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Correlation of Balance Tests Scores with Modified Physical Performance Test in Indian Community-Dwelling Older Adults
Sunita Yadav* MPT (Neuro), Deepti Dhar** MPT (Paediatrics)

Abstract: Background and Objective: There is sufficient evidence which shows significant relationship between balance tests and other functional tests but there is lack of literature regarding the relationship between balance tests (BBS, MDRT, BPOMA) and Modified Physical Performance Test in different age groups of older adults. Design: An Observational Study Subjects: 58 subjects were divided into three different age groups, having the mean age of 65.33.0 (Group-A), 73.72.4 (Group-B), 82.61.4 (Group-C), mean height of 161.45.6 (Group-A), 164.910.2 (Group-B), 160.35.9 (Group-C) & mean weight of 68.44.8 (GroupA), 72.76.9 (Group-B), 63.67.7 (Group-C) were recruited in this study from old age home and local community. Methods: Subjects in each group performed the tests in the following sequence: BBS (Berg Balance Scale), MDRT (Multi-Directional Reach Test), Modified-PPT (Physical Performance Test) & BPOMA (Balance Performance-Oriented Mobility Assessment of Tinetti) with rest period of 5-10 minutes between each scale. Result: The results suggested that there was a significant positive correlation between balance tests and Modified Physical Performance Test in different age groups of older adults. Conclusion: The current study concluded that Modified physical performance test is a efficient tool to assess static and dynamic balance and also physical function and ambulation in different age groups of older adults. It was also observed that out of these balance tests used in the study, MDRT was the most difficult to understand and perform by subjects above 70 years and the subjects above 80 years found it really hard to understand the procedure. Keywords: BBS, MDRT, BPOMA, Modified PPT, Balance, Physical Function.

INTRODUCTION The number of persons above the age of 60 years is fast growing, especially in India. India is the second most populous country in the world has 76.6 million people at or over the age of 60, constituting population. above Recurrent 7.7% falls of are total an

important cause of morbidity and mortality http://www.srji.co.cc

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in the elderly and are a marker of poor physical and cognitive status. Impaired balance and physical function are the main causes of fall among the older adults. Stability and orientation are to distinct goals of the postural control system. Postural control for stability and orientation requires both perception and action. Thus, postural control requires the complex interaction of
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their likelihood of falls and to enhance physical function. The Berg Balance Scale was developed by Kathy Berg (a Canadian physical therapist) in1993, as a means of measuring balance in the elderly. Multi-directional Reach Test (MDRT) is developed by Roberta A. Newton in 2001. It allows for analysis of the patient voluntary postural control. The Performance Oriented Mobility Assessment (POMA) scale was originally developed by Dr. Mary E. Tinetti and first published in 1986, is a widely used tool for assessing mobility and fall risk in older people. In this study balance subscale of Tinetti assessment is used to assess the balance of older adults.15 Brown, developed focus on the gross M, Sinacore, modified motor D.R. physical by

neural

and

musculoskeletal systems.

Several researchers show that as the age increases, the changes in the neural and musculoskeletal systems disturb the balance and physical activities.6 As age increases the physical activities and
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physical function also decreases due to decreased muscular power and strength. Both balance problems and physical inactivity affect the quality of life of older adults. Therefore the assessment of both balance and physical function is necessary for older adults in order to help establish appropriate awareness appropriate instrument people treatment of fall assistive have goals, risk and device increase assign and to

performance test in 2005 to provide more function substituting a chair rise task and a balance task for the writing and stimulated eating tasks described in the original PPT. The tool was more useful in identifying deficits in physical function than the self- report comparison measure, the functional status questionnaire. The authors concluded that the performance based measure could assist in early identification of minor problems in physical functioning, and allow for opportunity for early intervention for the patients.16 http://www.srji.co.cc

decrease the disability. Several such shown satisfactory physical reliability and validity in identifying older with balance and functional problems, discriminating older adults by their needs for different assistive device to maintain balance or predicting

Vol.1 No.2 2012 Several balancing researchers

Scientific Research Journal of India found that physical

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Ability to walk at least 50 feet before sitting to rest; Minimal use of rail or cane while climbing. Exclusion Criteria: Use of any assistive prosthetic device; History of any cardiac problem confirmed by physician; Any history of fainting spells or extended dizziness due to unknown reasons History of neurological; vestibular or auditory deficit confirmed by physician; History of any visual disorder which will not be corrected by optical glasses as confirmed by physician; MMSE score below 23; History of postural hypotension; History of recent fractures and severe arthritic conditions; History of any major surgeries during last 6 month; History of any previous balance training; Moderate to severe hypertensions

exercises

improve

function and previous studies also found significant correlation between balance scales and other functional tests.17,18,13,19 Therefore it is clear that there is a relationship between balance and physical function. Yet there is no study to show relationship between these scales or tests in different age groups. Therefore the main purpose of my study is to find out the relationship between balance tests and Modified physical performance test. Second purpose is, the Modified physical performance test assesses both balance and physical function in older adults no other tool is required because it measure the both static and dynamic balance and also physical function. It tells about fall risk, need of assistance device and functional limitations; additionally it takes less time to administer as compared to other scale.

