Test–retest reliability of the Vestibular Ocular Motor Screening (VOMS) tool and modified Balance Error Scoring System (mBESS) in US military personnel

Abstract

The Military Acute Concussion Evaluation 2 (MACE 2), which includes the Vestibular-Ocular Motor Screening (VOMS) tool and the single-leg stance component of the modified Balance Error Scoring System (mBESS), was introduced in 2018 as an assessment of acute mTBI in US military personnel. However, the reliability of the VOMS and mBESS in this population has not been established. ObjectivesThe primary purpose of this study was to examine the reliability of the VOMS across a 6-month period in healthy, uninjured US Army Special Operations Command (USASOC) personnel. DesignActive duty/heathy military personnel (n=108) completed the VOMS and mBESS at baseline and follow-up 6 months later (±1 month). MethodCronbach's alpha was used to examine the internal consistency of the VOMS and mBESS at both time points. Two-way mixed intra-class correlation coefficients (ICC) with consistency agreement were used to evaluate test–retest reliability. ResultsVOMS demonstrated excellent internal consistency (α=0.99), whereas, the mBESS demonstrated poor internal consistency (α=0.29). Test–retest reliability of VOMS items was moderate-to-good with ICCs ranging from 0.60 to 0.81. Test–retest reliability was moderate for mBESS total score (ICC=0.59) and double-leg stance (ICC=0.73), while single-leg (ICC=0.49) and tandem (ICC=0.02) stances were poor. ConclusionsThe findings suggest that VOMS has high internal consistency and moderate-to-good test–retest reliability. mBESS has poor internal consistency and poor-to-moderate test–retest reliability. The results suggest that VOMS is a reliable addition to the MACE-2, whereas, mBESS single-leg stance is less reliable. As such, mBESS double-leg stance may be a more reliable measure of balance in this population.