Balance outcome measures in cerebellar ataxia: a Delphi survey

Abstract

Purpose: Choosing an appropriate outcome measure for the assessment of balance among people with cerebellar ataxia is currently challenging as no guidelines are available. There is a need for further investigation with clinical experts in order to derive a set of standardized outcome measures with high clinical utility. Methods: A two-round internet-based Delphi survey was considered. A steering committee was formed to guide the Delphi process. Neurologists and physiotherapists with clinical and research experience in cerebellar ataxia were identified as the expert group. Consensus among the experts for recommendation was set at 75%. Results: Thirty experts representing 10 countries agreed to participate. The response rate for the rounds were 87% and 96%, respectively. Forty-one relevant outcome measures were identified. The Berg Balance Scale (BBS), the Scale for the assessment and rating of ataxia (SARA), the Timed Up and Go test (TUG) were identified as the best outcome measures for use with at least 75% consensus among the experts. Conclusion: The recommended outcome measures (SARA, BBS and TUG) are available at no cost, require little equipment and are quick and easy to perform; however, formal psychometric testing of the BBS and TUG in people with cerebellar ataxia is warranted.

Implications for Rehabilitation

• Currently, a wide range of outcome measures are available for the assessment of balance is people with cerebellar ataxia.

• Expert participants in this study identified the BBS, SARA and TUG as highly recommended for the assessment of balance.

• Formal psychometric property validation in people with cerebellar ataxia is required for the BBS and TUG.

• Balance scales
• BBS
• cerebellar ataxia
• SARA
• TUG

Acknowledgements

The authors wish to thank all individuals involved in this research, especially Steering committee: Professor John Sullivan, Dr John Mottershead, Dr Catherine Smith and Ms. Lesley Ward, Expert participants: Pedro Braga-Neto, Davide Cattaneo, Luigi Tesio, Elsdon Storey, Bing-wen Soong, Adolfo M. Bronstein, Amy J. Bastian, Anne Kloos, Diane Huss, Gail L. Widener, Laura Alice Santos de Oliveira, Felipe Fernandes Lemos, Ramachandran Sivakumar, Marlene Steyn, L. McGregor, Barbara Gardiner, Fleur Drewitt Fisher, Bronagh, Kathi Brandfass, Stu Blatt, Dagmar Timmann-Braun, Michael Strupp, and Joanna Jen, Administrative assistance: Marina Moss, Bruce Knox, David Jackson and pilot participants.

Declaration of interest

School of Physiotherapy research budget, University of Otago funded the following expenses. 1. Travel and refreshment expenses for members during steering committee meetings. 2. As a token of appreciation, an expert participant book mark and an acknowledgement letter were posted to all our participants.