Academy of Oncologic Physical Therapy EDGE Task Force: A Systematic Review of Measures of Balance in Adult Cancer Survivors

Abstract

Background and Purpose: Balance impairments are prevalent in adult cancer survivors, leading to increased fall risk and reduced quality of life. To identify survivors in need of balance and fall interventions and to track change with intervention, health care providers need measures with sound psychometric properties and high clinical utility. The purpose of this systematic review was to identify reliable, valid, and clinically useful measures of balance impairments in adult cancer survivors. Secondary purposes were to obtain minimal detectable change of identified balance measures and to determine use of measures to evaluate fall risk. Methods: A systematic review was conducted to assess psychometric properties and clinical utility of balance measures identified from the literature search. Two reviewers in a team independently extracted data from articles and evaluated cumulative evidence for each balance measure using the Cancer EDGE Task Force Outcome Measure Rating Form. Results: The search located 187 articles, with 54 articles retained for quality assessment of balance measures. The Fullerton Advanced Balance Scale and gait speed were highly recommended (rated 4). Balance Evaluation Systems Test, Timed Up and Go, and Five Times Sit to Stand were recommended (rated 3). Limitations: Selection bias is possible. Samples and settings across reviewed studies were widely heterogeneous. Conclusions: We recommend 5 balance measures for use in adult cancer survivors. Future research with existing balance measures should establish norms, responsiveness, and predictive validity for fall risk, while expanding to focus on imbalance in midlife survivors. Patient-reported outcome measures are needed for cancer-related imbalance.