Tinetti Assessment Tool

Overview of the Tinetti Assessment Tool (POMA)

The Tinetti Assessment Tool, formally known as the Performance-Oriented Mobility Assessment (POMA), was developed by Dr. Mary Tinetti in 1986. It is one of the most widely utilized and validated clinical instruments used by geriatricians, physical therapists, and occupational therapists to systematically evaluate static and dynamic balance and gait in older adults.

Structure of the Tinetti POMA Test

The assessment comprises 16 functional motor tasks divided into two distinct components:

1. Balance Sub-Scale (9 Tasks, 16 Points Maximum)

• Sitting Balance: Evaluates steady posture without sliding or leaning.
• Arising from Chair: Assesses ability to stand independently without arm assistance.
• Attempts to Arise: Observes single-attempt vs. multiple-effort rising.
• Immediate Standing Balance (First 5 seconds): Evaluates initial postural stabilization.
• Standing Balance: Assesses narrow-base unassisted stance.
• Nudged Test: Evaluates reactive postural response to three gentle sternal pushes.
• Eyes Closed Test: Evaluates reliance on vestibular and somatosensory input (Romberg-like effect).
• Turning 360 Degrees: Assesses continuous stepping and steadiness during pivot.
• Sitting Down: Observes controlled descent versus dropping into the seat.

2. Gait Sub-Scale (7 Tasks, 12 Points Maximum)

• Initiation of Gait: Assesses hesitations or false starts when beginning to walk.
• Step Length and Height: Evaluates foot clearance and swing phase for right and left limbs.
• Step Symmetry: Checks equality of stride lengths between sides.
• Step Continuity: Checks smooth transition versus halting steps.
• Path Deviation: Observes sway or lateral veer along a 10-foot walkway.
• Trunk Stability: Identifies compensatory sway or arm spreading.
• Walking Stance: Observes base width between heels during ambulation.

Fall Risk Stratification and Interpretation

The cumulative score (0 to 28) correlates directly with fall risk:

• 24 to 28 Points (Low Fall Risk): Normal mobility. Patient demonstrates intact postural control and uninhibited locomotion.
• 19 to 23 Points (Moderate Fall Risk): Moderate mobility impairment. Fall risk is elevated approximately twofold; physical therapy balance training or assistive devices may be warranted.
• $\le 18$ Points (High Fall Risk): Severe impairment. Correlates with an approximate fivefold increase in recurrent fall probability, requiring targeted fall prevention interventions.

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