Measurement Tools Berg Balance Scale (BBS) The BBS was developed to measure balance among in older balance people function with by impairment

METHODOLOGY This observational study recruited 58 subjects from old age homes and local community of Delhi and Dehradun meeting the inclusion criteria. Inclusion Criteria: Age - 60 to 89 year old healthy subjects; Gender- Both male and female; Ability to abduct and flex the shoulder up to 90 degrees; Ability to stand for minimum 10 min. without any assistance;

assessing the performance of 14 functional tasks. The results are based on how long it takes to complete specific tasks and how well the tasks are performed. Each task is measured on a five point ordinal scale ranging from 0 to 4 (0 = unable to perform, 4 = independent) so that the aggregate score ranges from 0 to 56. Multidirectional Reach Test (MDRT)

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The MDRT is an inexpensive, reliable and valid screening tool to measure the limits of postural stability in four directions (forward, backward, right & left) during standing. The distance of each reach is measured in centimetres or inches. Balance Performance Oriented Mobility Assessment (BPOMA) The Tinetti assessment is a physical taskoriented scale which measures the gait and balance activities of older adults. In this study BPOMA was used to assess the balance of the community dwelling older adults; it consists 9 tasks. 6 tasks are measured on a three point ordinal scale ranging from 0 to 2 and remaining three tasks are measured on a two point ordinal scale ranging from 0 to 1 ( 0 = unable to perform, 1 & 2 = independent). The maximum score is 16. Physical Performance Test (ModifiedPPT) An objective evaluation of overall physical function was obtained by using modified PPT. The severity of physical frailty in physical functioning was assessed using a modified PPT. It consists of 9 tasks; each task is measured on a five point ordinal scale ranging from 0 to 4 ( 0 = unable to perform, 4 = independent) except 7th task (turning 360 degrees) which ranges from 0 to 1 (0 = unsteady, 1 = steady). The maximum score is 36. inclusion and

The subjects were recruited based on exclusion criteria the subjects of different age groups 60 to 69 years of age (Group- A), 70 to 79 years of age (Group- B), and 80 to 89 years of age (Group- C). Subjects in each group performed the tests in a sequence i.e. BBS, MDRT, Modified-PPT, POMA. The whole procedure was explained to each subject and the subject signed a consent form before performing the study. Description data was collected which included age, gender, height, weight and number of falls in the past 6 months. MMSE score was also assessed. All subjects were assessed by all four scales or tests in the following order BBS, MDRT, Modified-PPT and BPOMA. All components of each scale were demonstrated to all the subjects and one practice session was done for all the components of four scales by all the subjects, after that reading was taken. Each test or scale was administered by myself. All subjects were offered rest breaks and water during the session and completed the approximately 60 minute testing protocol without complaint of fatigue or discomfort. The resting period of 5 to 10 minute was given after performing each scale. As a precautionary measure, blood pressure was checked prior to beginning of the test session and it was again taken at the end of the last test performed. One http://www.srji.co.cc

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person was always nearby vicinity of the subject. Data Analysis The data analysis was done on SPSS 11.5 software. The arithmetical mean and standard deviation of age, height and weight in demographic data were evaluated. Karl pearsons correlation test was done to analyse the correlation between balance tests (BBS, MDRT & POMA) with physical performance test (modified) among elderly people. Statistical significance level was set at < 0.05. The data analysis was done on SPSS 11.5 software. The arithmetical mean and standard deviation of age, height and weight in demographic data were evaluated. Karl pearsons correlation test was done to analyse the correlation between balance tests (BBS, MDRT & POMA) with physical performance test (modified) 0.05. among elderly people. Statistical significance level was set at <

1] was calculated. The mean and standard deviation of balance tests and physical performance test (modified) of Group A [Table 2], Group B [Table 3], & Group C [Table 4], was calculated. The correlation values of balance tests with modified physical performance test of Group A [Table 5], Group B [Table 6], & Group C [Table 7], were calculated. Karl pearsons correlation test was used to find out the correlation between BBS, MDRT & BPOMA with PPT (modified) in different age groups of older adults, Group A (60 69 years of age), Group B (70 79 years of age), and Group C (80 - 89 years of age); these three groups showed significant positive correlation between balance tests (BBS, MDRT & BPOMA) with physical performance test (modified). Table 1: Mean and standard deviation of demographic data
Group A Age Height Weight N 20 20 20 Group B Age Height Weight N 20 20 20 Mean 73.72.4 164.910.2 72.76.9 Mean 65.33.0 161.45.6 68.44.8

