Reliability, validity and adaptability of the Hindi version of Berg Balance Scale in patients with impaired balance having neurological illness

Authors

DOI:

https://doi.org/10.17267/2238-2704rpf.2025.6218

Keywords:

Cross-cultural Comparison, Patients, Physical Therapists, Pilot Projects, Psychometrics, Reliability

Abstract

ABSTRACT | BACKGROUND: As the Berg Balance Scale (BBS) is the most widely adaptable tool for quantifying the balance and different translated versions of this scale are available among several nations worldwide, a cross-cultural adaptation of the Hindi version of BBS (H-BBS) was necessary to establish it as an appropriate tool in Indian culture also. METHODS: According to international guidelines, the pre-final H-BBS was obtained after forward and backward translations of the original version (O-BBS) were performed by bilingual independent translators and physiotherapists blinded to the original version, followed by a content validation phase. Further, the study recruited 356 patients, out of which 122 patients participated in pilot study and 234 patients in psychometric evaluation. RESULTS: The H-BBS exhibited an excellent total content validation index (0.984), a good to excellent inter-evaluator reliability for the individual domain (ranging from 0.761 to 1) and computed score (0.719), a good to excellent intra-evaluator reliability of the individual domain (ranging from 0.848 to 1) and computed score (0.994), an excellent total internal consistency of all items (0.913), an excellent criterion validity with O-BBS (0.993), MiniBESTest (0.894) and TUG (-0.946). CONCLUSION: The H-BBS is an adapted tool for quantifying balance among different neurological deficits.

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References

1. Fusco A, Giancotti GF, Fuchs PX, Wagner H, Varalda C, Capranica L, et al. Dynamic Balance Evaluation: Reliability and Validity of a Computerized Wobble Board. J Strength Cond Res. 2020;34(6):1709-15. https://doi.org/10.1519/JSC.0000000000002518

2. Kiss R, Schedler S, Muehlbauer T. Associations between Types of Balance Performance in Healthy Individuals across the Lifespan: A Systematic Review and Meta-Analysis. Front Physiol. 2018;9:1366. https://doi.org/10.3389/fphys.2018.01366

3. Park SH. Tools for assessing fall risk in the elderly: a systematic review and meta-analysis. Aging Clin Exp Res. 2018;30(1):1-16. https://doi.org/10.1007/s40520-017-0749-0

4. Taghizadeh G, Martinez MP, Fereshtehnejad SM, Habibi SA, Nikbakht N, Alizadeh NH, et al. Psychometric properties of the Berg Balance Scale in idiopathic Parkinson's disease in the drug off-phase. Neurol Sci. 2018;39(12):2175-81. https://doi.org/10.1007/s10072-018-3570-4

5. Yeo SS, Kwon JW, Cho IH. Associations between age-related changes in the core vestibular projection pathway and balance ability: a diffusion tensor imaging study. Behav Neurol. 2020;2020:2825108. https://doi.org/10.1155/2020/2825108

6. Osoba MY, Rao AK, Agrawal SK, Lalwani AK. Balance and gait in the elderly: a contemporary review. Laryngoscope Investig Otolaryngol. 2019;4(1):143-53. https://doi.org/10.1002/lio2.252

7. Babaei-GA, Mohammadi H, Shahidi GA, Habibi SA, Forogh B, Ahadi T, et al. Reliability and validity of the Persian translation of Berg Balance Scale in Parkinson disease. Aging Clin Exp Res. 2017;29(5):857-62. https://doi.org/10.1007/s40520-016-0682-7

8. Ju J, Jiang Y, Zhou P, Li L, Ye X, Wu H, et al. Evaluation of the reliability and validity for X16 balance testing scale for the elderly. BMC Geriatr. 2018;18(1):112. https://doi.org/10.1186/s12877-018-0803

9. Park SH, Lee YS. The Diagnostic Accuracy of the Berg Balance Scale in Predicting Falls. West J Nurs. 2017;39(11):1502-25. https://doi.org/10.1177/0193945916670894

