Mini-BESTest Scores Research Articles

Balance function in critical illness survivors and evaluation of psychometric properties of the Mini-BESTest

Critical illness survivors commonly face impairments, such as intensive care unit-acquired weakness (ICUAW) which is characterized by muscle weakness and sensory deficits. Despite these symptoms indicating potential balance deficits, systematic investigations and validated assessments are lacking. Therefore, we aimed to assess balance function using the Mini-BESTest, evaluate its psychometric properties, and identify associated variables. Balance was assessed post-ICU discharge (V1) and at discharge from inpatient neurorehabilitation (V2) in patients with ≥ 5 days of invasive ventilation. Mini-BESTest measurement characteristics were evaluated in an ambulatory subgroup. A multiple linear regression was conducted. The prospective cohort study comprised 250 patients (34% female, 62 ± 14 years, median ICU stay 55 days). Median Mini-BESTest scores improved significantly from V1 (5 (IQR 0–15)) to V2 (18.5 (10–23)) with a large effect size. Excellent inter-rater and test–retest reliabilities of the Mini-BESTest were observed (ICC = 0.981/0.950). Validity was demonstrated by a very high correlation with the Berg Balance Scale (ρ = 0.90). No floor or ceiling effects were detected. Muscle strength, cognitive function, cerebral disease, critical illness polyneuropathy/myopathy, and depression were significantly associated with balance. Despite significant improvements during the rehabilitation period, balance disorders were prevalent in critical illness survivors. Ongoing therapy is recommended. Due to its excellent psychometric properties, the Mini-BESTest is suitable for use in critical illness survivors.Registration: The study was registered at the German Clinical Trials Register (DRKS00021753, date of registration: 2020-09-03).

Postural balance in COPD with obstructive sleep apnoea: a cross-sectional study.

The aim of this study was to assess the postural balance in COPD patients with obstructive sleep apnoea (OSA). Physical activity, anxiety and depression symptoms, mood, and falls were also assessed in this population. Moderate to severe COPD patients were assessed for laboratory and clinical postural balance (force platform and mini-balance evaluation systems test (Mini-BESTest)), physical activity (accelerometry), OSA (polysomnography), sleep quality (Pittsburgh Sleep Quality Index), sleepiness (Epworth Sleepiness Scale), anxiety and depression symptoms (Hospital Anxiety and Depression Scale), dyspnoea (modified Medical Research Council), clinical status (COPD Assessment Test) and mood (Brunel Mood Scale). Self-reported falls were recorded for 6 months via phone calls. COPD patients (n=70) were divided according to the polysomnography findings into the no OSA (n=30), mild OSA (n=25), and moderate to severe OSA (n=15) groups. Compared to patients with no OSA, those with moderate to severe OSA (msOSA group) presented median (interquartile range) increased path length (30.5 (23.9-34.5) cm versus 39.0 (30.6-52.6) cm, anteroposterior displacement (1.89 (1.39-2.31) cm versus 2.54 (2.06-2.83) cm and postural adjustment velocity (1.02 (0.80-1.15) cm·s-1 versus 1.30 (1.02-1.76) cm·s-1) (p<0.05). No differences were observed in the Mini-BESTest scores among the groups. The msOSA group presented a greater number of recurrent fallers in the first follow-up trimester. No association was observed between postural balance and age and pulmonary function. Individuals with COPD and moderate to severe OSA present changes in postural balance, including broader oscillation, faster postural adjustments and a greater risk of falls than those with no OSA. Physical activity, anxiety and depression symptoms, and mood are similar between COPD patients with and without OSA.

Moving together-benefits of a 12-week online dance training intervention on static and dynamic postural stability and gait speed in older women: an exploratory pre-post study.

