Key points
- The Berg Balance Scale (BBS) scores 14 everyday balance tasks for a total of 0–56 points.
- Rater reliability is high (pooled intra-rater 0.98, inter-rater 0.97), but individual change is harder to detect: depending on the starting score, about 4–7 points of change are needed to be 95% confident it's real.
- Used as a yes/no cut-off (≤45), the BBS misses most people who go on to fall. It works better as a graded scale, read alongside other assessments.
What the Berg Balance Scale is
The Berg Balance Scale was developed by Berg and colleagues to measure balance in older adults using tasks drawn from everyday life. In its validation work, scores related to clinical judgments and self-perceptions of balance, correlated moderately with laboratory measures of postural sway, and predicted the occurrence of multiple falls among elderly residents (Berg et al., 1992). It has since become one of the most widely used balance measures in rehabilitation, for older adults and for people after stroke.
How it's scored
A clinician observes the patient performing 14 movements — the kinds of transitions and static and dynamic postures daily life demands — and scores each one. Item scores are summed to a total out of 56; higher scores mean better balance.
How reliable is it?
Between and within raters, very. A systematic review of 11 studies (668 participants) found pooled intra-rater reliability of 0.98 and inter-rater reliability of 0.97 (Downs et al., 2013), consistent with Berg's own early reliability work (Berg et al., 1995).
The same review adds an important caveat: absolute reliability varies across the scale. The minimal detectable change at 95% confidence ranged from 2.8 to 6.6 points, and a ceiling effect was evident for some people — so the scale "might not detect modest, clinically important changes in balance in individual subjects."
How much change is real change?
For individual patients, a study of 118 older adults in physiotherapy rehabilitation estimated the change needed to be 95% confident a true change has occurred, by starting score (Donoghue & Stokes, 2009):
| Initial BBS score | Change needed (95% confidence) |
|---|---|
| 45–56 | 4 points |
| 35–44 | 5 points |
| 25–34 | 7 points |
| 0–24 | 5 points |
In practice, a two- or three-point improvement may be encouraging, but on its own it isn't strong evidence of change. (We cover the broader idea in reading progress against meaningful-change thresholds.)
What's a normal score?
In healthy community-dwelling people with a mean age of 70 or older, mean BBS scores across 17 studies ranged from 37 to 55, declining about 0.7 points per year with age and becoming more variable (Downs et al., 2014). "Normal" depends heavily on age, so a score is best interpreted against the patient's own baseline and peers.
The Berg and fall risk: use the whole scale
A cut-off of 45 is often quoted, but the evidence urges caution. In a prospective study of 210 community-dwelling older adults, a threshold of ≤45 identified only 25% of people who had any fall and 45% of those with multiple falls over the following year; the authors recommended keeping the BBS as a graded scale, since fall risk rose steadily as scores fell (Muir et al., 2008). A later systematic review found published cut-offs ranging from 45 to 51 and concluded the BBS should not be used alone to determine fall risk (Lima et al., 2018).
The takeaway: the Berg is a strong descriptor of balance and a useful way to track it, but fall-risk decisions should combine it with history and other measures — such as the Timed Up and Go, the 30-Second Chair Stand and the 4-Stage Balance Test.
Where objective capture helps
Because many Berg items are observed movements, how a patient performs them — sway, compensations, timing — carries information a 0–56 total can't hold. Kinetically can capture the movement-based items of the Berg Balance Scale from a smartphone video so they're recorded the same way at every visit; the scale itself remains clinician-scored. Objective capture is decision support, not a substitute for clinical judgment. For how the Berg fits alongside other standard tests, see our guide to clinical movement assessment tests.
References
- Berg KO, Wood-Dauphinee SL, Williams JI, Maki B. Measuring balance in the elderly: validation of an instrument. Canadian Journal of Public Health. 1992;83 Suppl 2:S7-S11. PubMed 1468055
- Berg K, Wood-Dauphinee S, Williams JI. The Balance Scale: reliability assessment with elderly residents and patients with an acute stroke. Scandinavian Journal of Rehabilitation Medicine. 1995;27(1):27-36. PubMed 7792547
- Downs S, Marquez J, Chiarelli P. The Berg Balance Scale has high intra- and inter-rater reliability but absolute reliability varies across the scale: a systematic review. Journal of Physiotherapy. 2013;59(2):93-99. doi:10.1016/S1836-9553(13)70161-9
- Donoghue D, Stokes EK. How much change is true change? The minimum detectable change of the Berg Balance Scale in elderly people. Journal of Rehabilitation Medicine. 2009;41(5):343-346. doi:10.2340/16501977-0337
- Downs S, Marquez J, Chiarelli P. Normative scores on the Berg Balance Scale decline after age 70 years in healthy community-dwelling people: a systematic review. Journal of Physiotherapy. 2014;60(2):85-89. doi:10.1016/j.jphys.2014.01.002
- Muir SW, Berg K, Chesworth B, Speechley M. Use of the Berg Balance Scale for predicting multiple falls in community-dwelling elderly people: a prospective study. Physical Therapy. 2008;88(4):449-459. doi:10.2522/ptj.20070251
- Lima CA, Ricci NA, Nogueira EC, Perracini MR. The Berg Balance Scale as a clinical screening tool to predict fall risk in older adults: a systematic review. Physiotherapy. 2018;104(4):383-394. doi:10.1016/j.physio.2018.02.002