10. Downs S, Marquez J, Chiarelli P. The Berg Balance Scale has high intra- and inter-rater reliability but absolute reliability varies across the scale: a systematic review. J Physiother. 2013;59(2):93-9. https://doi.org/10.1016/S1836-9553(13)70161-9

11. Azuma Y, Chin T, Miura Y. The relationship between balance ability and walking ability using the Berg Balance Scale in people with transfemoral amputation. Prosthe Orthot Int. 2019;43(4):396-401. https://doi.org/10.1177/0309364619846364

12. Lee YJ, Yi CH, Kim G. Analysis and comparison of the psychometric properties of two balance scales for elderly adults. Int J Ther Rehabil. 2017;24(12):520-7. https://doi.org/10.12968/ijtr.2017.24.12.520

13. Muir-Hunter SW, Graham L, Montero OM. Reliability of the Berg Balance Scale as a clinical measure of balance in community-dwelling older adults with mild to moderate Alzheimer disease: a pilot study. Physiother Can. 2015;67(3):255–62. https://doi.org/10.3138/ptc.2014-32. https://doi.org/10.3138/ptc.2014-32

14. Miodonska Z, Stepien P, Badura P, Choroba P, Kawa J, Derejczyk, Pietka E. Inertial data-based gait metrics correspondence to Tinetti Test and Berg Balance Scale assessments. Biomed Signal Process Control. 2018;44(2):38-47. https://doi.org/10.1016/j.bspc.2018.03.012

15. Miyata K, Hasegawa S, Iwamoto H, Otani T, Kaizu Y, Shinohara, T., et al. Comparing the measurement properties and relationship to gait speed recovery of the Mini-Balance Evaluation Systems Test and the Berg Balance Scale in ambulatory individuals with subacute stroke. Phys Ther Res. 2020;23(1):72–8. https://doi.org/10.1298/ptr.E10004

16. 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(6):677–87. https://doi.org/10.1093/ptj/pzx030

17. Newstead AH, Hinman MR, Tomberlin JA. Reliability of the Berg Balance Scale and balance master limits of stability tests for individuals with brain injury. J Neurol Phys. 2005;29(1):18-23. https://doi.org/10.1097/01.npt.0000282258.74325.cf

18. Al Shamsi H, Almutairi AG, Al Mashrafi S, Al Kalbani T. Implications of Language Barriers for Healthcare: A Systematic Review. Oman Med J. 2020;35(2):1-7. https://doi.org/10.5001/omj.2020.40

19. Lampropoulou S, Gizeli A, Kalivioti C, Billis E, Gedikoglou IA, Alexander N. Cross Cultural Adaptation of Berg Balance Scale in Greek for Various Balance Impairments. J Phys Med Rehabil Dis. 2016;2(1):1-13. https://doi.org/10.24966/PMRD-8670/100011

20. Miyamoto ST, Lombardi JI, Berg KO, Ramos LR, Natour J. Brazilian version of the Berg balance scale. Braz J Med Res. 2004;37(9):1411–21. https://doi.org/10.1590/s0100-879x2004000900017

21. Matsushima M, Yabe I, Uwatoko H, Shirai S, Hirotani M, Sasaki H. Reliability of the Japanese version of the Berg balance scale. Intern Med. 2014;53(15):1621–4. https://doi.org/10.2169/internalmedicine.53.2662

22. Freixes O, Passuni DA, Buffetti E, Elizalde M, Lastiri F. Berg Balance Scale: inter-rater and intra-rater reliability of the Spanish version with incomplete spinal cord injured subjects. Spinal Cord Ser Cases. 2020;6(1):1-5. https://doi.org/10.1038/s41394-020-0278-5

23. Halsaa, KE, Brovold T, Graver V, Sandvik L, Bergland A. Assessments of interrater reliability and internal consistency of the Norwegian version of the Berg Balance Scale. Arch Phys Med Rehabil. 2007;88(1):94-8. https://doi.org/10.1016/j.apmr.2006.10.016

