What Is the Tinetti Test?

The Tinetti Balance Assessment Tool is used by physical therapists to assess the quality of a patient’s gait and balance. The Tinetti test can help provide data about the severity of poor balance when standing, walking, and changing directions and is useful to help determine if a patient is at an increased risk of falls. 

This article discusses the Tinetti test, how it works, and what it is used for.

What Is the Tinetti Test?

A physical therapist uses the Tinetti Balance Assessment Tool to assess the quality of gait and balance deficits in patients with poor balance and decreased lower body stability. The Tinetti test is sometimes called the Performance Oriented Mobility Assessment (POMA).

Poor balance can result from a variety of different causes, including:

• Aging and associated muscle weakness
• Sedentary behavior
• Injuries that affect the ankles, knees, or hips
• Conditions that can cause weakness in the leg muscles, such as arthritis or spinal stenosis
• Neurological conditions that affect strength and balance, such as strokes, Parkinson’s disease, and multiple sclerosis (MS)
• Sensory loss from peripheral neuropathy

How It Works

The Tinetti test is an examination assessment divided into two categories for gait and balance. The gait assessment portion is scored out of 12 points while the balance assessment portion is scored out of 16 points. Both scores are combined for a total score out of 28 points. The physical therapist can score items with a 0, 1, or 2 based on the quality of movement observed with each of the items in the gait and balance sections.

Gait Assessment

A physical therapist will ask the patient to walk while observing the patient’s gait quality to score the following domains of the gait section of the Tinetti test:

• Hesitancy with gait (Does the patient initiate walking with or without hesitation due to decreased stability?)
• Step length and height (Is there a reciprocal or step-to gait pattern?)
• Foot clearance (Do the feet adequately clear the floor with steps, or is foot drop or drag present?)
• Step symmetry (Is step length between right and left sides equal?)
• Step continuity (Are steps smooth and continuous or discontinuous where a patient frequent stops or shuffles?)
• Path deviation (Does the patient walk in a straight line or deviate off path?)
• Trunk sway (Is the body unsteady, or is a walking aid such as a walker, crutches, or a cane needed?)
• Walking stance (Do the heels stay apart while walking or close together and almost touching?)

Balance Assessment

For the balance section of the Tinetti test, a physical therapist will ask the patient to perform the following positions while observing the quality of the patient's movements and ability to stay balanced:

• Sitting balanced in a chair 
• Rising from a chair
• Standing balance
• Standing balance when nudged at the chest
• Standing balance with eyes closed
• Turning 360 degrees
• Sitting down

Scoring

A score of 0 on each of the assessments indicates a problematic performance with gait and balance tasks, while a 1 or a 2 suggests less limitations. The lower overall score on the Tinetti test, the worse a patient’s gait and balance performance is.

In order to develop treatment plan, physical therapists must devise individualized goals for each patient that are measurable. Assessing balance can be difficult to track in objective terms, so the Tinetti test can provide a useful numerical score that can be tracked for improvement over time. 

The Tinetti test is also a useful indicator of a patient's risk of falls. A lower score on the Tinetti test is correlated with an increased risk of falls according to the following scoring guidelines:

• 18 points or less: High risk of falls
• 19-23 points: Moderate risk of falls
• 24 points or more: Low risk of falls
  

Uses

The Tinetti test is used as an objective way of assessing gait and balance deficits in patients. The balance portion of the Tinetti test can reveal where a patient demonstrates problems with balance including standing still, with movement up and down or forward and backward, changing directions, or when visual input is eliminated, 

The gait portion of the Tinetti test can reveal reasons why balance and gait are affected, such as weakness in one or both legs that affects overall balance, lower body stability, and ability to weight shift from one leg to another while taking steps. Common muscle groups that can be weak and cause gait deficits include:

• Hip flexors, which lift the leg up to clear the floor and advance each leg forward when taking steps
• Quadriceps, which extend the knee and provide stability to each leg
• Gluteus maximus, which helps to stabilize the lower body and propel the body forward when walking by extending the hip
• Gluteus medius, which stabilizes the pelvis and helps to maintain balance when weight shifting
• Tibialis anterior, which dorsiflexes the ankle to clear the foot from the floor

Summary

Physical therapists use the Tinetti Balance Assessment Tool to assess the gait and balance deficits in patients who have poor balance and decreased lower body stability. By scoring a patient on the Tinetti test, a physical therapist can further justify the need for physical therapy services to help improve overall patient safety and decrease the risk for falls.

A Word From Verywell

Because the quality of a patient’s balance can be hard to quantify, the Tinetti test can be a useful tool to help provide objective data indicating balance problems and risk for falls. This information can be useful to patients, physical therapists, physicians, and insurance companies to help justify needs for skilled physical therapy intervention and be used to track progress over time with treatment.