Which Balance Evaluation Systems Test sections best distinguish levels of post-stroke functional walking status?

Abstract

ObjectiveTo determine which sections of the Balance Evaluation Systems Test (BESTest) distinguish levels of post-stroke functional walking status and to establish their cut-off scores.DesignA retrospective cross-sectional study.Subjects and methodsThe BESTest was administered to 87 stroke patients who were able to walk without physical assistance upon discharge from the hospital. Subjects were divided into 3 functional walking status groups: namely, household ambulators, limited community ambulators, and unlimited community ambulators. The receiver operating characteristic curve was determined and the cut-off score and area under the receiver operating characteristic curve (AUROC) of each section calculated.ResultsIn the comparison of household and limited community ambulators, the accuracies of all BESTest sections were moderate (AUROC>0.7), and the cut-off scores were 36.1–78.6%. In the comparison of limited and unlimited community ambulators, one section (stability in gait) had high accuracy (AUROC=0.908, cut-off scores=73.8%) and 3 sections (biomechanical constraints, anticipatory postural adjustments, and postural response) had moderate accuracy (AUROC=0.812–0.834, cut-off scores=75.0–83.4%).ConclusionThis study demonstrated that different sections of the BESTest had different abilities to discriminate levels of post-stroke functional walking status, and identified cut-off values for targeted improvement.LAY ABSTRACTThe Balance Evaluation Systems Test (BESTest), a clinical postural control measure, categorizes postural control systems in 6 different sections. This study investigated which sections of the BESTest distinguish levels of post-stroke functional walking status, which, in turn, is based on walking speed. Among the slower walkers, all sections of the BESTest showed moderate relationships to categories of walking status. Among the faster walkers, 4 sections showed moderate to strong relationships and 2 sections showed weak relationships. This study may have clinical implications for rehabilitation aimed at improving functional walking status in individuals with stroke. These findings will help rehabilitation professionals assess postural control in relation to stroke patients’ ability to walk in different settings (e.g. their household or the community) and determine which postural control systems should be prioritized in therapeutic interventions.