumatic Brain Injury|acquired brain injury]], [[Spinal Cord Injury|spinal cord injury]], [[stroke]], [[Motor Neurone Disease MND|motor neurone disease]], normal pressure [[hydrocephalus]] and the [[Older People - An Introduction|elderly]] population.


== Method of Use  ==
=== Procedure ===
The test requires a hard armless chair, a stopwatch and also, a 15 feet even and uniform walkway. It has 2 sections:


*The Tinetti Falls Efficacy Scale is a&nbsp;10-item questionnaire designed to assess confidence in patients' ability to perform 10 daily tasks without falling as an indicator of how one's fear of falling impacts physical performance
# Assesses balance abilities in a chair and also in standing
*Each item is rated from 1 ("very confident") to 10 ("not confidenent at all"), and the per item ratings are added to generate a summary total score
# Assesses dynamic balance during [[gait]] on a 15 feet even walkway.
*Total scores can range from 10 (best possible) to 100 (worst possible). Thus, lower scores indicate more confidence and higher scores indicate lack of confidence and greater fear of falling


== Reference<br> ==
The patient is to sit in an armless chair and will be asked to rise up and stay standing. The patient will then turn 360° and then sit back down.<ref name=":1">Reiman MP, Manske RC. Functional testing in human performance. Champaign: Human kinetics, 2009. level of evidence D</ref> This is to test the patients' balance. Testing this, the evaluator will look at several key points including how the patient rises from and sits down on his/her chair, whether or not the patient stays upright while sitting and standing, what happens when the patient's eyes are closed or when the patient gets a small push against the sternum.<ref name=":0" />


== Evidence  ==
Next, the patient will have to walk a few meters at a normal speed, followed by turning and walking back at a “fast but safe” speed. The patient will then sit back down. 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 the straightness of the trunk.


=== Reliability ===
During this test, the patient can use any assistive devices ([http://www.physio-pedia.com/index.php/Walking_stick walking stick], [http://www.physio-pedia.com/index.php/Crutches crutches], [http://www.physio-pedia.com/index.php/Zimmer_frame zimmer frame]) they would normally use.<ref name=":0" />
== Interpretation ==
The Tinetti test has a gait score and a balance score. It uses a 3-point ordinal scale of 0, 1 and 2. [[Gait]] is scored over 12 and balance is scored over 16 totalling 28. 


<u>Test-retest Reliability:</u>
The lower the score on the Tinetti test, the higher the risk of falling. 
 
{| class="wikitable"
!Tinneti tool score
!Risk of fall
|-
|≤ 18
|High
|-
|19-23
|Moderate
|-
|≥ 24
|Low
|}


<u></u>''Geriatric:&nbsp;''(Tinetti et al, 1990)&nbsp;<ref name="Tinetti et al">Tinetti, M., Richman, D., et al. "Falls efficacy as a measure of fear of falling." Journal of gerontology 1990 45(6): P239</ref>
== Gait and Balance  ==


*Adequate test-retest reliability (r = 0.71)
# If the patient needs to rise in stages, it is possible that there is a problem with [http://www.physio-pedia.com/index.php/Proprioception proprioception] or [[Cerebellum|cerebellar]] problems.
# A shuffling gait, abnormal knee extension, high stepping, toe dragging and an inability to stop or turn are all signs of abnormalities during [http://www.physio-pedia.com/index.php/Gait_Cycle walking]. These signs need to be further evaluated because they could indicate several health problems such as partial vision loss, lowered strength in the [[knee]] or [http://www.physio-pedia.com/index.php/Hip hip] joints, problems with proprioception, [[Frontal Lobe Brain Injury|frontal lobe dysfunction]] or even vascular [[claudication]].
# When the patient falls into the chair upon returning it is indicative of poor knee and/or hip flexion<ref>Uysal I, Korkmaz NC, Cavlak U. [https://www.ncbi.nlm.nih.gov/pubmed/31815685 Assessment of the musculoskeletal performance with squat tests and performance-oriented measurements in older adults.] Journal of Back and Musculoskeletal Rehabilitation. 2019 Nov 22(Preprint):1-7.</ref>


''Chronic Stroke:&nbsp;''(Hellstrom &amp; Lindmark, 1999; n = 30; mean age = 65 (11) years; stroke onset between 5 and 84 months prior to assessment)&nbsp;<ref name="Hellstrom and Lindmark">Hellstrom, K. and Lindmark, B. "Fear of falling in patients with stroke: a reliability study." Clinical rehabilitation 1999 13(6): 509</ref>
== Clinimetric Properties  ==


*Excellent test-retest reliability (ICC = 0.97)
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 <br>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.<ref>Raîche M, Hébert R, Prince F, Corriveau H. Screening older adults at risk of falling with the Tinetti balance scale.Lancet, 2000; 356(9234):1001-2.  
</ref>


