1. bookVolume 15 (2021): Issue 3 (June 2021)
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01 Jun 2007
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access type Open Access

Diagnostic tests to assess balance in patients with spinal cord injury: a systematic review of their validity and reliability

Published Online: 30 Jun 2021
Page range: 111 - 118
Journal Details
License
Format
Journal
First Published
01 Jun 2007
Publication timeframe
6 times per year
Languages
English
Abstract Background

Sophisticated biomechanical instruments can assess balance in patients with spinal cord injury (SCI) with accuracy and precision; however, they are costly and time consuming to use. Clinical diagnostic tests to assess balance in patients with SCI are less costly and easier to use, but there is limited literature available regarding their reliability and validity.

Objectives

To review systematically articles reporting the validity and reliability of diagnostic tests used to assess balance function in patients with SCI.

Methods

We searched for articles in the English language from the earliest record to December 15, 2020, which reported validity or reliability of any clinical instrument or diagnostic test used to assess balance in patients with SCI. Articles assessing balance in paraplegic patients with causes other than SCI were excluded. Databases included MEDLINE, AMED, EMBASE, HMIC, PsycINFO, CINAHL, Scopus, and Google Scholar. The COSMIN Risk of Bias checklist was used to assess the studies included and PRISMA-DTA guidelines were applied.

Results

We included 16 articles that assessed the validity or reliability of 10 diagnostic tests. The Functional Reach Test (FRT), Berg Balance Scale (BBS), and Mini-Balance Evaluation Systems Test (Mini-BESTest) were assessed by more than 1 study, while the remaining 7 diagnostic tests including the Function in Sitting Test, T-Shirt Test, Motor Assessment Scale item 3, Sitting Balance Score, 5 Times Sit-to-Stand Test, Tinetti scale, and Sitting Balance Measure were assessed by 1 study each. The FRT has good-to-excellent test–retest reliability, excellent inter-rater reliability, and good construct, concurrent, and convergent validity. The BBS has excellent inter-rater and intra-rater reliability, high internal consistency, and good concurrent and construct validity. The Mini-BESTest has excellent test–retest reliability, excellent inter-rater reliability, high internal consistency, and good concurrent, convergent, and construct validity.

Conclusions

The FRT, BBS, and Mini-BESTest appear to be valid and reliable clinical instruments to assess balance function in patients with SCI.

Keywords

Balance function or postural stability is important for performing activities of daily living [1]. Balance function is necessary, even for performing simple tasks such as sitting, standing, and walking. Similarly, complex motor skills, such as running, jumping, and dancing, also depend on efficient balance control [2]. Balance control is achieved through the integration of sensory inputs, the central processing system, and neuromuscular response. Sensory inputs include visual, vestibular, and proprioceptive inputs; the central processing system includes the brain and spinal cord, while neuromuscular responses include motor control [3]. Disturbance in any of the systems that maintain normal balance function will result in impaired balance [4].

Neurological disorders almost always result in impaired balance. Although the main disturbance in these neurological conditions is present in central processing system, the neuro-muscular response and sensory inputs are also disturbed to some extent in these disorders [5]. Like those with other neurological disorders, individuals with spinal cord injury (SCI) also have poor balance function. In individuals with SCI, proprioception, the central processing system, and neuromuscular response are disturbed, which leads to an array of complications [6]. Although individuals with complete SCI remain wheel chair bound and only sitting balance is important for them, individuals with incomplete SCI need balance for both standing and sitting [7].

Because balance problems are known to disrupt rehabilitation and prevent patients with neurological conditions from performing activities of daily living, rehabilitation specialists always focus on balance function [8, 9]. Without appropriate balance training, individuals with SCI mostly remain bed bound and never function as productive members of society [10]. Many interventions and exercises are applied to manage balance problems in patients with SCI and almost all of them improve balance function to some extent [11]. Clinicians are always interested in making objective measurements of the improvement occurring as a result of therapeutic intervention and for this purpose they use clinical assessment or diagnostic tools [12].

Assessment of balance function in clinical settings is a daunting task. Many biomechanical instruments are available to assess balance function with accuracy and precision in patients with SCI; however, these sophisticated biomechanical instruments are usually not appropriate for use in clinical settings [13]. For research purposes, balance assessment is performed by measuring the center of pressure, forces, torques, and joint angles using a force plate analysis system or other instruments [14]. These biomechanical instruments can be used in laboratory settings, but they may not be applicable in clinical environments on a routine basis. The biomechanical instruments are costly, and the tests are time consuming. Moreover, use of the instruments may require highly trained personnel [15].

In contrast to biomechanical measures, nonbiomechanical measures in the form of clinical assessment tools or diagnostic tests are widely used in clinical settings [16]. Many clinical assessment tools are available to assess balance function in patients with SCI. Although clinical tools and tests are easier to administer than biomechanical tests [17], there is limited literature available regarding their reliability and validity. Therefore, the present review was conducted to systematically review articles reporting the validity and reliability of clinical instruments used to assess balance function in individuals with SCI.

Methods

A systematic review of diagnostic tests or clinical assessment tools was conducted according to PRISMA-DTA guidelines to the extent they apply [18]. Various databases including MEDLINE, Allied and Complementary Medicine (AMED), EMBASE for Excerpta Medica dataBASE, The Healthcare Management Information Consortium (HMIC), PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL) from EBSCO, and Scopus were searched. The search terms “spinal cord (injury, damage, compression, ischemia, trauma, contusion, laceration, transaction, syndrome),” OR “spinal (fracture, subluxation, dislocation, injury, trauma),” OR “cervical vertebrae injuries,” OR “lumbar vertebrae injuries,” OR “thoracic vertebrae injuries,” OR “SCI,” or “paraplegia,” OR “quadriplegia,” OR “tetraplegia,” AND “balance” OR “postural balance” OR “stability” OR “static balance” OR “dynamic balance” OR “walking balance” OR “sitting balance” OR “standing balance” OR “posture” OR “body equilibrium” OR “body posture” AND “clinical (assessment tools, instruments, scales, measurement tools, measures)” OR “nonbiomechanical (assessment tools, instruments, scales, measurement tools, measures)” OR “outcome (instruments, scales, tools, measures)” AND “reliability” OR “psychometric properties” OR “consistency” OR “validity” were used for the literature search, where AND and OR are logical operators. Truncations were used when they were appropriate.

