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Pennell A, Fisher J, Patey M, Miedema ST, Stodden D, Lieberman L, Webster C, Brian A. Measurement properties of Brief-BESTest scores from children, adolescents, and youth with visual impairments. Disabil Rehabil 2023:1-10. [PMID: 38037853 DOI: 10.1080/09638288.2023.2288935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/23/2023] [Indexed: 12/02/2023]
Abstract
Purpose: This study aimed to vet the measurement properties of Brief-BESTest scores in children, adolescents, and youth with visual impairment and blindness (YVI). Methods: A cross-sectional sample of YVI (N = 101) completed the Brief-BESTest, a modified version of the Y-Balance Test, the 360-degree turn test, bipedal quiet stance, and Activity-Specific Balance Confidence Scales. Thirty-seven YVI completed test-retest of the Brief-BESTest using a one-year interval. Using classical test theory, various forms of total and item-level Brief-BESTest score reliability and validity were investigated in YVI. Results: All inter-rater reliability coefficients were ≥ .80. When considering the eight items of the Brief-BESTest, 27 of the 28 possible correlations were statistically significant (p<.05). Various internal consistency and item difficulty results were strong. When taking total Brief-BESTest scores and their association with the complementary balance tasks/metrics into account, 11 of 13 associations were statistically significant (p<.05) providing strong convergent validity evidence. Being multimorbid and degree of vision significantly predicted total Brief-BESTest scores (p<.001) suggesting construct (i.e. known groups) validity. Numerous test-retest results (e.g. coefficients, limits of agreement) following the one-year interval were indicative of score stability. Conclusion: Practitioners and researchers should have confidence in, and consider adopting, the Brief-BESTest to examine multidimensional balance in YVI.
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Affiliation(s)
- Adam Pennell
- Natural Science Division, Pepperdine University, Malibu, CA, USA
| | - Jenna Fisher
- Department of Secondary Education and K-12 Health and Physical Education, West Chester University of Pennsylvania, West Chester, PA, USA
| | - Matthew Patey
- Department of Health & Kinesiology, Bridgewater State University, Bridgewater, MA, USA
| | - Sally Taunton Miedema
- Department of Educational and Developmental Science, University of South Carolina, Columbia, SC, USA
| | - David Stodden
- Department of Educational and Developmental Science, University of South Carolina, Columbia, SC, USA
| | - Lauren Lieberman
- Department of Kinesiology, Sports Studies & Physical Education, SUNY Brockport, Brockport, NY, USA
| | - Collin Webster
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham Dubai, Dubai, UAE
| | - Ali Brian
- Department of Educational and Developmental Science, University of South Carolina, Columbia, SC, USA
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Haselwander M, Henes Y, Weisbrod M, Diermayr G. [Balance Evaluation Systems Test: German translation, cultural adaptation and preliminary results on psychometric properties]. Z Gerontol Geriatr 2023; 56:125-131. [PMID: 35119528 PMCID: PMC10011337 DOI: 10.1007/s00391-022-02023-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/10/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND The Balance Evaluation Systems Test (BESTest) evaluates balance ability and identifies affected systems associated with balance deficits. OBJECTIVE The primary objective was the translation and cultural adaptation of the BESTest into German. Secondary objective was the preliminary evaluation of psychometric properties of the BESTest. METHOD In accordance with international guidelines, the BESTest was translated and adapted by a 7-step process. To test the psychometric properties, persons with subjective or objective balance deficits were included. Internal consistency was evaluated by means of Cronbach's alpha. The criterion validity was tested by measuring the correlation with the Berg Balance Scale (BBS). Construct validity was examined using the Activities-Specific Balance Confidence (ABC-D) scale and the known groups methods (fallers versus non-fallers). RESULTS A total of 27 subjects were included in the testing of the psychometric properties. Cronbach's alpha was 0.95 for the total scale. The correlation of BESTest scores with those of the BBS revealed a Spearmen's ρ of 0.84 (p < 0.001) and 0.61 (p < 0.001) with those of the ABC‑D scale. Fallers and non-fallers showed a trend towards different BESTest scores (p = 0.057). DISCUSSION This paper provides a German translation of the BESTest authorized by the developer. Our preliminary results confirm reliability and validity.
