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Objective To determine the minimal clinically important difference between the Berg Balance Scale and comfortable walking speed in acute-phase stroke patients. Design Multicenter, prospective, longitudinal study. Setting Inpatient acute stroke rehabilitation. Subjects Seventy-five patients with acute stroke, mean (SD) age 71.7 (12.2) years. Intervention Inpatients with acute stroke were assessed with the Berg Balance Scale and comfortable walking speed before and after rehabilitation. Physiotherapy was conducted to improve balance and gait over a 2-week period: an average of 40 min/day on weekdays and 20 min/day on weekends and holidays. Main measures The patients’ Berg Balance Scale, comfortable walking speed, Global Rating of Change scale (patient-rated and physiotherapist-rated), and motor score of the Functional Independence Measure were obtained. Minimal clinically important differences were estimated using both anchor- (receiver operating characteristic curves and change difference) and distribution-based approaches (minimal detectable change and 0.5× the change score [SD]). Results The baseline scores were 31.2 (18.9) for the Berg Balance Scale and 0.79 (0.35) m/s for comfortable walking speed. The minimal clinically important difference in the Berg Balance Scale was 6.5–12.5 points by the anchor-based approach and 2.3–4.9 points by the distribution-based approach. The minimal clinically important difference in comfortable walking speed was 0.18–0.25 m/s by the anchor-based and 0.13–0.15 m/s by the distribution-based approach. Conclusions A change of 6.5–12.5 points in the Berg Balance Scale and 0.18–0.25 m/s in the comfortable walking speed is required in these measurements’ anchor-based minimal clinically important differences to be beyond measurement error, and to be perceptible by both patients and clinicians.

Objectives: After confirming the measurement properties of the Berg Balance Scale (BBS) in patients with stroke by conducting a Rasch analysis, this study sought: (i) to generate a keyform as a tool for goal-setting and intervention-planning; and (ii) to determine the appropriate strata for separating patients’ postural balance ability. Design: Methodological analyses of cross-sectional study data.Patients: A pooled sample of 156 patients with stroke: mean (standard deviation) age 74.4 (12.9) years.Methods: This study evaluated the BBS’s rating scale structure, unidimensionality, and measurement accuracy (0: unable to perform or requiring help, to 4: normal performance) and then generated a keyform and strata.Results: The BBS rating scale fulfilled the category functioning criteria. Principal component analysis of standardized residuals confirmed the unidimensionality of the test. All items fit the Rasch analysis. Person ability-item difficulty matching was good. Person reliability was 0.96, and the patients were divided into 9 strata. The keyform for the BBS will enable clinicians and investigators to estimate patients’ postural balance ability and monitor their progress.Conclusion: The BBS has strong measurement properties. This study generated both a keyform that can contribute to clinicians’ decision-making in goalsetting and intervention-planning and strata that can facilitate understanding of patients’ abilities. LAY ABSTRACTPeople who have had a stroke often have difficulty maintaining postural balance and controlling their posture. The Berg Balance Scale (BBS) measures a person’s ability to maintain postural balance. Several analyses were performed to investigate the measurement properties of the BBS in patients who have had a stroke. Then, a keyform tool was generated and some strata (levels) determined that separate patients according to postural balance ability. A keyform can help therapists to identify items that a patient finds relatively  difficult. Use of a keyform can contribute to both rehabilitation goal-setting and planned interventions for patients. The strata can be  used to detect and measure changes in a patient’s postural balance ability. The findings of this study demonstrate that the BBS has  strong measurement properties and provides an appropriate keyform and 9 strata. Use of these tools can facilitate the rehabilitation of patients with stroke through quantification of a patient’s postural balance ability.