The search results were imported into reference manager software. After removal of duplicates, 2 authors scanned the reference lists of the retrieved articles. Additionally, Google Scholar was searched to locate other relevant research articles. Research studies published in the English language from the earliest record to December 15, 2020, which reported validity and/or reliability of any of the clinical instrument used for the assessment of balance function in SCI individuals, were included. We excluded studies that reported psychometric properties of biomechanical measures such as force plate analysis, which are not used in clinical settings. Research articles that included paraplegic patients with causes other than SCI were excluded. Letter to editors, review articles, expert opinion, conference papers, brief communications, and commentaries were also excluded.

Two reviewers independently screened the articles to exclude those research articles that did not fulfill the eligibility criteria. After excluding irrelevant studies, the full text of the remaining articles was studied by 2 independent reviewers and necessary data from all these studies were extracted. The COSMIN Risk of Bias checklist was used to assess risk of bias in the studies included [19, 20]. Any disagreements between 2 reviewers were resolved by consensus with a third reviewer, who was consulted to confirm the extracted data. Discrepancies between the reviewers were resolved by consensus.

Results

A preliminary literature search identified 248 research articles; however, after removal of duplicates, only 93 studies remained. These 93 research articles were evaluated thoroughly for eligibility criteria, and only 16 articles fulfilled the inclusion criteria, while the remaining 77 articles were excluded (Figure 1). The articles reported validity and/or reliability of 10 clinical instruments including the Functional Reach Test (FRT), Berg balance scale (BBS), Mini-Balance Evaluation Systems Test (Mini-BESTest), Function in Sitting Test, T-Shirt Test, Motor Assessment Scale item 3, Sitting Balance Score, 5 Times Sit-to-Stand Test, Tinetti scale, and Sitting Balance Measure. Eleven articles assessed individual clinical instruments, while the remaining 5 articles assessed more than one clinical instrument.

Figure 1

PRISMA flow diagram for record triage through the different phases of systematic review.

Good-to-excellent test–retest reliability of the FRT was reported by 6 articles [21, 22, 23, 24, 25, 26], while 1 article reported excellent inter-rater reliability (FRT) [27]. Construct, concurrent, and convergent validities of the FRT were reported by 1 article each [22, 23, 25]. Excellent inter-rater reliability of the BBS was reported by 2 articles [27, 28] and 1 article reported excellent intra-rater reliability [29], while 1 article reported high internal consistency [30]. Two articles reported concurrent validity of the BBS [28, 31] and 1 article reported construct validity [30]. The Mini-BESTest was assessed by 3 included articles [30, 32, 33]. These articles reported excellent test–retest reliability [32, 33], excellent inter-rater reliability [33], high internal consistency [30], and good concurrent, convergent [32], and construct validity [30] of the Mini-BESTest.

Excellent test–retest reliability and construct validity of the T-Shirt Test has been reported [22]. Excellent test–retest reliability, internal consistency, and concurrent validity of the Function in Sitting Test [34], good-to-excellent inter-rater reliability and criterion validity of the Motor Assessment Scale item 3 and Sitting Balance Score [35], excellent inter-rater reliability of the 5 Times Sit-to-Stand Test [27], good-to-excellent intra-rater reliability of the Tinetti scale [29], and high internal consistency and content validity of the Sitting Balance Measure [36] have been reported in 1 article each. Methodological quality varied across the studies (Table 1).

Summary of studies that assessed the validity or reliability of 10 clinical instruments