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Affiliation(s)
- Maren Haselwander
- Fakultät für Therapiewissenschaften, SRH Hochschule Heidelberg, Maria-Probst-Str. 3, 69123, Heidelberg, Deutschland.
| | - Yannick Henes
- Fakultät für Therapiewissenschaften, SRH Hochschule Heidelberg, Maria-Probst-Str. 3, 69123, Heidelberg, Deutschland
| | - Matthias Weisbrod
- Abteilung für Allgemeine Psychiatrie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Heidelberg, Voßstraße 2, 69115, Heidelberg, Deutschland.,Abteilung für Psychiatrie und Psychotherapie, SRH Klinikum Karlsbad - Langensteinbach, Guttmannstraße 1, 76307, Karlsbad, Deutschland
| | - Gudrun Diermayr
- Fakultät für Therapiewissenschaften, SRH Hochschule Heidelberg, Maria-Probst-Str. 3, 69123, Heidelberg, Deutschland
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Nakhostin-Ansari A, Nakhostin Ansari N, Mellat-Ardakani M, Nematizad M, Naghdi S, Babaki M, Farhangian M, Habibi AH, Tafakhori A, Hasson S. Reliability and validity of Persian versions of Mini-BESTest and Brief-BESTest in persons with Parkinson's disease. Physiother Theory Pract 2022; 38:1264-1272. [PMID: 32960126 DOI: 10.1080/09593985.2020.1822967] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Mini-BESTest and Brief-BESTest are used to assess balance in patients with a wide range of balance disorders. While there are Persian versions of Mini-BESTest and Brief-BESTest, the psychometric properties have not been thoroughly evaluated. This study aimed to assess the reliability and validity of the Persian versions of Mini-BESTest and Brief-BESTest in persons with Parkinson's disease (PD). METHODS Three medical students rated videotaped performances of 49 individuals with PD on the Persian Mini-BESTest, Persian Brief-BESTest, and Berg balance scale (BBS). Healthy adults were matched with persons having PD in terms of age and gender. RESULTS There were no floor and ceiling effects. Inter- and intra-rater reliability was excellent (ICC = 0.965-0.973). The minimal detectable changes were 2.37 and 3.47 for Persian versions of Mini-BESTest and Brief-BESTest, respectively. The Persian versions of Mini-BESTest and Brief-BESTest had very good correlations with BBS (r > 0.7) confirming construct validity. There was a very good correlation between the Mini-BESTest and the Brief-BESTest total scores (r = 0.78). There were significant differences between the persons with PD and healthy adults on both tests supporting discriminant validity. Significant differences in balance performances across Hoehn and Yahr stages were found which supported known-groups validity. CONCLUSION The Persian versions of Mini-BESTest and Brief-BESTest are reliable and valid instruments for balance evaluation in persons with PD. Further study to determine the reliability and validity of both tests when examining patients in real-time in the clinic is warranted.
