Using the systems framework for postural control to analyze the components of balance evaluated in standardized balance measures: a scoping review

Arch Phys Med Rehabil. 2015 Jan;96(1):122-132.e29. doi: 10.1016/j.apmr.2014.06.021. Epub 2014 Jul 27.


Objective: To identify components of postural control included in standardized balance measures for adult populations.

Data sources: Electronic searches of MEDLINE, EMBASE, and CINAHL databases using keyword combinations of postural balance/equilibrium, psychometrics/reproducibility of results/predictive value of tests/validation studies, instrument construction/instrument validation, geriatric assessment/disability evaluation, gray literature, and hand searches.

Study selection: Inclusion criteria were measures with a stated objective to assess balance, adult populations (18y and older), at least 1 psychometric evaluation, 1 standing task, a standardized protocol and evaluation criteria, and published in English. Two reviewers independently identified studies for inclusion. Sixty-six measures were included.

Data extraction: A research assistant extracted descriptive characteristics and 2 reviewers independently coded components of balance in each measure using the Systems Framework for Postural Control, a widely recognized model of balance.

Data synthesis: Components of balance evaluated in these measures were underlying motor systems (100% of measures), anticipatory postural control (71%), dynamic stability (67%), static stability (64%), sensory integration (48%), functional stability limits (27%), reactive postural control (23%), cognitive influences (17%), and verticality (8%). Thirty-four measures evaluated 3 or fewer components of balance, and 1 measure-the Balance Evaluation Systems Test-evaluated all components of balance.

Conclusions: Several standardized balance measures provide only partial information on postural control and omit important components of balance related to avoiding falls. As such, the choice of measure(s) may limit the overall interpretation of an individual's balance ability. Continued work is necessary to increase the implementation of comprehensive balance assessment in research and practice.

Keywords: Accidental falls; Aging; Chronic disease; Postural balance; Psychometrics; Rehabilitation.

Publication types

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

MeSH terms

  • Biomechanical Phenomena
  • Disability Evaluation
  • Humans
  • Physical Therapy Modalities
  • Postural Balance / physiology*
  • Psychometrics
  • Reproducibility of Results