Tests and Measures — Home Health Training

A standardised measure turns "patient is improving" into something a reviewer, a physician, and the patient can all see. It is also the fastest way to know whether your own plan is working.

Pick a small number, use them consistently, and repeat them at the same points.

Balance and fall risk

Measure	What it tells you	Notes
Timed Up and Go (TUG)	Functional mobility and fall risk	Needs a chair and 3 metres of clear floor — available in almost any home
Berg Balance Scale	Static and dynamic balance, 14 items	More sensitive, takes longer; good for a patient whose TUG is borderline
Tinetti (POMA)	Balance and gait, scored separately	Useful when gait quality is the concern
Functional Reach	Anticipatory postural control	Quick, needs only a wall and a ruler
30-Second Sit to Stand	Lower extremity strength and endurance	Also doubles as an exercise you can prescribe
4-Stage Balance Test	Static balance, progressive stances	Fast, no equipment

Gait and endurance

Measure	What it tells you
Gait speed over 10 metres	The single most predictive measure in older adults, and it takes a stopwatch and a hallway
6-Minute Walk Test	Functional endurance — often impractical in a small home; a 2-minute walk or step test may substitute
2-Minute Step Test	Endurance where there is no room to walk

Gait speed deserves particular attention. It predicts hospitalization, falls, and mortality, it needs almost nothing, and a change in it is easy to explain to a physician.

Function and ADLs

Measure	What it tells you
Barthel Index	Basic ADL independence
FIM-style scoring	Level of assistance across tasks
Katz ADL / Lawton IADL	Basic and instrumental activities
COPM	The patient's own priorities and their rating of performance and satisfaction — strong for OT and for goal-setting the patient actually cares about

Cognition and communication

Measure	What it tells you
MoCA / MMSE	General cognitive screening
SLUMS	Cognitive screening, sensitive to mild impairment
Trail Making	Executive function and divided attention — relevant to safety at home
Standardised aphasia and dysphagia measures	Per your SLP scope and agency protocol

Strength, range, and pain

Manual muscle testing, goniometry, grip strength, and a consistent pain scale — the same scale each visit. Record the position you measured in, or the number is not comparable next week.

Using them well

Choose few, and repeat them. Three measures used consistently beat eight used once.

Measure at fixed points — evaluation, at a defined interval, at recertification, and at discharge. Comparability is the whole point.

Record the conditions. Device used, assistance level, footwear, which room, time of day. A TUG done with a walker is not comparable to one done with a cane, and a patient measured at 8am is not the patient measured at 4pm.

Say what the number means. A score with no interpretation is data, not assessment:

TUG 18.2 seconds with rolling walker, up from 24.6 seconds at evaluation. Remains above the 13.5-second threshold associated with elevated fall risk; continued gait and balance training indicated.

That sentence does more for the episode than a paragraph of narrative. It shows progress, justifies continuing, and states the clinical reasoning — see Skilled Language — Writing What You Actually Did.

When a score does not improve, say so and say what you are changing. An unchanged measure with an unchanged plan is the pattern reviewers look for.

Making them work in a home

A hallway is your 10 metres; measure and mark it once, and reuse it
Carry a stopwatch, a tape measure, and a gait belt
Use a firm dining chair, not the recliner, and use the same one each time
Note when a measure had to be modified, and how
Some homes simply do not allow some tests — say which and why rather than recording an unreliable number