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Affiliation(s)
- Amin Nakhostin-Ansari
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Milad Mellat-Ardakani
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Nematizad
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Soofia Naghdi
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - MohammadJavad Babaki
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Farhangian
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hassan Habibi
- Department of Neurology, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Abbas Tafakhori
- Department of Neurology, School of Medicine, Imam Khomeini Hospital and Iranian Center of Neurological Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Scott Hasson
- Department of Physical Therapy, AugustaUniversity, Augusta, GA, USA
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Miyata K, Hasegawa S, Iwamoto H, Kaizu Y, Otani T, Shinohara T, Usuda S. Rasch Validation and Comparison of the Mini-BESTest and S-BESTest in Individuals With Stroke. Phys Ther 2022; 102:6482024. [PMID: 34972868 DOI: 10.1093/ptj/pzab295] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 10/13/2021] [Accepted: 12/03/2021] [Indexed: 02/09/2023]
Abstract
OBJECTIVE The purpose of this study was to compare the psychometric properties of the Mini-Balance Evaluation Systems Test (Mini-BESTest) and S-BESTest and to evaluate which is more suitable for use in clinical settings for individuals with stroke. METHODS This multicenter retrospective cross-sectional study investigated 115 individuals with stroke (mean age, 70.8 y [SD = 11.2 y]) who were able to stand without physical assistance. All individuals were examined with the BESTest and with the Mini-BESTest and S-BESTest scored based on the BESTest results. The data were analyzed using a Rasch analysis (partial credit model). RESULTS The Mini-BESTest results revealed a correctly functioning rating scale, good fit of the data to the model (apart from 1 overfit item), good reliability for both persons and items (6 statistically detectable levels of balance ability), local dependence between 1 item pair, and essential unidimensionality. The S-BESTest results demonstrated disordered rating scale thresholds (1 response option required collapsing), good fit of the data to the model (apart from 1 underfit item), good reliability for both persons and items (5 statistically detectable levels of balance ability), local dependence between 2 item pairs, and essential unidimensionality. CONCLUSION The analyses confirmed that the reliability of the S-BESTest was good and unidimensional and that the test provides several improved points, such as item redundancy and local independence of items. Nevertheless, the Mini-BESTest results supported previous findings as a whole and were better than those from the S-BESTest. IMPACT Rasch analysis demonstrated that the Mini-BESTest was a better balance assessment scale than the S-BESTest for individuals with stroke based on its psychometric properties. The Mini-BESTest may serve as a useful scale for assessing balance in individuals with stroke, and a keyform plot and strata may help clinical decision-making in terms of interpreting scores and goal setting.
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Affiliation(s)
- Kazuhiro Miyata
- Department of Physical Therapy, Ibaraki Prefectural University of Health Science, Ibaraki, Japan
| | - Satoshi Hasegawa
- Department of Rehabilitation, Public Nanokaichi Hospital, Gunma, Japan
| | - Hiroki Iwamoto
- Department of Rehabilitation Center, Hidaka Rehabilitation Hospital, Gunma, Japan
| | - Yoichi Kaizu
- Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences, Gunma, Japan.,Department of Rehabilitation Center, Hidaka Hospital, Gunma, Japan
| | - Tomohiro Otani
- Department of Physical Therapy, Ota College of Medical Technology, Gunma, Japan
| | - Tomoyuki Shinohara
- Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare, Gunma, Japan
| | - Shigeru Usuda
- Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences, Gunma, Japan
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Shinohara T, Saida K, Miyata K, Usuda S. Sections of the Brief-Balance Evaluation Systems Test Relevant for Discriminating Fast Versus Slow Walking Speeds in Community-Dwelling Older Women. J Geriatr Phys Ther 2022; 45:E1-E7. [PMID: 32769810 DOI: 10.1519/jpt.0000000000000280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Walking speed can be used to identify characteristics of frailty in older adults. It has a strong positive correlation with balance abilities. The Brief-Balance Evaluation Systems Test (Brief-BESTest) was developed to assess functions of the 6 balance control systems in a short time. However, for community-dwelling older adults, the relationship between walking speed and the Brief-BESTest needs to be clarified. Even the cutoff scores for each Brief-BESTest section should be indicated for physical therapists to effectively evaluate balance deficits. Our objective was to establish cutoff scores for individual Brief-BESTest sections, determine fast or slow walkers in community-dwelling older adults, and investigate the relationship between balance control systems and walking speed. METHODS In a cross-sectional study involving 55 participants 77 years and older, the Brief-BESTest was evaluated after grouping the participants based on their walking speeds in public community centers. We compared the age, history of falls, handgrip strength, quadriceps strength, appendicular skeletal muscle mass index, comfortable walking speeds, and the Brief-BESTest scores between the fast- and slow-walking groups by using the independent t test, Fisher exact test, or Mann-Whitney U test. We also determined the receiver operating characteristic curves, and calculated the cutoff, area under the curve (AUC), sensitivity, and specificity of each section. RESULTS All sections of the Brief-BESTest, except Section 1 (Biomechanical Constraints) were able to differentiate between fast and slow walkers in community-dwelling older women. Section VI (Stability in Gait) showed the highest AUC (0.83) and the cutoff score for the fast- and slow-walker groups was 3.0 points (sensitivity = 0.85, specificity = 0.81). Sections III, IV, and V (Anticipatory, Reactive, and Sensory Orientation, respectively) had moderate AUC (0.71-0.72). Sections I and II (Stability Limits) showed weak correlations with the walking speed. CONCLUSIONS Three sections (III, anticipatory postural adjustments; IV, reactive postural responses; and VI, stability in gait) could differentiate between fast and slow walkers. Section VI was a particularly important balance function measurement that differentiated the walking speed with the highest accuracy. Therefore, it should be a primary focus when physical therapists treat community-dwelling older adults.
