By Rachel Luzer, Aiyannah Wilson, and Chiamaka Obidigbo
Physical therapists spend a significant amount of time in school learning how to best diagnose and treat patients. In order to document the progress of a patient within their plan of care, physical therapists utilize assessments and/or outcome measures. Each body part has its own specific assessment or outcome measure. These assessments measure movement issues, such as your walking ability (gait), balance, and pain as well. Gait is a person’s pattern of walking which involves many muscles to control coordination and balance, this can also be compared to an individual’s stride. Some factors that can cause poor balance include muscle weakness associated with aging, hip, knee, & ankle injuries, arthritis, neurological conditions, and many more.
One very popular outcome measure that tests your functional balance and mobility. Is called the Functional Reach Test. It’s used to assess functional motion after an injury or an event that has limited your mobility. If you are having difficulty with balance or mobility this test is the perfect test for you. The Functional Reach Test is simple but very effective, it can even be done at home!
Here are the steps to successful perform this test:
Stand perpendicular to the wall (Side of body facing the wall)
Ensure your shoulders are 6 inches from the wall
Raise one arm to a parallel distance to the floor (90 degrees from your body)
Ensure your feet are shoulder width apart
Mark the starting distance of where you hand is compared to the wall
Ball up hands into a fist and reach/lean forward as far as you can without falling or tipping over
Record the final distance of where your hand can reach to compared to your initial start on the wall
Repeat steps 1-7 two more times and take the average of all three measurements for the true functional measurement
It is recommended for fall risk patients to try this test at home every 30 - 90 days to test mobility progress. Be sure to be close to a stable surface in case of a fall.
The Tinetti Test is another balance assessment tool popularly used by physical therapists to measure an individual’s gait and balance. The Tinetti Test helps provide analytical data when it comes to poor balance in standing and walking, more specifically in the lower part of the body, to determine if an individual is at a fall risk. The Tinetti Test is divided into two categories for gait and balance. The gait assessment is scored out of 12 points and the balance assessment is scored out of 16 points. For the gait portion, the individual is asked to walk while the physical therapist simultaneously observes and rates the quality of the gait. For the balance assessment, the individual performs different balance positions, again under the observation of the physical therapist.
Observations that are Scored include the following:
Gait Assessments | Balance Assessment |
Hesitancy with Gait | Sitting in a Chair |
Step Length and Height | Rising from a Chair |
Step Symmetry | Standing Balance |
Foot Clearance | Standing Balance (Nudge at chest) |
Step Continuity | Standing Balance (Eyes Closed) |
Path Deviation | Turning 360 Degrees |
Trunk Sway | Sitting Down |
Walking Distance | Heels apart Heels almost touching while walking |
When it comes to scoring, if an individual has scored anything less than a 3, it indicates/ suggests poor gait and balance . The scoring is as follows, 18 points or less suggests that the individual is at high risk of falls, 19-23 points suggest that the individual is at moderate risk of falls and finally 24 points or higher the individual is at a low risk of falls. This test can take up to 15 minutes to complete and after each scoring the physical therapist develops a treatment plan to address any impairments. The test can be administered periodically to track the individual’s progress.
The Oswestry Low Back Pain Disability Questionnaire is an assessment tool used to measure the degree of a patient's lower back pain and its effect on their daily activities. The assessment is self-reported and asks 10 questions regarding the patient’s symptoms and severity when performing tasks such as the patient’s sleeping, standing, or walking. Each question is scored from 0-5, 0 being no limitations and 5 representing complete disability, and added cumulatively out of 50. The Oswestry Disability questionnaire can be used to track functional limitations and insurance authorizations to ensure the patient is making progress on improving their symptoms. The 6 minute walk test (6MWT) is an outcome measure used to test a person’s endurance and functional fitness. This test is as simple as it sounds, you walk for a total of 6 minutes at a comfortable pace. The use of assistive devices are permitted such as a cane, however, another person cannot accompany you during the test. Rest breaks are allowed as needed. Scores are dependent upon the total distance that a person is able to walk during the 6 minute period. The 6 minute test is often administered in the hospital setting, but can be used anywhere. This test is likely to be performed during a patient’s initial evaluation and whenever the physical therapist believes it is necessary.
Another useful outcome measure used by physical therapists is The Timed Up and Go test. The Timed Up and Go Test also known as TUG, is a test used to measure a patient’s functional mobility, the ability to move around his or her environment. This test is mostly seen in elderly and older adults. This test helps determine risks for falling and a patient’s balance when walking. There are many benefits of this evaluative test: minimal equipment required, can be performed almost anywhere, won’t take too much time, and it can be self-performed at home.
Lastly, the Berg Balance Scale is another measurement tool used by physical therapists to assess a patient’s balance quality. The scale collects data through 14 questions in multiple scenarios including reaching, bending, standing, and pivoting for patients with a history of balance or lower-body impairment. Each question can be rated from 0-4 points, 0 requiring significant assistance, and 4 requiring no assistance while completing said task with a total scoring being out of 56 points. Throughout the assessment, the physical therapist will instruct the patient during the specific tasks such as sitting to standing without using their arms, sitting or standing unsupported for two minutes, or picking up objects from the floor. The Berg Balance Scale is an objective way to reveal balance issues within these categories and can additionally help evaluate if the patient is a fall risk.
Outcome measures are evaluative tests that are used by physcial therapists to assess their patients. Each test serves a different purpose and is chosen based on the needs of the patient. With these tools physical therapists can assess a patient's functional mobility, balance, endurance, pain levels and many others, more accurately.
References
BodyWorkshfr. (n.d.). TINETTI BALANCE & GAIT ASSESSMENT. TINETTI BALANCE & GAIT ASSESSMENT Retrieved February 13, 2023, from http://ptclinic.com/websites/991/files/TinettiBalanceAndGaitAssessment.pdf
CDC.Gov. (n.d.). Timed Up & Go (TUG). CDC. Retrieved February 13, 2023, from https://www.cdc.gov/steadi/pdf/TUG_test-print.pdf
Functional Reach Test (FRT). (n.d.). Physiopedia. Retrieved February 13, 2023, from https://www.physio-pedia.com/Functional_Reach_Test_(FRT)
International Spine & Pain Institute. (n.d.). Scoring the Oswestry Disability Index. OSWESTRY LOW BACK DISABILITY QUESTIONNAIRE. Retrieved February 13, 2023, from https://www.aaos.org/globalassets/quality-and-practice-resources/patient-reported-outcome-measures/spine/oswestry-2.pdf
Lasardi, M. M. (n.d.). Berg Balance Scale. Journal of Geriatric Physical Therapy. Retrieved February 13, 2023, from https://www.brandeis.edu/roybal/docs/Berg-Balance-Scale_Website.pdf
Weiner, D., & Duncan, P. (n.d.). Functional Reach Test. Functional Reach Test. Retrieved February 13, 2023, from http://www.hhvna.com/Functional_Reach_Test.pdf
Williams, T. (n.d.). TINETTI BALANCE ASSESSMENT TOOL. Summit Professional Education. Retrieved February 13, 2023, from https://blog.summit-education.com/wp-content/uploads/Tinetti-Balance-Assessment-Tool.pdf