It is a 12 item performance-based scale used for assessing and monitoring postural control following stroke.
The scale comprises of 12 items with increasing difficulty which measure balance in lying, sitting and standing
It is specially designed for individuals with stroke regardless of their postural competence.
It is especially sensitive for assessment of postural control in the first 3 months and can discriminate between right and left brain damage in individuals with stroke.
It measures the ability of an individual with stroke to maintain stable postures and equilibrium during positional changes
It consists of a 4 point scale where the items are scored from 0 to 3 and the total scoring ranges from 0 to 36.
50cm-high examination table (e.g. Bobath plane)
Stop watch
Pen
No specific manual or training required, but it is essential that the clinician using the scale must be aware of balance impairments and safety issues following stroke
Cost of equipment
Stroke patients
Searched 'Standard error of measurement (SEM) and PASS' in Google Scholar, Medline-EBSCO, CINAHL, PUBMED, and StrokEngine.
Chronic Stroke: (Liaw et al, 2008; n=52; mean age= 60.4(13.4);time since stroke- 6 to 292 months)
1.14 points
Acute Stroke: (Chien et al, 2007b; n=287; mean age= 65.5(11.3); 14 days post stroke)
2.4 points (+ 4.7 points, 95% CI)
Searched 'Minimal Detectable change (MDC) and PASS' in Google Scholar, Medline-EBSCO, CINAHL, PUBMED, and StrokEngine.
Sub-acute Stroke: (Chien et al, 2007a; n=40; mean age=58.6+/-12.0)
MDC at an individual score level: 2.22 points (95% CI)
MDC at a group score level: 0.50 points (95% CI)
Chronic Stroke: (Liaw et al, 2008)
Smallest Real Difference (SRD) of PASS: 3.2 points
Searched 'Minimally Clinically important Difference (MCID) and PASS' in Google Scholar, Medline-EBSCO, CINAHL, PUBMED, and StrokEngine.
Not Established
Searched 'Cut-off scores and PASS' in Google Scholar, Medline-EBSCO, CINAHL, PUBMED, and StrokEngine.
Not Established
Searched 'Normative data and PASS' in Google Scholar, Medline-EBSCO, CINAHL, PUBMED, and StrokEngine.
Healthy older adults: (Benaim et al, 1999; n=30; mean age= 63.3+/- 1.5 years)
Mean PASS score =35.7 points, range= 32 to 36 points
Searched 'Test-retest reliability and PASS' in Google Scholar, Medline-EBSCO, CINAHL, PUBMED, and StrokEngine.
Chronic Stroke:
Excellent test-retest reliability (Intra Class Coefficient (ICC)=0.84) (Chien et al, 2007a)
Excellent relative test-retest reliability (ICC=0.97) over 7 days (Liaw et al, 2008)Interrater reliability:
Searched 'Interrater reliability and PASS' in Google Scholar, Medline-EBSCO, CINAHL, PUBMED, and StrokEngine.
Stroke: (Benaim et al, 1999; n=12; 30 and 90 days post stroke; acute and sub-acute stroke)
Adequate to excellent inter-rater reliability for individual items (average alpha=0.88, range 0.64-1)
Excellent inter-rater reliability for total score (r=0.99, p<0.001)
Acute Stroke: (Mao et al, 2002; n=112;mean age=69.3+/-11.2; 14 days post stroke)
Adequate to excellent inter-rater reliability for individual items(median alpha=0.88, range 0.61-0.96)
Excellent inter-rater reliability (ICC=0.97, 95% confidence interval (CI 0.95-0.98)) for total score.
Acute Stroke: (Hsieh et al, 2002; n=169; mean age= 66.8(11.3))
Excellent inter-rater reliability of the trunk control items (PASS-TC: items 1,6,7,8,9 ICC =0.97)
Intrarater reliability:
Searched 'Intrarater reliability and PASS' in Google Scholar, Medline-EBSCO, CINAHL, PUBMED, and StrokEngine.