Physical inactivity negatively affects gait performance and postural stability in older adults resulting in a higher risk of fall accidents. Previous research has shown that in-person dance training improves various aspects of balance and lower-extremity function, however, little is known about the potential benefits of dance training delivered online on variables used for fall risk stratification in older adults. We aimed to explore the benefits of a 12-week online dance training intervention on static and dynamic postural stability and gait speed in older women. Forty-five older adults (44 women) were included in this exploratory pre-post study. The 12-week dance intervention consisted of two weekly 60-min classes in contemporary (improvisation) and salsa dance delivered online through Zoom video calls. Static and dynamic postural stability was assessed using the center of pressure (CoP) area and velocity (force platform), and the Mini Balance Evaluation Systems Test (Mini-BESTest), respectively. 10-m gait speed was measured using photo gates. Before and after comparisons were performed using paired sample t-tests. Thirty-two older women completed the study. There were no significant changes for static postural stability assessed by CoP area or velocity (P ≥ 0.218, Cohen d ≤ 0.234). The Mini-BESTest total score was significantly improved at post-intervention (23.88 ± 3.01) compared to baseline (22.56 ± 1.41, P = 0.007, d = 0.52). 10-m gait speed was significantly faster at post-intervention (1.68 ± 0.25 m/s) compared to baseline (1.57 ± 0.22 m/s, P < 0.001, d = 0.737). Although some caution is needed due to the uncontrolled study design, the results indicate that online dance training has a small effect on static postural stability but may be beneficial for gait speed and in particular dynamic postural control among older women. While the absolute increase in gait speed suggests limited clinical relevance, the change in Mini-BESTest score may reflect a clinically meaningful enhancement of dynamic postural control.

A PILOT FEASIBILITY STUDY INVESTIGATING BALANCE DELIVERY TO OLDER ADULTS WITH CHRONIC CONDITIONS IN REHAB SETTINGS

Abstract Little is known about the integration of balance exercise delivery into physical rehabilitation settings for older individuals with chronic conditions and fall risk. We assessed the feasibility, acceptability and limited efficacy of delivering evidence-based balance exercises to older adults with fall risk enrolled in cardiac rehabilitation (CR) for peripheral artery and/or cardiovascular disease through an explanatory sequential mixed methods pilot study. Phase one included a two-arm randomized trial comparing feasibility, acceptability and functional balance among 10 participants receiving an 8-week balance program delivered adjacent to CR and 10 participants receiving CR only. Phase two included semi-structured interviews to elicit perceived barriers/facilitators of program receipt. Data was analyzed using descriptive statistics to summarize feasibility and acceptability indicators and one-way ANCOVA to test balance effects (Short Physical Performance Battery [SPPB], Mini-BESTest). Qualitative data was analyzed through content analysis. Participants had a mean age of 72.3 (7.3). On average, treatment group participants attended 7.2 (1.8) out of 8 meetings and self-reported completion of 4.5 (1.8) exercise sessions/week. Adjusting for baseline values, the treatment group exhibited greater changes in the SPPB than the usual care group after 8 weeks (10.71±0.36 vs. 9.59±0.36; adjusted difference=1.13 [95% CI, 0.3,2.2]; p=0.045). Mini-BESTest scores were not significantly different (p=0.061). Participants expressed satisfaction with program duration and frequency, quality of instructional materials, challenge level, ease of home exercise completion, convenient delivery location, and improved balance self-awareness/skills. These findings could inform the design of future efficacy trials investigating balance integration within CR settings to improve reach of fall prevention efforts.

Comparative Analysis of the Impact of Virtual Reality Training and Conventional Physiotherapy on Balance and Gait in Older Adults with Parkinson's Disease

Background: Parkinson's disease (PD) is a neurodegenerative condition predominantly manifesting in motor impairments, notably in balance and gait. Recent advancements have highlighted Virtual Reality (VR) training as a potent alternative or adjunct to conventional physiotherapy (CPT) for the rehabilitation of these motor disturbances in PD patients. Objective: This study aimed to evaluate and compare the efficacy of VR training and CPT in ameliorating balance and gait issues in older adults diagnosed with PD. Methods: In this randomized controlled trial, 56 patients with PD were assigned either to VR training or to CPT. The VR training entailed immersive and interactive exercises specifically designed for balance and gait enhancement using VR technology. Conversely, CPT consisted of traditional exercises targeting similar motor skills. Standardized assessments for balance and gait were administered both prior to and following the intervention to all participants. Results: The intervention demonstrated that VR training led to more pronounced improvements in balance and gait parameters as compared to CPT. Notably, the Timed Up and Go test (TUG) exhibited an improvement of 4.2 seconds in the VR group versus 3.6 seconds in the CPT group, a difference statistically significant (p&lt;0.05). Similarly, the Berg Balance Scale (BBS) scores increased by 12.4 points in the VR group and 10.8 points in the CPT group, again showing a significant advantage for VR (p&lt;0.05). The Mini-BESTest scores improved by 2.6 points in the VR group compared to 2.1 points in the CPT group, reinforcing the superiority of VR (p&lt;0.05). Conclusion: The study conclusively finds that VR training surpasses CPT in enhancing balance and gait in older adults with PD. Offering an immersive, engaging, and tailored therapeutic environment, VR training emerges as a potent modality for augmenting rehabilitation outcomes in this demographic.

