Vol.1 ● No.

2 ● 2012 Scientific Research Journal of India 1

Correlation of Balance Tests Scores with Modified Physical

Performance Test in Indian Community-Dwelling Older Adults

Sunita Yadav* MPT (Neuro), Deepti Dhar** MPT (Paediatrics)

Abstract: Background and Objective: There is sufficient evidence which shows significant
relationship between balance tests and other functional tests but there is lack of literature
regarding the relationship between balance tests (BBS, MDRT, BPOMA) and Modified
Physical Performance Test in different age groups of older adults. Design: An Observational
Study Subjects: 58 subjects were divided into three different age groups, having the mean age
of 65.3±3.0 (Group-A), 73.7±2.4 (Group-B), 82.6±1.4 (Group-C), mean height of 161.4±5.6
(Group-A), 164.9±10.2 (Group-B), 160.3±5.9 (Group-C) & mean weight of 68.4±4.8 (Group-
A), 72.7±6.9 (Group-B), 63.6±7.7 (Group-C) were recruited in this study from old age home
and local community. Methods: Subjects in each group performed the tests in the following
sequence: BBS (Berg Balance Scale), MDRT (Multi-Directional Reach Test), Modified-PPT
(Physical Performance Test) & BPOMA (Balance Performance-Oriented Mobility Assessment
of Tinetti) with rest period of 5-10 minutes between each scale. Result: The results suggested
that there was a significant positive correlation between balance tests and Modified Physical
Performance Test in different age groups of older adults. Conclusion: The current study
concluded that Modified physical performance test is a efficient tool to assess static and
dynamic balance and also physical function and ambulation in different age groups of older
adults. It was also observed that out of these balance tests used in the study, MDRT was the
most difficult to understand and perform by subjects above 70 years and the subjects above 80
years found it really hard to understand the procedure.

Keywords: BBS, MDRT, BPOMA, Modified PPT, Balance, Physical Function.

INTRODUCTION
The number of persons above the country in the world has 76.6 million
age of 60 years is fast growing, especially people at or over the age of 60,
in India. India is the second most populous constituting above 7.7% of total

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Vol.1 ● No.2 ● 2012 Scientific Research Journal of India 2