Stroke: (Benaim et al, 1999)
Good intrarater reliability for individual items (average k=0.72, range 0.45-1)
Excellent intrarater reliability for total score (r=0.98, p<0.001)Searched 'Internal consistency and PASS' in Google Scholar, Medline-EBSCO, CINAHL, PUBMED, and StrokEngine.
Stroke:
Excellent internal consistency ( Cronbach's alpha= 0.95) (Benaim et al, 1999)
Excellent internal consistency (Cronbach's alpha= 0.94-0.96) at 14, 30, 90 and 180 days post stroke (Mao et al, 2002)
Acute Stroke:
Excellent internal consistency (Cronbach's alpha= 0.93-0.94)(Hseih et al, 2002)
Excellent internal consistency (Cronbach's alpha= 0.96) at 14 days post stroke (Chien et al, 2007b)
Concurrent validity:
Searched 'Concurrent validity and PASS' in Google Scholar, Medline-EBSCO, CINAHL, PUBMED, and StrokEngine.
Stroke: (Mao et al, 2002)
Excellent relationship with Fugl-Meyer Assessment modified balance scale (FMA-B) (p=0.95-0.97) and Berg Balance Scale (BBS) (p=0.92-0.95)
Stroke: (Wang et al,2004; n=77; mean age= 59.8(11.9);14, 30 and 90 days post stroke, acute and sub-acute stroke)
Excellent relationship between all measures (PASS, PASS-3P, BBS and BBS-3P) (rho>/=0.91, P<0.0001)
Excellent relationship with BBS (p=0.94,P<0.0001) and with PASS-3P (p=0.94,P<0.0001; ICC=0.97, 95%CI 0.96-0.98)
Acute Stroke: (Chien et al, 2007b)
Excellent relationship with the Short Form PASS (SFPASS)(ICC=0.98;96% variance)in 287 individuals at 14 days post stroke
Excellent relationship with the SFPASS (ICC=0.98) in 179 individuals with stroke
Acute Stroke: (Di Monaco et al, 2010; n=60; mean age= 68.0(12.2); mean time post stroke= 21.4 (13.3)days)
Excellent relationship with the Trunk Impairment Scale (TIS) (p=0.849, P<0.001)
Predictive validity:
Searched 'Predictive validity and PASS' in Google Scholar, Medline-EBSCO, CINAHL, PUBMED, and StrokEngine.
Stroke: (Benaim et al, 1999)
Good predictive validity of PASS total score (r=0.75,p<0.001), transfer items (r=0.74,p<0.006) and locomotion items (r=0.71,p<0.001) at 30 days post stroke when compared with Functional Independence measure (FIM) scores at 90 days post stroke
Stroke: (Mao et al, 2002)
Excellent predictive validity of PASS (p=0.86-0.90) at 14, 30 and 90 days post stroke when compared with the walking subscale of the Motor Assessment Scale at 180 days post stroke
Stroke: (Hsieh et al, 2002)
Excellent predictive validity of the trunk control items of PASS (PASS-TC: items 1,6,7,8,9) (r=0.68,p<0.001) at 14 days post stroke when compared with Barthel Index (BI) and Frenchay Activities Index (FAI) at 6 months post stroke
Stroke: (Wang et al, 2004;n=226 and n=202;14 and 30 days post stroke)
Excellent predictive validity of PASS and modified PASS that used 3-level scale (12-item PASS-3P) at 14 days (p=0.78) and 30 days (p=0.82) post-stroke when compared with BI scores at 90 days post-stroke
Acute Stroke: (Chien et al, 2007b)
Adequate predictive validity of PASS (r=0.49) and SFPASS (r=0.48) at 14 days post-stroke when compared with BI scores at 90 days post-stroke
Excellent predictive validity of PASS (r=0.83) and SFPASS (0.82) on replication of the process in 179 individuals following stroke on admission to rehabilitation with BI scores on discharge from hospital
Acute Stroke: (Di Monaco et al, 2010)
Excellent predictive validity of PASS (p=0.687,p<0.001)on admission to inpatient rehabilitation when compared with FIM discharge scores
Stroke: (Yu et al, 2012; n=85)
Sufficient predictive validity of PASS, when compared with BI (r2=0.39,p<0.001) and Stroke Rehabilitation Assessment of Movement mobility subscale (MO-STREAM) (r2=0.63,p<0.001 ) discharge scores
Searched 'Convergent validity and PASS' in Google Scholar, Medline-EBSCO, CINAHL, PUBMED, and StrokEngine.
