Standardized tools for assessing balance and mobility in stroke clinical practice guidelines worldwide: A scoping review.
Renato B Dos Santos, Annabelle Fiedler, Anchal Badwal and 5 others
PMID 36896249WHAT IT FOUND
Stroke guidelines worldwide rarely agree on which balance tests to use.
When they do, they mostly list the Berg Balance Scale, Timed Up and Go, and walk tests. These common tools miss reactive balance and cognitive challenges, and half the guidelines don't explain how they chose them.
Key findings
01Only ten of nineteen guidelines recommended specific standardized tools for assessing balance or mobility.
02The Berg Balance Scale, 6-Minute Walk Test, Timed Up and Go, and 10-Meter Walk Test were the most commonly specified tools.
03Most recommended tools challenge underlying motor systems and dynamic stability, but very few challenge reactive postural control or cognitive influences.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The review excluded guidelines written in Chinese, Korean, Turkish, Persian, and Dutch, so findings may not reflect global practice. No guidelines from low-income countries were included, limiting applicability to those settings. The analysis of which postural control components each tool challenges was performed by the review authors, not the guideline developers, which may introduce interpretation bias. The review found that only 70% of the tool-recommending guidelines provided implementation resources, and none of the guidelines from low-income countries were included to assess resource availability in those contexts.
Declared interests
The authors declare no conflicts of interest. Funding sources are not explicitly detailed in the provided text beyond the authors' institutional affiliations.
The easy way to misread this
Do not interpret the high frequency of tools like the Berg Balance Scale or Timed Up and Go as evidence that they are the best or most comprehensive assessments. The review shows these tools rarely challenge reactive postural control or cognitive influences, meaning they may miss key balance deficits relevant to fall risk.