population. Recurrent falls are an device to maintain balance or predicting

important cause of morbidity and mortality their likelihood of falls and to enhance
in the elderly and are a marker of poor physical function.
physical and cognitive status.2 The Berg Balance Scale was
Impaired balance and physical developed by Kathy Berg (a Canadian
function are the main causes of fall among physical therapist) in1993, as a means of
the older adults. Stability and orientation measuring balance in the elderly.
are to distinct goals of the postural control Multi-directional Reach Test
system. Postural control for stability and (MDRT) is developed by Roberta A.
orientation requires both perception and Newton in 2001. It allows for analysis of
action. Thus, postural control requires the the patient voluntary postural control.
complex interaction of neural and The Performance Oriented
musculoskeletal systems.4 Mobility Assessment (POMA) scale was
Several researchers show that as originally developed by Dr. Mary E.
the age increases, the changes in the neural Tinetti and first published in 1986, is a
and musculoskeletal systems disturb the widely used tool for assessing mobility
balance and physical activities.6 As age and fall risk in older people. In this study
increases the physical activities and balance subscale of Tinetti assessment is
physical function also decreases due to used to assess the balance of older adults.15
decreased muscular power and strength.11 Brown, M, Sinacore, D.R.
Both balance problems and physical developed the modified physical
inactivity affect the quality of life of older performance test in 2005 to provide more
adults. Therefore the assessment of both focus on gross motor function by
balance and physical function is necessary substituting a chair rise task and a balance
for older adults in order to help establish task for the writing and stimulated eating
appropriate treatment goals, increase tasks described in the original PPT. The
awareness of fall risk and assign tool was more useful in identifying deficits
appropriate assistive device and to in physical function than the self- report
decrease the disability. Several such comparison measure, the functional status
instrument have shown satisfactory questionnaire. The authors concluded that
reliability and validity in identifying older the performance based measure could
people with balance and physical assist in early identification of minor
functional problems, discriminating older problems in physical functioning, and
adults by their needs for different assistive
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Vol.1 ● No.2 ● 2012 Scientific Research Journal of India
allow for opportunity for early intervention
for the patients.16
Several researchers found that
balancing exercises improve physical
function and previous studies also found
significant correlation between balance
scales and other functional tests.17,18,13,19
Therefore it is clear that there is a
relationship between balance and physical
function.
Yet there is no study to show
relationship between these scales or tests
in different age groups. Therefore the main
purpose of my study is to find out the
relationship between balance tests and
Modified physical performance test.
Second purpose is, the Modified physical
performance test assesses both balance and
physical function in older adults no other
tool is required because it measure the
both static and dynamic balance and also
physical function. It tells about fall risk,
need of assistance device and functional
limitations; additionally it takes less time
to administer as compared to other scale.
METHODOLOGY
This observational study recruited
58 subjects from old age homes and local
community of Delhi and Dehradun
meeting the inclusion criteria. Inclusion
Criteria: Age - 60 to 89 year old healthy
subjects; Gender- Both male and female;
Ability to abduct and flex the shoulder up
3
to 90 degrees; Ability to stand for
minimum 10 min. without any assistance;
Ability to walk at least 50 feet before
sitting to rest; Minimal use of rail or cane
while climbing. Exclusion Criteria: Use
of any assistive prosthetic device; History
of any cardiac problem confirmed by
physician; Any history of fainting spells or
extended dizziness due to unknown
reasons History of neurological; vestibular
or auditory deficit confirmed by physician;
History of any visual disorder which will
not be corrected by optical glasses as
confirmed by physician; MMSE score
below 23; History of postural hypotension;
History of recent fractures and severe
arthritic conditions; History of any major
surgeries during last 6 month; History of
any previous balance training; Moderate to
severe hypertensions
Measurement Tools
Berg Balance Scale (BBS)
The BBS was developed to measure
balance among older people with
impairment in balance function by
assessing the performance of 14 functional
tasks. The results are based on how long it
takes to complete specific tasks and how
well the tasks are performed. Each task is
measured on a five point ordinal scale
ranging from 0 to 4 (0 = unable to
perform, 4 = independent) so that the
aggregate score ranges from 0 to 56.
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Vol.1 ● No.2 ● 2012 Scientific Research Journal of India
Multidirectional Reach Test (MDRT)
The MDRT is an inexpensive, reliable and
valid screening tool to measure the limits
of postural stability in four directions
(forward, backward, right & left) during
standing. The distance of each reach is
measured in centimetres or inches.
Balance Performance Oriented Mobility
Assessment (BPOMA)
The Tinetti assessment is a physical task-
oriented scale which measures the gait and
balance activities of older adults. In this
study BPOMA was used to assess the
balance of the community dwelling older
adults; it consists 9 tasks. 6 tasks are
measured on a three point ordinal scale
ranging from 0 to 2 and remaining three
tasks are measured on a two point ordinal
scale ranging from 0 to 1 ( 0 = unable to
perform, 1 & 2 = independent). The
maximum score is 16.
Physical Performance Test (Modified-
PPT)
An objective evaluation of overall physical
function was obtained by using modified
PPT. The severity of physical frailty in
physical functioning was assessed using a
modified PPT. It consists of 9 tasks; each
task is measured on a five point ordinal
scale ranging from 0 to 4 ( 0 = unable to
perform, 4 = independent) except 7th task
(turning 360 degrees) which ranges from 0
to 1 (0 = unsteady, 1 = steady). The
maximum score is 36.
4
Procedure
The subjects were recruited based on
inclusion and exclusion criteria the
subjects of different age groups 60 to 69
years of age (Group- A), 70 to 79 years of
age (Group- B), and 80 to 89 years of age
(Group- C). Subjects in each group
performed the tests in a sequence i.e. BBS,
MDRT, Modified-PPT, POMA. The whole
procedure was explained to each subject
and the subject signed a consent form
before performing the study. Description
data was collected which included age,
gender, height, weight and number of falls
in the past 6 months. MMSE score was
also assessed. All subjects were assessed
by all four scales or tests in the following
order BBS, MDRT, Modified-PPT and
BPOMA. All components of each scale
were demonstrated to all the subjects and
one practice session was done for all the
components of four scales by all the
subjects, after that reading was taken. Each
test or scale was administered by myself.
All subjects were offered rest breaks and
water during the session and completed the
approximately 60 minute testing protocol
without complaint of fatigue or
discomfort. The resting period of 5 to 10
minute was given after performing each
scale. As a precautionary measure, blood
pressure was checked prior to beginning of
the test session and it was again taken at
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Vol.1 ● No.2 ● 2012 Scientific Research Journal of India 5

