Tele-assessment of Berg balance scale, timed-up, go and box and block test in patients with chronic stroke: establishing agreement with the face-to-face assessment


  • Efthalia Panagiotopoulou Department of Physiotherapy, Clinical Exercise Physiology and Rehabilitation Laboratory, Faculty of Health Sciences, University of Thessaly, Lamia, Greece
  • Aspasia Mavronasou Department of Physiotherapy, Clinical Exercise Physiology and Rehabilitation Laboratory, Faculty of Health Sciences, University of Thessaly, Lamia, Greece
  • Savvas Spanos Department of Physiotherapy, Human Performance and Rehabilitation Laboratory, Faculty of Health Sciences, University of Thessaly, Lamia, Greece
  • Eleni A. Kortianou Department of Physiotherapy, Clinical Exercise Physiology and Rehabilitation Laboratory, Faculty of Health Sciences, University of Thessaly, Lamia, Greece



Berg balance scale, Box and block test, Reliability, Stroke, Tele-assessment, Timed-up and go test


Background: The COVID-19 pandemic has triggered rapid adaptive actions in favor of remote interventions and clinical assessment methods. The reliability of functional tests used in remote assessment is limited in patients with chronic stroke. The aim of the study was to assess the inter-reliability of the Berg balance scale, the timed-up and go test, and the box and block test via remote assessment, in patients with chronic stroke.

Methods: Fifteen patients (8 men and 7 women) underwent a home-based teleassessment using a software platform and a center-based face-to-face assessment, on two consecutive days. The assessment order was randomized and conducted by an independent examiner. All participants were instructed regarding the use of the software platform, home equipment preparation, and safety issues

Results: Participants aged 50-70 years (mean 59.6±7.34) with an average of 4.8±2.5 years after stroke and a moderate degree of motor dependence (Barthel scale: mean 83±8.61 units) completed all tests in both assessment procedures without experiencing adverse events. The inter-reliability was moderate for the total BBS score: ICC=0.869 (95% CI: 0.616 to 0.955), excellent for the total time of the TUG: ICC=0.968 (95% CI: 0.907 to 0.989) as well as for the upper right and left arm scores of the BBT: ICC=0.974 (95% CI: 0.922 to 0.991) and ICC=0.966 (95% CI: 0.897 to 0.988), respectively.

Conclusions: Tele-assessment for BBS, TUG, and BBT appears moderate to excellent inter-reliability in functionally independent patients with chronic stroke.


Chen J, Jin W, Dong WS, Jin Y, Qiao FL, Zhou YF, et al. Effects of Home-based Telesupervising Rehabilitation on Physical Function for Stroke Survivors with Hemiplegia. Am J Phys Med Rehabil. 2017;96(3):152-60.

Hwang R, Mandrusiak A, Morris NR, Peters R, Korczyk D, Russell T. Assessing functional exercise capacity using telehealth: Is it valid and reliable in patients with chronic heart failure? J Telemed Telecare. 2016; 23(2):225-32.

Pedreira da Fonseca E, Ribeiro da Silva NM, Pinto EB. Therapeutic Effect of Virtual Reality on Post-Stroke Patients: Randomized Clinical Trial. J Stroke Cerebrovasc Dis. 2017;26(1):94-100.

Chumbler NR, Li X, Quigley P, Morey MC, Rose D, Griffiths P, et al. A randomized controlled trial on Stroke telerehabilitation: The effects on falls self-efficacy and satisfaction with care. J Telemed Telecare. 2015;21(3):139-43.

Benvenuti F, Stuart M, Cappena V, Gabella S, Corsi S, Taviani A, et al. Community-Based Exercise for Upper Limb Paresis. Neurorehabil Neural Repair. 2014; 28(7):611-20.

Tchero H, Tabue-Teguo M, Lannuzel A, Rusch E. Telerehabilitation for Stroke Survivors: Systematic Review and Meta-Analysis. J Med Internet Res. 2018; 20(10):e10867.

Sarfo FS, Ulasavets U, Opare-Sem OK, Ovbiagele B. Tele-Rehabilitation after Stroke: An Updated Systematic Review of the Literature. J Stroke Cerebrovasc Dis. 2018;27(9):2306-18.

Tang J, Mandrusiak A, Russell T. The Feasibility and Validity of a Remote Pulse Oximetry System for Pulmonary Rehabilitation: A Pilot Study. Int J Telemed Appl. 2012;3:1-7.

Russell TG, Hoffmann TC, Nelson M, Thompson L, Vincent A. Internet-based physical assessment of people with Parkinson disease is accurate and reliable: A pilot study. J Rehabil Res Dev. 2013;50(5): 643.

Cox NS, Alison JA, Button BM, Wilson JW, Holland AE. Assessing Exercise Capacity Using Telehealth: A Feasibility Study in Adults with Cystic Fibrosis. Respir Care. 2013.

Rimmer JH, Thirumalai M, Young HJ, Pekmezi D, Tracy T, Riser E, et al. Rationale and design of the tele-exercise and multiple sclerosis (TEAMS) study: A comparative effectiveness trial between a clinic- and home-based telerehabilitation intervention for adults with multiple sclerosis (MS) living in the Deep South. Contemp Clin Trials. 2018;71:186-93.

Carpinella I, Cattaneo D, Bonora G, Bowman T, Martina L, Montesano A, et al. Wearable Sensor-Based Biofeedback Training for Balance and Gait in Parkinson Disease: A Pilot Randomized Controlled Trial. Arch Phys Med Rehabil. 2017;98(4):622-30.

