Original Editor - Brecht Haex
The Tinetti-test was published by Mary Tinetti (Yale University) to assess the gait and balance in older adults and to assess perception of balance and stability during activities of daily living and fear of falling. It is also called Performance-Oriented Mobility Assessment (POMA). 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.
The test requires a hard armless chair, a stopwatch and also, a 15 feet even and uniform walkway. It has 2 sections: one assesses balance abilities in a chair and also in standing; the other 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. 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.
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.
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|
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.The study by Usayl I et al. showed that the patients who had a higher score in a half squat (HS) and decline squat (DC) also had a higher score in Tinetti Performance Oriented Mobility Assessment (POMA), thus showing a significant correlation between squat and balance assessment in older patients
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.
Physiotherapist discuss use of test along with method of use
This video is a good view to get a generalised global view on administering the test.
- 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
- 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.
- Shumway-Cook A, Woollacott MH. Motor control: translating research into clinical practice. Philadelphia : Wolters Kluwer, 2016. level of evidence D
- 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
- Reiman MP, Manske RC. Functional testing in human performance. Champaign: Human kinetics, 2009. level of evidence D
- 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.
- 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.
- Bob abd Brad Tinetti Balance Test Available from: https://www.youtube.com/watch?v=EBHyLQiZcNI (last accessed 13.11.2019)