the end of the last test performed. One height of three Groups A, B and C [Table
person was always nearby vicinity of the 1] was calculated. The mean and standard
subject. deviation of balance tests and physical
Data Analysis performance test (modified) of Group – A
The data analysis was done on SPSS 11.5 [Table 2], Group – B [Table 3], & Group –
software. The arithmetical mean and C [Table 4], was calculated. The
standard deviation of age, height and correlation values of balance tests with
weight in demographic data were modified physical performance test of
evaluated. Karl pearson’s correlation test Group – A [Table 5], Group – B [Table 6],
was done to analyse the correlation & Group – C [Table 7], were calculated.
between balance tests (BBS, MDRT & Karl pearson’s correlation test was used to
POMA) with physical performance test find out the correlation between BBS,
(modified) among elderly people. MDRT & BPOMA with PPT (modified) in
Statistical significance level was set at < different age groups of older adults, Group
0.05. The data analysis was done on SPSS – A (60 – 69 years of age), Group – B (70
11.5 software. The arithmetical mean and – 79 years of age), and Group – C (80 - 89
standard deviation of age, height and years of age); these three groups showed
weight in demographic data were significant positive correlation between
evaluated. Karl pearson’s correlation test balance tests (BBS, MDRT & BPOMA)
was done to analyse the correlation with physical performance test (modified).
between balance tests (BBS, MDRT &
POMA) with physical performance test Table 1: Mean and standard deviation of
demographic data
(modified) among elderly people.
Statistical significance level was set at < Group – A
N Mean
0.05.
Age 20 65.3±3.0
Height 20 161.4±5.6
Weight 20 68.4±4.8
RESULT AND INTERPRETATION
A sample of 58 subjects were selected on Group – B
N Mean
the basis of inclusion and exclusion Age 20 73.7±2.4
criteria. Each group of older adults had 20 Height 20 164.9±10.2
Weigh
20 72.7±6.9
subjects except Group – C (81-89 years of t

age) which has only 18 subjects due to Group – C

unavailability of the subjects. The mean N Mean
Age 20 82.6±1.4
and standard deviation of age weight and
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Vol.1 ● No.2 ● 2012 Scientific Research Journal of India 6

Height 20 160.3±5.9 PPT (modified) 20 18.0±3.5

Weigh
20 63.6±7.7
t Table 4 shows mean and standard deviation of
Table 1 shows mean and standard deviation of balance tests and Modified physical performance
demographic data of different age groups. Group – test of Group A (80-89 Years of age).
(60 – 69 years of age), Group –B (70 – 79 years of
age) & Group – C ( 80 – 89 years of age). Figure 1: Mean and standard deviation of
balance tests (BBS, MDRT, & BPOMA)
Table 2: (Group – A) Mean and standard
with modified physical performance test
deviation (SD) of balance tests (BBS,
(modified) of Group A, B and C.
MDRT & BPOMA) and Physical
Performance Test (Modified).

Tests N Mean and SD

BBS 20 54±2.4
FR (MDRT) 20 13.6±2.6
BR (MDRT) 20 11.8±2.6
RR (MDRT) 20 12.5±2.5
LR (MDRT) 20 12.2±3.0
BPOMA 20 14.9±1.9
PPT (modified) 20 31.1±2.5