Article Methodological quality Patient characteristics Balance measure Validity Reliability
Adegoke et al. [21] Inadequate 20 adult nonambulatory patients with SCI FRT Test–retest reliability was assessed. ICC ranged from 0.98 to 0.99 in individuals with different levels of injuries
Boswell-Ruys et al. [22] Doubtful 30 adult patients with SCI FRT and T-Shirt Test Construct validity was assessed using ASIA scores, level of injury, and duration of injury. The tests had good construct validity in that they distinguished between subjects with higher (C6–T7) and lower (T8–L2) levels of injuries and between patients with acute and chronic SCI. The tests correlated with ASIA motor and sensory scores Test–retest reliability was assessed. ICC for the reach test ranged from 0.80 to 0.89 in different directions while ICC for T-Shirt Test ranged from 0.85 to 0.91 with different tasks of the test
Field-Fote and Ray [23] Adequate 32 adult patients with motor incomplete SCI FRT Concurrent validity was tested with center of pressure excursion. The correlation of forward, backward, right and left reach with center of pressure excursion were 0.71, 0.72, 0.95, and 0.61, respectively Test–retest reliability was assessed. ICCs ranged from 0.78 to 0.95 in different directions
Lynch et al. [24] Inadequate 30 adult patients with motor complete SCI FRT Test–retest reliability was assessed. ICC ranged from 0.85 to 0.94 in patients with different levels of injuries
Sprigle et al. [25] Doubtful 20 adult patients with SCI and injury duration less than 6 months FRT Convergent validity was assessed. The correlation of FRT with activities of daily living score was 0.46 Test–retest reliability was assessed. ICC was 0.85
Sprigle et al. [26] Inadequate 22 adult patients with chronic SCI FRT Test–retest reliability was assessed. ICC was 0.87
Srisim et al. [27] Inadequate 25 adult ambulatory patients with SCI BBS, FRT and Five Times Sit-to-Stand Test Inter-rater reliability was assessed. ICC for BBS, FRT, and Five Times Sit-to-Stand Test were 0.99, 1.00, and 0.99, respectively
Wirz et al. [28] Doubtful 42 adult patients with SCI BBS Concurrent validity was assessed. The correlation of BBS with SCIM mobility score, Walking Index for SCI, Falls Efficacy Scale, motor scores, and number of falls was 0.89, 0.82, 0.93, 0.81, 0.62, and 0.17, respectively Inter-rater reliability was assessed. ICC was 0.953
Tamburella et al. [29] Doubtful 23 adult patients with incomplete SCI BBS, Tinetti (total), Tinetti (equilibrium), Tinetti (locomotion) Intra-rater reliability was assessed. ICC for BBS, Tinetti (total), Tinetti (equilibrium), and Tinetti (locomotion) were 0.97, 0.22, 0.87, and 0.78, respectively
Jørgensen et al. [30] Adequate 46 adult patients with chronic SCI BBS and Mini-BESTest Construct validity was assessed. Strong correlations between both scales (r = 0.90) and between both scales and Timed Up and Go (r > 0.70), SCIM mobility scores (r > 0.80), and 10-Meter Walk Test (r > 0.80) support high construct validity Internal consistency was assessed. Cronbach α for BBS was 0.94 while α for Mini-BESTest was 0.95
Lemay and Nadeau [31] Inadequate 32 adult patients with motor incomplete SCI BBS Concurrent validity was assessed. The correlation of BBS with 2-minute walk test, Walking Index for SCI, 10-Meter Walk Test, and Timed Up and Go were 0.78, 0.81, 0.79, and –0.81, respectively, while its correlation with Functional Ambulation Inventory (SCI-FAI) ranged 0.71–0.74
Chan et al. [32] Adequate 21 adult patients with chronic motor incomplete SCI Mini-BESTest Concurrent and convergent validity was tested with measures of center of pressure velocity during eye open and eye closed standing and lower extremity muscle strength, respectively. The correlation of Mini-BESTest scores with center of pressure velocity during standing with eye open ranged from –0.48 to –0.76 and during standing with eye closed ranged from –0.04 to 0.07. The correlation of Mini-BESTest scores with lower extremity muscle strength was 0.73 Test–retest reliability was assessed. ICC for the total score of Mini-BESTest was 0.98
Roy et al. [33] Very good 23 adult patients with SCI Mini-BESTest Test–retest and inter-rater reliability was assessed.
ICC for test–retest and inter-rater reliability were 0.94 and 0.96, respectively
Abou et al. [34] Adequate 26 adult nonambulatory patients with chronic SCI Function in Sitting Test Concurrent validity was tested with modified FRT (forward and lateral) and posturography assessment (virtual time to contact). The correlation of function in sitting test with lateral reach was 0.64 while its correlation with forward reach and virtual time to contact was 0.16 and 0.23, respectively. Test–retest reliability and internal consistency was assessed.
ICC was 0.95 Cronbach α was 0.81
Jørgensen et al. [35] Adequate 48 adult patients with SCI Motor Assessment Scale item 3 and Sitting Balance Score Criterion validity was assessed. The correlation between the scales were in relation to neurological injury level (r = 0.19–0.51), extent of injury (r = 0.57–0.68), functional independence measure (r = 0.13–0.68), and 5 additional mobility and locomotor items (r = 0.10–0.49) Inter-rater reliability was assessed. For Motor Assessment Scale item 3 k with linear weights (kw) ranged from 0.83 to 0.91 with different raters while for Sitting Balance Score k with linear weights (kw) ranged from 0.69 to 0.96 with different raters
Wadhwa and Aikat [36] Doubtful 30 adult patients with SCI Sitting Balance Measure Content validity of Sitting Balance Measure was established through qualitative review by experts and by calculating content validity ratio. Internal consistency was assessed. Cronbach α was 0.96

ASIA, American Spinal Injury Association; BBS, Berg Balance Scale, FRT, Functional Reach Test; ICC, intraclass correlation coefficient; Mini-BESTest, Mini-Balance Evaluation Systems Test; SCI, Spinal Cord Injury; SCIM, Spinal Cord Independence Measure.

Discussion

SCI and its sequelae in the form of paralysis and impaired sensations result in a wide range of physical and psychological disorders [37]. SCI usually results in lifelong disability and rehabilitation interventions aim to minimize complications and maximize independence of individuals with SCI [38]. Mobility training, transfer training, wheelchair maneuverability, gait training, and balance training are important components of rehabilitation for individuals with SCI [39]. Among these components, rehabilitation specialists always give more focus to balance training because without good balance function, patients with SCI cannot achieve maximum independence [40]. Almost all other rehabilitation components depend on proper postural stability and that is why clinicians start balance training from the first day of rehabilitation and continue this training until the rehabilitation protocols are complete [41].

Many outcome measures are available to assess balance function in patients with neurological disorders. These outcome measures range from highly complicated biomechanical measures requiring sophisticated instrumentation to simple and easily administered clinical tests [42]. Owing to the complexity and cost of biomechanical measures, they are seldom used in clinical practice; however, they are frequently used by researchers. By contrast, clinical tests are frequently used by clinicians to assess balance function [43]. A variety of outcome measures is used in clinical practice, each of which assesses different aspects of balance function [44]. Ten clinical instruments that can be used to assess balance function of individuals with SCI in clinical settings were identified in the current systematic review. These include the FRT, BBS, Mini-BESTest, Function in Sitting Test, T-Shirt Test, Motor Assessment Scale item 3, Sitting Balance Score, 5 Times Sit-to-Stand Test, Tinetti scale, and Sitting Balance Measure. Most of these clinical instruments are not specific to individuals with SCI, and they can be used to assess balance function in the elderly and in patients with other neurological diseases [45].

