Tinetti Balance Test

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:

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:

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.