Comparison of 3 short-form BESTests in stroke
Table III. Inter-rater reliability of the S-BESTest, Brief-BESTest, and Mini-BESTest in people with subacute stroke (n = 12)
Inter-rater reliability
S-BESTest
Brief-BESTest
ICC (2,5)
Total
Domain
Domain
Domain
Domain
Domain
Domain
0.95
I: Biomechanical constraints
0.91
II: Stability limits
0.96
III: Anticipatory postural adjustment 0.88
IV: Reactive postural Response
0.90
V: Sensory orientation
0.91
VI: Stability in gait
0.91
Mini-BESTest
95% CI ICC (2,5) 95% CI ICC (2,5) 95% CI
0.91–0.98
0.78–0.97
0.90–0.99
0.75–0.96
0.78–0.97
0.82–0.97
0.83–0.97 0.98
0.97
0.99
0.96
0.98
0.99
0.97 0.97–0.99
0.93–0.99
0.98–0.99
0.91–0.99
0.95–0.99
0.98–0.99
0.94–0.99 0.98
–
–
0.92
0.97
0.86
0.97 0.96–0.99
–
–
0.84–0.97
0.94–0.99
0.72–0.95
0.95–0.99
All intraclass correlation coefficient (ICCs) were significant, with p-value of < 0.001. 95% CI: 95% confidence interval.
the Brief-BESTest had the highest number of patients
who had the maximum score (15.7%).
Internal responsiveness
After 2 and 4 weeks of rehabilitation, the majority of
patients showed improvement of balance performance
as demonstrated by significant increases in total scores
of the S-BESTest, Brief-BESTest, Mini-BESTest, and
BESTest (Table VI). Those score changes were larger
Table IV. Demographic and clinical characteristics of patients
with subacute stroke (n = 70) in validity and responsiveness study
687
Characteristics Mean (SD) Range
Age, years
Sex, M/F, n
Time since stroke, days
Type of stroke ischaemic/haemorrhagic, n
Affected side (right/left), n
MMSE (/30)
FM-LE (/34)
BBS (/56)
S-BESTest (/39)
Brief-BESTest (/24)
Mini-BESTest (/28)
BESTest (/108) 55.24 (12.11)
44/26
15.81 (15.6)
64/6
37/33
27.33 (1.87)
19.39 (10.06)
31.24 (19.96)
17.41 (12.73)
8.80 (7.46)
10.93 (8.58)
55.26 (34.15) 30–77
7–103
24–30
2–34
0–56
0–39
0–23
0–26
0–104
MMSE: Mini-Mental State Examination; FM-LE: Fugl-Meyer Stroke Assessment–
lower extremity motor subscale; BBS: Berg Balance Scale; S-BESTest: Stroke-
Balance Evaluation Systems Test; Brief-BESTest: Brief-Balance Evaluation
Systems Test; Mini-BESTest: Mini-Balance Evaluation Systems Test; BESTest:
Balance Evaluation Systems Test; SD: standard deviation.
during 0–2 weeks than 2–4 weeks in all BESTest
versions, indicating larger recovery at 0–2 weeks.
The number of patients who had no change in score
post-rehabilitation was seen only when assessing with
the BESTest. The highest number of those who had
no change in score was found when using the Brief-
BESTest at 2–4 weeks post-rehabilitation. The SRM
of the S-BESTest, Brief-BESTest, Mini-BESTest, and
BESTest were large, ranging from 1.19 to 1.57, in-
dicating sufficient internal responsiveness. Minimal
Table V. Floor and ceiling effect of the S-BESTest, Brief-BESTest,
Mini-BESTest, and BESTest
Patients with subacute stroke
(n = 70)
S-BESTest
Floor effect
Ceiling effect
Brief-BESTest
Floor effect
Ceiling effect
Mini-BESTest
Floor effect
Ceiling effect
BESTest
Floor effect
Ceiling effect
Baseline
n (%) 2 weeks
n (%)
4 weeks
n (%)
13 (18.6)
0 (0.0) 3 (4.3)
3 (4.3) 0 (0.0)
8 (11.4)
14 (20)
0 (0.0) 2 (2.9)
3 (4.3) 0 (0.0)
11 (15.7)
15 (21.4)
0 (0.0) 4 (5.7)
2 (2.9) 0 (0.0)
5 (7.1)
4 (5.7)
0 (0.0) 0 (0.0)
0 (0.0) 0 (0.0)
3 (4.3)
S-BESTest: Stroke-Balance Evaluation Systems Test; Brief-BESTest: Brief-
Balance Evaluation Systems Test; Mini-BESTest: Mini-Balance Evaluation
Systems Test; BESTest: Balance Evaluation Systems Test
Table VI. Internal responsiveness of the S-BESTest total score, the Brief-BESTest total score, the Mini-BESTest total score, and the
BESTest total score measure at 0–2 weeks and 2–4 weeks after physical therapy rehabilitation
Balance assessment
S-BESTest (/39)
0–2 weeks
2–4 weeks
Brief-BESTest (/24)
0–2 weeks
2–4 weeks
Mini-BESTest (/28)
0–2 weeks
2–4 weeks
BESTest (/108)
0–2 weeks
2–4 weeks
Before
Mean (SD) After
Mean (SD)
17.41 (12.73)
25.27 (10.93) 25.27 (10.93)
30.31 (7.93)
8.79 (7.46)
14.24 (7.00)
Change
Mean (SD)
SRM No change
n (%) MDC95
7.86 (6.14)*
5.04 (3.91)* 1.28
1.29 2 (2.86)
5 (7.14) 4.99
4.28
14.24 (7.00)
17.99 (5.19) 5.46 (3.47)*
3.74 (2.82)* 1.57
1.33 3 (4.28)
9 (12.86) 2.92
2.74
10.93 (8.58)
16.14 (8.58) 16.14 (8.58)
19.94 (6.62) 5.21 (4.06)*
3.80 (3.18)* 1.28
1.19 4 (5.71)
4 (5.71) 3.35
3.35
55.23 (34.15)
77.29 (26.32) 77.29 (26.32)
90.66 (16.98) 22.06 (17.90)*
13.37 (10.85)* 1.23
1.23 1 (1.43)
0 (0) 9.47
7.29
*Significant difference between before and after rehabilitation (p < 0.001).
SD: standard deviation; SRM: standardized response mean; n (%) no change: number of patients showed no change in score; MDC95: minimal detectable
change at 95% confidence interval.
J Rehabil Med 51, 2019