The present search retrieved 16 research articles that reported validity and/or reliability of clinical instruments to assess balance function in patients with SCI. This clearly highlights the scarcity of literature regarding these clinical instruments. The instruments are widely used in clinical settings; however, the limited literature shows that they have not received robust attention from researchers. There is a need for high quality research regarding the validity and reliability of these clinical instruments because without high quality evidence, clinicians may not be confident to use these clinical instruments. The present review systematically evaluated available literature that assessed the clinical instruments used to assess balance function in patients with SCI.

FRT, BBS, and Mini-BESTest are the most commonly used clinical instruments used to assess balance function [27, 30] and can be used for a variety of conditions. Patients with musculoskeletal disorders, such as chronic low back pain, and patients with neurological conditions, such as stroke, can be assessed with these instruments, which can be used in the geriatric population [46]. Most articles in current review reported good-to-excellent reliability and good validity of the FRT, BBS, and Mini-BESTest to assess balance function in patients with SCI. These clinical instruments provide valid and reliable outcome measures for assessing balance in patients with balance disorders [47, 48]. Apart from these 3 instruments, the validity and reliability of other clinical instruments are rarely described in the literature. The available literature reported that the T-Shirt Test has excellent test–retest and construct validity, while the Function in the Sitting Test has excellent test–retest reliability, internal consistency, and concurrent validity.

Despite that the current review assimilates the available literature regarding outcome measures used in clinical settings to assess balance function in patients with SCI, it has some limitations. First, due to heterogeneity in the data, it was not feasible to conduct a meta-analysis and so only descriptive results are presented. Second, due to the scarce and limited literature it was difficult to draw firm conclusions regarding the reliability and validity of various clinical instruments. The protocols used to conduct the systematic review were not registered, for example in PROSPERO [49].

Conclusion

Few research studies determined the reliability and validity of clinical instruments in the assessment of balance function in SCI individuals. From the available literature, it appears that FRT, BBS, and Mini-BESTest are valid and reliable clinical instruments for the assessment of balance function in individuals with SCI. Due to scarcity of literature regarding the validity and reliability of other clinical instruments, no firm conclusions can be drawn regarding their use in clinical settings. Large multicenter studies are recommended to determine the validity and reliability of clinical instruments.

Figure 1

PRISMA flow diagram for record triage through the different phases of systematic review.
PRISMA flow diagram for record triage through the different phases of systematic review.

Summary of studies that assessed the validity or reliability of 10 clinical instruments

Article Methodological quality Patient characteristics Balance measure Validity Reliability
Adegoke et al. [21] Inadequate 20 adult nonambulatory patients with SCI FRT Test–retest reliability was assessed. ICC ranged from 0.98 to 0.99 in individuals with different levels of injuries
Boswell-Ruys et al. [22] Doubtful 30 adult patients with SCI FRT and T-Shirt Test Construct validity was assessed using ASIA scores, level of injury, and duration of injury. The tests had good construct validity in that they distinguished between subjects with higher (C6–T7) and lower (T8–L2) levels of injuries and between patients with acute and chronic SCI. The tests correlated with ASIA motor and sensory scores Test–retest reliability was assessed. ICC for the reach test ranged from 0.80 to 0.89 in different directions while ICC for T-Shirt Test ranged from 0.85 to 0.91 with different tasks of the test
Field-Fote and Ray [23] Adequate 32 adult patients with motor incomplete SCI FRT Concurrent validity was tested with center of pressure excursion. The correlation of forward, backward, right and left reach with center of pressure excursion were 0.71, 0.72, 0.95, and 0.61, respectively Test–retest reliability was assessed. ICCs ranged from 0.78 to 0.95 in different directions
Lynch et al. [24] Inadequate 30 adult patients with motor complete SCI FRT Test–retest reliability was assessed. ICC ranged from 0.85 to 0.94 in patients with different levels of injuries
Sprigle et al. [25] Doubtful 20 adult patients with SCI and injury duration less than 6 months FRT Convergent validity was assessed. The correlation of FRT with activities of daily living score was 0.46 Test–retest reliability was assessed. ICC was 0.85
Sprigle et al. [26] Inadequate 22 adult patients with chronic SCI FRT Test–retest reliability was assessed. ICC was 0.87
Srisim et al. [27] Inadequate 25 adult ambulatory patients with SCI BBS, FRT and Five Times Sit-to-Stand Test Inter-rater reliability was assessed. ICC for BBS, FRT, and Five Times Sit-to-Stand Test were 0.99, 1.00, and 0.99, respectively
Wirz et al. [28] Doubtful 42 adult patients with SCI BBS Concurrent validity was assessed. The correlation of BBS with SCIM mobility score, Walking Index for SCI, Falls Efficacy Scale, motor scores, and number of falls was 0.89, 0.82, 0.93, 0.81, 0.62, and 0.17, respectively Inter-rater reliability was assessed. ICC was 0.953
Tamburella et al. [29] Doubtful 23 adult patients with incomplete SCI BBS, Tinetti (total), Tinetti (equilibrium), Tinetti (locomotion) Intra-rater reliability was assessed. ICC for BBS, Tinetti (total), Tinetti (equilibrium), and Tinetti (locomotion) were 0.97, 0.22, 0.87, and 0.78, respectively
Jørgensen et al. [30] Adequate 46 adult patients with chronic SCI BBS and Mini-BESTest Construct validity was assessed. Strong correlations between both scales (r = 0.90) and between both scales and Timed Up and Go (r > 0.70), SCIM mobility scores (r > 0.80), and 10-Meter Walk Test (r > 0.80) support high construct validity Internal consistency was assessed. Cronbach α for BBS was 0.94 while α for Mini-BESTest was 0.95
Lemay and Nadeau [31] Inadequate 32 adult patients with motor incomplete SCI BBS Concurrent validity was assessed. The correlation of BBS with 2-minute walk test, Walking Index for SCI, 10-Meter Walk Test, and Timed Up and Go were 0.78, 0.81, 0.79, and –0.81, respectively, while its correlation with Functional Ambulation Inventory (SCI-FAI) ranged 0.71–0.74
Chan et al. [32] Adequate 21 adult patients with chronic motor incomplete SCI Mini-BESTest Concurrent and convergent validity was tested with measures of center of pressure velocity during eye open and eye closed standing and lower extremity muscle strength, respectively. The correlation of Mini-BESTest scores with center of pressure velocity during standing with eye open ranged from –0.48 to –0.76 and during standing with eye closed ranged from –0.04 to 0.07. The correlation of Mini-BESTest scores with lower extremity muscle strength was 0.73 Test–retest reliability was assessed. ICC for the total score of Mini-BESTest was 0.98
Roy et al. [33] Very good 23 adult patients with SCI Mini-BESTest Test–retest and inter-rater reliability was assessed.
ICC for test–retest and inter-rater reliability were 0.94 and 0.96, respectively
Abou et al. [34] Adequate 26 adult nonambulatory patients with chronic SCI Function in Sitting Test Concurrent validity was tested with modified FRT (forward and lateral) and posturography assessment (virtual time to contact). The correlation of function in sitting test with lateral reach was 0.64 while its correlation with forward reach and virtual time to contact was 0.16 and 0.23, respectively. Test–retest reliability and internal consistency was assessed.
ICC was 0.95 Cronbach α was 0.81
Jørgensen et al. [35] Adequate 48 adult patients with SCI Motor Assessment Scale item 3 and Sitting Balance Score Criterion validity was assessed. The correlation between the scales were in relation to neurological injury level (r = 0.19–0.51), extent of injury (r = 0.57–0.68), functional independence measure (r = 0.13–0.68), and 5 additional mobility and locomotor items (r = 0.10–0.49) Inter-rater reliability was assessed. For Motor Assessment Scale item 3 k with linear weights (kw) ranged from 0.83 to 0.91 with different raters while for Sitting Balance Score k with linear weights (kw) ranged from 0.69 to 0.96 with different raters
Wadhwa and Aikat [36] Doubtful 30 adult patients with SCI Sitting Balance Measure Content validity of Sitting Balance Measure was established through qualitative review by experts and by calculating content validity ratio. Internal consistency was assessed. Cronbach α was 0.96