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Affiliation(s)
- Tomoyuki Shinohara
- Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare, Takasaki-shi, Gunma, Japan
| | - Kosuke Saida
- Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare, Takasaki-shi, Gunma, Japan
| | - Kazuhiro Miyata
- Department of Physical Therapy, Ibaraki Prefectural University of Health Science, Ami, Ibaraki, Japan
| | - Shigeru Usuda
- Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences, Maebashi-shi, Gunma, Japan
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Lo CWT, Lin CY, Tsang WWN, Yan CH, Wong AYL. Psychometric Properties of Brief-Balance Evaluation Systems Test Among Multiple Populations: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2021; 103:155-175.e2. [PMID: 34015349 DOI: 10.1016/j.apmr.2021.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To synthesize evidence regarding the psychometric properties of the Brief-Balance Evaluation Systems Test (BESTest) in assessing postural controls across various populations. DATA SOURCES Articles were searched in 9 databases from inception to March 2020. STUDY SELECTION Two reviewers independently screened titles, abstracts, and full-text articles to include studies that reported at least 1 psychometric property of the Brief-BESTest. There were no language restrictions. DATA EXTRACTION The 2 independent reviewers extracted data (including psychometric properties of Brief-BESTest) from the included studies. The methodological quality of the included studies was appraised by the Consensus-based Standards for the Selection of Health Status Measurement Instruments checklist, and the quality of statistical outcomes was assessed by the Terwee et al method. A best-evidence synthesis for each measurement property of the Brief-BESTest in each population was conducted. DATA SYNTHESIS Twenty-four studies encompassing 13 populations were included. There was moderate to strong positive evidence to support the internal consistency (Cronbach α>0.82), criterion validity (ρ≥0.73, r≥0.71), and construct validity (ρ≥0.66, r≥0.50, area under curve>0.72) of the Brief-BESTest in different populations. Moderate to strong positive evidence supported the responsiveness of the Brief-BESTest in detecting changes in postural controls of patients 4 weeks after total knee arthroplasty or patients with subacute stroke after 4-week rehabilitation. However, there was strong negative evidence for the structural validity of this scale in patients with various neurologic conditions. The evidence for the reliability of individual items and measurement errors remains unknown. CONCLUSIONS The Brief-BESTest is a valid (criterion- and construct-related) tool to assess postural control in multiple populations. However, further studies on the reliability of individual items and minimal clinically important difference of the Brief-BESTest are warranted before recommending it as an alternative to the BESTest and Mini-BESTest in clinical research/practice.
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Affiliation(s)
- Cathy W T Lo
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - William W N Tsang
- Department of Physiotherapy, School of Nursing and Health Studies, The Open University of Hong Kong, Hong Kong SAR, China
| | - Chun Hoi Yan
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Arnold Y L Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China.