Effects of HiBalance training program on physical function of individuals with idiopathic Parkinson disease: a systematic review and meta-analysis.

The effectiveness of the HiBalance training program for individuals with Parkinson disease (PD) remains debated, prompting a systematic investigation. This study aims to assess whether the HiBalance training program yields favorable outcomes on physical function and self-reported function measures in PD individuals. A systematic search across PubMed, Cochrane Library, Ovid, Scopus, and PEDro databases identified studies exploring HiBalance training's impact on physical function in idiopathic PD. Publication date restrictions were not applied. Two independent reviewers evaluated bias risk using the Cochrane Risk of Bias tool and study quality using the PEDro scale. Effect size (standardized mean difference, SMD) and heterogeneity (Higgins I2) were determined. Six studies underwent qualitative analysis, with two randomized-controlled trials and one multi-center clinical trial being included in the meta-analysis. HiBalance training exhibited a significant impact on physical function (SMD = 0.49; P = 0.0003). The Mini-BESTest score and gait velocity displayed improvements with moderate-effect sizes. However, solely gait velocity showed clinical enhancement. Yet, these benefits did not remain at the 6- and 12-month follow-ups post-intervention. Self-reported function measures showed no alteration post-HiBalance training. Publication bias was absent. HiBalance training led to clinically significant improvements solely in gait velocity, though these gains waned over time. The findings suggest the necessity of refining the HiBalance program to sustain positive outcomes and ensure lasting enhancements. This underscores the importance of post-HiBalance training exercise programs to maintain benefits in the long term. The protocol of this review and meta-analysis was registered at PROSPERO (CRD42022325649). Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022325649 .

Exploring mobility dysfunction in people with and without impaired cognition in Parkinson disease

IntroductionThe relationship between mobility and cognition has been studied in the aging population and associations have been also reported in people with Parkinson's disease (PD). ObjectiveTo compare different aspects of gait and balance between individuals with PD who have normal cognition and those with impaired cognition, using both clinical and instrumented measures. MethodsOne-hundred forty-three participants with PD were divided into two groups: 1) normal cognition (n = 71) and 2) impaired cognition (n = 72) based on the Montreal Cognitive Assessment (MoCA) cut-off. Groups were compared using instrumented and clinical measures of gait and balance in the following domains: Sensory Orientation, Anticipatory Postural Adjustments, Automatic Postural Responses and Dynamic Balance for Gait. Instrumented measures were obtained via wearable sensors while performing eight different motor tasks and clinical measures were obtained with the Mini-BESTest. ResultsThe total Mini-BESTest score was not different between groups. However, the Dynamic Gait domain was worse in individuals with impaired cognition. Among the instrumented measures across domains, all significant group differences were in the Dynamic Gait domain, specifically, dual-task gait speed, dual-task stride length, stance time, and turn velocity. ConclusionsDynamic balance during gait was more impaired in people with PD who had abnormal cognition than those with normal cognition, for both clinical and instrumented measures. All other balance domains did not differ between groups, for both instrumented and clinical measures.

Fall Prevalence and Associated Risk Factors in the Hospitalised Adult Population: A Crucial Step Towards Improved Hospital Care.