RESULT AND INTERPRETATION A sample of 58 subjects were selected on the basis of inclusion and exclusion criteria. Each group of older adults had 20 subjects except Group C (81-89 years of age) which has only 18 subjects due to unavailability of the subjects. The mean and standard deviation of age weight and height of three Groups A, B and C [Table

Group C N Mean Age 20 82.61.4 Height 20 160.35.9 Weight 20 63.67.7 Table 1 shows mean and standard deviation of demographic data of different age groups. Group

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(60 69 years of age), Group B (70 79 years of age) & Group C ( 80 89 years of age).

Table 2: (Group A) Mean and standard deviation (SD) of balance tests (BBS, MDRT & BPOMA) and Physical Performance Test (Modified).
Tests BBS FR (MDRT) BR (MDRT) RR (MDRT) LR (MDRT) BPOMA PPT (modified) N 20 20 20 20 20 20 20 Mean and SD 542.4 13.62.6 11.82.6 12.52.5 12.23.0 14.91.9 31.12.5

Figure 1: Mean and standard deviation of balance tests (BBS, MDRT, & BPOMA) with modified physical performance test (modified) of Group A, B and C.

Table 2 shows mean and standard deviation of balance tests and modified physical performance test of Group-A (60-69 Years of age).

Table 3: (Group B) Mean and standard deviation (SD) of balance tests (BBS, MDRT & BPOMA) and Physical Performance Test (Modified).
Tests BBS FR (MDRT) BR (MDRT) RR (MDRT) LR (MDRT) BPOMA PPT (Modified) N 20 20 20 20 20 20 20 Mean and SD 27.75.3 12.03.4 9.93.9 11.23.3 11.44.3 12.92.2 27.75.3

Table 5: (Group A) Correlations of balance tests (BBS, MDRT, & POMA) with Physical Performance Test (Modified)
Balance Tests BBS Vs PPT (modified) FR( MDRT) Vs PPT (modified) BR (MDRT) Vs PPT (modified) RR (MDRT) Vs PPT (modified) LR (MDRT) Vs PPT (modified) BPOMA Vs PPT (modified) r value .759 .592 .671 .541 .518 .826 P value .000 .006 .001 .014 .019 .000

Table 3 shows mean and standard deviation of balance tests and physical performance test (modified) of Group-A (70-79 Years of age).

Table 5 shows correlation of balance tests with physical performance test (modified), all the balance tests show significant correlation except right and left reaches which show moderately significant correlations with physical performance test (modified) of Group A (60 69 years of age).

Table 4: (Group C) Mean and standard deviation (SD) of balance tests (BBS, MDRT & BPOMA) and Physical Performance Test (Modified).
Tests BBS FR (MDRT) BR (MDRT) RR (MDRT) LR (MDRT) BPOMA PPT (modified) N 20 20 20 20 20 20 20 Mean and SD 42.63.6 5.52.2 3.21.9 4.92.3 4.42.2 10.51.4 18.03.5

Figure 2: Correlation Graph of Berg Balance Scale (BBS) and Physical Performance Test (Modified) of Group A.

Table 4 shows mean and standard deviation of balance tests and Modified physical performance test of Group A (80-89 Years of age).

Figure 2 depicts correlation between BBS and modified PPT. It shows positive significant correlation in 60-69 years of age group i.e. Group A.

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Figure 3: Correlation Graph Of Forward Reach (FR) of MDRT and Physical Performance Test (Modified) Of Group A.

Figure 6: Correlation Graph Of Lateral Reach (LR) of MDRT and Physical Performance Test (Modified) of Group A.

Figure 3 depicts correlation between FR of MDRT and PPT (modified). It shows positive significant correlation in 60-69 years of age group i.e. Group A.

Figure 6 depicts correlation between LR of MDRT and PPT (modified). It shows positive significant correlation in 60-69 years of age group i.e. Group A.

Figure 4: Correlation Graph of Backward Reach (BR) of MDRT and Physical Performance Test (Modified) Of Group A.

Figure 7: Correlation Graph of Balance Performance Oriented Mobility Assessment (BPOMA) with Physical Performance Test (Modified) of Group A.

Figure 4 depicts correlation between BR of MDRT and PPT (modified). It shows positive significant correlation in 60-69 years of age group i.e. Group A.

Figure 5: Correlation Graph of Right Reach (RR) of MDRT and Physical Performance Test (Modified) of Group A.

Figure 7 depicts correlation between BPOMA and Modified PPT (modified). It shows positive significant correlation in 60-69 years of age group i.e. Group A.