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Shinohara T, Saida K, Miyata K. Ability of the Brief-Balance Evaluation Systems Test to evaluate balance deficits in community-dwelling older adults: a cross-sectional study. Physiother Theory Pract 2020; 38:1381-1388. [PMID: 33289587 DOI: 10.1080/09593985.2020.1840682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND A method for assessing balance that differentiates between balance deficit can help guide effective interventions for preventing falls in older adults. OBJECTIVE This study aimed to clarify the relationship between balance control systems and falls, and to examine the ability of the Brief-Balance Evaluation Systems Test (BESTest) to evaluate balance deficits in older adults. METHODS Overall, 109 community-dwelling older adults participated in this study. The history of falls in the last year was investigated. Balance deficits were assessed using the Brief-BESTest, the functional reach test, the Timed up and Go Test, and the one leg balance test. We analyzed the difference between the fallers and non-fallers across two different age groups. RESULTS Among younger-older group participants (age < 75 years), there were no significant differences between fallers and non-fallers across all variables. Among older-older group participants (age ≥ 75 years), there were significant differences in the Brief-BESTest total (p= .011; fallers, 13.5 versus non-fallers, 17.0) and section IV scores (postural responses of the Brief-BESTest; p= .026, 2.0 versus 5.0). There was no significant difference in other balance measurements. CONCLUSIONS The postural responses assessed by the Brief-BESTest may serve important functions and may be associated with falls in older adults.
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Affiliation(s)
- Tomoyuki Shinohara
- Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare, Takasaki-Shi, Japan
| | - Kosuke Saida
- Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare, Takasaki-Shi, Japan
| | - Kazuhiro Miyata
- Department of Physical Therapy, Ibaraki Prefectural University of Health Science, Ibaraki, Japan
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Aydoğan Arslan S, Demirci CS, Katirci Kirmaci Zİ, Uğurlu K, Keskin ED. Reliability and Validity of Turkish Version of The Brief-BESTest in Stroke Patients. Top Stroke Rehabil 2020; 28:488-497. [PMID: 33148123 DOI: 10.1080/10749357.2020.1841424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The Brief-BESTest is the short version of the BESTest used to evaluate balance and fall risk in a multiple disease populations. The clinicians need practical, short application scales to evaluate the risk of falling, balance and rehabilitation results. OBJECTIVE This study aims to investigate the validity and reliability of the Turkish version of the Brief-BESTest (Brief-BESTest-T) in stroke patients. METHODS This study included a total of 40 subacute and chronic stroke patients (mean age of 60.28 ± 9.96 years). The Brief-BESTest, Berg Balance Scale (BBS), Timed Up and Go Test (TUG), Functional Reach Test (FRT), Falls Efficacy Scale (FES) and 10 m walking test were applied to the patients. RESULTS A strong correlation was observed between the1st and 2nd evaluation Brief-BESTest-T total scores (r = 0.933). Cronbach's alpha coefficient was excellent. According to the correlation analysis performed to test the inter-rater reliability, a very high correlation (r = 0.906) was observed between the Brief-BESTest-T total scores. A high correlation was found between the Brief-BESTest-T and BBS and TUG, while a moderate correlation was found between the FRT, FES, and 10 m walking test. The clinical cut-off point for the Brief-BESTest - T was determined to be 9 points with an AUC of 0.872. There were no floor and ceiling effects found. CONCLUSIONS This study showed that the Brief-BESTest-T had excellent internal consistency, intra-rater, and inter-rater reliability. Its concurrent, discriminant, and known-groups validity were also good and had no substantial floor and ceiling effects.
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Affiliation(s)
- Saniye Aydoğan Arslan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Kırıkkale University, Kırıkkale, Turkey
| | - Cevher Savcun Demirci
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Balıkesir University, Balıkesir, Turkey
| | - Zekiye İpek Katirci Kirmaci
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, SANKO University, Gaziantep, Turkey
| | - Kübra Uğurlu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Kırıkkale University, Kırıkkale, Turkey
| | - Esra Dilek Keskin
- Department of Physical Medicine and Rehabilitation, Faculty of Medical Sciences, Kırıkkale University, Kırıkkale, Turkey
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Kasser SL, Jacobs JV, Sibold J, