Postural control and fear of falling assessment in people with chronic obstructive pulmonary disease: a systematic review of instruments, international classification of functioning, disability and health linkage, and measurement properties

Arch Phys Med Rehabil. 2013 Sep;94(9):1784-1799.e7. doi: 10.1016/j.apmr.2013.04.012. Epub 2013 Apr 28.


Objectives: To systematically review the instruments used to assess postural control and fear of falling in people with chronic obstructive pulmonary disease (COPD), and to synthesize and evaluate their breadth of content and measurement properties.

Data sources: MEDLINE, EMBASE, Web of Science, CINAHL, CENTRAL, PsycINFO, PEDro, and OTSeeker databases searched in September 2012.

Study selection: Two independent reviewers performed the selection of articles, the ICF linking process and quality assessment. Only quantitative studies were included, irrespective of language or publication date.

Data extraction: This systematic review comprised two phases. Phase 1 aimed to identify the commonly used instruments to assess postural control and fear of falling in the COPD literature. The breadth of content of each instrument was examined based on the International Classification of Functioning, Disability and Health (ICF). In phase 2, a measurement property search filter was adopted and used in four electronic databases to retrieve properties reported in the COPD population. The COSMIN checklist was used to assess the methodological quality of each measurement property reported.

Data synthesis: Seventeen out of 401 publications were eligible in phase 1. Seventeen instruments were identified including 15 for postural control and 2 for fear of falling assessment. The Berg Balance Scale, the Short Physical Performance Battery, and the Activities-specific Balance Confidence (ABC) scale were the most frequently used instruments to assess postural control and fear of falling respectively. The ICF categories covered varied considerably among instruments. The Balance Evaluation Systems test and ABC presented the greatest breadth of content. Measurement properties reported included criterion predictive validity (4 instruments), construct validity (11 instruments) and responsiveness (1 instrument), with inconsistent findings based on 'fair' and 'poor' quality studies.

Conclusions: Different instruments with heterogeneous content have been used to assess postural control and fear of falling outcomes. Standardized assessment methods and best evidence on measurement properties is required in the COPD literature.

Keywords: ABC; Activities-specific Balance Confidence; BBS; BESTest; BODE; Balance Evaluation Systems Test; Berg Balance Scale; CBMS; COPD; COSMIN; COnsensus-based Standards for selection of health status Measurement INstruments; Community Balance and Mobility Scale; FES; FRT; Falls Efficacy Scale; Fear; Functional Reach Test; GOLD; Global Initiative for Chronic Obstructive Lung Disease; ICF; International Classification of Functioning, Disability and Health; OLS; One-Leg Stance; Outcome assessment (health care); Postural balance; Pulmonary disease, chronic obstructive; Rehabilitation; SOT; SPPB; SST; Self efficacy; Sensory Organization Test; Short Physical Performance Battery; Sit-to-Stand Test; body mass index, airflow obstruction, dyspnea, and exercise capacity; chronic obstructive pulmonary disease.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Accidental Falls*
  • Humans
  • International Classification of Diseases
  • Physical Therapy Modalities*
  • Postural Balance*
  • Psychometrics
  • Pulmonary Disease, Chronic Obstructive / physiopathology*
  • Pulmonary Disease, Chronic Obstructive / psychology*
  • Pulmonary Disease, Chronic Obstructive / rehabilitation