Background Falls among the adult population are a major global health concern with severe repercussions for individuals and healthcare systems. The purpose of this study was to investigate the prevalence and associated risk factors of falls in hospitalized patients in order to improve hospital care for elderly adults. Materials and methods The research was conducted at two institutions of tertiary care in Abbottabad, Pakistan. After extensive screening and obtaining informed consent, a total of 210 participants aged 50 and older were enrolled in the study. Mental status, history of falls, ambulation/elimination status, vision, gait/balance, systolic blood pressure, medication use, and predisposing diseases were evaluated using the Long Term Care Fall Risk Assessment Form. Additionally, the Dynamic Gait Index was utilized to evaluate various aspects of gait. Results 58.6% of participants reported a history of falls in the previous year, according to the findings. BMI, imbalance, vertigo, and fear of falling were significantly associated with an increased risk of falls in older individuals. The Long-Term Care Fall Risk Assessment, the Montreal Cognitive Assessment (MoCA), the Dynamic Gait Index (DGI), and the Mini-BESTest scores revealed that patients with a history of falls had inferior functional and cognitive outcomes. Falls were more common among individuals with a robust BMI, especially men. Conclusions The study results highlight the multifactorial nature of falls in the adult population and the need for targeted interventions to address modifiable risk factors. To enhance hospital care for high-risk patients, proactive fall prevention strategies, including regular risk assessments and individualized interventions, should be implemented. This study provides important insights into the prevalence and causes of accidents among hospitalized patients, particularly in developing nations such as Pakistan. ​​​​​​.

Mini-BESTest cutoff points for classifying fallers and non-fallers female older adults

BACKGROUND: The Mini-Balance Evaluation Systems Test (Mini-BESTest) is an efficient screening tool healthcare professionals use to predict the risk of falls in older adults. However, the Mini-BESTest cutoff scores to classify fallers and non-fallers were established using men and women in the same sample. Considering the higher number and prevalence of falls in older women, it is important to know the Mini-BESTest accuracy and the cutoff score specifically for this population. AIM: We examined the capability and accuracy of the Mini-BESTest for identifying fallers and non-fallers female older adults without neurological impairments and established the cutoff scores according to different age groups. METHOD:Eighty-one female older adults were classified into fallers (n=40) and non-fallers (n=41) groups according to their retrospective history of falls in the last 12 months. Fallers and non-fallers were divided into three age groups according to the following ranges: 65-69 years, 70-74 years, and 75+ years. We used the receiver operating characteristic (ROC) curves to determine the relative performances of the Mini-BESTest score for classifying participants with and without a history of falls. RESULTS: The Mini-BESTest is a good and highly accurate tool for identifying female Brazilian fallers and non-fallers. The Mini-BESTest cutoff scores established to classify fallers and non-fallers female older adults in the different age groups were 26 points for 65-69 years and 24 points for 70-74 years and 75+ years. INTERPRETATION: The Mini-BESTest is an important tool that health professionals in clinical practice can use to estimate the risk of falls for older Brazilian women.

#6031 ASSOCIATION BETWEEN THE MINI-BESTEST AND POSTUROGRAPHY IN PATIENTS ON HEMODIALYSIS

Abstract Background and Aims Patients on hemodialysis present complications due chronic kidney disease and hemodialysis treatment that compromise postural balance. Posturography is the gold standard device for measuring postural balance; however, its cost limits the use of this method for routine patient evaluation. Alternatively, the Mini Balance Evaluation Systems Test (Mini-BESTest) have been used to evaluate postural balance, as it is inexpensive and has high test-retest reliability. Therefore, the aim of this study was to evaluate the association between the Mini-BESTest and posturography in patients on hemodialysis. Method A cross-sectional study was conducted with patients aged ≥18 years who were undergoing hemodialysis treatment for at least three months. Patients were excluded if presented physical or cognitive incapable to perform the proposed tests, assisted gait, uncorrected visual impairments, severe and unstable comorbidities, and hospitalization in the past three months. Postural balance was evaluated by the Mini-BESTest and posturography [a force plate recorded the center of pressure (COP) path length in a static position with eyes opened (EO) and eyes closed (EC) on a firm surface]. The normality of the data was analyzed using the Shapiro‒Wilk test. The associations between Mini-BESTest score and COP path length in the EO and EC were tested using Spearman´s correlation coefficients. Then, two multiple linear regression models were constructed with COP path length in the EO and EC as the dependent variable and Mini-BESTest score and potential confounders (age, gender, diabetes mellitus, body index mass, hemodialysis efficiency index, and hemoglobin) as independent variables. A p value &amp;lt;0.05 was considered as statistically significant. Results This study included 109 patients (58.4 ± 12.9 years, 57.8% male). The Mini-BESTest was correlated with COP path length in the EO (ρ = -0.365, p &amp;lt; 0.001) and EC (ρ = -0.279, p = 0.003). The multiple linear regression models showed an association of the Mini-BESTest with COP path length in the EO (R2 = 0.28; adjusted R2 = 0.23; p &amp;lt; 0.001) and EC (R2 = 0.26; adjusted R2 = 0.20; p &amp;lt; 0.001). Conclusion The Mini-BESTest was associated with posturography in patients on hemodialysis. Therefore, the Mini-BESTest is a feasible test to evaluate postural balance in clinical routine practice during the physical function evaluation of these patients.

