Activities-Specific Balance Confidence in People with Multiple Sclerosis

Abstract

Objective. To evaluate the validity of the Activities-specific Balance Confidence scale (ABC) in people with multiple sclerosis (PwMS). Design. A multicentre, cross-sectional study. Setting. Six rural and urban Swedish sites, including specialized units at hospitals and primary care centers. Participants. A sample of 84 PwMS with subjective gait and balance impairment but still able to walk 100 m (comparable with EDSS 1–6). Outcome Measures. Timed Up and Go, Timed Up and Gocog, 25-foot Timed Walk Test, Four Square Step Test, Dynamic Gait Index, Chair Stand Test, 12-item MS Walking Scale, self-reported falls, and use of assistive walking device were used for validation. Results. The concurrent convergent validity was moderate to good (0.50 to −0.75) with the highest correlation found for the 12-item MS Walking Scale. The ABC discriminated between multiple fallers and nonfallers but not between men and women. Ecological validity is suggested since ABC discriminated between users of assistive walking device and nonusers. The internal consistency was high at α = 0.95, and interitem correlations were between 0.30 and 0.83. Conclusion. This study supports the validity of the ABC for persons with mild-to-moderate MS. The participants lacked balance confidence in many everyday activities, likely restricting their participation in society.

Use of a Short Version of the Activities-specific Balance Confidence Scale in Multiple Sclerosis

“…12 Previous research has demonstrated that the ABC scale is a valid measure of balance confidence in individuals with MS and is able to discriminate between multiple fallers and nonfallers. 18 The mean ABC scale scores for the current MS and control groups were consistent with previous research. 11,18,19,28 The results of the present investigation reveal that the internal consistency of the Abbreviations: ABC, Activities-specific Balance Confidence; ABC-6, short 6-item version of ABC; MS, multiple sclerosis.…”

“…19 In addition, the results of the present study demonstrated that both versions had moderate convergent validity, which is similar to past research that has shown that the ABC scale has moderate convergent validity differentiating between individuals with MS who do and do not fall. 18 The ABC and ABC-6 scales had good sensitivity and specificity in distinguishing MS participants with a high fall risk from controls. Indeed, these findings indicate that both versions are capable of differentiating balance confidence in persons with a high likelihood of falling from that in individuals without a high likelihood of falling.…”

“…11 The ABC scale has been found to be reliable and valid in people with MS. [13][14][15][16][17] Furthermore, the ABC scale has moderate-to-good concurrent convergent validity compared with various clinical and biomechanical balance tests, and it has been found to discriminate between people with MS with and without a history of falling. 18 The ABC scale can take 5 to 20 minutes to administer. This time commitment has been considered a constraint in the clinical setting; thus, it has been suggested that a shorter version of the ABC scale may be advantageous to assess balance confidence.…”

Objective and subjective measures reflect different aspects of balance in multiple sclerosis

“…The ABC Scale has been shown to have high test-rest reliability (Pearson correlation = 0.92) and internal consistency (Cronbach α = 0.96) in community-dwelling older adults [21]. In PwMS, the ABC Scale also shows good test-retest reliability (Pearson correlation = 0.92) [2] and concurrent validity with other objective and subjective balance measures [10,22].…”

Whom to Target for Falls-Prevention Trials

“…3,[5][6][7]9,10 People with MS also often sustain fallrelated injuries. 6,8,11,14 Falls in people with MS are also associated with reduced balance confidence, 15 social isolation, and reduced participation in occupational and leisure activities. 16,17 Although the cross-sectional data do not clarify the direction of these associations, it is theorized that falling likely contributes to reduced balance confidence, socialization, and participation in activities.…”