Table 2 shows mean and standard deviation of

balance tests and modified physical performance
test of Group-A (60-69 Years of age). Table 5: (Group A) Correlations of
balance tests (BBS, MDRT, & POMA)
Table 3: (Group – B) Mean and standard
with Physical Performance Test
deviation (SD) of balance tests (BBS,
(Modified)
MDRT & BPOMA) and Physical
Performance Test (Modified). Balance Tests r P
value value
Tests N Mean and SD BBS Vs PPT (modified) .759 .000
BBS 20 27.7±5.3 FR( MDRT) Vs PPT .592 .006
FR (MDRT) 20 12.0±3.4 (modified)
BR (MDRT) 20 9.9±3.9 BR (MDRT) Vs PPT .671 .001
RR (MDRT) 20 11.2±3.3 (modified)
LR (MDRT) 20 11.4±4.3 RR (MDRT) Vs PPT .541 .014
BPOMA 20 12.9±2.2 (modified)
PPT (Modified) 20 27.7±5.3 LR (MDRT) Vs PPT .518 .019
(modified)
Table 3 shows mean and standard deviation of BPOMA Vs PPT (modified) .826 .000
balance tests and physical performance test
(modified) of Group-A (70-79 Years of age).
Table 5 shows correlation of balance tests with
physical performance test (modified), all the
Table 4: (Group – C) Mean and standard
balance tests show significant correlation except
deviation (SD) of balance tests (BBS, right and left reaches which show moderately
MDRT & BPOMA) and Physical significant correlations with physical performance
Performance Test (Modified). test (modified) of Group – A (60 – 69 years of age).

Tests N Mean and SD

BBS 20 42.6±3.6 Figure 2: Correlation Graph of Berg
FR (MDRT) 20 5.5±2.2 Balance Scale (BBS) and Physical
BR (MDRT) 20 3.2±1.9 Performance Test (Modified) of Group –
RR (MDRT) 20 4.9±2.3 A.
LR (MDRT) 20 4.4±2.2
BPOMA 20 10.5±1.4
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Vol.1 ● No.2 ● 2012 Scientific Research Journal of India 7

Figure 2 depicts correlation between BBS and

modified PPT. It shows positive significant Figure 5 depicts correlation between RR of MDRT
correlation in 60-69 years of age group i.e. Group – and PPT (modified). It shows positive significant
A. correlation in 60-69 years of age group i.e. Group –
A.

Figure 3: Correlation Graph Of Forward Figure 6: Correlation Graph Of Lateral

Reach (FR) of MDRT and Physical Reach (LR) of MDRT and Physical
Performance Test (Modified) Of Group – Performance Test (Modified) of Group –
A. A.

Figure 6 depicts correlation between LR of MDRT

Figure 3 depicts correlation between FR of MDRT and PPT (modified). It shows positive significant
and PPT (modified). It shows positive significant correlation in 60-69 years of age group i.e. Group –
correlation in 60-69 years of age group i.e. Group – A.
A.
Figure 7: Correlation Graph of Balance
Figure 4: Correlation Graph of Backward Performance Oriented Mobility
Reach (BR) of MDRT and Physical Assessment (BPOMA) with Physical
Performance Test (Modified) Of Group – Performance Test (Modified) of Group –
A. A.

Figure 4 depicts correlation between BR of MDRT

and PPT (modified). It shows positive significant
correlation in 60-69 years of age group i.e. Group –
A. Figure 7 depicts correlation between BPOMA and
Modified PPT (modified). It shows positive
Figure 5: Correlation Graph of Right significant correlation in 60-69 years of age group
Reach (RR) of MDRT and Physical i.e. Group – A.
Performance Test (Modified) of Group -
A.
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Vol.1 ● No.2 ● 2012 Scientific Research Journal of India 8

Table 6: Correlations of balance tests Figure 9 depicts correlation between FR of MDRT

(BBS, MDRT, & BPOMA) with Physical and PPT (modified). It shows positive significant
correlation in 70-79 years of age group i.e. Group –
Performance Test (modified) of Group - B. B.
Balance Tests r P
value value
BBS Vs PPT (modified) .944 < .01
Figure 10: Correlation graph of Backward
FR( MDRT) Vs PPT .874 < .01 Reach (BR) of MDRT with Physical
(modified) Performance Test (Modified) Of Group –
BR (MDRT) Vs PPT .893 < .01 B.
(modified)
RR (MDRT) Vs PPT .826 < .01
(modified)
LR (MDRT) Vs PPT .710 < .01
(modified)
BPOMA Vs PPT (modified) .856 < .01

Table 6 shows significant correlation between

balance tests (BBS, MDRT & BPOMA) and
modified physical performance test in older adults
[Group – B (70 – 79 years of age)].
Figure 10 depicts correlation between BR of
Figure 8: Correlation graph of Berg Balance MDRT and PPT (modified). It shows positive
Test (BBS) with Physical Performance Test significant correlation in 70-79 years of age group
(Modified) Of Group – B. i.e. Group – B.

