The sensibility of bedside tests of balance and mobility

Introduction: The development of new clinical instruments typically involves assessment of validity, reliability, and responsiveness, but not sensibility. Sensibility refers to the ease of use of an instrument, and its appropriateness to the population and setting of interest. Sensibility may be an important determinant of the uptake of an instrument into clinical practice. We evaluated the sensibility of 5 clinical measures of balance and mobility. Methods: Hospitalized seniors completed 5 measures of mobility and balance: the Timed Up and Go (TUG), the Functional Reach (FR), the Physical Performance and Mobility Exam (PPME), the Tinetti Gait and Balance (TGB), and the Hierarchical Assessment of Balance and Mobility (HABAM). We assessed ease and time of administration. The subjects views were assessed by asking if the test bothered them in any way and if they would mind doing the test daily. Users' views were assessed by asking 26 internal medicine residents to rate each instrument on whether it provided useful information, and whether it could be incorporated into their daily rounds. A general linear model was used to compare the mean time to administer each test. Non-parametric measures were used to evaluate the residents' Likert rankings. Results: 19 patients (89% female, mean age 82.7) agreed to participate. Mean test administration times, in minutes, were: TGB (2.9±1.3), TUG (3.5±2.0), FR (2.7±1.6), PPME (8.6±3.6), and HABAM (2.6±1.0). Administration time for the PPME was significantly greater than that for the other instruments (p<0.01). Residents were more likely to say that the HABAM provided useful information than all other tests. As well, residents were more likely to say that they would use the HABAM, FR, and TUG during their daily rounds. Conclusions: The sensibility of clinical tests may determine their uptake into daily practice. Assessment of the sensibility of clinimetric tests should be added to the traditional assessments of validity, reliability and responsiveness.