Chou CH, Hwang CL, Wu YT. Effect of exercise on physical function, daily living activities, and quality of life in the frail older adults: a meta-analysis. Arch Phys Med Rehabil. 2012; 93:237–44. ChouCH HwangCL WuYT Effect of exercise on physical function, daily living activities, and quality of life in the frail older adults: a meta-analysis Arch Phys Med Rehabil 2012 93 237 44 Search in Google Scholar

Wulf G, Shea C, Lewthwaite R. Motor skill learning and performance: a review of influential factors. Med Educ. 2010; 44:75–84. WulfG SheaC LewthwaiteR Motor skill learning and performance: a review of influential factors Med Educ 2010 44 75 84 Search in Google Scholar

Winter DA, Patla AE, Ishac M, Gage WH. Motor mechanisms of balance during quiet standing. J Electromyogr Kinesiol. 2003; 13:49–56. WinterDA PatlaAE IshacM GageWH Motor mechanisms of balance during quiet standing J Electromyogr Kinesiol 2003 13 49 56 Search in Google Scholar

de Kam D, Roelofs JMB, Bruijnes AKBD, Geurts ACH, Weerdesteyn V. The next step in understanding impaired reactive balance control in people with stroke: the role of defective early automatic postural responses. Neurorehabil Neural Repair. 2017; 31:708–16. de KamD RoelofsJMB BruijnesAKBD GeurtsACH WeerdesteynV The next step in understanding impaired reactive balance control in people with stroke: the role of defective early automatic postural responses Neurorehabil Neural Repair 2017 31 708 16 Search in Google Scholar

Alves J, Santos A. Virtual reality therapy for balance training in aging and neurological disorders. J Adv Neurosci Res. 2016; 3:1–8. AlvesJ SantosA Virtual reality therapy for balance training in aging and neurological disorders J Adv Neurosci Res 2016 3 1 8 Search in Google Scholar

Hardin EC, Kobetic R, Triolo RJ. Ambulation and spinal cord injury. Phys Med Rehabil Clin N Am. 2013; 24:355–70. HardinEC KobeticR TrioloRJ Ambulation and spinal cord injury Phys Med Rehabil Clin N Am 2013 24 355 70 Search in Google Scholar

Jannings W, Pryor J. The experiences and needs of persons with spinal cord injury who can walk. Disabil Rehabil. 2012; 34:1820–6. JanningsW PryorJ The experiences and needs of persons with spinal cord injury who can walk Disabil Rehabil 2012 34 1820 6 Search in Google Scholar

Nas K, Yazmalar L, Şah V, Aydın A, Öneş K. Rehabilitation of spinal cord injuries. World J Orthop. 2015; 6:8–16. NasK YazmalarL ŞahV AydınA ÖneşK Rehabilitation of spinal cord injuries World J Orthop 2015 6 8 16 Search in Google Scholar

Harkema SJ, Schmidt-Read M, Lorenz DJ, Edgerton VR, Behrman AL. Balance and ambulation improvements in individuals with chronic incomplete spinal cord injury using locomotor training–based rehabilitation. Arch Phys Med Rehabil. 2012; 93:1508–17. HarkemaSJ Schmidt-ReadM LorenzDJ EdgertonVR BehrmanAL Balance and ambulation improvements in individuals with chronic incomplete spinal cord injury using locomotor training–based rehabilitation Arch Phys Med Rehabil 2012 93 1508 17 Search in Google Scholar

