Comparison of 3 short-form BESTests in stroke
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Table I. Summary of the Balance Evaluation Systems Test (BESTest: S-BESTest, Brief-BESTest and Mini-BESTest)
Number of tasks
Number of items
Domains and Items of the scale
Domain I: Biomechanical Constraints
1. Base of support
2. CoM alignment
3. Ankle strength and range
4. Hip/trunk lateral strength
5. Sit on floor and standup
Domain II: Stability limits
6. Lateral Lean Paretic Side
7. Lateral lean non-paretic side
8. Verticality paretic side
9. Verticality non-paretic side
10. Functional reach-forward
11. Functional reach-lateral paretic side
12. Functional reach-lateral non-paretic side
Domain III: Anticipatory postural adjustment
13. Sit to stand
14. Rise to toes
15. Stand on paretic leg
16. Stand on non-paretic leg
17. Alternate stair touching
18. Standing arm raise
Domain IV: Reactive postural response
19. In place response-forward
20. In place response-backward
21. Compensatory stepping correction-forward
22. Compensatory stepping correction-backward
23. Compensatory stepping correction-lateral paretic side
24. Compensatory stepping correction-lateral non-paretic side
Domain V: Sensory orientation
25. Eyes open, firm surface
26. Eyes closed, firm surface
27. Eyes open, foam surface
28. Eyes closed, foam surface
29. Incline-eyes closed
Domain VI: Stability in gait
30. Gait-level surface
31. Change in gait speed
32. Walk with head turns
33. Walk with pivot turns
34. Step over obstacle
35. Timed up and go (TUG)
36. TUG with dual task
Scoring scale
Total score
Estimated time to complete, min
BESTest Mini-BESTest Brief-BESTest S-BESTest
27
36 13
16 6
8 11
13
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0–3
108
30–45
by comparing the score of time 1 and time 2 for each rater. The
S-BESTest and Brief-BESTest scores were extracted from the
relevant subset of the BESTest items. As scoring scale of the
Mini-BESTest was different from other BESTest versions (Table
I), the reliability of the Mini-BESTest was assessed separately 1
month later to prevent recall bias by using the same videotape
and repeated in 7 days.
For the assessment of validity and responsiveness, 70 patients
with stroke who were referred to physical therapy at Lerdsin
Hospital were assessed using the BESTest and BBS 3 times:
at baseline, at 2 weeks and at 4 weeks after rehabilitation. This
allowed for comparison of psychometric properties across time.
Baseline demographic and clinical information was gathered
from the patients and charts. Before testing, vital signs were
monitored to ensure stable medical status. A single therapist
administered the BESTest before the BBS on all 70 patients at
3 time-points. The scoring methods of the S-BESTest, Brief-
BESTest and Mini-BESTest were similar to those employed
in the reliability section. A 15-point Global Rating of Change
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0–2
28
10–15
Same as BESTest
24
5–7
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Same as BESTest
39
7–10
(GRC) where –7 indicates a very great deterioration, +7 indi-
cates a very great improvement and 0 indicates no change, was
also administered to the patient. Patients independently rated
the overall change (using GRC criteria) in their balance perfor-
mance at 2 weeks and at 4 weeks after rehabilitation (25). All
patients received the same verbal instruction and were allowed
to rest as long as they required. Patient’s performance was vi-
deotaped for further review and analysis. Total assessment time
was approximately 1.5 h. If the test could not be completed in
1 day, it was continued on the next day.
Data analysis
The correlations between the scores from the test and videotape
were examined using the Spearman rank-order correlations.
Correlation coefficients of 0.80 or higher indicated excellent
correlation, 0.50–0.79 indicated moderate correlation, and
0.00–0.49 indicated poor correlation (26). Intra-rater and
inter-rater reliability were calculated using ICC model 3, k
J Rehabil Med 51, 2019