ACTIVITIES-SPECIFIC BALANCE CONFIDENCE (ABC) SCALE

Type of test:
• Time to administer: 5-10 minutes to administer.
• Clinical Comments: This test, along with a functional balance test, such as the Berg, will tell the clinician if their client is
over confident or under confident about falling.

Purpose/population for which tool was developed: The ABC is one of several tools designed to measure an individual’s confidence
in his/her ability to perform daily activities without falling. These tools were designed for use with older adults. The ABC was
designed to include a wider continuum of activity difficulty and more detailed item descriptors than the Falls Efficacy Scale (FES)
(see Appendix 2)1 Fear of falling is important to assess because it is a likely confound in measuring postural performance.
Deterioration in balance may result from activity restriction mediated by the fear of falling. 1
When appropriate to use: Asking a yes/no question on fear of falling (e.g., “are you fearful of falling?) may indicate when the full
scale should be used. This may work better for females than males.2 The internal consistency does not decrease appreciably with the
deletion of a few items; (12 of 16 are necessary). If fewer items are used, compute a total score by dividing by the number of items
answered.
Scaling: Ordinal. Scale has 16 items (score 0-1600 possible). The score is recorded as a percentage (%), with 100% the highest level
of confidence. Max score of 1600 divided by 16 items = 100%
Equipment needed:
Questionnaire (Appendix 1) and pencil

Directions: See appendix 1. The authors do not state what to do if the client says that it is an activity they never do. The questions
are arranged in a hierarchical order yet this may not be true for all clients.

Reliability: The ABC demonstrates a high level of internal consistency.

Reference N= Sample Description Reliability Statistic

Internal Consistency: (how the items in the scale relate to each other and to the group of items as a whole). Reliability
statistic= Chronbach’s alpha (α)
Powell, 19951 60 Seniors living at home over 65 years α = .96
old.
Steffen, 20053 87 community-dwelling seniors .93

Huang, 20094 168 Community dwelling, “less frail”, >60 Baseline: 0.96
y.o. in Taiwan 8 weeks: 0.98

Talley, 20085 213 Older woman at risk of falling 0.95 at baseline and 12
weeks

Salbach, 20066 51 People with stroke α = .94

ABC-French Canadian version .93
Cattaneo, 20077 20 Multiple Sclerosis 0.92

Peretz, 20068 157 Parkinson’s patients and patients with ABC-HLGD α = .90
high level gait disorders (HLGD) with ABC-Control α = .83
ABC scale and modified ABC-6 scale; ABC-PD α = .91
HLGD N=70, controls N=68, PD N=19. ABC 6-HLGD α = .81
ABC 6-Contol α = .86
ABC 6-PD α = .90

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Test Retest Reliability: Test retest reliability varied with the ABC from 0.70 to 0.92. The MDC was more divergent with the
highest MDC = 38% change and the lowest was 13%.

X [SD] Test/Retest
Reference Population N Time Between Testing MDC95
(time one) Reliability
Personal care home
Holbein-Jenny,
residents; Age 26 24.9 1-2 weeks ICC (1,1) = 0.70 37.8
20059
Range74-92
Patients from outpatient
Miller, 200310 50 21.1 4 weeks ICC (3,1) = 0.91 17.5
clinic
Consecutive, ambulant,
new, and return patients
Parry, 2001 (UK
11 (n=119) and their 39 1 week ICC = 0.89
ABC)
friends and relatives
(n=74)
Powell, 19951 Community dwelling 21 27.7 2 weeks. r = 0.92; 21.7
older adults; Age: 65-
95