=== Validity  ===
'''Physiotherapist discuss the use of test along with the method of use'''


<u>Criterion Validity:</u>  
This video is a good view to get a generalised global view of the administration of the test.
{{#ev:youtube|https://www.youtube.com/watch?v=EBHyLQiZcNI|width}}<ref>Bob abd Brad Tinetti Balance Test Available from: https://www.youtube.com/watch?v=EBHyLQiZcNI (last accessed 13.11.2019)</ref>  


<u></u>''Geriatric:&nbsp;''(Huang &amp; Wang, 2009)&nbsp;<ref name="Huang and Wang">Huang, T. T. and Wang, W. S. "Comparison of three established measures of fear of falling in community-dwelling older adults: psychometric testing." International Journal of Nursing Studies 2009 46(10): 1313-1319</ref>
*Adequate concurrent validity with the ABC Scale (r = -0.55)
*Adequate concurrent validity with the Geriatric Fear of Falling Measurement (r = -0.57)
''Geriatric:&nbsp;''(Powell and Myers, 1995; n = 60 community dwelling seniors aged 65-95; self-classified as either high or low in mobility confidence)&nbsp;<ref name="Powell and Myers">Powell, L. and Myers, A. "The activities-specific balance confidence (ABC) scale." The Journals of Gerontology: Series A 1995 50(1): M28</ref>
*Excellent correlation with the Activities Specific Balance Confidence Scale (ABC) (r = 0.84)
''Spinal Cord Injury:&nbsp;''(Wirz et al, 2010)&nbsp;<ref name="Wirz et al">Wirz, M., Muller, R., et al. "Falls in persons with spinal cord injury: validity and reliability of the Berg Balance Scale." Neurorehabil Neural Repair 2010 24(1): 70-77</ref>
*Excellent concurrent validity with the Berg Balance Scale and the 16-item FES-I (r = -0.81)
<u>Construct Validity:</u>
<u></u>''Geriatric:&nbsp;''(Huang &amp; Wang, 2009)&nbsp;<ref name="Huang and Wang">Huang, T. T. and Wang, W. S. "Comparison of three established measures of fear of falling in community-dwelling older adults: psychometric testing." International Journal of Nursing Studies 2009 46(10): 1313-1319</ref>
*Poor correlation with age (r = -0.23)
*Excellent correlation with balance (r = 0.66)
*Excellent correlation with gait (r = 0.67)
*Excellent correlation with mobility (r = 0.71)
*Adequate correlation with fall history (r = -0.47)
*Poor correlation with medical conditions (r = -0.18)
*Adequate correlation with self-rated health status (r = 0.36)
=== Responsiveness  ===
''Elderly:&nbsp;''(Powell &amp; Myers, 1995)&nbsp;<ref name="Powell and Myers">Powell, L. and Myers, A. "The activities-specific balance confidence (ABC) scale." The Journals of Gerontology: Series A 1995 50(1): M28</ref>
*Large responsiveness between low and high mobility groups (Effect size = 1.20)
''Elderly:&nbsp;''(Harada et al, 1995; n = 53 individuals living in two residential care facilities for the elderly)&nbsp;<ref name="Harada et al">Harada, N., Chiu, V., et al. "Screening for balance and mobility impairment in elderly individuals living in residential care facilities." Physical Therapy 1995 75(6): 462</ref>
*Sensitivity (59%)
*Specificity (82%)
''Parkinson Disease:&nbsp;''(Cakit et al 2007)&nbsp;<ref name="Cakt et al">Cakt, B. D., Nacir, B., et al. "Cycling progressive resistance training for people with multiple sclerosis: a randomized controlled study." American Journal of Physical Medicine and Rehabilitation 2010 89(6): 446-457</ref>
*FES scores improved significantly (p &lt; 0.01) in treadmill group but not in control group. (Also significant score change for BBS and DGI). However, FES did not differentiate “fallers” and “non-fallers” at baseline nor after treadmill training
=== Miscellaneous<br>  ===
== Links  ==
[http://www.rehabmeasures.org/PDF%20Library/Falls%20Efficacy%20Scale.pdf Tinetti Falls Efficacy Scale]
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
<div class="researchbox">
<rss>Feed goes here!!|charset=UTF-8|short|max=10</rss>
</div>
== References  ==
== References  ==
<references />


References will automatically be added here, see [[Adding References|adding references tutorial]].
[[Category:Neurological - Outcome Measures]]
 
[[Category:Vrije_Universiteit_Brussel_Project]]
<references />
[[Category:Outcome Measures]]
 
[[Category:Older People/Geriatrics]]
[[Category:Outcome_Measures]][[Category:Stroke]]
[[Category:Balance]]
[[Category:Gait]]
[[Category:Older People/Geriatrics - Outcome Measures]]
[[Category:Older People/Geriatrics - Assessment and Examination]]
[[Category:Balance - Special Tests]]

Latest revision as of 12:16, 13 September 2023

Original Editor - Brecht Haex as part of the Vrije Universiteit Brussel's Evidence-based Practice project.