Table 6: Correlations of balance tests (BBS, MDRT, & BPOMA) with Physical Performance Test (modified) of Group - B.
Balance Tests BBS Vs PPT (modified) FR( MDRT) Vs PPT (modified) BR (MDRT) Vs PPT (modified) RR (MDRT) Vs PPT (modified) LR (MDRT) Vs PPT (modified) BPOMA Vs PPT (modified) r value .944 .874 .893 .826 .710 .856 P value < .01 < .01 < .01 < .01 < .01 < .01

Figure 5 depicts correlation between RR of MDRT and PPT (modified). It shows positive significant correlation in 60-69 years of age group i.e. Group A.

Table 6 shows significant correlation between balance tests (BBS, MDRT & BPOMA) and

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modified physical performance test in older adults [Group B (70 79 years of age)].

Figure 8: Correlation graph of Berg Balance Test (BBS) with Physical Performance Test (Modified) Of Group B.

Figure 10 depicts correlation between BR of MDRT and PPT (modified). It shows positive significant correlation in 70-79 years of age group i.e. Group B.

Figure 11: Correlation graph of Right Reach (RR) of MDRT with Physical Performance Test (Modified) of Group B.

Figure 8 depicts correlation between BBS and PPT (modified). It shows positive significant correlation in 70-79 years of age group i.e. Group B.

Figure 11 depicts correlation between RR of MDRT and PPT (modified). It shows positive significant correlation in 70-79 years of age group i.e. Group B.

Figure 9: Correlation graph of Forward Reach of MDRT with Physical Performance Test (Modified) of Group B.

Figure 12: Correlation graph of Left Reach (LR) of MDRT with Physical Performance Test (Modified) Of Group B.

Figure 9 depicts correlation between FR of MDRT and PPT (modified). It shows positive significant correlation in 70-79 years of age group i.e. Group B.

Figure 12 depicts correlation between LR of MDRT and PPT (modified). It shows positive significant correlation in 70-79 years of age group i.e. Group B.

Figure 10: Correlation graph of Backward Reach (BR) of MDRT with Physical Performance Test (Modified) Of Group B.

Figure 13: Correlation graph of Balance Performance Oriented Mobility Assessment (BPOMA) with Physical Performance Test (Modified) Of Group B.

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Figure 13 depicts correlation between POMA and PPT (modified). It shows positive significant correlation in 71-79 years of age group i.e. Group B

Figure 15 depicts correlation between FR of MDRT and PPT (modified). It shows positive significant correlation in 81-89 years of age group i.e. Group C.

Table 7: Correlations of balance tests (BBS, MDRT, & BPOMA) with Physical Performance Test (Modified) Group-C.
r P value value BBS Vs PPT (modified) .789 < .01 FR( MDRT) Vs PPT (modified) .822 < .01 BR (MDRT) Vs PPT (modified) .852 < .01 RR (MDRT) Vs PPT (modified) .770 < .01 LR (MDRT) Vs PPT (modified) .752 < .01 B POMA Vs PPT (modified) .651 < .01 Table 7: also shows significant correlation between balance tests ( BBS, MDRT & BPOMA) and physical performance test (modified) in older adults [Group C ( 80 89 years of age)]. Balance Tests

Figure 16: Correlation graph of Backward Reach (BR) of MDRT with Physical Performance Test (Modified) of Group C.

Figure 14: Correlation graph of Berg Balance Scale (BBS) with Physical Performance Test (Modified ) Of Group C.

Figure 16 depicts correlation between BR of MDRT and PPT. It shows positive significant correlation in 81-89 years of age group i.e. Group C.

Figure 17: Correlation graph of Right Reach (RR) of MDRT with Physical Performance Test (Modified) of Group C.

Figure 14 depicts correlation between BBS and PPT (modified). It shows positive significant correlation in 81-89 years of age group i.e. Group C.

Figure 17 depicts correlation between RR of MDRT and PPT (modified). It shows positive significant correlation in 81-89 years of age group i.e. Group C.

Figure 15: Correlation graph Of Forward Reach (FR) of MDRT with Physical Performance Test (Modified) Of Group C.

Figure 18: Correlation graph of Left Reach (LR) of MDRT with Physical Performance Test (Modified) of Group C.

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Figure 18 depicts correlation between LR of MDRT and PPT (modified). It shows positive significant correlation in 81-89 years of age group i.e. Group C.

the functional decline. Balance instability and physical inactivity in older adults contribute to this decline in ADLs (activities of daily living). Therefore, effective balance and functional assessments are needed to document balance and functional abilities and in this segment of the older adult population. This information is critical to the design of all prevention/reduction these individuals.25 The BBS, MDRT, & BPOMA have documented validity and reliability to assess balance abilities. As well as physical performance test (modified) has also documented validity and reliability to assess functional abilities in community dwelling older adults. Previous researchers found significant relationship between balance scales (BBS, MDRT & BPOMA) with other functional performance tests; Barthel mobility subscale, Time up and go Test and Physical Performance Test respectively 13, 25, 26. But there is little to no documentation of relationship between three balance scales with PPT (modified). Thus this study was done to find out the relationship of these three balance scales with physical performance test (modified). The clinical trial studied the correlation between balance tests (BBS, MDRT, & BPOMA) and physical performance test programs and to maintain or improve the quality of life for

Figure 19: Correlation graph of Balance Performance Oriented Mobility Assessment (BPOMA) with Physical Performance Test (Modified) of Group C.