Steffen,200812 Community dwelling 36 70(19) 1 week ICC(2,1)= 0.94 13%

adults with
Parkinsonism

Cattaneo, 20077 Multiple Sclerosis 20 57(25) 3 days ICC(2,1) = 0.92 20%

Validity:
Although there often is no gold standard to measure the ABC against, the ABC is correlated with other self-administered tests and
demonstrates Bandura’s work on self-efficacy “that perceived capability rather than actual physical ability is more predictive of
behavior in a given domain”. Clinical application of this would include working on the patient’s confidence in their balance as well as
objective balance activities.
Construct / Concurrent Validity: It is difficult to always differentiate between these 2 types of validity. Evaluating this property
requires a “gold standard” measure with which to compare the tests results. Such a “gold standard” is often not available.
Population N= Support for Validity
Young and older 34 Correlations between ABC and maximal strength (.75), rapid step test (-.54).13
women Young Unimpaired =12
Older Unimpaired = 12
Older Impaired = 10
Seniors over 65 60 ABC is correlated with FES (-.84), Physical Self-Efficacy Scale Scores (.49),
PANAS scale (.12)1, walking speed (.56) and FES (-.65).2
Pts with hip fx 56 There is no correlation between changes in FIM scores and change in ABC scores
for 56 patients in a specialized rehabilitation program.14 The Falls-Efficacy Scale
(FES) and ABC were not correlated in this population.
Pts in a balance and 71 Correlation between dizziness handicap inventory (DHI) and ABC (age 26-88) was -
vestibular clinic .64.15
Mild balance 177 ABC correlated with tandem stance time, unipedal stance time, tandem walking,
impairment TUG, 6MWT, Tinneti’s Performance Oriented Mobility Assessment (.52-.63).16

184 Patients with stooping, crouching, and kneeling (SCK) difficulties, characteristics
associated with SCK included ABC Scale score. (OR=0.97; 95% CI, 0.95-0.99).17
Community 50 ABC correlated with BBS (.75) and TUG (.70).18 (Mean age = 82)
dwelling elderly

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Vestibular 137 ABC with DGI = .58. This relationship increases for those with mild to moderate
dysfunction vestibular weakness and decreases for those with severe or total vestibular
weakness.19 (Mean age = 61)

32 ABC not correlated with Four Square Step Test (FSST) 20

4-month follow-up 73 ABC correlated with BBS (.77), FES (.68), Gait Speed (.65), Modified Barthel
of hip fx pts. (.67).21
Community 140 ABC with Simple & Complex walking while talking test (WWT) (-0.55 & -.54)22
dwelling women 65-
75 yrs of age
Community swelling 168 ABC with FES baseline/8weeks (.88/.89) Geriatric Rear of falling (GFFM) (-0.57/-
>60 yr old seniors in .61)4
Taiwan
Ambulatory adults first session n=12 ABC with BESTest (.685),Stability Limits/Verticality section (0.78)Anticipatory
with a wide range of second session n=11 Postural Adjustments section( 0.41)23
balance function
Patients with 34 ABC with BESTest = 0.60, Fibromyalgia Impact Questionnaire (FIQ) severity
Fibromyalgia -0.64, fatigue (-.60), stiffness(-.40), physical impairment(-.71), pain(-.56), anxiety
(-.40) and depression (-.55)24
Older adults living 167 ABC with Tandem stance (0.39), one leg stance ( 0.41), TUG (-0.58)25
in retirement
villages
Older woman at risk 213 ABC with survey of Activities and Fear of Falling in the Elderly (SAFE) (-0.65), age
of falling (-0.23), BBS (0.57), gait speed ( 0.51), TUG( -0.39), # Act. Restrictions (-0.43),
geriatric depression scale ( -0.38), fall history (-0.20), # Medical Conditions
(-0.32), Assistive device use( 0.51), 8 subscales of the SF-36 (.68-.24).
No correlation with ABC and outdoor falls.5

Patients with stroke 25 ABC with DGI (0.68), BBS (.83)26

Community 63 ABC with Reintegration to Normal Living (RNL) Index, (0.53) 27
dwelling seniors
91 ABC with Ambulatory Self-Confidence Questionnaire (ASCQ)
(0.87)28
Subjects with ABC with BBS(0.48), DGI (0.54), TUG (-0.38), DI(-0.45), and DHI (-0.70)29
Multiple Sclerosis 51
(MS)
The instrument went through three phases in its development. Therapists (15) and clients receiving therapy (12) gave input, then 60
seniors went through structured interviews, and finally 21 subjects were administered the ABC scale and balance testing. 1
Bandura’s work on self-efficacy suggests “that perceived capability rather than actual physical ability is more predictive of behavior in
a given domain2,30

Predictive Validity: The cut off for high confidence is generally >80%, with a cutoff of <67% for a Fear of Falling.
Population N Results
Senior Living Facility 287 Using regression and ABC scores as the dependent variable; depression, use of walking
aid, slow gait speed and race were independent variables that were significant 31.
Individuals with ABC scores less than 50% were 2.6 times more likely to be depressed,
were 3.8 times more likely to walk slower than .9m/s, were 4.4 times more likely to use
a walking aid and were 5.4 times more likely to show impaired gait/balance than
individuals with ABC scores greater than 50%.31
Seniors over 65 60 There was no significant difference on ABC scores for people who fell versus people
who did not fall, with a cutoff score = 80.1
278 ABC DGI.(0.49)32 Scores were lower for women than men on total score and stair
climbing item.32

