The Activities-Specific Balance Confidence (Abc) Scale Form printable pdf download

The Activities-Specific Balance Confidence (Abc) Scale Form

The Activities-Specific Balance Confidence (ABC) Scale

Patient Name: _________________________________ DOB: ___________ Date: ______________

For each of the following activities, please indicate your level of self-confidence by choosing a

corresponding number from the following rating scale:

10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

No confidence ----------------------------------------------------------------------- Completely confident

“How confident are you that you will not lose your balance or become unsteady when you…

Walk around the house? ______%

Walk up or down stairs? ______%

Bend over and pick up a slipper (or item) from the front of a closet floor _____%

Reach for a small can off a shelf at eye level? _____%

Stand on your tiptoes and reach for something above your head? _____%

Stand on a chair and reach for something? _____%

Sweep the floor? _____%

Walk outside the house to a car parked in the driveway? _____%

Get into or out of a car? _____%

10.

Walk across a parking lot to the mall (store)? _____%

11.

Walk up or down a ramp? _____%

12.

Walk in a crowded mall where people rapidly walk past you? _____%

13.

Are bumped into by people as you walk through the mall? _____%

14.

Step onto or off an escalator while you are holding onto a railing? _____%

15.

Step onto or off an escalator while holding onto parcels such that you cannot

hold onto the railing? _____%

16.

Walk outside on icy sidewalks? _____%

Instructions for Scoring:

The ABC is an 11-point scale and ratings should consist of whole numbers (0-100) for each item. Total the ratings

(possible range = 0 – 1600) and divide by 16 to get each subject’s ABC score.

Total Score: _______________________

The Activities-Specific Balance Confidence (Abc) Scale Form