Know Your Fall Risk Without Doing a Thing

By Nancy Alexander, PT, CSCS

When you think of fall prevention and assessing your fall risk, what do you think of? Typically, you would think it would include how well you can perform a certain physical activity, right? In the clinic, physical therapists have quite a few trusted physical assessments we can administer. There is a Timed-Up-And-Go test, the Tinetti Gait and Balance test, and the BERG to name a few. Physicians these days are asking you to stand on one leg to screen for any fall risk.

 All of these are valid balance tests, and all are performance-based tests. But did you know there is an assessment that is highly respected in the medical world and you don’t have to do a thing. It’s true.

There is a fall risk assessment out there and you could do it right now in your own chair. It is called the Activities-specific Balance Confidence (ABC) scale, and it is reported to be one of the most accurate measures of fall risk available.  It was developed in 1995 (Powell and Myers) and consists of 16 questions gauging your confidence while doing certain activities. Turns out that your confidence to perform a certain activity is quite revealing.

According to Physiopedia, the ABC scale is reported to be an accurate measure to identify fall risk in populations including those with a stroke, multiple sclerosis, Parkinson’s Disease, vestibular disorders, in the elderly, and those with other neurological conditions that can affect balance. The ABC scale is a subjective measure of confidence and consists of 16 questions that require you to rate your confidence that you will not lose your balance or become unsteady while performing certain activities. Here they are:

1. Walking around the house
2. Walking up or down stairs
3. Bending over to pick up a slipper from the front of a closet floor
4. Reaching for a small can off a shelf at eye level
5. Standing on tiptoes and reaching for something above his/her head
6. Standing on a chair to reach for something
7. Sweeping the floor
8. Walking outside the house to a car parked in the driveway
9. Getting into or out of a car
10. Walking across a parking lot to the mall
11. Walking up or down a ramp
12. Walking in a crowded mall where people rapidly walk past
13. Being bumped into people as they walk through the mall
14. Stepping on to or off an escalator while holding onto a railing
15. Stepping onto or off an escalator while holding onto parcels (so that they are not able to hold the railing)
16. Walking outside on icy sidewalks

You can complete this assessment right here and right now. Here’s how:

Instructions to Participants:

For each of the following, please indicate your level of confidence in doing the activity without losing your balance or becoming unsteady from choosing one of the percentage points on the scale from 0% to 100%. If you do not currently do the activity in question, try and imagine how confident you would be if you had to do the activity. If you normally use a walking aid to do the activity or hold onto someone, rate your confidence as if you were using these supports.

How to score:

Total all your reported percentages. This is your percent of self-confidence.

Scoring: Your total percentage / 16 questions = Total ABC Score

For example:

Let’s say that of the 16 questions, you reported 100% for 6 of them. For five of them, you reported 50%, and for the other five, you reported 0%. The total for all your reported percentages would add up to 850 % of self-confidence.

Scoring: 850 / 16 = approximately 53%

Total ABC Score = 53%

Interpreting your score:

Here is what the research says as a result of your score:

• 80% = high level of physical functioning
• 50-80% = moderate level of physical functioning
• < 50% = low level of physical functioning

                               Myers AM (1998)

• < 67% = older adults at risk for falling; predictive of future fall

                               LaJoie Y (2004)

For our example here, with a score of 53%, you would be at a moderate level of physical functioning (though barely over the 50% level) who is also at risk for a future fall.

Confidence in your mobility matters. This research-based assessment is proof of that. Though this is a reliable indicator of fall risk, know that most physicians and physical therapists include other tests – physical performance tests – in your evaluation to help complete the picture of you and your fall risk. All these assessments also provide great information on how to create a successful treatment plan for you.

Know, too, that research also backs up the fact that you can improve your balance – at any age.

With all the focus on physical tests for performance, know that your confidence also matters as to whether you might be at risk for falls. Please consult with your physician or movement specialist to further discuss your health and fall risk to help create a treatment plan to meet your specific needs. Why not get started now by completing this questionnaire.

By addressing your mobility and balance now, you take power into your own hands. Keep doing tomorrow what you can do today. And keep moving.

Sources:

Physiopedia: https://www.physio-pedia.com/Activities-Specific_Balance_Confidence_Scale

Powell LE & Myers AM. The Activities-specific Balance Confidence (ABC) Scale. Journal of Gerontology Med Sci 1995; 50(1):M28-34.

Myers AM, Fletcher PC, Myers AH, Sherk W. Discriminative and evaluative properties of the activities-specific balance confidence (ABC) scale. J Gerontol A Biol Sci Med Sci. 1998 Jul;53(4):M287-94. doi: 10.1093/gerona/53a.4.m287. PMID: 18314568.

Lajoie Y, Gallagher SP. Predicting falls within the elderly community: comparison of postural sway, reaction time, the Berg balance scale and ABC scale for comparing fallers and non-fallers. Arch Gerontol Geriatr. 2004;38:11-26.