Test and Measures: Adult 2012

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Community Dwelling Elderly 60 Using the median of the ABC scores of 80% (or 800 score) as a “cut-point” for
differentiation of high-confidence (N=10) versus the rest of the subjects (N=11), the
groups were statistically different with sway (M/L) and walking speed. 2
100 For subjects > 75 years, independently able to walk 10m for five trials and able to
understand instructions, a score of <67% was considered to be classified as Fear of
Falling (FoF). These individuals demonstrated a slower preferred gait velocity (higher
stride-length and stride-time variability) than those without FoF, but no specific gait or
balance parameters, or the ability to dual task while walking were found suggesting the
FoF group uses a slower cadence as an adaptive mechanism. 33
Homebound 11 Scores of < 50% correspond to homebound elderly or the person cannot leave their
home without assist.34
Mild balance impaired 167 ABC Odds ratio for frequent falling (adjusted for age and sex) was .71 p = NS; 16
Elderly 80 Average ABC for people who fall 48% and non-fallers 87.5% 35
Community Seniors 60 Average ABC for people who fall 38% and non-fallers 81% 1
Patients with PD, 40-85 yrs of age 120 Chinese version of ABC
>80 (high) reduction of fall risk; Odds Ratio = 0.06 (95% CI:0.01, 0.65, p=0.020)
50-80 (moderate) reduction of fall risk: Odds Ratio = 0.10 (95% CI: 0.01, 1.29, p=NS)
36

Clients with Lower Limb 415 For subjects with <80% (n=269), the mean QoL was 6.84 (2.17), > 80-100% (n= 146),
Amputations the mean QoL (0 worse to 10 best) was 8.42(1.47) demonstrating those with a higher
balance confidence reported a higher quality of life. 37
Clients with previous hip fracture 79 ABC Odds ratio (adjusted for age, gender, chronic conditions and medications) for
falls was NS except for indoor falls 0.98(.96-1.00)38
Older women with low bone mass 98 The ABC score was the highest predictor (p<.001) of community balance and mobility
scale scores (R2=.57) and normal-paced gait (R2=.34) in this population when using
regression analysis. This supports Bandura’s Theory that perceived capability is more
predictive of activity than actual physical ability.30
Post polio Syndrome (PPS) 172 ABC with Health Related Quality of Life (HRQOL), (0.4)39

Sensitivity/specificity: The sensitivity and specificity of the ABC is varied among diagnosis/condition.
Population N= Cutoff Score and Description
People with and 174 Using a cut off of 85, the ABC identifies balance dysfunction for all subjects (sensitivity = 83%,
without balance specificity = 90%). For people younger than 60 using a cut off of 96 (sensitivity = 96%, specificity =
dysfunction 81%). For people over 60 a cut off of 85 (Sensitivity = 85%, Specificity = 81%). 40

Seniors from 125 Predicts falls using a cut off of 67 and above (sensitivity = 84%, specificity = 88%) The article combined
YMCA, nursing the BBS and reaction time with the ABC to get a better predictive model. 41
home and Senior
residencies
42
Clients with PD 49 With a cut off of 76%, the ABC predicts falls (Sensitivity = 84%, specificity = 63%.
Clients with PD 124 With a cut off ABC score of 80%, ABC was assessed with subjects with PD and controls on the Push and
Release test and the Pull test.
Push and Release – 1st Trial (Sensitivity =90 %, Specificity =38%)
Push and Release – 3rd Trial (Sensitivity =90%, Specificity =55%)
Pull – 1st Trial (Sensitivity = 85%, Specificity = 51%)
Pull 3rd Trial (Sensitivity = 65%, Specificity = 75%) 43
Clients with PD 157 ABC-16 demonstrated ability to differentiate between PD and controls (Sensitivity =58%, Specificity =
and High Level 96%) and HLGD and controls (Sensitivity = 96%, Specificity = 96%)8
gait disturbances
Subject with 51 With an ABC cutoff of 40%, ABC was able to predict fallers (previous mo) in subjects with MS
Multiple sclerosis (Sensitivity =65%, Specificity = 77%)29
(MS)
NOTE: Clinicians need to choose a cut-off score based on the specific purpose for which the test is used.

Test and Measures: Adult 2012

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Responsiveness / sensitivity to change:
Summary: Generally, the ABC demonstrated change with intervention. This is a measure of confidence of balance. Clinicians should
address both the specific balance activity as well as the balance confidence.

