Tinetti Gait and Balance Test

Procedures

The examination is subdivided into two assessments: balance and gait. It is important to note that the examiner should be near the patient at all times to provide support if the patient harbingers the risk of falling. The examination should take approximately ten to fifteen minutes to perform. The scoring system is ordinal with a range of zero to two. A score of zero means severe impairment versus a score of two, which would indicate independence. A lower total score means that there is more impairment.[7]

Materials required: a stable, hard, and armless chair; a stopwatch; a 15-foot hallway with a smooth surface.

First, the examiner will begin with the balance assessment. The patient will start seated in a hard, armless, stable chair. The patient will be asked to rise from the seated position without using their arms or hands. Next, while the patient is standing, the examiner will ask the patient to move their feet as close together as possible. The examiner will then press on the patient’s sternum with the palm of the hand three times. This will be done once with the patient’s eyes open and then with the eyes closed. Lastly, the patient will be asked to make a 360 degree turn and sit back down in the chair. The scoring system for this portion is broken down into ten standardized scoring subsets for a total score of sixteen.

The second part of the evaluation assesses the patient’s gait. The examiner must walk alongside the patient at all times to provide support. The patient can use an assistive device if they use one regularly. The patient will start this aspect of the examination from the standing position. The patient should be told the complete set of instructions prior to initiating the test. It is also appropriate to provide cues throughout the exam if needed. For example, the patient will be told to walk about fifteen feet at a regular pace and then turn around to walk back to the starting point at a quick but safe pace. The scoring system for this portion is broken down into seven standardized scoring subsets for a total score of twelve.

The scores from both portions of the examination will be added together for a total score.  

Scoring categories and score allotment.[8][7]

Indications

This test should be performed on patients over the age of 65 and those with sarcopenia, frailty syndrome, dementia, hearing or vision impairments, Parkinson disease, multiple sclerosis, traumatic brain injury, stroke, urinary incontinence, diabetes, cardiovascular pathologies, peripheral vascular disorders, anxiety, sleep disorders, people receiving hemodialysis and other previously identified risk factors for fall. Furthermore, it should be performed on any patient deemed to possess fall risk.[9][10]

Potential Diagnosis

All scoring sections and the three total scores from this assessment (balance, gait, and total scores) should be considered when creating a differential diagnosis for the patient. The utility of this assessment is not only in evaluating a patient's fall risk, but it can also elude to various underlying pathologies through the interpretation of each category and subcategory.[7][11][12]

Normal and Critical Findings

If a patient scores less than or equal to eighteen, the patient is at high risk for fall incidents. Conversely, patients who score between nineteen to twenty-three have a moderate fall risk, and those scoring greater than or equal to twenty-four are at a statistically low risk.

An average value of 26.21 can be found in men aged between 65 and 79 years, whereas an average value of 25.16 can be found in women aged between 65 and 79 years. The average recordable value for men above 80 is 23.29, while for women, the average value is 17.20.[13]

Interfering Factors

The outcome of this assessment is primarily affected by patient comorbidities and exercise tolerance.[7] This test cannot be undertaken for assessing unstable patients.

Complications

There are not many complications associated with this assessment. The examiner acts as a spotter to reduce complications related to fall.[4] Additional complications could include musculoskeletal complaints such as sprains and strains.

Patient Safety and Education

This test is used to assess the odds of falls in a high-risk population. Thus, the examiner acts as a spotter, standing next to the patient and ready to provide assistance and support at all times.[6]

Clinical Significance

For the Tinetti Gait and Balance assessment, the interrater reliability, sensitivity, and specificity for predicting fall vary in the literature. This is primarily due to the patient populations selected in the various studies and slight variations in the assessment performed. Faber et al. suggest that the interrater reliability for the balance assessment and total score was good with an R score of 0.4 to 0.93. However, the interrater reliability for the gait assessment was lower, with an R score of 0.72 to 0.89. The sensitivity and specificity in predicting falls were 62.5 to 66.1% for the total score.[14] 

Another study suggested a sensitivity between 64 to 95.5% and specificity between 60 to 100%.[15] Although the assessment may not capture all patients who have risks of falls, it is cheap, simple, reproducible. It may shed light on underlying pathologies pertaining to its impact on the gait or balance.[16]

This test is a screening tool to identify a patient's fall risk. If the patient has a high total score but a low score in one of the scoring categories, then that aspect needs to be addressed as it can be a risk factor for a future fall. Furthermore, if the patient has a low total score, the practitioner should identify any underlying pathology and govern appropriate management strategies. Moreover, the practitioner should ensure these patients have appropriate support and a safe environment at home against fall risks.[17][18] However, this test needs to be validated among cohorts of high-risk populations with specific gait and balance disorders.