Ann M Wilson
Title: Balance-Related Outcome Measures of Acquired Brain Injury Patients in a Student-Led Onsite Physical Therapy Clinic: A Retrospective Records Review
Authors: Parke Humphrey, SPT; Corey Kaleshnik, SPT; Lauren Wilson, SPT; Ann Wilson, PT, MEd, GCS
Affiliation(s): 1. Physical Therapy Program, University of Puget Sound
Purpose: Individuals with Acquired Brain Injury (ABI) often have balance impairments. Interventions targeting these impairments may improve balance and thus increase overall societal participation. The purpose of this review was to identify the types of balance-related outcome measures used to assess balance impairments in patients with ABI in a student-led onsite physical therapy clinic.
Subjects: 13 individuals with an ABI receiving care at a student-run clinic.
Materials & Methods: 23 records were selected for this review; however, only 13 of these met inclusion criteria. 12 subjects had a primary diagnosis of CVA and 1 subject had a primary diagnosis of TBI. The average number of balance measures per subject was 2.25 with all subjects having at least one measure taken. The mean age of the subjects was 59.8 years with a range of 35 to 85 years. The mean amount of time since ABI onset to the episode of care was 5.2 years with a range of 8 months to 21 years and a standard deviation of 4.8 years. The mean number of visits for our subjects in each episode of care was 12.4 with a range of 4 to 19 visits and a standard deviation of 4.9. The named balance measures we evaluated were the Berg Balance Scale, Dynamic Gait Index, Timed Up and Go, and the Mini-BESTest. Additionally there were subjects that were evaluated based on general static and dynamic balance.
Results: The most commonly used recognized outcome measures were the Berg Balance Scale (N=8), Dynamic Gait Index (N=3), Timed up and Go (N=2) and the Mini-BESTest (N=2). In addition 8 records identified that either static or dynamic balance or both were assessed using other methods (N=8). Of the 13 subjects, 9 improved by a score greater than or equal to the MDC or MCID.
Conclusions: Although the majority of student therapists are using validated measures to assess balance, a number are assessing balance in other ways that make it difficult to determine which components of balance are being assessed or how successful the targeted interventions were. Despite this, meaningful change was seen in 69.2% (N=9) of subjects that were evaluated with recognized outcome measures.
Clinical Relevance: Meaningful change can be seen in patients with ABI who may be several years out from their original injury in relatively short episodes of care or with infrequent visits. While general balance measures might be appropriate to help inform a therapist’s decision-making process to work on specific deficits, this review highlights the importance of also including a named outcome measure to detect significant changes across many case studies.
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University of Puget Sound
Wilson, Lauren M.; Kaleshnik, Corey R.; Humphrey, Parke K.; and Wilson, Ann M., "Balance-Related Outcome Measures of Acquired Brain Injury Patients in a Student-Led Onsite Physical Therapy Clinic: A Retrospective Records Review" (2016). Physical Therapy Research Symposium. 24.