Population descriptor N Reference and intervention Responsive: Data supporting responsiveness

Yes / No
44
Clients with moderate to 12 Brown, 2001 Yes Initial ABC score=35
severe loss of vestibular Mean of 3.8 months, 4.6 visits of d/c ABC score=44
function physical therapy. Mean change 10%, p<.04
Mean age 65
People with peripheral 20 Richardson, 200145 No Average change after intervention
neuropathy 3 week intervention vs. control ABC scale showed no change; both groups
group started at 80%
Group Differences Significant? No
Clients with hip fx 56 Petrella, 200014 Yes Average change after intervention
Rehabilitation Program Before=30 (23)%
The FES was better in measuring After=39 (22) % (p = .01)
the significance of the change.
Had the experiment been The power of the test was below .80
continued past d/c the change
score may have been larger or had
there been more concentration on
behavioral determinants of well-
being the responsiveness may have
been higher.
Pts with migraine- 39 Whitney, 2000 46 Yes Average change after intervention.
related vestibulopathy Intervention: Physical Therapy, Change of 14 points on ABC scale (p<.01)
and vestibular 4.9 visits for 4 months.
dysfunction with hx of
migraine
Pts with vestibular 62 Wrisley, 2002 47 Yes Ave. change after intervention: Yes
disorders with and Physical Therapy, mean of 4 visits Group with migraine:
without history of over mean of 3 mo. 35% improvement
migraine headaches Control Group without migraine:
50% decline
Group differences significant: Yes
Group with migraine:
Initial to d/c: 54-67% Δ 12, p<.01
Control Group without migraines:
Initial to d/c: 52% -76% Δ 25, p<.001
Persons in Retirement 63 Myers, 1998 34 Yes Group differences significant? Yes
homes 26 week exercise intervention vs 35% improvement for exercise group
control (Average age = 60-94)
Community dwelling 61 Marigold, 2005 48 No Randomized; No difference btw groups
adults with chronic Agility training (N=30) or Agility Training:
stroke Stretching/Weight shift (N=31) 68(19) to 74(18) to 76(17); p<.001
3x/wk for 10 weeks and 1 mo Stretching/Weight shift:
follow-up. 58(21) to 68(19) to 65(20); p<.001
Subjects with Multiple 44 Cattaneo, Sept. 2007 56 (Clinical No Pre to Post difference in scores:
sclerosis Rehabilitation) Three groups: 1) 2.32
1)Balance rehab with both motor 2) 12.55
and sensory strategies 3) 0.9
2) Balance rehab with only No statistical difference for groups.
sensory strategies
3)”Conventional therapy” – no
specific balance strategies

Test and Measures: Adult 2012

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Responsive:
Population descriptor N Reference and intervention Yes / No Data supporting responsiveness
49
Hip or Knee 27 Myers, 1998 Yes Baseline pre-surgery 72(17)%
replacement 6 weeks post-op 68(17)%
6 mos post-op 83(15)%
Significant change across time.
59% improvement pre-op to 6 mos post-op.
Vestibular Disorders 38 Whitney, 2002 50 Yes 20-40 year old: 57(24) initial; 67(23) at
20-40 and matched 60- discharge
80. 60-80 year old: 68(25) initial; 80(20) at
discharge
A clinically significant change on ABC set at
10 or greater.
Central Vestibular 45 Brown, 2006 51 Yes Pre to post change
dysfunction Custom-designed PT program 13(23)%; p<.01
Mean = 5 visits, over 5 months Mean d/c score: 55%

Chronic central and 28 Danilov, 2007 52 Yes The average ABC score increased 38%.
peripheral vestibular Patients were treated with the Pre-treatment 61.72(20)
disorders BrainPort balance device; 1-1.5 hr, Post-treatment 78.0 (19)
BID 3-4.5 days/week. Treatment p<0.001
included joint mobility exercises and
balance training using the BrainPort
balance device.
Community dwelling 27 Hess, 2005 53 Yes Experimental:
balance impaired 10 wks; light intensity strength Pre-exercise 80(15); Post 88(10); p<.04
training program. Control Group:
Experimental (N=13) Pre-exercise 81(12); Post 81(14);
Control (N=14)