Figure 11: Correlation graph of Right

Reach (RR) of MDRT with Physical
Performance Test (Modified) of Group -
B.

Figure 8 depicts correlation between BBS and PPT

(modified). It shows positive significant correlation
in 70-79 years of age group i.e. Group – B.
Figure 9: Correlation graph of Forward
Reach of MDRT with Physical
Performance Test (Modified) of Group -
B.
Figure 11 depicts correlation between RR of
MDRT and PPT (modified). It shows positive
significant correlation in 70-79 years of age group
i.e. Group – B.
Figure 12: Correlation graph of Left
Reach (LR) of MDRT with Physical
Performance Test (Modified) Of Group -
B.

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Vol.1 ● No.2 ● 2012 Scientific Research Journal of India 9

Figure 14: Correlation graph of Berg

Balance Scale (BBS) with Physical
Performance Test (Modified ) Of Group -
C.

Figure 12 depicts correlation between LR of

MDRT and PPT (modified). It shows positive
significant correlation in 70-79 years of age group
i.e. Group – B.

Figure 13: Correlation graph of Balance

Performance Oriented Mobility Figure 14 depicts correlation between BBS and
PPT (modified). It shows positive significant
Assessment (BPOMA) with Physical
correlation in 81-89 years of age group i.e. Group –
Performance Test (Modified) Of Group - C.
B.
Figure 15: Correlation graph Of Forward
Reach (FR) of MDRT with Physical
Performance Test (Modified) Of Group -
C.

Figure 13 depicts correlation between POMA and

PPT (modified). It shows positive significant
correlation in 71-79 years of age group i.e. Group –
B

Table 7: Correlations of balance tests

(BBS, MDRT, & BPOMA) with Physical Figure 15 depicts correlation between FR of
Performance Test (Modified) – Group-C. MDRT and PPT (modified). It shows positive
Balance Tests r P significant correlation in 81-89 years of age group
value value i.e. Group – C.
BBS Vs PPT (modified) .789 < .01
FR( MDRT) Vs PPT .822 < .01 Figure 16: Correlation graph of Backward
(modified) Reach (BR) of MDRT with Physical
BR (MDRT) Vs PPT .852 < .01 Performance Test (Modified) of Group -
(modified) C.
RR (MDRT) Vs PPT .770 < .01
(modified)
LR (MDRT) Vs PPT .752 < .01
(modified)
B POMA Vs PPT (modified) .651 < .01
Table 7: also shows significant correlation between
balance tests ( BBS, MDRT & BPOMA) and
physical performance test (modified) in older adults
[Group – C ( 80 – 89 years of age)].