Figure 19 depicts correlation between BPOMA and PPT (modified). It shows positive significant correlation in 81-89 years of age group i.e. Group C.

DISCUSSION Assessing balance and physical abilities as they relate to falls in older adults is complex due to many social and health related issues that may be involved. The geriatric population above 80 years adults presents a more complicated situation due to a sedentary life style, a lower level of function, and the dynamics of their physical and emotional environments. Any one or combination of these factors may lead to a falls at any time because the level of the older adults performance may not meet the demands of the environment or task at hand. The need to reduce this functional decline is an important health care issue. It is important to identify those factors that contribute to

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(modified) among elderly people who were divided into three age categories. Berg Balance Scale (BBS) The last two items of the Berg Balance Test are considered the most difficult to perform. These tasks are: item no. 13 & 14 (stand with feet in tandem for 30 seconds, stand on one leg respectively), One study found that item numbers 12, 13, & 14 are the most difficult tasks to perform, but in the current study only 6 subjects (Group B & C) found difficulty to perform the 12th task. All the subjects got grade 4 for the 1st, 2nd, 3rd, & 4th components of the BBS. Not one subject reached up to 25cm for the 8th component (Reaching forward with outstretched arm while standing) of the BBS. In the current study the mean values (54, 49 & 42, as shown in tables 2, 3 & 4) of BBS in different age groups are lower from the findings (55,55; 53,52; & 52,48 for male and female respectively) of one study in 3 age groups (60-69, 70-79, & 80+ years).
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number of female subjects are more than males so it could be the reason for lowest values. Another study found mean values of BBS in fallers (36.5) and nonfallers (35.7) older adults;25 these values are very low as compared to the current study. The reasons could be one that the mean age of this study population is 838.8 years which shows very older subjects. Secondly they examined community dwelling older adults who were home bound and have a neurological or musculoskeletal diagnosis that may disturb the balance and contribute to falls . In another study the mean value of BBS is 48.6 and the mean age of this study is 74.1 7.9 years which is approximately similar to Group-B of the current study. The mean value of BBS of the current study is 49.65 which is slightly more, the reason could be the age difference because the mean age of the Group-B is 73.70 2.4 which shows that the subjects were mostly between 71 to 75 years and the subjects of the above said study were mostly between 68 to 81 years, so this could be the reason for the lowest value of BBS among 254 communitydwelling older adults.13 A study done by Patricia S. Smith found significant relationship between BBS and forward reach in post acute stroke patients (r = 0.78).27 The BBS has also been shown to correlate with both the Tinetti mobility index (r = 0.91) and the get up & http://www.srji.co.cc

This difference may be due

to age difference. They have given the average mean of age (69); they did not mention the mean value of age for individual groups so the subjects of the this study may be slightly younger than my study; in this study the mean values for females in each age group have lower than males and in the current study the scores of the tests for the females also lower and the

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go test (r = - 0.76).28 A correlation greater than 0.70 between total BBS and total Fugl-Mayer-Scale (FMS) scores have been reported in older adults.
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groups. It also indicates that there is a relationship between age and height with performance on the lateral reach test. These results similar to the study who reported that, similar to functional reach performance is positively correlated with height and negatively correlated with age.22 The four heighted persons were present in the current study, the values of all the components of MDRT were greater to these heighted persons as compared to other subjects. Mean scores on performance of the functional and lateral reach tests in the present study are lower than mean scores reported elsewhere.13,29,
30

The above

studies shows correlations between BBS and other functional tests. This current study also shows significant correlation between BBS and physical performance test (modified), [r = 0.759, P = <0.01 (Group - A); r = 0.944, P = <0.01 (Group B); ); r = 0.789, P = <0.01 (Group - C); as shown in tables 5, 6, 7 & figures 2, 8, and 14 respectively]. The reason of significant correlation between BBS and physical performance test (modified) could be one that the five components are similar between BBS and PPT (modified) and secondly both BBS and PPT (modified) assess static and dynamic balance and also physical activity. Multi-directional Reach Test (MDRT) In MDRT backward reach is the most difficult task to perform because most of the subjects of the Group-C used to take a step behind while performing this reach. MDRT is considered the more time taking test and most difficult to understand by the subjects because the mostly older adults use the spine not the ankle for the reaches. This current study shows there is a significant relationship between components (FR, BR, RR & LR) of MDRT and physical performance test (modified) in older adults of different age

