Balance Confidence Questionnaire
How confident are you that you will not lose your balance or become unsteady when you…
- For each activity, choose the number that matches how confident you feel — from 0% (no confidence) to 100% (complete confidence).
- If you don't currently do an activity, imagine how confident you would be if you had to do it.
- Answer every question. There are no right or wrong answers — go with your first instinct.
- This takes about five minutes.
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 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?
…walk across a parking lot to the mall?
…walk up or down a ramp?
…walk in a crowded mall where people rapidly walk past you?
…are bumped into by people as you walk through the mall?
…step onto or off an escalator while holding onto a railing?
…step onto or off an escalator holding parcels so you cannot hold the railing?
…walk outside on icy sidewalks?
Your results
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