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Vol.1 ● No.2 ● 2012 Scientific Research Journal of India
Figure 16 depicts correlation between BR of
MDRT and PPT. It shows positive significant
correlation in 81-89 years of age group i.e. Group –
C.
Figure 17: Correlation graph of Right
Reach (RR) of MDRT with Physical
Performance Test (Modified) of Group -
C.
Figure 17 depicts correlation between RR of
MDRT and PPT (modified). It shows positive
significant correlation in 81-89 years of age group
i.e. Group – C.
Figure 18: Correlation graph of Left
Reach (LR) of MDRT with Physical
Performance Test (Modified) of Group –
C.
Figure 18 depicts correlation between LR of
MDRT and PPT (modified). It shows positive
significant correlation in 81-89 years of age group
i.e. Group – C.
Figure 19: Correlation graph of Balance
Performance Oriented Mobility
Assessment (BPOMA) with Physical
Performance Test (Modified) of Group –
C.
10
Figure 19 depicts correlation between BPOMA and
PPT (modified). It shows positive significant
correlation in 81-89 years of age group i.e. Group –
C.
DISCUSSION
Assessing balance and physical
abilities as they relate to falls in older
adults is complex due to many social and
health related issues that may be involved.
The geriatric population above 80 years
adults presents a more complicated
situation due to a sedentary life style, a
lower level of function, and the dynamics
of their physical and emotional
environments. Any one or combination of
these factors may lead to a falls at any time
because the level of the older adult’s
performance may not meet the demands of
the environment or task at hand. The need
to reduce this functional decline is an
important health care issue. It is important
to identify those factors that contribute to
the functional decline. Balance instability
and physical inactivity in older adults
contribute to this decline in ADLs
(activities of daily living). Therefore,
effective balance and functional
assessments are needed to document
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Vol.1 ● No.2 ● 2012 Scientific Research Journal of India
balance and functional abilities and in this
segment of the older adult population. This
information is critical to the design of all
prevention/reduction programs and to
maintain or improve the quality of life for
these individuals.25
The BBS, MDRT, & BPOMA have
documented validity and reliability to
assess balance abilities. As well as
physical performance test (modified) has
also documented validity and reliability to
assess functional abilities in community
dwelling older adults. Previous researchers
found significant relationship between
balance scales (BBS, MDRT & BPOMA)
with other functional performance tests;
Barthel mobility subscale, Time up and go
Test and Physical Performance Test
respectively 13, 25, 26. But there is little to no
documentation of relationship between
three balance scales with PPT (modified).
Thus this study was done to find out the
relationship of these three balance scales
with physical performance test (modified).
The clinical trial studied the correlation
between balance tests (BBS, MDRT, &
BPOMA) and physical performance test
(modified) among elderly people who
were divided into three age categories.
Berg Balance Scale (BBS)
The last two items of the Berg Balance
Test are considered the most difficult to
perform. These tasks are: item no. 13 & 14
(stand with feet in tandem for 30 seconds,
11
stand on one leg respectively), One study
found that item numbers 12, 13, & 14 are
the most difficult tasks to perform,25 but in
the current study only 6 subjects (Group B
& C) found difficulty to perform the 12th
task. All the subjects got grade 4 for the
1st, 2nd, 3rd, & 4th components of the
BBS. Not one subject reached up to 25cm
for the 8th component (Reaching forward
with outstretched arm while standing) of
the BBS.
In the current study the mean values (54,
49 & 42, as shown in tables 2, 3 & 4) of
BBS in different age groups are lower
from the findings (55,55; 53,52; & 52,48
for male and female respectively) of one
study in 3 age groups (60-69, 70-79, &
80+ years).34 This difference may be due to
age difference. They have given the
average mean of age (69); they did not
mention the mean value of age for
individual groups so the subjects of the
this study may be slightly younger than my
study; in this study the mean values for
females in each age group have lower than
males and in the current study the scores of
the tests for the females also lower and the
number of female subjects are more than
males so it could be the reason for lowest
values. Another study found mean values
of BBS in fallers (36.5) and nonfallers
(35.7) older adults;25 these values are very
low as compared to the current study. The
reasons could be one that the mean age of
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Vol.1 ● No.2 ● 2012 Scientific Research Journal of India
this study population is 83±8.8 years
which shows very older subjects. Secondly
they examined community dwelling older
adults who were home bound and have a
neurological or musculoskeletal diagnosis
that may disturb the balance and contribute
to falls . In another study the mean value
of BBS is 48.6 and the mean age of this
study is 74.1± 7.9 years which is
approximately similar to Group-B of the
current study. The mean value of BBS of
the current study is 49.65 which is slightly
more, the reason could be the age
difference because the mean age of the
Group-B is 73.70 ± 2.4 which shows that
the subjects were mostly between 71 to 75
years and the subjects of the above said
study were mostly between 68 to 81 years,
so this could be the reason for the lowest
value of BBS among 254 community-
dwelling older adults.13
A study done by Patricia S. Smith found
significant relationship between BBS and
forward reach in post acute stroke patients
(r = 0.78).27 The BBS has also been
shown to correlate with both the Tinetti
mobility index (r = 0.91) and the “get up &
go test” (r = - 0.76).28 A correlation greater
than 0.70 between total BBS and total
Fugl-Mayer-Scale (FMS) scores have been
reported in older adults.18 The above
studies shows correlations between BBS
and other functional tests. This current
study also shows significant correlation
12
between BBS and physical performance
test (modified), [r = 0.759, P = <0.01
(Group - A); r = 0.944, P = <0.01 (Group -
B); ); r = 0.789, P = <0.01 (Group - C); as
shown in tables 5, 6, 7 & figures 2, 8, and
14 respectively]. The reason of significant
correlation between BBS and physical
performance test (modified) could be one