In a sample of 14 community dwelling

elderly females (age, 70-87 years), a study reported a mean functional reach of 26.78.9cm.30 In another research, with a larger sample of 254 elderly communitydwelling adults (mean age = 74.17.9 years), It was reported a mean forward, backward, right and left reach tests scores of 22.68.6cm, 11.57.8cm,17.57.6 & 16.87.4cm respectively.13 Yet another study reported mean left and right lateral reach test scores of 21.02.5cm and 20.00.5cm respectively, from 60 healthy females over the age of 65 (mean age = 72.55.0 years).29 In each of the above mentioned studies scores were defined as the mean multiple trials which may reflect score inflation due to learning over multiple trials. In contrast, scores in http://www.srji.co.cc

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present study were recorded from a single trial. Additionally, subjects used the ankle movements rather than spine movements which reflects the negative correlation between age and ankle muscle strength, sensation and ability to generate large amounts of force at the ankle joint.31 One of studies in past have revealed that MDRT demonstrated significant inverse relationships with scores on the time up & go test (TUG): [FR (r = -0.442) BR (r = 0.333), RR (r = - 0.260), LR (r = - 0.310) which is a functional performance test.13 Similarly current study showed significant correlation between MDRT and modified physical performance test which is again a functional performance test with high validity and reliability. Hence it can be said that MDRT with also shows good correlation different functional

as shown in table- 1). Another study found mean value of 132.9 among females (mean age = 83.87.7 years),33 which is more as compared to mean value (10.51.4, as shown in table- 4 ) of GroupC of the current study, in fact mean age was similar (82.61.3 years, as shown in table- 1 ). The subjects for Group-C were all above 80 and physical frailty component was more among the subjects of the current study while in the above said study where mean value was 83.87.7 years, many subjects less than may 80 years. Hence the balance scores were better for them. Physical Performance Test (ModifiedPPT) In modified physical performance test, the Ist & 2nd tasks were considered the most difficult task to perform by the subjects mainly for the Groups B & C. Seven subjects were using the assistive devices for the 8th & 9th components (climb one flight of stairs and climb stairs) of the physical performance test (modified) and four subjects climbed the stairs by holding the one sided railing. In one study it was found that the mean value of the PPT (modified) score among 27 frail obese older volunteers after treatment was 29.42.2 and for control group it was 29.82.0.34 Mean age was 71.15.1for treatment group which matched the current age of Group B but http://www.srji.co.cc

performance tests. Tinetti Balance Subscale During the performance of this test, the subjects did not find any difficulty with any of the tasks in the balance of performance-oriented mobility assessment (BPOMA) of Tinetti. One study found a mean among the community dwelling older women with no health problems on the balance subset of 12.61.7 (mean age = 74.76.0 years),
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which is similar to mean value (12.92.1, as shown in table- 3) of Group-B of the current study (mean age = 73.72.4 years,

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the mean value is lower i.e. 27.65.2 as shown in table- 3, this difference is may be due to age because in my study the mean age for the Group - B is 73.72.4, which shows that the subjects were slightly older which reflects the negative correlation between age and physical function.35 The mean age of group-A of current study is 65.23.0 which is slightly younger than the control group (694.6) of the above study, therefore the mean value for this group of my study is more and second reason could be that the subjects were obese which also reflects the negative correlation between obesity and physical function.
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subjects 16 were female. It has been well established that in females balance component is affected due to larger body mass in the upper segment the of body. The age is an important factor that affects both balance and physical function of older adults. Declines in standing balance have been attributed to sensory, musculoskeletal and cognitive changes, typically in some combination as multiple systems fall below minimal functional thresholds.36 The results of the balance tests and physical performance test (modified) are different in different age groups of older adults, which proved that the disturbance in balance and physical function also differ in severity (mild, moderate and severe for group A, B & C respectively) among different age groups of older adults. Thus assessment and treatment also differ to provide effective evaluation and treatment in different age groups. Additionally safety measures are necessary for the Group C (80-89 years of age) in the assessment and treatment also to prevent fall. CONCLUSION There is a significant relationship between balance tests and physical performance test (modified) and physical performance test (modified) is an efficient tool to assess static and dynamic balance and also physical function and ambulation in different age groups of older adults. It was also observed that out of the these balance http://www.srji.co.cc