24. Alghwiri AA, Alghadir AH, Al-Momani MO, Whitney SL. The activities-specific balance confidence scale and berg balance scale: Reliability and validity in Arabic-speaking vestibular patients. J Vestib Res. 2016;25(5-6):253-9. https://doi.org/10.3233/VES-160568

25. 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(3):245-50. https://doi.org/10.1038/sc.2009.119

26. Qutubuddin AA, Pegg PO, Cifu DX, Brown R, McNamee S, Carne W. Validating the Berg Balance Scale for patients with Parkinson's disease: a key to rehabilitation evaluation. Arch Phys Med Rehabil. 2005;86(4):789-92. https://doi.org/10.1016/j.apmr.2004.11.005

27. Conradsson M, Lundin-Olsson L, Lindelöf N, Littbrand H, Malmqvist L, Gustafson Y, et al. Berg balance scale: inter-rater test-retest reliability among older people dependent in activities of daily living and living in residential care facilities. Phys Ther. 2007;87(9):1155-63. https://doi.org/10.2522/ptj.20060343

28. Salavati M, Negahban H, Mazaheri M, Soleimanifar M, Hadadi M, Sefiddashti L, et al. The Persian version of the Berg Balance Scale: inter and intra-rater reliability and construct validity in elderly adults. Disabil Rehabil. 2012;34(20):1695–8. https://doi.org/10.3109/09638288.2012.660604

29. Azad A, Taghizadeh G, Khaneghini A. Assessments of the reliability of the Iranian version of the Berg Balance Scale in patients with multiple sclerosis. Acta Neurol Taiwan [Internet]. 2011;20(1):22–8. Cited in: PMID: 21249592

30. Ulus Y, Durmus D, Akyol Y, Terzi Y, Bilgici A, Kuru O. Reliability and validity of the Turkish version of the Falls Efficacy Scale International (FES-I) in community-dwelling older persons. Arch Gerontol Geriatr. 2012;54(3):429–33. https://doi.org/10.1016/j.archger.2011.06.010

31. Razmjouie F, Ghoochani BZ, Ghahremani L, Sokout T, Asadollahi A, Abyad A. Validation of the Persian version of the 9-item Berg Balance Scale among older Iranians. Oman Med J. 2023;38(3):1–8. https://doi.org/10.5001/omj.2023.77

32. Ottonello M, Ferriero G, Benevolo E, Sessarego P, Dughi D. Psychometric evaluation of the Italian version of the Berg Balance Scale in rehabilitation inpatients. Eur J Med Phys Rehabil [Internet]. 2003;39(4):181-9. Available from: https://www.minervamedica.it/en/journals/europa-medicophysica/article.php?cod=R33Y2003N04A0181

33. El-Gilany AH, Hatata ES, Aayob NS, Refaat R. Validation of the Arabic version of the Berg Balance Scale (A-BBS) among elderly residents in a rural community. Age Ageing [Internet]. 2009;9(1):3-7. Available from: https://platform.almanhal.com/Reader/Article/8573

34. Jung HY, Park JH, Shim JJ, Kim MJ, Hwang MR, Kim SH. Reliability test of Korean version of Berg Balance Scale. J Korean Acad Rehab Med [Internet]. 2006;30(6):611–8. Available from: https://www.e-arm.org/journal/view.php?number=1533&utm_source=chatgpt.com

Published

11/06/2025

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Section

Original Articles

How to Cite

1.
Kaur M, Sharma N. Reliability, validity and adaptability of the Hindi version of Berg Balance Scale in patients with impaired balance having neurological illness. Rev Pesq Fisio [Internet]. 2025 Nov. 6 [cited 2025 Dec. 5];15:e6218. Available from: https://journals.bahiana.edu.br/index.php/fisioterapia/article/view/6218