23 Silsupadol, 2009 54 45 min, 3x/wk x Yes – only a) Change =13.20

4wk with b) Change = 2.31
a) Single task balance training n=8 single task c) Change = 3.94
b )Dual task balance training w/fixed training Difference between groups with single-task
priority instructions n= 8 differs from dual-task p<.001
c) Dual task balance training
variable-priority instructions n= 7
Older woman at risk of 213 Talley, 2008 5 No ABC mean change in score = -1.1. Possible
falling Subjects were treated with a 12 ceiling effect for less frail subjects.
week, randomized controlled trial of
fall prevention.
Osteoporosis women 98 Liu-Ambrose, 2004 57 Yes 1. 76(23) to 81(17)%; p<.03
Randomized control; 13 weeks 2. 78(15) to 83(12)%; p<.03
1. Resistance (N=32) 3. 76(24) to 76(18)%; p = NS
2. Agility Training (N=34)
3. General strengthening (N=32)
Improvement in group 1 and 2 = 6%
small effect size (-.19)
Independent community 31 Murphy,2008 58 No No significant change in the ABC Scale
dwelling older women 5 Form, Yang Style Tai Chi 2x/wk following 12 week training at any retest time
with or at risk for for 12 wks. Tested pre intervention, increment.
osteoporosis post intervention, 6 months post and
12 months post.

Test and Measures: Adult 2012

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Community dwelling 60 Sze, 2008 55 Hong Kong community Yes Pre-program 109(30)** ;
balance impaired dwellers with high risk of falls post-program 123(21)**
participated in Falls prevention p =0.001
clinic (12 sessions 1x/wk) followed
by community step down program **seeking clarification of score totals from
(falls prevention education, weekly author
ex class, and 2 home visits in
following 9 mos).

184 Hernandez, 2008 17 Older adults Yes A) No SCK difficulty 83(14)%

with at least mild balance B) Low SCK difficulty 73(19)%
impairment grouped by ability to C) Hi SCK difficulty 65(18)%
stoop, crouch, or kneel (SCK)

157 Peretz, 2006 8 Subjects in three Yes A) HLGD 60(19)%

groups to study ABC -16 and ABC-6 B) PD 81(13)%
with balance impaired and controls. C) Controls 96(2)%
A) High level gait disorders
(HLGD) N=70
B) PD N=19
C) Controls N=68
Older adults living in 167 Cyarto, 2008 25 No Change:
retirement villages Exercise twice weekly for 20 weeks, 1) 6(3)% change significant p<.05 32%
subjects clustered in three groups: of group increased ABC score at least
1) home based exercise 10%
program n=38 2) -2(2)% NS
2) group based exercise 3) 16% of group increased ABC score at
program n=81 least 10%
3) supervised walking 4) -5(2)% NS15% of group increased
program n=48 ABC score at least 10%
Discordance was noted between changes in
ABC scores with improvement in balance
ability, but little to no improvement in balance
confidence as well as minimal change in
balance ability and improvement in balance
confidence.
House hold or 24 Yang, 200859 No Significant changes in pre-training to post-
community ambulators RCT to research the effects of virtual training in the experimental group. Pre-training
with stroke reality-based training on community 79(12), post training 87(7), p=0.05, but this
ambulation in subjects post stroke. was not maintained at one month post training.
Control group (n=9) received
treadmill training, 20 min/session,
3x/wk x 3wk.
Experimental group (n=11) received
virtual reality based treadmill
training, 20min/session, 3x/wk x 3
wk.

30 Lord, 200860 No There was a noted decrease in second testing

Subjects with stroke were seen for indicating a possible over estimation in the
treatment in a hospital based setting initial study.(at 95%CI)
under the direction of a physical a) post intervention decline was -0.6
therapist (n=16) or in the community (-14.8 to 13.5) p=NS
supervised by a physical therapist b)six month follow up change was -4.9 (-18.8
assistant. to 9.0) p=NS

Test and Measures: Adult 2012

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N Responsive: Data supporting
Population descriptor Reference and intervention Yes / No
= responsiveness
Patients with chronic 32 Badaracco, 2007 61 Yes ABC significant change was
dizziness, ages 34-82 Patients underwent vestibular 10%; p<0.001
yr. rehabilitation daily x 2 hrs/day for 12
sessions.
Parkinson’s Disease 19 Lun, 2005 62 No No significant change in home
In home and PT groups, PT 2x/week for 8 or PT group
wks.
Incomplete SCI (iSCI) 4 Musselman, 2009 63 Yes-varied Increase in balance confidence
Body weight supported treadmill training during skilled training (median
(BWSTT) and skill training for walking. =11% of change). Reduction in
scores with BWSTT (medium
= -2% of change).
“Less Frail” Taiwanese 168 Huang, 20094 No 1) 0..41
community dwellers . Pre and post Fear of Falling Intervention
60 yr old Program X 8 weeks 2) 7.93
1) Standardized response
2) Grouped by mobility 3) 6.61
improvement
3) Grouped by mobility
deterioration
Non demented seniors 25 McKinley, 200864 Percent change from baseline
at risk for falls 10 wk (40hr, 2hr, 2x/wk) pre, post and to post treatment:
follow up testing 1) Tango class = 17%
1)Tango class 2) Walk group = 2%
2) walk group