Comparison of the immediate effects of plantar vibration of both feet with the plantar vibration of the affected foot on balance in patients with stroke: Preliminary findings

ObjectivePlantar vibration is one of the strategies to enhance balance in stroke patients. This study compared the effects of the plantar vibration of both feet and the plantar vibration of the most affected side in patients with stroke. MethodsThis study was a single-blind clinical trial. Post-stroke patients with balance impairment were enrolled in the study and underwent two treatment sessions with a one-week interval. They received both feet's plantar vibration in one session and plantar vibration of the most affected side in the other session (frequency 100 Hz, 5 min). Mini-BESTest, Modified Modified Ashworth Scale (MMAS), and Semmes-Weinstein monofilament examination (SWME) were used to evaluate balance, spasticity, and plantar sensation, before and after the treatment sessions. ResultsTen patients with a mean age of 52.9 (SD = 5.48) years were enrolled in the study. Mini-BESTest scores of balance and plantar flexor muscle spasticity were significantly improved after both feet plantar vibration and plantar vibration of the more affected side. There was no significant difference between the effectiveness of both sides plantar vibration and the most affected side plantar vibration. There were no significant improvements in SWME sensory scores after plantar vibration of either both sides or the most affected side. ConclusionPlantar vibration of both sides had no additional benefits in this group of patients with chronic stroke. Plantar vibration of more affected side can be used for improving balance and plantar flexor spasticity post-stroke. The Plantar vibration had no effects on the affected foot sensibility.

Assessing balance in people with bilateral vestibulopathy using the Mini-Balance Evaluation Systems Test (Mini-BESTest): feasibility and comparison with healthy control data

ObjectivesBilateral vestibulopathy (BVP) leads to unsteadiness when walking, which worsens in darkness or on uneven ground, as well as falls. Since simple balance tests struggle to distinguish between BVP and healthy participants, we aimed (1) to test if the Mini-BESTest is feasible in BVP, (2) how people with BVP perform on the Mini-BESTest and (3) to compare these scores with healthy reference data.MethodsFifty participants with BVP completed the Mini-BESTest. 12-month falls incidence was obtained by questionnaire. To compare the overall and sub-scores between our participants with BVP and those of healthy participants from the literature (n = 327; obtained via PubMed searches), Mann–Whitney U tests were used. Sub scores within the BVP group were also compared. Spearman correlations were used to investigate the relationships between Mini-BESTest score and age.ResultsNo floor or ceiling effects were observed. Participants with BVP had significantly lower Mini-BESTest total scores than the healthy group. Anticipatory, reactive postural control and sensory orientation sub scores of the Mini-BESTest were significantly lower in BVP, while dynamic gait sub scores were not significantly different. A stronger negative correlation between age and Mini-BESTest total score was found in BVP than in the healthy group. Scores did not differ between patients with different falls history.ConclusionThe Mini-BESTest is feasible in BVP. Our results confirm the commonly reported balance deficits in BVP. The stronger negative association between age and balance in BVP might reflect the age-related decline in the remaining sensory systems with which people with BVP compensate.