Another study found the mean values of physical performance test (modified) in community dwelling older adults. The mean values of three groups [obese elderly, nonobese frail, and nonobese nonfrail] were 34.40.5, 29.30.7 and 27.80.8 respectively. The second group of above study matched with Group - B of the current study in respect similar age, weight and condition but the mean value of physical performance test (modified) is more than the current study, the reason could be that the subjects of my study may be more frail and reason could be the larger number of female subject in the current study compared to this study, there both genders were in equal proportion while in the current study out of 20
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tests used in the study, MDRT was the most difficult to understand and perform for people above 70 years and subjects above 80 years found it really hard to understand the procedure. According to this test the subject was supposed to perform movement at the ankle joint but more of trunkal mobility was seen in people above 80 years while performing this test. Hence it can be said that MDRT is not a very feasible test for cheeking balance in subjects above 80 years. Clinical significance As the Indian population over the age of 60 years continues to grow, there will be rise in the level of functional disability and prolonging imperative methods health. that are It is to therefore screening identify appropriate developed

functional level as well as the balance issues in an elderly person rather than giving other tests which are time taking, separately for balance and functional performance. Limitations In the present study, the sample size was small. The sample size of age Group C (81-89 years of age) was relatively smaller as compared to other groups. Gait subscale of performance oriented mobility assessment is not included in this study. Future Research Future study can be done with larger sample size to see the results. Future research is needed to find out the reliability and validity of modified physical performance test with balance scales (PPT, MDRT & BPOMA) in elderly. In my study the value of the left lateral reach is more than right lateral reach for the heighted person. Future study can be done to identify that why this difference has come and this difference is significant or not.

community dwelling elderly individuals with functional impairment who should be referred for a detailed physical therapy evaluation. As we have seen that PPT (modified) incorporates all important entities of balance and function hence, simply administering modified physical performance testing can well define the References 1. Alexander 2001. 2. Dr. Kalache, from: Bruno www. Dr.

older people: National/Regional review of India. Available from: http:// www.who.int/ageing/projects/SEA RO

Lunenfold. Health and men ageing. Available B. Who_nmh_nph_01.2.pdf. Krishnaswamy, Gnanasambandam Usha. Falls in

http://www.srji.co.cc

Vol.1 No.2 2012 3. Christopher M. of

Scientific Research Journal of India Fredericks. the motor

27

limited older adults. J Gerontology. 2010;495-502. 8. Keith smith. Sensory changes: Senior series. Available from: http:// www. Goldenbuckeye.com, http://senior series.osu.edu. 9. Marjorie Shumway. Nashner. control: H. Woolacott, Lewis and in Ann M.,

Pathophysiology

systems: principles and clinical presentations. F.A. Davis company. Philadelphia: Jean-Francois Vilain; 1996. p. 284. 4. Ann control Shumway-cookjorie H.woollacott. theory and H., Motor practical Morjorie

Cook, Ageing changes and

posture sensory muscular

applications. 2nd ed. Lippincott Williams and Wilkins: 2001. p. 164-165, 181-182, 222-238. 5. Kathryn H. Schmitz, Ann R. Cappola. The interaction of cancer and aging: Estallishing the need for breast cancer rehabilitation. J Cancer epidemiol biomarkers prev. 2007;16(5):866-72. 6. Jan Janseen, sleven B. Heymsfield, Robert Ross. Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. J American geriatrics society. 2002;50(5):889-896. 7. David Kieran Roger clark, F. A. carolynnpattern, Robert J, Reid, Feilding.

organization

coordination. The international J of ageing and human development. 1986;23(2):97-114. 10. H.J.J.(cojanne) kars, B. Eng., Juha M., Hijmans, Jann H.B. Geertzen, Wiebren Zijlsta. The effect of reduced somatosensation on standing balance: A systematic review. J Diabetes Sci Technal. 2009 July; 3(4): 931-943. 11. Siobhan M White, Thomas R Wojcicki, in Edward mcauley. older ltd. Physical activity and quality of life community J dwelling central adults. 12. Lusardi, Biomed M.M.

2009;7:10. Functional performance in community living older adults. J Geriatric Phys Ther. 2004;26(3):14-22.

Carobello, Edward M. Phillips, Impaired voluntary neuromuscular activation limits muscle power in mobility

http://www.srji.co.cc

Vol.1 No.2 2012

Scientific Research Journal of India

28

13. Roberta A. Newton. Validity of multidirectional stability in reach older medical properties oriented test: adults. a J practical measure for limits of Gerontology 14. Clinimetric performance 1. 15. Kathryn D. Mitchell, Roberta A. Newton. mobility assistive 189. 16. Dennis T. Villareal, Marian banks, Catheraian Siener, David R. Sina Core, Samuel Klein. Physical frailty and body composition in obese elderly men and women. J Obesity 17. Angela A Conrad Research Wooton. J. An 2004;12:913-920. integrative review of Tai Chi research: An alternative form of physical activity to improve balance and prevent falls in older adults. J Orthopaedic Nursing. 2010 April; 29(2): 108-116. 18. Matsuda, Patricia Noritake, Ciol, Shumway-Cook,Anne, Performance-oriented assessment (POMA) sciences. of the

