Comparison of Reliability, Validity, and Responsiveness of the Mini-BESTest and Berg Balance Scale in Patients With Balance Disorders

Background Recently, a new tool for assessing dynamic balance impairments has been presented: the 14-item Mini-BESTest. Objective The aim of this study was to compare the psychometric performance of the Mini-BESTest and the Berg Balance Scale (BBS). Design A prospective, single-group, observational design was used in the study. Methods Ninety-three participants (mean age=66.2 years, SD=13.2; 53 women, 40 men) with balance deficits were recruited. Interrater (3 raters) and test-retest (1–3 days) reliability were calculated using intraclass correlation coefficients (ICCs). Responsiveness and minimal important change were assessed (after 10 sessions of physical therapy) using both distribution-based and anchor-based methods (external criterion: the 15-point Global Rating of Change [GRC] scale). Results At baseline, neither floor effects nor ceiling effects were found in either the Mini-BESTest or the BBS. After treatment, the maximum score was found in 12 participants (12.9%) with BBS and in 2 participants (2.1%) with Mini-BESTest. Test-retest reliability for total scores was significantly higher for the Mini-BESTest (ICC=.96) than for the BBS (ICC=.92), whereas interrater reliability was similar (ICC=.98 versus .97, respectively). The standard error of measurement (SEM) was 1.26 and the minimum detectable change at the 95% confidence level (MDC95) was 3.5 points for Mini-BESTest, whereas the SEM was 2.18 and the MDC95 was 6.2 points for the BBS. In receiver operating characteristic curves, the area under the curve was 0.92 for the Mini-BESTest and 0.91 for the BBS. The best minimal important change (MIC) was 4 points for the Mini-BESTest and 7 points for the BBS. After treatment, 38 participants evaluated with the Mini-BESTest and only 23 participants evaluated with the BBS (out of the 40 participants who had a GRC score of ≥3.5) showed a score change equal to or greater than the MIC values. Limitations The consecutive sampling method drawn from a single rehabilitation facility and the intrinsic weakness of the GRC for calculating MIC values were limitations of the study. Conclusions The 2 scales behave similarly, but the Mini-BESTest appears to have a lower ceiling effect, slightly higher reliability levels, and greater accuracy in classifying individual patients who show significant improvement in balance function.

[1]  S. Fritz,et al.  Rating scale analysis of the Berg Balance Scale. , 2004, Archives of physical medicine and rehabilitation.

[2]  C. Goldsmith,et al.  Use of the standard error as a reliability index of interest: an applied example using elbow flexor strength data. , 1997, Physical therapy.

[3]  S. Tyson,et al.  How to measure balance in clinical practice. A systematic review of the psychometrics and clinical utility of measures of balance activity for neurological conditions , 2009, Clinical rehabilitation.

[4]  Meir Plotnik,et al.  Postural instability and fall risk in Parkinson’s disease: impaired dual tasking, pacing, and bilateral coordination of gait during the “ON” medication state , 2011, Experimental Brain Research.

[5]  F. Horak.  Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls? , 2006, Age and ageing.

[6]  Lillemor Lundin-Olsson,et al.  Berg Balance Scale: Intrarater Test-Retest Reliability Among Older People Dependent in Activities of Daily Living and Living in Residential Care Facilities , 2007, Physical Therapy.

[7]  Gammon M. Earhart,et al.  Functional Gait Assessment and Balance Evaluation System Test: Reliability, Validity, Sensitivity, and Specificity for Identifying Individuals With Parkinson Disease Who Fall , 2011, Physical Therapy.

[8]  Lisa C. Blum,et al.  Usefulness of the Berg Balance Scale in Stroke Rehabilitation: A Systematic Review , 2008, Physical Therapy.

[9]  A. Jette,et al.  Sensitivity to Change and Responsiveness of Four Balance Measures for Community-Dwelling Older Adults , 2011, Physical Therapy.

[10]  Naomi Vaisrub,et al.  Biostatistics: The Bare Essentials , 2009 .

[11]  Rolf Johansson,et al.  Human postural dynamics. , 1991, Critical reviews in biomedical engineering.

[12]  Ricardo Oliveira Guerra,et al.  Interobserver reproducibility of the Berg Balance Scale by novice and experienced physiotherapists , 2009, Physiotherapy theory and practice.

[13]  P. Stratford,et al.  Development and Initial Validation of the Back Pain Functional Scale , 2000, Spine.

[14]  R. Hays,et al.  Recommended methods for determining responsiveness and minimally important differences for patient-reported outcomes. , 2008, Journal of clinical epidemiology.