that the five components are similar
between BBS and PPT (modified) and
secondly both BBS and PPT (modified)
assess static and dynamic balance and also
physical activity.
Multi-directional Reach Test (MDRT)
In MDRT backward reach is the most
difficult task to perform because most of
the subjects of the Group-C used to take a
step behind while performing this reach.
MDRT is considered the more time taking
test and most difficult to understand by the
subjects because the mostly older adults
use the spine not the ankle for the reaches.
This current study shows there is a
significant relationship between
components (FR, BR, RR & LR) of
MDRT and physical performance test
(modified) in older adults of different age
groups. It also indicates that there is a
relationship between age and height with
performance on the lateral reach test.
These results similar to the study who
reported that, similar to functional reach
performance is positively correlated with
height and negatively correlated with
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Vol.1 ● No.2 ● 2012 Scientific Research Journal of India
age.22 The four heighted persons were
present in the current study, the values of
all the components of MDRT were greater
to these heighted persons as compared to
other subjects. Mean scores on
performance of the functional and lateral
reach tests in the present study are lower
than mean scores reported elsewhere.13,29, 30
In a sample of 14 community dwelling
elderly females (age, 70-87 years), a study
reported a mean functional reach of
26.7±8.9cm.30 In another research, with a
larger sample of 254 elderly community-
dwelling adults (mean age = 74.1±7.9
years), It was reported a mean forward,
backward, right and left reach tests scores
of 22.6±8.6cm, 11.5±7.8cm,17.5±7.6 &
16.8±7.4cm respectively.13 Yet another
study reported mean left and right lateral
reach test scores of 21.0±2.5cm and
20.0±0.5cm respectively, from 60 healthy
females over the age of 65 (mean age =
72.5±5.0 years).29 In each of the above
mentioned studies scores were defined as
the mean multiple trials which may reflect
score inflation due to learning over
multiple trials. In contrast, scores in
present study were recorded from a single
trial. Additionally, subjects used the ankle
movements rather than spine movements
which reflects the negative correlation
between age and ankle muscle strength,
sensation and ability to generate large
amounts of force at the ankle joint.31
13
One of studies in past have revealed that
MDRT demonstrated significant inverse
relationships with scores on the time up &
go test (TUG): [FR (r = -0.442) BR (r = -
0.333), RR (r = - 0.260), LR (r = - 0.310)
which is a functional performance test.13
Similarly current study showed significant
correlation between MDRT and modified
physical performance test which is again a
functional performance test with high
validity and reliability. Hence it can be
said that MDRT also shows good
correlation with different functional
performance tests.
Tinetti Balance Subscale
During the performance of this test, the
subjects did not find any difficulty with
any of the tasks in the balance of
performance-oriented mobility assessment
(BPOMA) of Tinetti.
One study found a mean among the
community dwelling older women with no
health problems on the balance subset of
12.6±1.7 (mean age = 74.7±6.0 years),32
which is similar to mean value (12.9±2.1,
as shown in table- 3) of Group-B of the
current study (mean age = 73.7±2.4 years,
as shown in table- 1). Another study found
mean value of 13±2.9 among females
(mean age = 83.8±7.7 years),33 which is
more as compared to mean value
(10.5±1.4, as shown in table- 4 ) of Group-
C of the current study, in fact mean age
was similar (82.6±1.3 years, as shown in
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Vol.1 ● No.2 ● 2012 Scientific Research Journal of India
table- 1 ). The subjects for Group-C were
all above 80 and physical frailty
component was more among the subjects
of the current study while in the above said
study where mean value was 83.8±7.7
years, many subjects less than may 80
years. Hence the balance scores were
better for them.
Physical Performance Test (Modified-
PPT)
In modified physical performance test, the
Ist & 2nd tasks were considered the most
difficult task to perform by the subjects
mainly for the Groups B & C. Seven
subjects were using the assistive devices
for the 8th & 9th components (climb one
flight of stairs and climb stairs) of the
physical performance test (modified) and
four subjects climbed the stairs by holding
the one sided railing.
In one study it was found that the mean
value of the PPT (modified) score among
27 frail obese older volunteers after
treatment was 29.4±2.2 and for control
group it was 29.8±2.0.34 Mean age was
71.1±5.1for treatment group which
matched the current age of Group – B but
the mean value is lower i.e. 27.6±5.2 as
shown in table- 3, this difference is may be
due to age because in my study the mean
age for the Group - B is 73.7±2.4, which
shows that the subjects were slightly older
which reflects the negative correlation
between age and physical function.35 The
14
mean age of group-A of current study is
65.2±3.0 which is slightly younger than
the control group (69±4.6) of the above
study, therefore the mean value for this
group of my study is more and second
reason could be that the subjects were
obese which also reflects the negative
correlation between obesity and physical
function.35
Another study found the mean values of
physical performance test (modified) in
community dwelling older adults. The
mean values of three groups [obese
elderly, nonobese frail, and nonobese
nonfrail] were 34.4±0.5, 29.3±0.7 and
27.8±0.8 respectively.15 The second group
of above study matched with Group - B of
the current study in respect similar age,
weight and condition but the mean value
of physical performance test (modified) is
more than the current study, the reason
could be that the subjects of my study may
be more frail and reason could be the
larger number of female subject in the
current study compared to this study, there
both genders were in equal proportion
while in the current study out of 20
subjects 16 were female. It has been well
established that in females balance
component is affected due to larger body
mass in the upper segment the of body.
The age is an important factor that affects
both balance and physical function of older
adults. Declines in standing balance have
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Vol.1 ● No.2 ● 2012 Scientific Research Journal of India 15