Emerich L, Parsons KC, Stein A. Competent care for persons with spinal cord injury and dysfunction in acute inpatient rehabilitation. Top Spinal Cord Inj Rehabil. 2012; 18:149–66. EmerichL ParsonsKC SteinA Competent care for persons with spinal cord injury and dysfunction in acute inpatient rehabilitation Top Spinal Cord Inj Rehabil 2012 18 149 66 Search in Google Scholar

van Hedel HJA, Dietz V. Rehabilitation of locomotion after spinal cord injury. Restor Neurol Neurosci. 2010; 28:123–34. van HedelHJA DietzV Rehabilitation of locomotion after spinal cord injury Restor Neurol Neurosci 2010 28 123 34 Search in Google Scholar

Mancini M, Horak FB. The relevance of clinical balance assessment tools to differentiate balance deficits. Eur J Phys Rehabil Med. 2010; 46:239–48. ManciniM HorakFB The relevance of clinical balance assessment tools to differentiate balance deficits Eur J Phys Rehabil Med 2010 46 239 48 Search in Google Scholar

Arora T, Oates A, Lynd K, Musselman KE. Current state of balance assessment during transferring, sitting, standing and walking activities for the spinal cord injured population: a systematic review. J Spinal Cord Med. 2020; 43:10–23. AroraT OatesA LyndK MusselmanKE Current state of balance assessment during transferring, sitting, standing and walking activities for the spinal cord injured population: a systematic review J Spinal Cord Med 2020 43 10 23 Search in Google Scholar

Chaudhry H, Bukiet B, Ji Z, Findley T. Measurement of balance in computer posturography: comparison of methods—a brief review. J Bodyw Mov Ther. 2011; 15:82–91. ChaudhryH BukietB JiZ FindleyT Measurement of balance in computer posturography: comparison of methods—a brief review J Bodyw Mov Ther 2011 15 82 91 Search in Google Scholar

Clark RA, Bryant AL, Pua Y, McCrory P, Bennell K, Hunt M. Validity and reliability of the Nintendo Wii Balance Board for assessment of standing balance. Gait Posture. 2010; 31:307–10. ClarkRA BryantAL PuaY McCroryP BennellK HuntM Validity and reliability of the Nintendo Wii Balance Board for assessment of standing balance Gait Posture 2010 31 307 10 Search in Google Scholar

Alexander MS, Anderson KD, Biering-Sorensen F, Blight AR, Brannon R, Bryce TN, et al. Outcome measures in spinal cord injury: recent assessments and recommendations for future directions. Spinal Cord. 2009; 47:582–91. AlexanderMS AndersonKD Biering-SorensenF BlightAR BrannonR BryceTN Outcome measures in spinal cord injury: recent assessments and recommendations for future directions Spinal Cord 2009 47 582 91 Search in Google Scholar

Lam T, Noonan VK, Eng JJ; SCIRE Research Team. A systematic review of functional ambulation outcome measures in spinal cord injury. Spinal Cord. 2008; 46:246–54. LamT NoonanVK EngJJ SCIRE Research Team A systematic review of functional ambulation outcome measures in spinal cord injury Spinal Cord 2008 46 246 54 Search in Google Scholar

Salameh JP, Bossuyt PM, McGrath TA, Thombs BD, Hyde CJ, Macaskill P, et al. Preferred reporting items for systematic review and meta-analysis of diagnostic test accuracy studies (PRISMA-DTA): explanation, elaboration, and checklist. BMJ. 2020; 370:m2632. doi: 10.1136/bmj.m2632 SalamehJP BossuytPM McGrathTA ThombsBD HydeCJ MacaskillP Preferred reporting items for systematic review and meta-analysis of diagnostic test accuracy studies (PRISMA-DTA): explanation, elaboration, and checklist BMJ 2020 370 m2632 10.1136/bmj.m2632 Open DOISearch in Google Scholar

Mokkink LB, de Vet HCW, Prinsen CAC, Patrick DL, Alonso J, Bouter LM, Terwee CB. COSMIN Risk of Bias checklist for systematic reviews of Patient-Reported Outcome Measures. Qual Life Res. 2018; 27:1171–9. MokkinkLB de VetHCW PrinsenCAC PatrickDL AlonsoJ BouterLM TerweeCB COSMIN Risk of Bias checklist for systematic reviews of Patient-Reported Outcome Measures Qual Life Res 2018 27 1171 9 Search in Google Scholar

Prinsen CAC, Mokkink LB, Bouter LM, Alonso J, Patrick DL, de Vet HCW, Terwee CB. COSMIN guideline for systematic reviews of patient-reported outcome measures. Qual Life Res. 2018; 27:1147–57. PrinsenCAC MokkinkLB BouterLM AlonsoJ PatrickDL de VetHCW TerweeCB COSMIN guideline for systematic reviews of patient-reported outcome measures Qual Life Res 2018 27 1147 57 Search in Google Scholar

Adegoke BOA, Ogwumike OO, Olatemiju A. Dynamic balance and level of lesion in spinal cord injured patients. Afr J Med Med Sci. 2002; 31:357–60. AdegokeBOA OgwumikeOO OlatemijuA Dynamic balance and level of lesion in spinal cord injured patients Afr J Med Med Sci 2002 31 357 60 Search in Google Scholar