[15]  Marco Schieppati,et al.  Comparison of Cawthorne-Cooksey exercises and sinusoidal support surface translations to improve balance in patients with unilateral vestibular deficit. , 2003, Archives of physical medicine and rehabilitation.

[16]  Antonio Nardone,et al.  Using psychometric techniques to improve the Balance Evaluation Systems Test: the mini-BESTest. , 2010, Journal of rehabilitation medicine.

[17]  G. Guyatt,et al.  Measurement of health status. Ascertaining the minimal clinically important difference. , 1989, Controlled clinical trials.

[18]  T. Steffen,et al.  Test-Retest Reliability and Minimal Detectable Change on Balance and Ambulation Tests, the 36-Item Short-Form Health Survey, and the Unified Parkinson Disease Rating Scale in People With Parkinsonism , 2008, Physical Therapy.

[19]  C. Cook,et al.  Identifying Myelopathy Caused by Thoracic Syringomyelia: A Case Report , 2008, The Journal of manual & manipulative therapy.

[20]  E. DeLong,et al.  Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. , 1988, Biometrics.

[21]  R. Orr.  Contribution of muscle weakness to postural instability in the elderly. A systematic review. , 2010, European journal of physical and rehabilitation medicine.

[22]  D. Bonett.  Sample size requirements for estimating intraclass correlations with desired precision , 2002, Statistics in medicine.

[23]  F. Horak,et al.  The Balance Evaluation Systems Test (BESTest) to Differentiate Balance Deficits , 2009, Physical Therapy.

[24]  C. Maher,et al.  Global Rating of Change Scales: A Review of Strengths and Weaknesses and Considerations for Design , 2009, The Journal of manual & manipulative therapy.

[25]  I. bonan,et al.  Clinical tools for assessing balance disorders , 2008, Neurophysiologie Clinique/Clinical Neurophysiology.

[26]  B. E. Maki,et al.  Measuring balance in the elderly: validation of an instrument. , 1992, Canadian journal of public health = Revue canadienne de sante publique.

[27]  C. Velozo,et al.  Minimum Detectable Change of the Berg Balance Scale and Dynamic Gait Index in Older Persons at Risk for Falling , 2011, Journal of geriatric physical therapy.

[28]  T. Stevenson.  Detecting change in patients with stroke using the Berg Balance Scale. , 2001, The Australian journal of physiotherapy.

[29]  J. Steiner,et al.  Health and Quality of Life Outcomes , 2006 .

[30]  F. Horak,et al.  Voluntary control of postural equilibrium patterns , 2003, Behavioural Brain Research.

[31]  D. Altman,et al.  Statistics notes: Cronbach's alpha , 1997 .

[32]  A. Członkowska,et al.  Risk factors for falls in stroke patients during inpatient rehabilitation , 2009, Clinical rehabilitation.

[33]  K. Bo Foreman,et al.  Accuracy of Fall Prediction in Parkinson Disease: Six-Month and 12-Month Prospective Analyses , 2011, Parkinson's disease.

[34]  G. Guyatt,et al.  Using the entire cohort in the receiver operating characteristic analysis maximizes precision of the minimal important difference. , 2009, Journal of clinical epidemiology.

[35]  F. Horak,et al.  Comparing the Mini-BESTest with the Berg Balance Scale to Evaluate Balance Disorders in Parkinson's Disease , 2011, Parkinson's disease.

[36]  Lynne M Connelly,et al.  Cronbach's alpha. , 2011, Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses.

[37]  C. Terwee,et al.  Mind the MIC: large variation among populations and methods. , 2010, Journal of clinical epidemiology.

[38]  Gammon M Earhart,et al.  Utility of the Mini-BESTest, BESTest, and BESTest Sections for Balance Assessments in Individuals With Parkinson Disease , 2011, Journal of neurologic physical therapy : JNPT.

[39]  M. Gossman,et al.  Balance performance among noninstitutionalized elderly women. , 1989, Physical therapy.

[40]  E. Franzén,et al.  Translation and validation of the Swedish version of the mini-BESTest in subjects with Parkinson's disease or stroke: A pilot study , 2012, Physiotherapy theory and practice.

[41]  Robert J Peterka,et al.  Sensorimotor integration for multisegmental frontal plane balance control in humans. , 2012, Journal of neurophysiology.

[42]  C. Cook.  Clinimetrics Corner: The Minimal Clinically Important Change Score (MCID): A Necessary Pretense , 2008, The Journal of manual & manipulative therapy.

[43]  Tiffany E Shubert,et al.  Evidence-Based Exercise Prescription for Balance and Falls Prevention: A Current Review of the Literature , 2011, Journal of geriatric physical therapy.