Stroke: (Benaim et al, 1999)
Excellent correlations between PASS and FIM total score (r=0.73), transfer tasks (r=0.82) and locomotor tasks (r=0.73); and motricity scores of lower limb (r=0.78) and upper limb (r=0.63)
Adequate negative correlations with the star cancellation test of spatial inattention (r=0.53) and lower limb pressure sensitivity (r=0.45) as well as upper limb pressure sensitivity (r=0.42)
Adequate negative correlations with measurement of postural stabilization (r=0.48) and postural orientation with respect to gravity (r=0.36) (Benaim et al, 1999; n=31; 90 days post stroke)
Stroke: (Mao et al, 2002)
Excellent convergent validity between PASS and BI (p= 0.88-0.92)
Stroke: (Hsieh et al, 2002)
Excellent convergent validity of PASS-TC with BI (r=0.89) and with the Fugl-Meyer balance test (FM-B) (r=0.73)
Stroke: (Wang et al, 2004)
Excellent convergent validity of the PASS and PASS 3P with BI (p=0.84, p= 0.82 respectively)
Stroke: (Chien et al,2007b)
Excellentcorrelations between the PASS, SF PASS and BI, (PASS R=0.87; SFPASS r=0.86) and between the PASS, SFPASS and FIM (PASS r=0.75; SFPASS r=0.75)
Searched 'Content validity and PASS' in Google Scholar, Medline-EBSCO, CINAHL, PUBMED, and StrokEngine.
Not established
Searched 'Content validity and PASS' in Google Scholar, Medline-EBSCO, CINAHL, PUBMED, and StrokEngine.
Not established
Searched 'Floor and ceiling effects and PASS' in Google Scholar, Medline-EBSCO, CINAHL, PUBMED, and StrokEngine.
Stroke: (Benaim et al, 1999; n=58; 30 and 90 days post stroke )
Large ceiling effects at 90 days post stroke (38%)
Stroke: (Mao et al, 2002;14, 30, 90 and 180 days post stroke)
Adequatefloor and ceiling effects at all time points (floor effect range 2.2-3.8%; ceiling effect range 3.3-17.5%)
Searched 'Responsiveness and PASS' in Google Scholar, Medline-EBSCO, CINAHL, PUBMED, and StrokEngine.
Stroke: (Mao et al, 2002)
Large responsiveness of PASS from 14-30 days (Effect Size (ES)=0.89)
Moderate responsiveness from 30-90 days (ES=0.64)
Low responsiveness from 90-180 days (ES=0.31)
Large overall responsiveness from 14-180 days (ES=1.12)
Large responsiveness from 14-180 days (ES=1.54) in severe stroke
Stroke: (Wang et al, 2004; n=202 and n=167; 14,30and 90 days post stroke)
Large responsiveness of the PASS and PASS-3P from 14-30 days post stroke (Standard Response Mean (SRM) =0.84 and 0.86 respectively) and from 14-90 days post stroke (SRM=1.02 and 1.04 respectively)
Moderate responsiveness from 30-90 days post stroke (SRM=0.65 and 0.67 respectively)
Moderate responsiveness of PASS and PASS-3P (PASS SRM range 0.43-0.78; PASS-3P SRM range 0.46-0.78) in individuals with mild stroke (Fugl Meyer motor assessment (FM) score of 80 or greater)
Moderate to large responsiveness (PASS SRM range 0.52-1.12; PASS -3P SRM range 0.56-1.19) in individuals with moderate stroke (FM score 36 to 79)
Large responsiveness (PASS SRM range 0.92-1.35; PASS-3P SRM range 0.92-1.34) in individuals with severe stroke (FM score 0 to 35)
Large responsiveness of both measures in the period of 14-30 days and 14-90 days post stroke as compared to 30-90 days post stroke.