Evaluation of Hemiplegic Gait Based on Plantar Pressure and Inertial Sensors

Gait quantitative evaluation plays an important role in indicating gait ability, comparing the effects of different rehabilitation programs, and indicating rehabilitation plans. However, traditional gait quantitative evaluation methods are mostly based on a variety of gait subscales and rely on doctors’ evaluations. Moreover, patients need to cooperate to complete a variety of movements, which is highly complex. To achieve objective gait assessment and reduce the difficulty of gait assessment and the dependence on doctors, we attempted to use inertial measurement units (IMUs) and plantar pressure insole sensors for gait quantitative assessment. We collected information on various joint angles and plantar pressure insole of stroke patients and healthy people during walking and scored the patients with the Mini Balance Evaluation System (Mini-BES) Test. Then, based on the collected data, we performed gait division and feature extraction and used the random forest to obtain the feature importance. Finally, we used the importance-weighted Euclidean distance to characterize the walking ability and compared it with the Mini-BES test score. The experimental results demonstrate that the wearable device has good accuracy for gait assessment, and the collected data has good repeatability. The linear correlation between the extracted distance score and the Mini-BES test score is -0.94. Thus, it is feasible to use wearable devices to evaluate lower limb rehabilitation through a walking test, which could potentially replace the complex Mini-BES test.

The effect of perturbation-based balance training on balance control and fear of falling in older adults: a single-blind randomised controlled trial

BackgroundPerturbation-based balance training (PBT) is an emerging intervention shown to improve balance recovery responses and reduce falls in everyday life in older adults. However, perturbation interventions were heterogeneous in nature and need improvement. This study aims to investigate the effects of a PBT protocol that was designed to address previously identified challenges of PBT, in addition to usual care, on balance control and fear of falling in older adults at increased risk of falling.MethodsCommunity-dwelling older adults (age ≥ 65 years) who visited the hospital outpatient clinic due to a fall incident were included. Participants received PBT in addition to usual care (referral to a physiotherapist) versus usual care alone. PBT consisted of three 30-minute sessions in three weeks. Unilateral treadmill belt accelerations and decelerations and platform perturbations (shifts and tilts) were applied during standing and walking on the Computer Assisted Rehabilitation Environment (CAREN, Motek Medical BV). This dual-belt treadmill embedded in a motion platform with 6 degrees of freedom is surrounded by a 180° screen on which virtual reality environments are projected. Duration and contents of the training were standardised, while training progression was individualised. Fear of falling (FES-I) and balance control (Mini-BESTest) were assessed at baseline and one week post-intervention. Primary analysis compared changes in outcome measures between groups using Mann-Whitney U tests.ResultsEighty-two participants were included (PBT group n = 39), with a median age of 73 years (IQR 8 years). Median Mini-BESTest scores did not clinically relevantly improve and were not significantly different between groups post-intervention (p = 0.87). FES-I scores did not change in either group.ConclusionsParticipation in a PBT program including multiple perturbation types and directions did not lead to different effects than usual care on clinical measures of balance control or fear of falling in community-dwelling older adults with a recent history of falls. More research is needed to explore how to modulate PBT training dose, and which clinical outcomes are most suitable to measure training effects on balance control.Trial registrationNederlands Trial Register NL7680. Registered 17-04-2019 – retrospectively registered. https://www.trialregister.nl/trial/7680.

Predictors of balance in individuals with Parkinson’s disease: A cross-sectional study

IntroductionSome previous studies investigated predictors of balance in individuals with Parkinson's Disease (PD). However, outcomes commonly evaluated in the rehabilitation of individuals with PD that could predict balance deficits have not yet been investigated. ObjectiveTo determine whether the variables muscle strength, physical activity and depression are predictors of balance in individuals with PD. Material and methodsThis is a cross-sectional study in which the investigated variables included: trunk and knee extensors’ muscle strength (modified sphygmomanometer test - MST), physical activity level (Adjusted Human Activity Profile score) and depression (Patient Health Questionnaire-9 - PHQ-9). The outcome variable was balance, as assessed by the Mini-BESTest. Multiple regression analysis was used to determine which predictor variables explain the outcome variable. ResultsA total of 50 individuals with PD, mean age 67 ± 8.8 years, 68% male, 40% HY 2.5 were included. The mean value of the dominant limb extensor muscle strength was 139 ± 45 mmHg, and the mean trunk extensor muscle strength value was 81.9 ± 19 mmHg. More than half of the sample (52%, n = 26) was classified as moderately active. Most of the sample (78%) had mild depression. The average Mini-BESTest score was 21 ± 5.4. The physical activity level explained 29% of the balance variance. When depression was included in the model, the explained variance increased to 35%. The other independent variables were not included in the model. ConclusionThe findings of the present study showed that the physical activity level and depression were able to explain 35% of the balance variation.

