Measurement properties of the Activities-specific Balance Confidence Scale in adults from the general population with concussion: a report from the Toronto Concussion Study.

The aim of this study was to establish the internal consistency and construct validity of the Activities-specific Balance Confidence (ABC) Scale and ABC-6 in adults from the general population with concussion. Prospective analysis. Outpatient concussion care clinic. Adults from the general population with concussion referred to a concussion care clinic within 7 days of injury (n=511). Not applicable. Balance confidence was assessed with the Activities-specific Balance Confidence Scale (ABC) and the ABC-6. Concussion symptoms were characterized using the Sport Concussion Assessment Tool (SCAT5) symptom checklist. Instrumented measures of balance and gait included centre of pressure (COP) velocity and double support time, respectively. Balance was also assessed using the mBESS (modified Balance Error Scoring System). The ABC and ABC-6 were strongly correlated (ρ=0.980, p<0.001). Cronbach's α for ABC and ABC-6 were 0.966 and 0.940, respectively. Factor analysis verified the existence of 2 components of the ABC, one including all items of the ABC-6 as well as 3 additional items. ABC and ABC-6 were moderately significantly correlated with SCAT5 symptom number, severity, and symptom domain (ρ=-0.350 to -0.604). However, correlations between ABC and ABC-6 with instrumented measures of balance and gait were not statistically significant, except for of double support time during dual task gait with ABC-6 (ρ=-0.218). In community dwelling adults with concussion, the ABC and ABC-6 have good internal consistency. Convergent validity is stronger for symptom endorsement measures within SCAT5 domains, which has a similar construct (subjectivity) to balance confidence. Both the ABC and ABC-6 are valid measures of balance self-efficacy in adults from the general population with concussion. The ABC-6 may be a useful tool for characterizing the impact of concussion on perceptions of the ability to perform functional tasks that challenge balance and mobility.

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