Boswell-Ruys CL, Sturnieks DL, Harvey LA, Sherrington C, Middleton JW, Lord SR. Validity and reliability of assessment tools for measuring unsupported sitting in people with a spinal cord injury. Arch Phys Med Rehabil. 2009; 90:1571–77. Boswell-RuysCL SturnieksDL HarveyLA SherringtonC MiddletonJW LordSR Validity and reliability of assessment tools for measuring unsupported sitting in people with a spinal cord injury Arch Phys Med Rehabil 2009 90 1571 77 Search in Google Scholar

Field-Fote EC, Ray SS. Seated reach distance and trunk excursion accurately reflect dynamic postural control in individuals with motor-incomplete spinal cord injury. Spinal Cord. 2010; 48:745–49. Field-FoteEC RaySS Seated reach distance and trunk excursion accurately reflect dynamic postural control in individuals with motor-incomplete spinal cord injury Spinal Cord 2010 48 745 49 Search in Google Scholar

Lynch SM, Leahy P, Barker SP. Reliability of measurements obtained with a modified functional reach test in subjects with spinal cord injury. Phys Ther. 1998; 78:128–33. LynchSM LeahyP BarkerSP Reliability of measurements obtained with a modified functional reach test in subjects with spinal cord injury Phys Ther 1998 78 128 33 Search in Google Scholar

Sprigle S, Maurer C, Holowka M. Development of valid and reliable measures of postural stability. J Spinal Cord Med. 2007; 30:40–49. SprigleS MaurerC HolowkaM Development of valid and reliable measures of postural stability J Spinal Cord Med 2007 30 40 49 Search in Google Scholar

Sprigle S, Wootten M, Sawacha Z, Thielman G. Relationships among cushion type, backrest height, seated posture, and reach of wheelchair users with spinal cord injury. J Spinal Cord Med. 2003; 26:236–43. SprigleS WoottenM SawachaZ ThielmanG Relationships among cushion type, backrest height, seated posture, and reach of wheelchair users with spinal cord injury J Spinal Cord Med 2003 26 236 43 Search in Google Scholar

Srisim K, Saengsuwan J, Amatachaya S. Functional assessments for predicting a risk of multiple falls in independent ambulatory patients with spinal cord injury. J Spinal Cord Med. 2015; 38:439–45. SrisimK SaengsuwanJ AmatachayaS Functional assessments for predicting a risk of multiple falls in independent ambulatory patients with spinal cord injury J Spinal Cord Med 2015 38 439 45 Search in Google Scholar

Wirz M, Muller R, Bastiaenen C. Falls in persons with spinal cord injury: validity and reliability of the Berg Balance Scale. Neurorehabil Neural Repair. 2010; 24:70–7. WirzM MullerR BastiaenenC Falls in persons with spinal cord injury: validity and reliability of the Berg Balance Scale Neurorehabil Neural Repair 2010 24 70 7 Search in Google Scholar

Tamburella F, Scivoletto G, Iosa M, Molinari M. Reliability, validity, and effectiveness of center of pressure parameters in assessing stabilometric platform in subjects with incomplete spinal cord injury: A serial cross-sectional study. J Neuroeng Rehabil. 2014; 11:86–98. TamburellaF ScivolettoG IosaM MolinariM Reliability, validity, and effectiveness of center of pressure parameters in assessing stabilometric platform in subjects with incomplete spinal cord injury: A serial cross-sectional study J Neuroeng Rehabil 2014 11 86 98 Search in Google Scholar

Jørgensen V, Opheim A, Halvarsson A, Franzén E, Roaldsen KS. Comparison of the Berg Balance Scale and the Mini-BESTest for assessing balance in ambulatory people with spinal cord injury: validation study. Phys Ther. 2017; 97:677–87. JørgensenV OpheimA HalvarssonA FranzénE RoaldsenKS Comparison of the Berg Balance Scale and the Mini-BESTest for assessing balance in ambulatory people with spinal cord injury: validation study Phys Ther 2017 97 677 87 Search in Google Scholar

Lemay JF, Nadeau S. Standing balance assessment in ASIA D paraplegic and tetraplegic participants: concurrent validity of the Berg Balance Scale. Spinal Cord. 2010; 48: 245–50. LemayJF NadeauS Standing balance assessment in ASIA D paraplegic and tetraplegic participants: concurrent validity of the Berg Balance Scale Spinal Cord 2010 48 245 50 Search in Google Scholar

Chan K, Unger J, Lee JW, Johnston G, Constand M, Masani K, Musselman KE. Quantifying balance control after spinal cord injury: reliability and validity of the mini-BESTest. J Spinal Cord Med. 2019; 42(suppl 1):141–8. ChanK UngerJ LeeJW JohnstonG ConstandM MasaniK MusselmanKE Quantifying balance control after spinal cord injury: reliability and validity of the mini-BESTest J Spinal Cord Med. 2019 42 suppl 1 141 8 Search in Google Scholar

Roy A, Higgins J, Nadeau S. Reliability and minimal detectable change of the mini-BESTest in adults with spinal cord injury in a rehabilitation setting. Physiother Theory Pract. 2021: 37:126–34. RoyA HigginsJ NadeauS Reliability and minimal detectable change of the mini-BESTest in adults with spinal cord injury in a rehabilitation setting Physiother Theory Pract. 2021 37 126 34 Search in Google Scholar

Abou L, Sung JH, Sosnoff JJ, Rice LA. Reliability and validity of the function in sitting test among non-ambulatory individuals with spinal cord injury. J Spinal Cord Med. 2020; 43:846–53. AbouL SungJH SosnoffJJ RiceLA Reliability and validity of the function in sitting test among non-ambulatory individuals with spinal cord injury J Spinal Cord Med 2020 43 846 53 Search in Google Scholar

Jørgensen V, Elfving B, Opheim A. Assessment of unsupported sitting in patients with spinal cord injury. Spinal Cord. 2011; 49:838–43. JørgensenV ElfvingB OpheimA Assessment of unsupported sitting in patients with spinal cord injury Spinal Cord 2011 49 838 43 Search in Google Scholar

