INTERRATER RELIABILITY OF THE TINETTI BALANCE SCORES IN NOVICE AND EXPERIENCED PHYSICAL THERAPY CLINICIAN

Objective: To examine interrater agreement of scores by physical thera py novices and experienced clinicians an videotaped and live performan ces of the balance portion of Tinetti's Performance Oriented Mobility Assessment (BPOMA). Design: A reliability design was used to assess th e interrater agreement and consistency of the BPOMA scores in an elder ly population. Setting: General community hospital and skilled nursing facility. Patients: Twenty-six residents of a skilled nursing home, r anging in age from 66 to 90yrs ((x) over bar = 80.4, SD = 6.8), partic ipated In Phase 1. Twenty-four hospital inpatients and five residents of a skilled nursing home, ranging in age from 60 to 92yrs ((x) over b ar = 74.7, SD = 7.9), participated in Phase 2. Raters: Three student p hysical therapists scored the patients in Phase 1. One student was des ignated the administrating rater (AR). The AR instructed, guarded, and scored the subjects. The other two students were the observing raters (ORs), whose role was to observe and score the subject's performances . Nine physical therapy clinicians, ranging from 0 to 6 years of exper ience, rated subjects in Phase 2, Main Outcome Measures: Consistency a nd agreement of BPOMA scores were compared between clinicians with var ying levels of experience. In Phase 1, BPOMA was scored on-site by thr ee student physical therapists. In Phase 2, videotaped performances we re scored by five physical therapists. one: physical therapist assista nt, and three student physical therapists. Results: Phase 1 demonstrat ed fair to excellent kappa coefficients (.40-1.00) in all maneuvers ac ross all raters. The ORs had higher agreement compared with the AR, ra nging from good to excellent (.75-1.00), Phase 2 demonstrated fair to good kappa coefficients (.40-.75) In 5 of a maneuvers across all nine raters, When comparing proportion of observed agreement to evaluate th e years of experience on rater agreement, there was no significant dif ference between clinician groups. Conclusions: Fair to good reliabilit y of BPOMA scores occurred across many raters of varied experience wit h a small amount of training. (C) 1997 by the American Congress of Reh abilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.