Comparison of the structural validity of three Balance Evaluation Systems Test in older adults with femoral or vertebral fracture

Abstract

The Balance Evaluation Systems Test (BESTest), a clinical balance measure, categorizes balance into 6 factors. The aim of this study was to determine which short versions of the BESTest, Mini-BESTest, and Brief-BESTest, were most appropriate for assessing balance impairments in older adults with femoral or vertebral fracture. Subjects were older adults (age ≥65 years), who could walk with out physical assistance. The models' fitting was evaluated for four BESTest models (BESTest, one-factor Mini-BESTest, four-factor Mini-BESTest, and Brief-BESTest). The four-factor Mini-BESTest model was the only model that had a good fit and reflected the balance ability in older adults with femoral or vertebral fracture. We suggest that the using the four-factor Mini-BESTest model and seeing dynamic balance as composed of four factors may help therapists in making clinical decisions. Objective: To clarify and compare the structural validity of 3 Balance Evaluation Systems Tests (BESTest, Mini-BESTest, and Brief-BESTest) in older adults with femoral or vertebral fractures. Design: Cross-sectional study. Subjects: Ninety-four older adults (age ≥65 years) with femoral or vertebral fractures, who could walk without physical assistance. Methods: Four BESTest models (BESTest, one-factor Mini-BESTest, four-factor Mini-BESTest, and Brief-BESTest) were examined using confirmatory factor analysis, and the models' goodness-of-fit was assessed. Unidimensionality of the best-fitting model was confirmed by Rasch principal component analysis on the residuals. Results: Confirmatory factor analysis showed that the four-factor Mini-BESTest model (comparative fit index = 0.952; Tucker-Lewis index = 0.937; root-mean square error of approximation = 0.060; standardized root-mean-square residual = 0.062) has a better structure than other models. The principal component analysis of standardized residuals showed that the variance attributable to Rasch factor was good, with eigenvalues < 2, confirming the factor's unidimensionality. Conclusion: The four-factor Mini-BESTest model shows good structural validity in older adults with femoral or vertebral fracture. Evaluating dynamic balance by focusing on 4 components (anticipatory postural adjustments, postural responses, sensory orientation, and stability in gait) may help therapists in making clinical decisions.

Response to letter to the editor from Franco Franchignoni and Andrea Giordano

“…Our additional analysis suggested that the same measure may have different characteristics depending on the disease. Despite the effect of sample size, the background diseases and symptoms were different between Franchignoni et al's series study (1,(3)(4)(5)(6)9) and the present study (2). Balance is a complex ability that involves rapid, automatic, anticipatory, reactive integration, and sensory strategies, and its properties should differ between age-related functional decline and balance disturbances with neurological symptoms.…”

“…We thank Franchignoni and Giordano for their insightful comments (1) on our article (2). As their comments suggest, our study has problems regarding generalization based on the sample size, subject characteristics (i.e.…”

Rasch Validation of the Mini-BESTest in People With Parkinson Disease

“…For this latter scale, structural analysis points toward the presence of (still not clearly defined) multidimensionality. 32,33 Rasch analysis confirmed the correct functioning of the 3 response categories of the Mini-BESTest (ie, they could distinguish distinct levels of balance ability) and thus their adequateness for contributing to a good measurement quality. 21 All items showed good fit to the Rasch model, that is, appropriateness of the scale's items for measuring the latent construct of interest (dynamic balance).…”

“…On the other hand, the Mini-BESTest unidimensionality precludes proposing any separate subscore17,33 based on the postural control systems postulated in BESTest. For this latter scale, structural analysis points toward the presence of (still not clearly defined) multidimensionality 32,33…”

“…techniques (CFA and Rasch analysis) have been increasingly used in rehabilitation research. 29 Within a debate regarding the structural validity of the BESTest, Mini-BESTest, and Brief-BESTest, [30][31][32] CFAs of the Mini-BESTest had already reported the unidimensionality of the scale in different neurological disorders. 17,33 In the current study, our analyses univocally confirmed the unidimensional structure of the Mini-BESTest.…”