Top Contributors - Kim Jackson, Sinead Greenan, Lucinda hampton, Oyemi Sillo, WikiSysop, Vidya Acharya, Lauren Lopez, Scott Buxton, Uchechukwu Chukwuemeka, Amrita Patro, Aminat Abolade, 127.0.0.1, Evan Thomas and Naomi O'Reilly

Introduction[edit | edit source]

Used to assess balance in elderly

The Tinetti-test, also called Performance-Oriented Mobility Assessment (POMA) assesses a person's perception of balance and stability during activities of daily living and their fear of falling.[1][2] It is a very good indicator of the fall risk of an individual.

  • The test comprises two short sections that contain one examining static balance abilities in a chair and then standing, and the other gait

View this 3-minute video to visualise the test.

[4]

Access here to see how to calculate a Tinetti test score.

Intended Population[edit | edit source]

It is used in various settings eg those diagnosed with Multiple Sclerosis (MS), Parkinson's, acquired brain injury, spinal cord injury, stroke, motor neurone disease, normal pressure hydrocephalus and the elderly population.

Procedure[edit | edit source]

The test requires a hard armless chair, a stopwatch and also, a 15 feet even and uniform walkway. It has 2 sections:

  1. Assesses balance abilities in a chair and also in standing
  2. Assesses dynamic balance during gait on a 15 feet even walkway.

The patient is to sit in an armless chair and will be asked to rise up and stay standing. The patient will then turn 360° and then sit back down.[5] This is to test the patients' balance. Testing this, the evaluator will look at several key points including how the patient rises from and sits down on his/her chair, whether or not the patient stays upright while sitting and standing, what happens when the patient's eyes are closed or when the patient gets a small push against the sternum.[1]

Next, the patient will have to walk a few meters at a normal speed, followed by turning and walking back at a “fast but safe” speed. The patient will then sit back down. 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 the straightness of the trunk.

During this test, the patient can use any assistive devices (walking stick, crutches, zimmer frame) they would normally use.[1]

Interpretation[edit | edit source]

The Tinetti test has a gait score and a balance score. It uses a 3-point ordinal scale of 0, 1 and 2. Gait is scored over 12 and balance is scored over 16 totalling 28.

The lower the score on the Tinetti test, the higher the risk of falling.

Tinneti tool score Risk of fall
≤ 18 High
19-23 Moderate
≥ 24 Low

Gait and Balance[edit | edit source]

  1. If the patient needs to rise in stages, it is possible that there is a problem with proprioception or cerebellar problems.
  2. A shuffling gait, abnormal knee extension, high stepping, toe dragging and an inability to stop or turn are all signs of abnormalities during walking. These signs need to be further evaluated because they could indicate several health problems such as partial vision loss, lowered strength in the knee or hip joints, problems with proprioception, frontal lobe dysfunction or even vascular claudication.
  3. When the patient falls into the chair upon returning it is indicative of poor knee and/or hip flexion[6]

Clinimetric Properties[edit | edit source]

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.[7]

Physiotherapist discuss the use of test along with the method of use

This video is a good view to get a generalised global view of the administration of the test.

[8]

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 Shumway-Cook A, Woollacott MH. Motor control: translating research into clinical practice. Philadelphia : Wolters Kluwer, 2016. level of evidence D
  2. ↑ Tinetti ME, Williams TF, Mayewski R, Fall Risk Index for elderly patients based on number of chronic disabilities. Am J Med 1986:80:429-434
  3. ↑ Lin MR, Hwang HF, Hu MH, Wu HD, Wang YW, Huang FC. Psychometric comparisons of the timed up and go, one-leg stand, functional reach, and Tinetti balance measures in community-dwelling older people.Journal of the American Geriatric Society, 2004; 52(8):1343-8. level of evidence B
  4. ↑ Jeff James. Tinetti test. Available from: https://www.youtube.com/watch?v=N88_W845nz8 [last accessed 6/6/2009]
  5. ↑ Reiman MP, Manske RC. Functional testing in human performance. Champaign: Human kinetics, 2009. level of evidence D
  6. ↑ Uysal I, Korkmaz NC, Cavlak U. Assessment of the musculoskeletal performance with squat tests and performance-oriented measurements in older adults. Journal of Back and Musculoskeletal Rehabilitation. 2019 Nov 22(Preprint):1-7.
  7. ↑ Raîche M, Hébert R, Prince F, Corriveau H. Screening older adults at risk of falling with the Tinetti balance scale.Lancet, 2000; 356(9234):1001-2.
  8. ↑ Bob abd Brad Tinetti Balance Test Available from: https://www.youtube.com/watch?v=EBHyLQiZcNI (last accessed 13.11.2019)
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