The measurement of balance post-stroke. Part 3: Instrumented measurement tools

The restoration of balance skills is an important aspect of stroke physiotherapy, but the lack of appropriate outcome measures has been identified as a factor hampering development of the evidence base. In recent years instrumented measurement tools such as those measuring postural sway have become popular for research and clinical use. A systematic review of ways to measure balance using instrumented measurement tools was undertaken. CINAHL, MEDLINE, and EMBASE databases were searched for tests which measured balance post-stroke and could be used in clinical settings. They were assessed for reliability, validity, sensitivity to change, suitability for use in clinical settings and with a wide range of stroke severity. Forty-three papers were identified. For clarity and ease of presentation, these were divided into tests of postural sway, weight distribution, and responses to external perturbations. All had some information about their psychometric properties but none had been comprehensively tested and none fulfilled the criteria for an outcome measure for stroke physiotherapy interventions. Platform measures of postural sway had limited reliability and validity as a measure of balance disability, while responses to external perturbations had been insufficiently tested. Measurement of weight distribution showed more promise however. Here, there was reasonable evidence of reliability and validity, the equipment was simple to use although it could be expensive and difficult to move, but simple 'low-tech' methods (for standing balance) have been suggested which merit further investigation.