Ferre CL, Brandão M, Surana B, Dew AP, Moreau NG, Gordon AM. Caregiver-directed home-based intensive bimanual training in young children with unilateral spastic cerebral palsy: a randomized trial. Dev Med Child Neurol. 2016;59(5):497-504.

Carlson RV, Boyd KM, Webb DJ. The revision of the Declaration of Helsinki: past, present and future. Br J Clin Pharmacol. 2004;57(6):695-713.

Colle F, Bonan I, Gellez Leman MC, Bradai N, Yelnik A. Fatigue after stroke. Ann Readapt Med Phys. 2006; 49(6):361-4.

Duffy L, Gajree S, Langhorne P, Stott DJ, Quinn TJ. Reliability (Inter-rater Agreement) of the Barthel Index for Assessment of Stroke Survivors: Systematic Review and Meta-analysis. Stroke. 2013;44(2):462-8.

Stevenson TJ. Detecting change in patients with stroke using the Berg Balance Scale. Aus J Physiother. 2001;47(1):29-38.

Podsiadlo D, Richardson S. The Timed “Up & Go”: A Test of Basic Functional Mobility for Frail Elderly Persons. J Am Geriatr Soc. 1991;39(2):142-8.

Platz T, Pinkowski C, Van Wijck F, Kim IH, Di Bella P, Johnson G. Reliability and validity of arm function assessment with standardized guidelines for the Fugl-Meyer Test, Action Research Arm Test and Box and Block Test: a multicentre study. Clin Rehabil. 2005; 19(4):404-11.

Durfee WK, Savard L, Weinstein S. Technical feasibility of teleassessments for rehabilitation. IEEE Trans Neural Syst Rehabil Eng. 2007;15(1):23-9.

Cabana F, Boissy P, Tousignant M, Moffet H, Corriveau H, Dumais R. Interrater agreement between telerehabilitation and face-to-face clinical outcome measurements for total knee arthroplasty. Telemed J E Health. 2010;16(3):293-8.

Faria CD, Teixeria-Salmelal LF, Neto MG, Rodrigues-de-Paula F. Performance based tests in subjects with stroke: Outcome scores reliability and measurement errors. Clin Rehabil. 2012;26(5):260-9.

Everard G, Otmane-Tolba Y, Rosselli Z, Pellissier T, Ajana K, Dehem S, et al. Concurrent validity of an immersive virtual reality version of the Box and Block Test to assess manual dexterity among patients with stroke. J Neuro Engineer Rehabil. 2022.

Hertzog MA. Considerations in determining sample size for pilot studies. Res Nurs Health. 2008;31(2): 180-91.

Koo TK, Li MY. A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research. J Chiropr Med. 2016;15(2):155-63.

Bland JM, Altman DG. Measuring agreement in method comparison studies. Stat Methods Med Res.1999;8(2):135-60.

Housley SN, Garlow AR, Ducote K, Howard A, Thomas T, Wu D, et al. Increasing Access to Cost Effective Home-Based Rehabilitation for Rural Veteran Stroke Survivors. Austin J Cerebrovasc Dis Stroke. 2016;3(2): 1-11.

Gillespie D, MacLellan C, Ferguson-Pell M, Taeger A, Manns PJ. Balancing Access with Technology: Comparing In-Person and Telerehabilitation Berg Balance Scale Scores among Stroke Survivors. Physiother Can. 2021;73(3):276-85.

Guidarelli C, Lipps C, Stoyles S, Dieckmann NF, Winters-Stone KM. Remote administration of physical performance tests among persons with and without a cancer history: Establishing reliability and agreement with in-person assessment. J Geriatr Oncol. 2022;13(5):691-7.

Peyrusqué E, Granet J, Pageaux B, Buckinx F, Aubertin-Leheudre M. Assessing physical performance in older adults during isolation or lockdown periods: Web-Based Video Conferencing as a Solution. J Nutr Health Aging. 2022;26(1):52-6.

Cho S, Kim WS, Paik NJ, Bang H. Upper-Limb Function Assessment Using VBBTs for Stroke Patients. IEEE Comp Graph Appl. 2016;36(1):70-8.

Oña ED, Jardón A, Cuesta-Gómez A, Sánchez-Herrera-Baeza P, Cano-de-la-Cuerda R, Balaguer C. Validity of a Fully-Immersive VR-Based Version of the Box and Blocks Test for Upper Limb Function Assessment in Parkinson's Disease. Sensors. 2020;20(10):2773.

Gieser SN, Gentry C, LePage J, Makedon F. Comparing Objective and Subjective Metrics Between Physical and Virtual Tasks. J Nutr Health Aging. 2016;9:740.

Chen JJ, Cooper MD, Haddad F, Sladkey A, Nussbaum E, Radom-Aizik S. Tele-Exercise as a Promising Tool to Promote Exercise in Children With Cystic Fibrosis. Front Public Health. 2018;6:269.

Mavronasou A, Asimakos A, Vasilopoulos A, Katsaounou P, Kortianou EA. Remote administration of the short physical performance battery, the 1-minute sit to stand, and the Chester step test in post-COVID-19 patients after hospitalization: establishing inter-reliability and agreement with the face-to-face assessment. Disab Rehabil. 2023;3:1-11.

Kortianou EA, Tsimouris D, Mavronasou A, Lekkas S, Kazatzis N, Apostolara ZE, et al. Application of a home-based exercise program combined with tele-rehabilitation in previously hospitalized patients with COVID-19: A feasibility, single-cohort interventional study. Pneumon. 2022;35(2):12.






Original Research Articles