Tinetti test

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Top Contributors - Simisola Ajeyalemi, Uchechukwu Chukwuemeka, Naomi O'Reilly and Brecht Haex

Description

The Tinetti-test[1] was published by Mary Tinetti (Yale University) to assess the gait and balance in older adults[2]. It is also called Performance-Oriented Mobility Assessment (POMA).[3] It also is a very good indicator of the fall risk of an individual. It has better test-retest, discriminative and predictive validities concerning fall risk than other tests including Timed Up and Go test (TUG), one-leg stand and functional reach test.[4]

Procedure

The test requires a hard armless chair, a stopwatch and also, a 15feet even and uniform walkway. It has 2 sections; one assesses balance abilities in a chair and also in standing, and the other assesses dynamic balance during gait on a 15feet 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 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.[3]

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 straightness of the trunk.

During this test, the patient can use any assistive devices (walking stick, crutches, zimmer frame) they would normally use.[3]


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. 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

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 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. When the patient falls into his/her chair upon returning it is indicative of poor knee and/or hip flexion.


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.[6]

References

  1. 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
  2. Berg KO, Wood-Dauphinée SL, Williams JI, Maki B. Measuring balance in the elderly: validation of an instrument. Can J Public Health.1992;83(suppl 2) :S7– S11.
  3. 3.0 3.1 3.2 Shumway-Cook A, Woollacott MH. Motor control: translating research into clinical practice. Philadelphia : Wolters Kluwer, 2016. level of evidence D
  4. 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
  5. Reiman MP, Manske RC. Functional testing in human performance. Champaign: Human kinetics, 2009. level of evidence D
  6. 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.