Dataset Information

The Balance Evaluation Systems Test (BESTest) to differentiate balance deficits.

ABSTRACT:

Background

Current clinical balance assessment tools do not aim to help therapists identify the underlying postural control systems responsible for poor functional balance. By identifying the disordered systems underlying balance control, therapists can direct specific types of intervention for different types of balance problems.

Objective

The goal of this study was to develop a clinical balance assessment tool that aims to target 6 different balance control systems so that specific rehabilitation approaches can be designed for different balance deficits. This article presents the theoretical framework, interrater reliability, and preliminary concurrent validity for this new instrument, the Balance Evaluation Systems Test (BESTest).

Design

The BESTest consists of 36 items, grouped into 6 systems: "Biomechanical Constraints," "Stability Limits/Verticality," "Anticipatory Postural Adjustments," "Postural Responses," "Sensory Orientation," and "Stability in Gait."

Methods

In 2 interrater trials, 22 subjects with and without balance disorders, ranging in age from 50 to 88 years, were rated concurrently on the BESTest by 19 therapists, students, and balance researchers. Concurrent validity was measured by correlation between the BESTest and balance confidence, as assessed with the Activities-specific Balance Confidence (ABC) Scale.

Results

Consistent with our theoretical framework, subjects with different diagnoses scored poorly on different sections of the BESTest. The intraclass correlation coefficient (ICC) for interrater reliability for the test as a whole was .91, with the 6 section ICCs ranging from .79 to .96. The Kendall coefficient of concordance among raters ranged from .46 to 1.00 for the 36 individual items. Concurrent validity of the correlation between the BESTest and the ABC Scale was r=.636, P<.01.

Limitations

Further testing is needed to determine whether: (1) the sections of the BESTest actually detect independent balance deficits, (2) other systems important for balance control should be added, and (3) a shorter version of the test is possible by eliminating redundant or insensitive items.

Conclusions

The BESTest is easy to learn to administer, with excellent reliability and very good validity. It is unique in allowing clinicians to determine the type of balance problems to direct specific treatments for their patients. By organizing clinical balance test items already in use, combined with new items not currently available, the BESTest is the most comprehensive clinical balance tool available and warrants further development.

SUBMITTER: Horak FB

PROVIDER: S-EPMC2676433 | biostudies-literature | 2009 May

REPOSITORIES: biostudies-literature

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Publications

The Balance Evaluation Systems Test (BESTest) to differentiate balance deficits.

Horak Fay B FB Wrisley Diane M DM Frank James J

Physical therapy 20090327 5

<h4>Background</h4>Current clinical balance assessment tools do not aim to help therapists identify the underlying postural control systems responsible for poor functional balance. By identifying the disordered systems underlying balance control, therapists can direct specific types of intervention for different types of balance problems.<h4>Objective</h4>The goal of this study was to develop a clinical balance assessment tool that aims to target 6 different balance control systems so that speci ...[more]

PMID: 19329772

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Project description:BACKGROUND:The reliability and convergent validity of the Balance Evaluation Systems Test (BESTest) in people with subacute stroke have been established, but its responsiveness to rehabilitation has not been examined. OBJECTIVE:The study objective was to compare the responsiveness of the BESTest with those of other clinical balance tools in people with subacute stroke. DESIGN:This was a prospective cohort study. METHODS:Forty-nine people with subacute stroke (mean age=57.8 years, SD=11.8) participated in this study. Five balance measures-the BESTest, the Mini-BESTest, the Berg Balance Scale, the Postural Assessment Scale for Stroke Patients, and the Community Balance and Mobility Scale (CB&M)-were used to measure balance performance before and after rehabilitation or before discharge from the hospital, whichever came first. The internal responsiveness of each balance measure was classified with the standardized response mean (SRM); changes in Berg Balance Scale scores of greater than 7 were used as the external standard for determining the external responsiveness. Analysis of the receiver operating characteristic curve was used to determine the accuracy and cutoff scores for identifying participants with balance improvement. RESULTS:Participants received 13.7 days (SD=9.3, range=5-44) of physical therapy rehabilitation. The internal responsiveness of all balance measures, except for the CB&M, was high (SRM=0.9-1.2). The BESTest had a higher SRM than the Mini-BESTest and the CB&M, indicating that the BESTest was more sensitive for detecting balance changes than the Mini-BESTest and the CB&M. In addition, compared with other balance measures, the BESTest had no floor, ceiling, or responsive ceiling effects. The results also indicated that the percentage of participants with no change in scores after rehabilitation was smaller with the BESTest than with the Mini-BESTest and the CB&M. With regard to the external responsiveness, the BESTest had higher accuracy, sensitivity, specificity, and posttest accuracy than the Postural Assessment Scale for Stroke Patients and the CB&M for identifying participants with balance improvement. Changes in BESTest scores of 10% or more indicated changes in balance performance. LIMITATIONS:A limitation of this study was the difference in the time periods between the first and the second assessments across participants. CONCLUSIONS:The BESTest was the most sensitive scale for assessing balance recovery in participants with subacute stroke because of its high internal and external responsiveness and lack of floor and ceiling effects.

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Dataset Information

The Balance Evaluation Systems Test (BESTest) to differentiate balance deficits.

Background

Objective

Design

Methods

Results

Limitations

Conclusions

Publications

The Balance Evaluation Systems Test (BESTest) to differentiate balance deficits.

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