Moseia A. The effects of a homebased exercise program on physical function in frail older adults. J of geriatric Phys Ther. 2010 Apriljune;33(2): 78-84. 19. Homjet Tal-Hatu Kolapo, Fashoyin Oyinlola Funmilayo. Balance

56A(4);M248-M252. mobility

retraining in post stroke patients using a simple, effective and affordable technique reduction De L equilibre aprs un accident vasculaire cerebral grace a une technique accessible. 20. Ganvir functional SD. simple, J efficace et American of

assessment. J Phys Ther 2006 July

balance scale indicates need for device. 2006;1(3):183-

neurological sciences. 2007; 26(2). Assessment in capacity elderly

population by elderly mobility scale in wardha. Indian academy of geriatrics. 2008;4:89-97. 21. Tm steffen, LA Mollinger. Agegender related test performance in community-dwelling adults. J of neurological 22. Patricia S Phys Smith, Ther. Judith A 2005;29(4):181-188. Hombree, Mary E Thompson. Berg balance scale and functional reach: determining the best clinical tool for individuals post acute stroke. J Clinical 2004;18(7):811-818. rehablilitation.

http://www.srji.co.cc

Vol.1 No.2 2012 23. Berg K,

Scientific Research Journal of India Wood-Dauphinu S, patients. J American

29 Heart

Williams J, Gayton D. Measuring balance in the elderly: preliminary development of an instrument. J Phys Ther association. 2001 sept 10. 24. Jennifer S Brach, Jessie M Vanswearingen, Anne B Newman, Andrea M Kriska. Identifying early decline of physical function in community-dwelling older womem : performance-based and self report measures. J American Phys Ther Association. 2001 Sept 10. 25. Teresa Steffen, Megan Seney. Test-retest reliability and minimal detectable change on balance and ambulation tests, the 36-item short form health survey and the unified Parkinson disease rating scale in people with parkinsonism. J Phys Ther. 2008 june;88(16):733-746. 26. Mary Thompson, Ann Medley. Forward functional and reach lateral in sitting younger,

Association. 2002;33:1022. 28. Sabrina E., Trader, Roberta A. Newton, RonitaL., Cromwell. Balance abilities of homebound older adults classified as fallers and nonfallers. J of geriatric Phys Ther. 26(3):03. 29. Duncan PW, Weiner DK, Chandler J, Studenskis S. Functional reach: a new clinical measure of balance. J Gerontol Med Sd. 1990;45:M192M197. 30. DeWaard B, Bentrup B, Hollman J, Brasseur J. Relationship of the functional reach and lateral reach tests in elderly females. J Geriatr Phys Ther. 2002; 25:4-9 31. Sadashiv Ram Aggarwal, Deepak kumar. Lower extremity muscle strength and balance performance in Indian community-dwelling elderly men aged 50 years and above. Indian J of Phys Ther and occupational therapy. 2007;1(2). 32. Chiara Mecagni, Janet Pullin Smith, Kay E Roberts, Susan B O Sullivan. Balance and ankle range of motion in community-dwelling aged 64 to 87 years : A correlational study. J of American

middle-aged and older adults. J of geriatric Phys Ther. 30(2):07. 27. Hui-Fen Mao, Fing Hsueh, FeiFang Tang, Ching-Fan Sheu. Analysis and comparison of the psychometric properties of three balance measures for stroke

http://www.srji.co.cc

Vol.1 No.2 2012

Scientific Research Journal of India Physical insulin-like testosterone activity growth in 1

30 and sulphate, and active

Phys Ther Association. 2000 May 30; 33. Dennist , Villareal, Marian Banks, David R, Sinacare, Catherine Siener, Sarmuel Klein. Effect of weight loss and exercise on frailty in obese older adults. Arch Intern Med. 2006;166:860-866. 34. Karen W, Hayes, Marjorie E. Johnson. Measures of adult general performance tests. Arthritis care and research. 2003 Oct 15;49(55):S28-S42. 35. Marc Bonnefoy, Tomasz Kostka, Marie C. Patricol, Sophic E, Bethouze, Brono Mathian et al.

dehydroepiandrosterone

healthy

elderly people. J

Ageing oxford

journals. 1998;27:745-751. 36. Dr. Sandra Brauer, Y Voner Burns, Prudence Galley. Lateral reach: a clinical measure of medio-lateral postural stability. J Phys Ther Res Int. 1990;4:81-88.

CORRESPONDENCE
*Student, Dolphin Institute, Dehradun affiliated to H.N.B Garhwal University, Uttarakhand, India Mob: 08882590557. **Lecturer, Dolphin Institute, Uttarakhand. India

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