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.
Highlights
The Berg Balance Scale (BBS) is a multi-item generic balance measure, but its ceiling effects have been well documented when administered to individuals even as early as three months post- stroke (Blum & Korner-B itensky, 2008; Mao, Hsueh, Tang, Sheu, & Hsieh, 2002)
Internal consistency, intra-rater and inter-rater reliability, and concurrent validity (Portney & Watkins, 2009), convergent validity (Portney & Watkins, 2009), discriminant validity (Portney & Watkins, 2009) and known-groups validity (Portney & Watkins, 2009) of the Brief-Balance Evaluation Systems Test (BESTest) were assessed in a group of individuals with stroke
The Brief-BESTest was effective in discriminating the stroke participants from controls, as well as the individuals with stroke who required assistive device for outdoor mobility from non-those who did not. aAUC = Area under curve; Brief-BESTest = Brief-Balance Evaluation Systems Test; CI = Confidence interval
Summary
Balance dysfunction is common after stroke (Geurts, de Haart, van Nes, & Duysens, 2005), and is related to poorer mobility (Geiger, Allen, O’Keefe, & Hicks, 2001) and ability to perform activities of daily living (Hyndman & Ashburn, 2003), and falls (Quigley, 2016). Despite its excellent psychometric properties in various populations (Chinsongkram et al, 2014; Horak et al, 2009; Jacobs & Kasser, 2012; Leddy, Crowner, & Earhart, 2011a), there are concerns with redundancy of items and long administration time involved (40–60 min) (Horak et al, 2009; Padgett, Jacobs, & Kasser, 2012) To address these limitations, the 14-item Mini-B ESTest was developed (Franchignoni, Horak, Godi, Nardone, & Giordano, 2010). The objective of this study was to examine the floor and ceiling effects, reliability, and validity of the Brief-BESTest in individuals with chronic stroke
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