Healthy community 36 Westlake, 2007 65 No No significant change in the

dwelling seniors “FallProof Program” balance training balance training group. Scores
(n=17) and falls prevention education significantly declined in the
(n=19). Balance training included 3x/wk education group. Pre
x 8 wk. 87.5(10.711), post 79(24.2), p
=0.047
Patients with essential 58 Parisi, 200666 Yes Statistically significant
tremor (ET) Studied three groups: differences in group mean
1) Essential tremor without head tremor scores (difference = 11%,
(N=14) 95%CI, 1.3-19.6) between
2) Essential tremor with head tremor control group and ET with
(N=16) head tremor.
3) Control Group (N=28)
Subjects on 30 Fife, 200667 No No statistical difference in
Antiepileptic Effects of three medications: ABC scores
Medications (AED) A) Lamotrigine (N=10) A) 86%
B) Carbamazepine (N=10) B) 82%
C) Gabapentin (N=10) C) 81%

Reference data
Subjects ABC Scale
Myers, et al (1996)2 did not find a Females mean=58% 66%
statistical difference between genders. Males mean=66%
This may be due to the small sample (N=43) Females 58%
size (N=21). (N=26) Non-fearful 74%
(N=16) Fearful but not avoiding 69%
(N=18) Fearful and avoiding 31%

Test and Measures: Adult 2012

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Medell, 200013 (N=12), mean age=21; young adults 97%
(N=12) mean age=69; unimpaired older adults 95%
(N=10) Older adults with balance 69%
impairments
Miller (2000) found that age, gender, (N=230) People with amputation due to 54%
marital status, education, employment vascular complications.
status, income, years since amputation,
mobility device, walking ability,
comorbidity, joint pain, fall injury,
number of medications, alcohol intake,
perceived health, ADL limitation, (N=205) People with amputations due to 75%
depression, adaptation to amputation nonvascular reasons.
and prothesis demonstrated significant
differences in subgroups on the ABC
scale. Interestingly there were no
differences in ABC scores for level of
amputation or number of falls in the
past year.68
Steffen (2005) The ABC scores (N=32) Males, community-dwelling 89%
comparing males and females are
statistically different using a Mann-
Whitney U analysis. As age increased (N=51) Females, community-dwelling 94%
the ABC scores decreased.

Hakim 2004 (N=94) seniors > 60 (N=41) no exercise 66(26)%

years old, 69 (N=29) exercise 84(18)%
(N=29) Tai Chi 87(9)%
Shumany Cook 2000 (N=18) 70 Young controls 96(5)%
Elderly non-faller 93(7)%
Elderly fallers 53(17)%
Holbein-Jenny (2005) (N=26); residents of care homes 9 54(25)%; CI = 44-64%
Salbach, 2006 (N=89); people with Ischemic stroke 59%
stroke 71 Hemorrhage stroke 60%
First stroke 59%
Recurrent stroke 60%
L hemiparesis 57%
R hemiparesis 61%
Walker 46(21)
Cane 54(18)
No assistive device 67(21)
Note: Other ABC scores by groups (N=82) Mean age 59; no health problems 91%
given in article showed age and gender (N=25) Mean age 69; diabetes 70%
differences (need reference) (N=56) Mean age 72; heart problems 77%
(N=93) Mean age 65; foot problems 79%
(N=69) Mean age 64; vision problems 79%
(N=20) Mean age 64; bladder problems 76%
(N=170) Arthritis, Osteoporosis and COPD Low 80’s
(N=225) Physically active 89%
(N=17) Somewhat physically active 69%
(N=42) Not at all active 74%
Brauer, 2000 72 (N=65) Non-fallers; mean age = 72 87(1)%
(N=35) Fallers; mean age = 74 87(2)%
(N=16) Frequent fallers; mean age = 74 85(4)%
(N=19) Recurrent fallers; mean age = 75 82(3)%

