Content » Vol 51, Issue 9

Original report

Comparison of measurement properties of three shortened versions of the balance evaluation system test (BESTest) in people with subacute stroke

Thitimard Winairuk, Marco Y.C. Pang, Vitoon Saengsirisuwan, Fay B. Horak, Rumpa Boonsinsukh
Physical Therapy, Srinakharinwirot University, Thailand
DOI: 10.2340/16501977-2589

Abstract

Objectives: To examine the reliability, validity and responsiveness of 3 different short versions of the Balance Evaluation Systems Test (BESTest: S--BESTest, Brief-BESTest and Mini-BESTest) in patients with subacute stroke.
Design: A prospective cohort study.
Participants: Patients with subacute stroke.
Methods: Patients were assessed using the full
BESTest. Scores of 3 short-form BESTests were later extracted. The intra-rater and inter-rater reliability (n = 12) were gathered from 5 raters. Concurrent validity was assessed with the Berg Balance Scale (BBS). Floor/ceiling effect, internal responsiveness and external responsiveness with the BBS (n = 70) were assessed at baseline, 2 weeks and 4 weeks post-rehabilitation.
Results and conclusion: All short-form BESTests demonstrated excellent intra-rater and inter-rater reliability (intraclass correlation coefficient (ICC) = 0.95–0.99) and excellent concurrent validity (r = 0.93–0.96). Unlike the Brief-BESTest and Mini-BESTest, the S-BESTest and BESTest had no significant floor/ceiling effects (< 20%). The standardized response mean of all 4 BESTest versions were large, ranging between 1.19 and 1.57, indicating sufficient internal responsiveness. The area under the curve of the S-BESTest and BESTest were significantly higher than the Brief-BESTest and Mini-BESTest, reflecting better accuracy of the S-BESTest and BESTest in identifying patients with subacute stroke who had balance improvement using the minimal clinically important difference of 6 and 16 points, respectively. These findings suggest that the S-BESTest is a short-form BESTest that is appropriate for assessing balance impairments in patients with subacute stroke.

Lay Abstract

The aim of this study is to determine which short versions of the Balance Evaluation System Test (BESTest), S-BESTest, Brief-BESTest and Mini-BESTest, are most appropriate for assessing balance impairments in patients with subacute stroke. Participants were patients with subacute stroke: 12 in the reliability assessment and 70 in the validity testing. Patients were assessed using 3 short-form BESTests. All short-form BESTests demonstrated excellent reliability and excellent validity, but the S-BESTest demonstrated better accuracy in identifying patients with subacute stroke who had balance improvement using the cutoff score of 6 points. These findings suggest that the S-BESTest is a short-form BESTest that is appropriate for assessing balance impairments in patients with subacute stroke

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