Tinetti Balance Test

This is a two-step screening method that evaluates balance and gait impairment to provide fall risk.

You can read more about the score interpretation and original study in the text below the calculator.


The Tinetti balance test evaluates static and dynamic balance during a 10 to 15-minute assessment. It is also known as the Performance Oriented Mobility Assessment (POMA).

There are two sections in the test, each targeting a different functionality: balance (with 9 items) and gait (with 8 items).

The Tinetti test has been performed on older populations suffering from conditions such as Parkinson’s disease, stroke, normal pressure hydrocephalus or amyotrophic lateral sclerosis.


The original study conducted by Mary Tinetti in 1986 involved a cohort of 79 patients admitted to 3 intermediate care facilities.

Each subject’s fall score was represented by the number of index factors present during evaluation.

Compared to other fall predicting models, the Tinetti test has established better test-retest and discriminative validity.

Scores equal to or less than 18 indicate high fall risk, scores between 19 and 23 indicate moderate risk while scores of 24 and above suggest that the patient presents a low fall risk.


Balance Section
1

Sitting balance

2

Rises from chair

3

Attempts to rise

4

Immediate standing balance (first 5 seconds)

5

Standing balance

6

Nudged

7

Eyes closed

8A

Turning 360 degrees - steps

8B

Turning 360 degrees - steadiness

9

Sitting down

Gait Section
10

Indication of gait (Immediately after told to ‘go’.)

11A

Step length and height - Right

11B

Step length and height - Left

12A

Foot clearance - Right

12B

Foot clearance - Left

13

Step symmetry

14

Step continuity

15

Path

16

Trunk

17

Walking time

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Tinetti balance test explained

This balance and gait model represents a clinical evaluation of fall risk. It is also known as the Tinetti Mobility Test or as the Performance Oriented Mobility Assessment (POMA).

Whilst in this test, the two sections need to be performed together in an integrated 10 to 15-minute assessment, if needed to check different functionality, the two sections may be used separately.

The instruction for the balance section has the subject seated in a hard, armless chair, while performing different actions, as required by the assessor.

The instruction for the gait assessment has the subject stand up and walk across the room or down the hallway, first at a “usual pace” then back at a more rapid pace.

Where there is hesitation and rising from chair in stages, the patient may have problems with proprioception or the cerebellar areas of balance.

In case walking assistance is required, the assessor will provide it and will also make a note of this. Examples of abnormalities during walking include abnormal knee extension, high stepping, toe dragging or shuffling gait.

The following table introduces the items in the Tinetti balance test:

Item Balance section Answers (points)
1 Sitting balance Leans or slides in chair (0)
Steady, safe (1)
2 Rises from chair Unable to without help (0)
Able, uses arms to help (1)
Able without use of arms (2)
3 Attempts to rise Unable to without help (0)
Able, requires >1 attempt (1)
Able to rise, 1 attempt (2)
4 Immediate standing balance (first 5 seconds) Unsteady (staggers, moves feet, trunk sway) (0)
Steady but uses walker or other support (1)
Steady without walker or other support (2)
5 Standing balance Unsteady (0)
Steady but wide stance and uses support (1)
Narrow stance without support (2)
6 Nudged Begins to fall (0)
Staggers, grabs, catches self (1)
Steady (2)
7 Eyes closed Unsteady (0)
Steady (1)
8A Turning 360 degrees - steps Discontinuous steps (0)
Continuous (1)
8B Turning 360 degrees - steadiness Unsteady (grabs, staggers) (0)
Steady (1)
9 Sitting down Unsafe (misjudged distance, falls into chair) (0)
Uses arms or not a smooth motion (1)
Safe, smooth motion (2)
  Gait section Answers (points)
10 Indication of gait (Immediately after told to ‘go’.) Any hesitancy or multiple attempts (0)
No hesitancy (1)
11A Step length and height - Right Step to (0)
Step through R (1)
11B Step length and height - Left Step to (0)
Step through L (1)
12A Foot clearance - Right Foot drop (0)
R foot clears floor (1)
12B Foot clearance - Left Foot drop (0)
L foot clears floor (1)
13 Step symmetry Right and left step lengths not equal (0)
Right and left step lengths appear equal (1)
14 Step continuity Stopping or discontinuity between steps (0)
Steps appear continuous (1)
15 Path Marked deviation (0)
Mild/moderate deviation or uses w. aid (1)
Straight without w. aid (2)
16 Trunk Marked sway or uses w. aid (0)
No sway but flex. knees or back or uses arms for stability (1)
No sway, flex., use of arms or w. aid (2)
17 Walking time Heels apart (0)
Heels almost touching while walking (1)

The above fall risk test can be used in addition to other balance or mobility tools such as the Berg balance scale.

There are other models that offer a similar mobility evaluation, such as the Elderly mobility scale, but instead of fall risk, focus on the patient’s ability to perform activities of daily living.

 

Tinetti score interpretation

The balance section consists of 9 items whilst the gait section consists of 8 items.

Each of these items has answer choices that are weighted on an ordinal scale from 0 to 1 or 2.

This depends on the severity of the impairment that is observed, where 0 is most severe and 2 indicates the ability to perform said tasks independently.

The balance section scores range between 0 and 16 whilst the gait section scores are between 0 and 12.

Therefore the maximum attainable score in the Tinetti balance test is 28.

The guideline is that the higher the score, the higher the degree of functional independence in the patient.

The following table introduces the three score categories and their interpretation:

Tinetti score Fall risk interpretation
Below 19 High fall risk
19 - 23 Moderate fall risk
24 and above Low fall risk
 

About the study

The original study was conducted in 1986 by Mary Tinetti in 1986 and involved a cohort of seventy-nine elderly patients admitted to three intermediate care facilities. From these, twenty-five became recurrent fallers.

Each subject’s fall risk score was the number of index factors present during evaluation, where the more risk factors, the higher the fall risk.

The test has proven better test-retest and discriminative validity than the Up and Go test (TUG) and is known as a dynamic assessment of mobility.

 

Original source

Tinetti ME, Williams TF, Mayewski R. Fall risk index for elderly patients based on number of chronic disabilities. Am J Med. 1986; 80(3):429-34.

Other references

1. Lin MR, Hwang HF, Hu MH, Wu HD, Wang YW, Huang FC. Psychometric comparisons of the timed up and go, one-leg stand, functional reach, and Tinetti balance measures in community-dwelling older people. J Am Geriatr Soc. 2004; 52(8):1343-8.

2. Mancini M, Horak FB. The relevance of clinical balance assessment tools to differentiate balance deficits. Eur J Phys Rehabil Med. 2010; 46(2): 239–248.


App Version: 1.0.1

Coded By: MDApp

Specialty: Geriatrics

System: Nervous

Objective: Screening

Type: Test

No. Of Items: 17

Year Of Study: 1986

Article By: Denise Nedea

Published On: April 3, 2017 · 10:08 AM

Last Checked: April 3, 2017

Next Review: April 3, 2018