Test and Measures: Adult 2012

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Whitney, 2005 40 (N=32) Control under 60 y/o 98(4)%; 97-100
(N=49) Control over 60 y/o 88(19)%; 79-95
(N=47) Balance dysfunction under 60 y/o 65(22)%; 58-72
(N=46) Balance dysfunction over 60 y/o 61(22)%; 54-68

(N=140) Community dwelling women 65-75 88(13)%

Liu-Ambrose, 200822
(N=166) Women mean age=76 90(11)%
(N=112) Men, mean age=77 95(8)%
Herman, 200932 (N=166) Women ,mean age=76 – only stair 87(20)%
item
94(12)%
(N=112) Men, mean age=77 – only stair item

Letgers, 2006 39 (N=9) Age 40-49 42(16-80)%

Subjects with Post Polio Syndrome (N=80)Age 50-59 43(2-95)%
(PPS) (N=54)Age 60-69 46(2-91)%
(N=19)Age 70-79 30(8-70)%
(N= 7) Age > 80 39(1-51)%
Overall median score 42(1-95)%
Cattaneo, 200629 Whole Group (N=51) 51(26)%
Subjects with Multiple Sclerosis (MS) Fallers (N=20) 37(19)%
Non Fallers (N=31) 61(25)%
Whitney, 2004 73 (N=23) Mild DHI (0-30) 74(14)%
DHI = Dizziness Handicapped (N=44) Moderate DHI (31-60) 55(22)%
Inventory.
DHI groups listed are significantly (N=18) Severe DHI (61-100) 28(16)%
different.
Adken, 200374 (N=58) PD clients 69%
(N=30) Control 93%
Wolf, 2003 (N=286) Residents in (N=145) Tai Chi participants 53(19)%
congregate living facilities.75 (N=141) Wellness participants 50(21)%
Whitehead, 2003 21 (N=73) Hip fracture, 4 mo. follow-up 50(23)%
Table 1 Total ABC %
Steffen, TM, Mollinger, LA (2005). Age-and
Standard Confidence gender-related test performance in community-
Age (y) Gender N Mean
Deviation Interval dwelling adults: multi-directional reach test, berg
balance scale, sharpened Romberg tests, activities-
Male 9 93 7 88-98 specific balance confidence scale, and physical
50-59
Female 15 95 5 92-98 performance test. Journal of Neurological Physical
Therapy 29(4): 181-188.
Male 9 96 6 92-100
60-69
Female 10 93 5 89-96

Male 10 96 4 93-98
70-79
Female 14 86 15 77-95

Male 4 91 13 71-100
80+
Female 12 82 16 72-92

TOTAL SAMPLE 83 91 11 89-93

Test and Measures: Adult 2012

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 ACTIVITIES-SPECIFIC BALANCE CONFIDENCE (ABC) SCALE

Ceiling and floor effect:

Summary: There appears to be no ceiling effect in general with the ABC
In the ABCUK version 10% of subjects reached the ceiling (193 consecutive, new and return patients and their friends and relatives
attending falls and syncope facility)11
Slabach ( 2006) reported no ceiling effect for patients within one year of stroke. 8
Kressig (2001) reports no ceiling or floor effect in a study of 287 seniors living in senior living facilities 31
Cattaneo (2006) reports no ceiling effect on ABC with subjects with multiple sclerosis 29

Interpreting results: The ABC is situational-specific when assessing balance confidence in daily activities.1 A review of the “Fear of
Falling” concept can be found in Physical Therapy, 82 (3), 2002 article by K. Legters. In 67 people with PD the best predictors for
total ABC score was gait measured by UPDRS item 29 and item 30 (pre-test) and one-legged stance test.76

Other:
• The original authors suggest that therapists need to explore the reasons why people do not do certain activities. 2
There is a modified British version of the ABC. The version still has 16 items and is scaled 0-100%. Words have been changed
to correspond to the culture, (N=189) α=.98, test-retest reliability = .89.11
There is a modified ABC for Canadian French speaking people (ABC-CF). Cultural language changes have been made. (n=35) α
= .93.6
Whitney et al (2000) developed the following formula to allow for determination of clinically significant improvement [ABC
score] + [100 – DHI1 score] + [4 x DGI2] which give a maximum score of 296. Clinical experience showed >270 no impairment,
240-270 minimal impairment, 120-240 moderate impairment and below 120 severe impairment. 46
Blanchard et al (2007) have established a similar scale, the “Activities Specific Fall Caution” Scale (AFC) for residential living
seniors for residential care specific content.77
The ABC-S is a simplified version of the ABC; developed to have a more friendly use cue format and eliminates the question
regarding walking on ice. The ABC-S has α = 0.86 demonstrating good internal consistency. (n=197).78
• Peretz et al (2006) developed a short version of the ABC (ABC-6).The ABC-6 included questions # 5, 6, 13, 14, 15, and 16 from
the original ABC scale. ABC-6 α = .081-0.90 in subjects with high level gait disorders (HLGD), PD, and controls. (N= 157). 8