been attributed to sensory, musculoskeletal perform movement at the ankle joint but
and cognitive changes, typically in some more of trunkal mobility was seen in
combination as multiple systems fall people above 80 years while performing
below minimal functional thresholds.36 The this test. Hence it can be said that MDRT
results of the balance tests and physical is not a very feasible test for cheeking
performance test (modified) are different balance in subjects above 80 years.
in different age groups of older adults,
Clinical significance
which proved that the disturbance in
As the Indian population over the age of
balance and physical function also differ in
60 years continues to grow, there will be
severity (mild, moderate and severe for
rise in the level of functional disability and
group A, B & C respectively) among
prolonging health. It is therefore
different age groups of older adults. Thus
imperative that appropriate screening
assessment and treatment also differ to
methods are developed to identify
provide effective evaluation and treatment
community dwelling elderly individuals
in different age groups. Additionally safety
with functional impairment who should be
measures are necessary for the Group – C
referred for a detailed physical therapy
(80-89 years of age) in the assessment and
evaluation. As we have seen that PPT
treatment also to prevent fall.
(modified) incorporates all important

CONCLUSION entities of balance and function hence,

There is a significant relationship between
balance tests and physical performance test
(modified) and physical performance test
(modified) is an efficient tool to assess
static and dynamic balance and also
physical function and ambulation in
different age groups of older adults. It was
also observed that out of the these balance
tests used in the study, MDRT was the
most difficult to understand and perform
for people above 70 years and subjects
above 80 years found it really hard to
understand the procedure. According to
this test the subject was supposed to
simply administering modified physical
performance testing can well define the
functional level as well as the balance
issues in an elderly person rather than
giving other tests which are time taking,
separately for balance and functional
performance.
Limitations
In the present study, the sample size was
small. The sample size of age Group – C
(81-89 years of age) was relatively smaller
as compared to other groups. Gait subscale
of performance oriented mobility
assessment is not included in this study.

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Vol.1 ● No.2 ● 2012 Scientific Research Journal of India 16

elderly. In my study the value of the left

Future Research
lateral reach is more than right lateral
Future study can be done with larger
reach for the heighted person. Future study
sample size to see the results. Future
can be done to identify that why this
research is needed to find out the
difference has come and this difference is
reliability and validity of modified
significant or not.
physical performance test with balance
scales (PPT, MDRT & BPOMA) in
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CORRESPONDENCE
*Student, Dolphin Institute, Dehradun affiliated to H.N.B Garhwal University, Uttarakhand, India Mob:
08882590557. **Lecturer, Dolphin Institute, Uttarakhand. India

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