Effects of Home-Based Boxing Training on Trunk Performance, Balance, and Enjoyment of Patients With Chronic Stroke.

To investigate the effect of 6 weeks of home-based boxing training on trunk performance, balance, fear of falling, and level of therapy enjoyment in individuals with chronic stroke. Eighteen participants with chronic stroke were randomly divided into boxing and control groups (9 patients per group). The boxing group received home-based boxing training for 25 minutes plus balance and trunk exercise training for 15 minutes, while the control group received only home-based balance and trunk exercise training for 40 minutes, three days a week for 6 weeks. The Trunk Impairment Scale (TIS), Mini-Balance Evaluation Systems Test (Mini-BESTest), Activities-specific Balance Confidence (ABC) scale, and Physical Activity Enjoyment Scale (PACES) were assessed at baseline, and at 2, 4, and 6 weeks post-training. The Wilcoxon signed rank test and Mann-Whitney U-test were used to determine differences between pre- and post-training within and between groups. Statistical significance was set at p<0.05. The TIS scores significantly increased from 13 to 17 points in the boxing group (p<0.05) compared to an increase from 15 to 17 points in the control group (p<0.05). The Mini-BESTest scores significantly increased from 14 to 22 points in the boxing group (p<0.05) compared to an increase from 17 to 20 points in the control group (p<0.05). There were no differences in the TIS, Mini-BESTest, ABC, and PACES scores between the two groups. Home-based boxing training with balance and trunk exercise training had a similar training effect compared to home-based balance and trunk exercise training.

Balance Function after Balance Exercise Assist Robot Therapy in Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation: A Pilot Study.

This study compared the balance function in patients after allogeneic hematopoietic stem cell transplantation (allo-HSCT) with their balance function after subsequent training sessions with a Balance Exercise Assist Robot (BEAR). In this prospective observational study, inpatients who underwent allo-HSCT from human leukocyte antigen-mismatched relatives were enrolled from December 2015 to October 2017. Patients were allowed to leave their clean room after allo-HSCT and underwent balance exercise training using the BEAR. Sessions (20-40 min) were performed 5 days per week and consisted of three games that were performed four times each. A total of 15 sessions were performed by each patient. Patient balance function was assessed before BEAR therapy according to the mini-balance evaluation systems test (mini-BESTest), and patients were divided into two groups (Low and High) based on a 70% cut-off value for the total mini-BESTest score. Patient balance was also assessed after BEAR therapy. Fourteen patients providing written informed consent fulfilled the protocol: six patients in the Low group, and eight patients in the High group. In the Low group, there was a statistically significant difference between pre- and post-evaluations in postural response, which a sub-item of the mini-BESTest. In the High group, there was no significant difference between pre- and post-evaluations in the mini-BESTest. BEAR sessions improve balance function in patients undergoing allo-HSCT.

Cutoff Point of Mini-Balance Evaluation Systems Test Scores for Elderly Estimated by Center of Pressure Measurements by Linear Regression and Decision Tree Classification.

