688
T. Winairuk et al.
Table VII. Minimal clinically important difference (MCID) and related parameters of the S-BESTest, the Brief-BESTest, the Mini-BESTest,
and the BESTest to identify balance improvement using the Berg Balance Scale (BBS) as reference
External responsiveness
0–2 weeks
MCID
AUC
Sensitivity
Specificity
LR+
LR–
Post-test accuracy, %
2–4 weeks
MCID
AUC
Sensitivity
Specificity
LR+
LR–
Post-test accuracy, %
S-BESTest (/39) Brief-BESTest (/24) Mini-BESTest (/28) BESTest (/108)
6.5
0.84 (0.75–0.94)
0.78 (0.60–0.91)
0.82 (0.66–0.92)
4.24
0.27
80 5.5
0. 77* , ** (0.66–0.88)
0.63 (0.46–0.78)
0.84 (0.67–0.95)
4.04
0.44
70 7.5
0.68* , ** (0.56–0.81)
0.91 (0.75–0.98)
0.39 (0.24–0.57)
1.50
0.24
63 18.5
0.89 (0.82–0.98)
0.79 (0.63–0.90)
0.94 (0.79–0.99)
12.63
0.22
83
5.5
0.89 (0.82–0.97)
0.78 (0.65–0.89)
0.84 (0.60–0.97)
4.97
0.26
80 4.5
0.79* , ** (0.68–0.91)
0.74 (0.49–0.91)
0.72 (0.58–0.84)
2.68
0.36
66 4.5
0.79* , ** (0.67–0.91)
0.78 (0.65–0.89)
0.74 (0.49–0.91)
2.98
0.29
77 13.5
0.89 (0.81–0.98)
0.89 (0.67–0.99)
0.86 (0.74–0.94)
6.52
0.12
87
*Significant difference of AUC with the BESTest (p < 0.01).
**Significant difference of AUC with the S-BESTest (p < 0.01).
CI: confidence interval; AUC: area under the curve; LR+: positive likelihood ratio; LR–: negative likelihood ratio.
detectable change at 95% confidence interval (95% CI)
(MDC 95 ) of the S-BESTest, Brief-BESTest, and Mini-
BESTest measured at 0–2 weeks were comparable to
those measured at 2–4 weeks, except the MDC 95 of the
BESTest at 0–2 weeks was higher than that at 2–4 weeks.
External responsiveness
The external responsiveness using the BBS as refe-
rence is shown in Table VII. MCID of all BESTest
versions at 0–2 weeks were higher than at 2–4 weeks,
indicating larger recovery at 0–2 weeks. The AUC of
the S-BESTest and BESTest were significantly higher
than the Brief-BESTest and Mini-BESTest, reflecting
better accuracy of the S-BESTest and BESTest in iden-
tifying patients with subacute stroke who had balance
improvement using the proposed MCID (Fig. 1). This
was also supported by higher post-test accuracy (80%
or more) and meaningful LR+/LR– of the S-BESTest
and BESTest.
Table VIII shows the external responsiveness, using
the GRC as reference. It can be seen that the AUC
values using the GRC as reference were lower than
AUC values calculated by using the BBS as reference.
None of the AUC using the GRC as reference sho-
wed excellent discrimination to identify patients with
subacute stroke who had balance improvement (< 0.8).
The proposed MCID was varied among all BESTest
versions with low post-test accuracy, especially at 2–4
weeks, and the LR+/LR– fell outside of the acceptable
range. These results indicated that the MCID using
the GRC as reference had low accuracy in correctly
identifying patients with subacute stroke who have
balance improvement.
Table VIII. Minimal clinically important difference (MCID) and related parameters of the S-BESTest, the Brief-BESTest, the Mini-BESTest,
and the BESTest to identify balance improvement using the global rating of change (GRC) as reference
External responsiveness
0–2 weeks
MCID
AUC
Sensitivity
Specificity
LR+
LR–
Post-test accuracy, %
2–4 weeks
MCID
AUC
Sensitivity
Specificity
LR+
LR–
Post-test accuracy, %
S-BESTest (/39) Brief-BESTest (/24) Mini-BESTest (/28) BESTest (/108)
2.5
0.73 (0.55–0.91)
0.50 (0.23–0.77)
0.91 (0.80–0.97)
5.60
0.55
83 4.5
0.73 (0.56–0.90)
0.66 (0.52–0.78)
0.71 (0.42–0.92)
2.31
0.47
74 1.5
0.71 (0.54–0.88)
0.93 (0.83–0.98)
0.43 (0.18–0.71)
1.62
0.17
83 8.5
0.71 (0.53–0.88)
0.86 (0.74–0.94)
0.57 (0.29–0.82)
2.00
0.25
77
4.5
0.69 (0.38–1)
1 (0.16–1)
0.44 (0.32–0.57)
1.79
0
56 3.5
0.68 (0.42–0.93)
1 (0.16–1)
0.51 (0.39–0.64)
2.06
0
41 3.5
0.69 (0.40–1)
0.47 (0.35–0.60)
1 (0.16–1)
0
0.53
53 2.5
0.50 (–0.35–1)
0.50 (0.01–0.99)
0.91 (0.82–0.97)
5.67
0.55
5
CI: confidence interval; AUC: area under the curve; LR+: positive likelihood ratio; LR–: negative likelihood ratio.
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