Clinical measurement of walking balance in people post stroke: a systematic review

Objective: To identify walking balance measures which have been established for use with ambulatory people post stroke and reflect the balance requirements of community walking. Data sources: MEDLINE, Embase, AMED. Review methods: Measures reflecting walking balance, with tasks that include a stepping action in standing, used with people post stroke were reviewed. Measures with clinical utility were evaluated for psychometric properties, including reliability, validity and clinical interpretation. Results: Nine measures (24 papers) were identified that met the requirement of measuring walking balance in people post stroke with demonstrated clinical utility. Outcome measures with multiple tasks (Brunel Balance Assessment, Modified Emory Functional Ambulation Profile, Dynamic Gait Index, Community Balance and Mobility Scale, and mini-Balance Evaluation Systems Test) as opposed to single task measures (Step Test, Side Step Test and Four Square Step Test, Timed Up and Go), reflect a broader range of walking balance required to accommodate the variable challenges which may be expected at the community level of walking. Most tools report excellent reliability when used by physiotherapists. Validity remains far more challenging to establish. Evaluation of clinical interpretation is limited for all measures. Conclusion: The multiple-task outcome measures reviewed reflected walking balance activities often undertaken during community mobility. Single-task measures may be useful as screening measures, identifying walking balance deficits associated with basic/lower levels of walking balance. Construct validity and clinical interpretability of each measure in ambulatory people post stroke requires further research to identify the level of community mobility represented by each measure of walking balance.