Psychometric properties of Brief‐Balance Evaluation Systems Test (Brief‐BESTest) in evaluating balance performance in individuals with chronic stroke

Abstract

ObjectiveTo examine the psychometric properties of the Brief‐Balance Evaluation Systems Test (Brief‐BESTest) in individuals with chronic stroke.Materials and MethodsThis was an observational study with repeated measurements involving 50 participants with chronic stroke [mean (SD) age: 59.2 (7.3) years]. Each participant with stroke was evaluated with the Brief‐BESTest, Berg balance scale (BBS), Postural Assessment Scale for Stroke Patients (PASS), Fugl‐Meyer Motor Assessment (FMA), Chedoke‐McMaster Stroke Assessment (CMSA), Montreal Cognitive Assessment (MoCA), and Geriatric Depression Scale (GDS). Two raters (rater 1 and 2) provided the Brief‐BESTest scores of the first 27 participants independently to establish inter‐rater reliability. After 15 min of rest, the same 27 participants were evaluated with the Brief‐BESTest again by rater 1 to establish intra‐rater reliability. The Brief‐BESTest scores of the stroke group were also compared with those of the control group [n = 27, mean (SD) age: 56.7 (7.7) years].ResultsThe Brief‐BESTest had no substantial floor and ceiling effects, good intra‐rater (ICC 2,1 = 0.974) and inter‐rater (ICC 2,1 = 0.980) reliability and internal consistency (Cronbach's alpha = 0.818). The minimal detectable change at 95% confidence level was 2 points. The Brief‐BESTest showed moderate to very strong correlations with other balance (BBS and PASS) and motor impairment (FMA, CMSA) measures (r s = .547–.911, p < .001), thus revealing good concurrent and convergent validity. Its correlation with measures that evaluated other constructs was weaker (MoCA: r s = .437, p = .002) or non‐significant (GDS: r s = −0.152, p = .292), thus showing good discriminant validity. Good known‐groups validity was established, as the Brief‐BESTest was effective in distinguishing participants with stroke from controls (cutoff score: <18, area under curve: 0.942), and individuals with stroke who required assistive device for their outdoor mobility from those who did not (cutoff score <14, area under curve: 0.810).ConclusionsThe Brief‐BESTest has good reliability and validity in assessing balance function in individuals with chronic stroke.

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

“…The S-BESTest, the Mini-BESTest, the Brief-BESTest, and the BESTest demonstrated good internal responsiveness (large SRM), suggesting all 4 versions of the BESTest were sensitive in detecting the effectiveness of rehabilitation in subacute stroke. Results regarding acceptable SRM were in accordance with previous studies on psychometric properties of the BESTest in patients with subacute and community-dwelling stroke (13,15,17). However, when considering the external responsiveness using the BBS as the reference, our study showed that only the S-BESTest and the original BESTest demonstrated higher accuracy in identifying the patients with subacute stroke who had balance improvement with the mean MCID of 6 and 16 points, respectively.…”

“…However, when there is the need for reducing assessment time or the need to identify patients with balance improvement, the S-BESTest is the most appropriate choice for balance assessment in patients with subacute stroke. In contrast, the Brief-BESTest and the Mini-BESTest may be more suitable for assessing postural control in patients with chronic stroke, as previous studies found no floor effect in patients with chronic stroke using the Brief-BESTest and the Mini-BESTest (15,17). The floor effect of the Brief-BESTest and Mini-BESTest in subacute stage may be due to the fact that these 2 scales contain items that are more difficult for patients with subacute stroke to perform.…”

“…Two short versions of the BESTest, which can reduce the assessment time are currently available. The brief-BESTest, which contains only 6 items, one for each domain of the BESTest, was validated in patients with chronic stroke, but has not been validated in patients with subacute stroke (14,15). The Mini-BESTest is another short version, which deletes the first and second domains of the BESTest to evaluate the dynamic component of postural control (16).…”

Exoskeleton use in post-stroke gait rehabilitation: a qualitative study of the perspectives of persons post-stroke and physiotherapists

“…The CMSA leg and foot scale each comprise of levels 1–7, the lower the level the greater the degree of neurological deficit. Evaluation measures included the 10 m walk test (10MWT) [ 33 ], 6 min walk test (6minWT) [ 34 ], and the Brief Balance Evaluation Systems Test (Brief-BESTest) [ 35 ]. These descriptive and evaluation measures were used to characterize the PWS participant group (refer to Table 2 ).…”

Acupuncture for balance dysfunction in patients with stroke

“…[ 7 ] Balance dysfunction after stroke is related to poorer mobility, and ability to perform activities of daily living, and falls. [ 8 ] Patients with hemiplegia after stroke have weakened or lost control of motor function on the affected side of the trunk. The patients’ standing balance and walking ability are limited due to the damage of balance center in the nervous system.…”