Tinetti Gait and Balance Test

Procedures

The examination is subdivided into 2 assessments: balance and gait. It is important to note that the examiner should always be near the patient to provide support if the patient exhibits the risk of falling. The examination should take approximately 10 to 15 minutes to perform. The scoring system is ordinal, with a range of 0 to 2. A score of 0 means severe impairment, versus a score of 2 indicating independence. A lower total score means that there is more impairment.[7] Materials required: a stable, hard, and armless chair, a stopwatch, and a 15-foot hallway with a smooth surface.

First, the examiner begins with the balance assessment. The patient start seated in a hard, armless, stable chair. The patient is asked to rise from seated without using their arms or hands. Next, while the patient is standing, the examiner asks the patient to move their feet as close together as possible. The examiner presses the patient’s sternum with the palm 3 times. This can be done once with the patient’s eyes open and then with the eyes closed. Lastly, the patient is asked to make a 360-degree turn and sit back in the chair. The scoring system for this portion is broken down into 10 standardized scoring subsets for a total score of 16.

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 1 regularly. The patient starts this aspect of the examination from the standing position. The patient should be told the complete instructions before initiating the test. It is also appropriate to provide cues throughout the exam if needed. For example, the patient is told to walk about 15 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 7 standardized scoring subsets for a total score of 12. The scores from both portions of the examination 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 with a fall risk.[9][10]

Potential Diagnosis

All scoring sections and the 3 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 18, the patient is at high risk for fall incidents. Conversely, patients who score between 19 and 23 have a moderate fall risk. Those scoring over or equal to 24 are at a statistically low risk.

An average value of 26.21 can be found in men aged between 65 and 79, whereas an average value of 25.16 can be found in women aged between 65 and 79. 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 falls.[4] Additional complications could include musculoskeletal complaints such as sprains and strains.

Patient Safety and Education

This test assesses 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 and 95.5% and a specificity between 60 and 100%.[15] Although the assessment may not capture all fall-risk patients, it is cheap, simple, and reproducible. It may shed light on underlying pathologies impacting 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 1 of the scoring categories, that aspect must 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 must be validated among cohorts of high-risk populations with specific gait and balance disorders.