Understanding balance ability and assessing the risk of possible falls are very important for elderly rehabilitation. The Mini-Balanced Evaluation System Test (Mini-BESTest) is an important survey for older adults to evaluate subject balance, but it is not easy to complete due to various limitations of physical activities, including occasional fear of injury. A center of pressure (CoP) signal can be extracted from a force pressure plate with a short recording time, and it is relatively achievable to ask subjects to stand on a force pressure plate in a clinical environment. The goal of this study is to estimate the cutoff score of Mini-BESTest scores from CoP data. CoP signals from a human balance evaluation database with data from 75 people were used. Time domain, frequency domain, and nonlinear domain parameters of 60 s CoP signals were extracted to classify different cutoff point scores for both linear regression and a decision tree algorithm. Classification performances were evaluated by accuracy and area under a receiver operating characteristic curve. The correlation coefficient between real and estimated Mini-BESTest scores by linear regression is 0.16. Instead of linear regression, binary classification accuracy above or below a cutoff point score was developed to examine the CoP classification performance for Mini-BESTest scores. The decision tree algorithm is superior to regression analysis among scores from 16 to 20. The highest area under the curve is 0.76 at a cutoff point score of 21 for the CoP measurement condition of eyes opened on the foam, and the corresponding classification accuracy is 76.15%. CoP measurement is a potential tool to estimate corresponding balance and fall survey scores for elderly rehabilitation and is useful for clinical users.

Responsiveness of the Mini-Balance Evaluation System Test in Type 2 Diabetic Patients with Peripheral Neuropathy.

Mini-BESTest is an instrument for assessing the balance impairment; however, the use of the Mini-BESTest in type 2 diabetic patients with peripheral neuropathy is not well documented in the literature. The aim of this study was to examine the responsiveness and the minimal important change (MIC) of the Mini-BESTest after four weeks of the balance exercises. A prospective single group pretest-posttest design was applied, and forty-eight type 2 diabetic patients with peripheral neuropathy were participated (mean age of 59.04 ± 7.533 years; 3 males and 45 females). All participants were given an interventionprogram including foot care and balance exercises (50-minute sessions, three timesaweek for four weeks). The responsiveness of the Mini-BESTest was determined using two approaches: 1) the distribution-based method evaluating the change scores (pre- and post-intervention), the effect size (ES), the standard response mean (SRM), the standard error of measurement (SEM) and the minimum detectable change (MDC95) and 2) the anchor-based method evaluating the MIC using the Global Rating of Change scale (GRC) as an external criterion. After the balance exercises treatment, the Mini-BESTest scores significantly improved (p < 0.001) with an ES of 3.9 and SRM of 4.32. SEM was 0.73 and MDC95 was 2.03 points. The area under the receiver operating characteristic (ROC) curve corresponded to 81%. The cutoff point of the Mini-BESTest was ≥5 points corresponding to the GRC ≤3 versus >3 for the discrimination of the Mini-BESTest between improvement and no improvement after exercises. The Mini-BESTest can be demonstrated as high responsiveness according to the determination of the distribution-based and the anchor-based methods. The MIC of the Mini-BESTest was taken as ≥5 points and could be used as an outcome measure for the discriminated evaluation of type 2 diabetic patients with peripheral neuropathy.

The minimal clinically important difference of the mini-balance evaluation systems test in patients with early subacute stroke

ABSTRACT Background: There is insufficient evidence regarding the minimal clinically important difference (MCID) of the Mini-Balance Evaluation Systems Test (Mini-BESTest). Objective: To determine the MCID of the Mini-BESTest in patients with early subacute stroke. Patients and Methods: In this prospective cohort study, the Mini-BESTest score of 50 patients with stroke was obtained within 1 week of their admission, their Mini-BESTest and Global Rating of Change Scale (GRCS) scores were obtained at discharge. The GRCS scores were reported by both the patients and their physical therapists. We evaluated the correlation between the Mini-BESTest change scores and the GRCS by determining Spearman’s rank correlation coefficient. The MCID was calculated using 0.5× standard deviation (SD) for the distribution method and the change difference and receiver operating curve (ROC) for the anchor method. Results: The mean (SD) number of days between evaluations was 15.4 (4.8), and the Mini-BESTest score at admission was 17.7 (5.2) and 23.1 (3.5) at discharge. The correlation between the GRCS and the change in the Mini-BESTest score was 0.28 (p = .04) for the patients and 0.54 (p < .001) for the therapists. The MCID based on the distribution method was 3 points for 0.5× SD. The MCID values based on the anchor method were 2.3 for the change difference and 0.5 for the ROC in the patient-rated GRCS, and 4.2 for the change difference and 4.5 for the ROC in the physical therapist-rated GRCS. Conclusions: The MCID based on the anchor method was 4.2–4.5 points, and the MCID based on the distribution method was 2.3 points.