Tinetti Balance Test
The Tinetti Balance Test is important for assessing fall risk, balance perception, and fear of falling in older adults. According to the Centers for Disease Control and Prevention, 3 million older adults visit an emergency department because of a fall each year.
Among them, 800,000 require hospitalization, often because of a head injury or hip fracture. Even more frightening, as of 2021, the CDC reports that 78 out of every 100,000 older adults who fall will die as a result of the fall.
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Summary
- The Tinetti Balance Test assesses fall risk, balance, and gait function in older adults, helping to identify those at higher risk for serious injuries.
- A total score below 19 indicates a high fall risk, while scores between 19-24 suggest a medium risk, and 25-28 indicate a low risk.
- The test is quick and easy to administer, making it useful in various clinical settings, though it has limitations for higher-functioning clients.
- Using the Tinetti Balance Test alongside other assessments can guide treatment plans, fall prevention strategies, and assistive device recommendations.
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Falls are the most common cause of traumatic brain injuries and hip fractures in this population, and it is not a secret that both of these injuries can lead to prolonged and sometimes permanent losses in functional independence, declines in health and mobility, and increased need for physical assistance or supervision from others. These physical implications are reason enough to prioritize fall prevention for our clients. Still, beyond long-lasting physical/or cognitive impairments, falls can lead to heavy financial burdens and social isolation.
When it comes to choosing an outcome measure for assessing balance, mobility, and fall risk, you have many options. To get the most out of a test, you need to ensure it is appropriate for your client, the setting you work in, and their balance and mobility level.
In this article, we will explore the Tinetti Mobility Test, also called the Tinetti Balance Test or the Performance-Oriented Mobility Assessment (POMA). By the end of this article, you should feel confident in selecting the correct client for this assessment, interpreting the results, and using them to set goals and guide treatment.
What is the Tinetti Balance Test?
The Tinetti Balance Test is an activity-level outcome measure designed to assess balance, fall risk, and gait function in seniors. Researchers conducted testing mainly on the older population, but some information also exists for other populations. This test assesses fall risk and is sensitive enough to detect significant changes in client presentation as they perform gait maneuvers, and position changes common to daily activities.
The test has two sections. The first section assesses static balance, first in a chair and then in standing, while the second assesses gait. This test can be a great screen of balance, which physical therapists can easily incorporate into an initial assessment in the hospital, SNF, in-patient rehab, home, or out-patient. Any client who can stand can undergo the Tinetti Balance Test, which is appropriate for most clients.
However, it exhibits a significant ceiling effect as it assesses only basic standing balance and gait. Many of your clients will achieve a total score on this test but may still be at risk for falls when presented with higher-level balance challenges.
This test is free to administer, and you can find copies online. Some variations exist, but this information refers to the 16-item, 28-point Tinetti Balance Test.
How to administer the Tinetti Balance Test
Before you begin the test, gather the necessary equipment and ensure your client is safe by having extra help when indicated, using a gait belt, and providing assistive devices and rest breaks as needed.
Have these on hand before you begin:
- Stopwatch
- A hard, armless chair
- 15ft (4.57m) walkway
- Form to record scores
- Assistive devices as needed
The Tinetti Balance Test/POMA consists of 16 items scored on an ordinal scale from 0-2 points, with a score of “2” indicating independence. Items are scored based on quality of performance or on the amount of support or assistance needed to complete the item.
The first nine items assess static balance:
- Sitting balance
- Rising from an armless chair
- Attempts at rising from a chair
- Immediate standing balance (initial 5s)
- Standing balance
- Standing balance when nudged
- Standing balance with eyes closed
- Turning 360 degrees
- Sitting down in a chair
Total up the points out of 16 possible points.
The following seven items assess gait over a 15 ft. or 4.57m walkway:
- Initiation of gait
- Step length and height on each foot
- Step symmetry
- Step continuity
- Path
- Trunk sway
- Walking stance
Total up the points out of 12 possible points.
Sum the individual balance and gait scores to get a total score out of 28 points.
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How do you interpret Tinetti?
After administering the outcome measure and totaling the score, the next step is to interpret it.
What does a score of 10/28 points or 20/28 points on the Tinetti Balance Test mean for the client, their goals, and their ongoing therapy needs?
PTs use these total point cutoff scores to interpret the Tinetti Balance Test.
- < 19 high fall risk
- 19-24 medium fall risk
- 25-28 low fall risk
The Minimal Detectable Change is around 4 points.
The Shirley Ryan Ability Lab has compiled and reported cutoff scores and other psychometric data, including some normative values for the Tinetti Balance Test for older adults, clients with stroke, Parkinson’s Disease, ALS, and non-specific populations based on research studies. You can find this information on their website.
The Tinetti Balance Test is an easy and quick assessment of balance and gait. However, PTs should note that when evaluated by the EDGE task forces, the MS Edge Group was unable to recommend this test for any EDSS level; both MS Edge and StrokeEDGE failed to recommend the use of the Tinetti Balance Test for clients in any setting (acute, in-patient, SNF, out-patient, home health); and StrokeEDGE was unable to recommend this test for clients with strokes of any chronicity.
PD Edge found a limited study group and was unable to recommend it for clients at Hoehn & Yahr stage 1. They did recommend its use in Hoehn & Yahr stages 2-4 but did not recommend its use in Hoehn & Yahr stage 5.
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Using the Tinetti Balance Test to guide client care
Now that you know the administration and interpretation of the Tinetti Balance Test, let’s quickly discuss how you can use this information to guide client care. Establishing a fall risk score early in your plan of care allows you to set goals to reduce fall risk and reevaluate the client during regular progress assessments.
This information can also guide your prescription of an assistive device and education on home safety and treatments to reduce fall risk. The Tinetti Balance Test allows you to pinpoint potential impairments related to standing balance, sitting balance, transfers, and gait, but don’t forget to use other tests and measures like MMTs, flexibility, range of motion measurements, sensory integration evaluations, vestibular tests, pain assessments and balance confidence scales to gather a comprehensive picture of the client. This information will help you select treatments that hopefully reduce the client’s fall risk and prevent fall-related injury.
As you know, the Tinetti Balance Test is just one of many balance and fall risk assessments. However, we hope you now see that basic fall risk assessments do not always have to be complicated and time-consuming. With a little planning, you can easily screen all of your older adult clients for fall risk and, if needed, refer them to a provider whose specialty is balance and gait.
Resources
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