Wadhwa G, Aikat R. Development, validity and reliability of the ‘Sitting Balance Measure’ (SBM) in spinal cord injury. Spinal Cord. 2016; 54:319–23. WadhwaG AikatR Development, validity and reliability of the ‘Sitting Balance Measure’ (SBM) in spinal cord injury Spinal Cord 2016 54 319 23 Search in Google Scholar

Anderson KD. Targeting recovery: priorities of the spinal cord-injured population. J Neurotrauma. 2004; 21:1371–1383. AndersonKD Targeting recovery: priorities of the spinal cord-injured population J Neurotrauma 2004 21 1371 1383 Search in Google Scholar

Amatachaya S, Wannapakhe J, Arrayawichanon P, Siritarathiwat W, Wattanapun P. Functional abilities, incidences of complications and falls of patients with spinal cord injury 6 months after discharge. Spinal Cord. 2011; 49:520–4. AmatachayaS WannapakheJ ArrayawichanonP SiritarathiwatW WattanapunP Functional abilities, incidences of complications and falls of patients with spinal cord injury 6 months after discharge Spinal Cord 2011 49 520 4 Search in Google Scholar

Kirshblum SC, Priebe MM, Ho CH, Scelza WM, Chiodo AE, Wuermser LA. Spinal cord injury medicine. 3. Rehabilitation phase after acute spinal cord injury. Arch Phys Med Rehabil. 2007; 88(3 Suppl 1):S62–70. KirshblumSC PriebeMM HoCH ScelzaWM ChiodoAE WuermserLA Spinal cord injury medicine. 3. Rehabilitation phase after acute spinal cord injury Arch Phys Med Rehabil. 2007 88 3 Suppl 1 S62 70 Search in Google Scholar

Barbeau H, Nadeau S, Garneau C. Physical determinants, emerging concepts, and training approaches in gait of individuals with spinal cord injury. J Neurotrauma. 2006; 23:571–85. BarbeauH NadeauS GarneauC Physical determinants, emerging concepts, and training approaches in gait of individuals with spinal cord injury J Neurotrauma 2006 23 571 85 Search in Google Scholar

Tamburella F, Scivoletto G, Molinari M. Balance training improves static stability and gait in chronic incomplete spinal cord injury subjects: a pilot study. Eur J Phys Rehabil Med. 2013; 49:353–64. TamburellaF ScivolettoG MolinariM Balance training improves static stability and gait in chronic incomplete spinal cord injury subjects: a pilot study Eur J Phys Rehabil Med 2013 49 353 64 Search in Google Scholar

Nardone A, Schieppati M. The role of instrumental assessment of balance in clinical decision making. Eur J Phys Rehabil Med. 2010; 46:221–37. NardoneA SchieppatiM The role of instrumental assessment of balance in clinical decision making Eur J Phys Rehabil Med 2010 46 221 37 Search in Google Scholar

Yelnik A, Bonan I. Clinical tools for assessing balance disorders. Neurophysiol Clin. 2008; 38:439–45. YelnikA BonanI Clinical tools for assessing balance disorders Neurophysiol Clin 2008 38 439 45 Search in Google Scholar

Noohu MM, Dey AB, Hussain ME. Relevance of balance measurement tools and balance training for fall prevention in older adults. J Clin Gerontol Geriatr. 2014; 5:31–5. NoohuMM DeyAB HussainME Relevance of balance measurement tools and balance training for fall prevention in older adults J Clin Gerontol Geriatr 2014 5 31 5 Search in Google Scholar

Sibley KM, Straus SE, Inness EL, Salbach NM, Jaglal SB. Clinical balance assessment: perceptions of commonly-used standardized measures and current practices among physiotherapists in Ontario, Canada. Implement Sci. 2013; 8:33. doi: 10.1186/1748-5908-8-33 SibleyKM StrausSE InnessEL SalbachNM JaglalSB Clinical balance assessment: perceptions of commonly-used standardized measures and current practices among physiotherapists in Ontario, Canada Implement Sci. 2013 8 33 10.1186/1748-5908-8-33 Open DOISearch in Google Scholar

Park E-Y, Kim W-H. Correlation of Berg balance scale and functional reach test. Phys Ther Korea. 2007; 14:28–34. ParkE-Y KimW-H Correlation of Berg balance scale and functional reach test Phys Ther Korea 2007 14 28 34 Search in Google Scholar

Moore JL, Potter K, Blankshain K, Kaplan SL, O’Dwyer LC, Sullivan JE. A core set of outcome measures for adults with neurologic conditions undergoing rehabilitation: a clinical practice guideline. J Neurol Phys Ther. 2018; 42:174–220. MooreJL PotterK BlankshainK KaplanSL O’DwyerLC SullivanJE A core set of outcome measures for adults with neurologic conditions undergoing rehabilitation: a clinical practice guideline J Neurol Phys Ther 2018 42 174 220 Search in Google Scholar

Tyson SF, Connell LA. How to measure balance in clinical practice. A systematic review of the psychometrics and clinical utility of measures of balance activity for neurological conditions. Clin Rehabil. 2009; 23:824–40. TysonSF ConnellLA How to measure balance in clinical practice. A systematic review of the psychometrics and clinical utility of measures of balance activity for neurological conditions Clin Rehabil 2009 23 824 40 Search in Google Scholar

Page MJ, Shamseer L, Tricco AC. Registration of systematic reviews in PROSPERO: 30,000 records and counting. Syst Rev. 2018; 7:32. doi: 10.1186/s13643-018-0699-4 PageMJ ShamseerL TriccoAC Registration of systematic reviews in PROSPERO: 30,000 records and counting Syst Rev. 2018 7 32 10.1186/s13643-018-0699-4 Open DOISearch in Google Scholar

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