Sub-acute Stroke: (Chien et al, 2007a)
Small responsiveness of the PASS (d=0.41) over an interval of 2 weeks
Stroke: (Chien et al, 2007b)
Small responsiveness of the PASS (ES=0.42)
Small responsiveness of the PASS (ES=0.43) (Chien et al, 2007b; n=179 ; admission to rehabilitation to discharge from hospital)
Stroke: (Yu et al, 2012; n=85; individuals with stroke from admission to discharge)
Adequate internal responsiveness of PASS(d=0.87)
Sufficient external responsiveness(ic=0.44, r2=0.20, p<0.001), (ic=0.77, r2=0.59, p<0.001) to changes in function (BI changes scores) and changes in mobility (MO-STREAM change scores)
This scale is easy to administer with no special requirement.
Any clinician can easily, rapidly and confidently administer the scale.
However, the clinician must have the understanding of balance impairments and safety issues that are seen following stroke.
It is more sensitive for assessment of stroke in the first 3 months and can discriminate between patients with right and left brain damage.
Benaim C, Pérennou DA, Villy J, Rousseaux M, Pelissier JY. Validation of a standardized assessment of postural control in stroke patients: the Postural Assessment Scale for Stroke Patients (PASS). Stroke. 1999;30(9):1862-8.
Chien CW, Hu MH, Tang PF, Sheu CF, Hsieh CL. A comparison of psychometric properties of the smart balance master system and the postural assessment scale for stroke in people who have had mild stroke. Arch Phys Med Rehabil. 2007a;88(3):374-80.
Chien CW, Lin JH, Wang CH, Hsueh IP, Sheu CF, Hsieh CL. Developing a Short Form of the Postural Assessment Scale for people with Stroke. Neurorehabil Neural Repair. 2007b;21(1):81-90.
Di monaco M, Trucco M, Di monaco R, Tappero R, Cavanna A. The relationship between initial trunk control or postural balance and inpatient rehabilitation outcome after stroke: a prospective comparative study. Clin Rehabil. 2010;24(6):543-54.
Hsieh CL, Sheu CF, Hsueh IP, Wang CH. Trunk control as an early predictor of comprehensive activities of daily living function in stroke patients. Stroke. 2002;33(11):2626-30.
Liaw LJ, Hsieh CL, Hsu MJ, Chen HM, Lin JH, Lo SK. Test-retest reproducibility of two short-form balance measures used in individuals with stroke. Int J Rehabil Res. 2012;35(3):256-62.
Liaw LJ, Hsieh CL, Lo SK, Chen HM, Lee S, Lin JH. The relative and absolute reliability of two balance performance measures in chronic stroke patients. Disabil Rehabil. 2008;30(9):656-61.
Mao HF, Hsueh IP, Tang PF, Sheu CF, Hsieh CL. Analysis and comparison of the psychometric properties of three balance measures for stroke patients. Stroke. 2002;33(4):1022-7.
Persson CU, Hansson PO, Danielsson A, Sunnerhagen KS. A validation study using a modified version of Postural Assessment Scale for Stroke Patients: Postural Stroke Study in Gothenburg (POSTGOT). J Neuroeng Rehabil. 2011;8:57.
Wang CH, Hsueh IP, Sheu CF, Yao G, Hsieh CL. Psychometric properties of 2 simplified 3-level balance scales used for patients with stroke. Phys Ther. 2004;84(5):430-8.
Yu WH, Hsueh IP, Hou WH, Wang YH, Hsieh CL. A comparison of responsiveness and predictive validity of two balance measures in patients with stroke. J Rehabil Med. 2012;44(2):176-80.
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