References:
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3. Steffen, T. and L. Mollinger, Age- and gender related test performance in community-dwelling adults: multi-directional
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performance test. J Neurol Phys Ther, 2005. 29 (4): p. 181-188.
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ADMINISTRATION
The ABC can be self-administered or administered via personal or telephone interview. Larger typeset should be used for self-
administration, while an enlarged version of the rating scale on an index card will facilitate in-person interviews. Regardless of
method of administration, each respondent should be queried concerning their understanding of instructions, and probed regarding
difficulty answering specific items.

INSTRUCTIONS TO PARTICIPANTS
For each of the following, please indicate your level of confidence in doing the activity without losing your balance or becoming
unsteady by choosing one of the percentage points on the scale from 0% to 100%. If you do not currently do the activity in question,
try and imagine how confident you would be if you had to do the activity. If you normally use a walking aid to do the activity or hold
onto someone, rate your confidence as if you were using these supports. If you have any questions about answering any of these
items, please ask the administrator.

INSTRUCTIONS FOR SCORING

The ABC is an 16 point scale and ratings should consist of whole numbers (0 to 100) for each item. Total the ratings (possible range
= 0 to 1600) and divide by 16 to get each subject’s ABC score. If a subject qualifies his/her response to items #2, #9, #11, #14 or #15
(different ratings for “up” vs “down” or “onto” vs “off”), solicit separate ratings and use the lowest confidence of the two (as this will
limit the entire activity, for instance likelihood of using the stairs).

*Powell LE & Myers AM. The Activities-specific Balance Confidence (ABC) Scale. J Gerontol Med Sci 1995; 50 (1):M28-34

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Appendix 1

Client Name: Date: Therapist:

THE ACTIVITIES-SPECIFIC BALANCE CONFIDENCE (ABC) SCALE*
For each of the following activities, please indicate your level of self-confidence by choosing a
corresponding number from the following rating scale:
0% 10 20 30 40 50 60 70 80 90 100%
No confidence completely confident

“How confident are you that you will not lose your balance or become unsteady when you . . .

1. . . . walk around the house? %

2. . . . walk up or down stairs? %
3. . . . bend over and pick up a slipper from front of a closet floor? %
4. . . . reach for a small can off a shelf at eye level? %
5. . . . stand on tip toes and reach for something above your head? %
6. . . . stand on a chair and reach for something? %
7. . . . sweep the floor? %
8. . . . walk outside the house to a car parked in the driveway? %
9. . . . get into or out of a car? %
10. . . . walk across a parking lot to the mall? %
11. . . . walk up or down a ramp? %
12. . . . walk in a crowded mall where people rapidly walk past you? %
13. . . . are bumped into by people as you walk through the mall? %
14. . . . step onto or off of an escalator while you are holding onto a railing?
%
15. . . . step onto or off an escalator while holding onto parcels such that you
cannot hold onto the railing? %
16. . . . walk outside on icy sidewalks? %

Test and Measures: Adult 2012

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Appendix 2

Confidence in Mobility (a.k.a. Falls Efficacy Scale –FES)

Directions: Ask subject or have him/her fill out this questionnaire:
“How confident are you that you can…[activity 1-10 below]…without falling?”
Ask the subject to rate his/her confidence on a scale of 1-10 (1=extreme confidence; 10=no confidence at all).
Name: ______________________________________ Date: ____________________

“How confident are you that you can……[ ]………. without falling?”

1 2 3 4 5 6 7 8 9 10
extreme confidence ←-----------------------------------→ no confidence at all

Score Activity
Take a bath or shower
Reach into cabinets or closets
Prepare meals not requiring carrying heavy or hot objects
Walk around the house
Get in and out of bed
Answer the door or telephone
Get in and out of a chair
Get dressed and undressed
Light housekeeping
Simple shopping
TOTAL SCORE
Reliability: Internal consistency: = .901 Test-retest: (r=.71) in 18 cognitively intact seniors over 65.

Test and Measures: Adult 2012

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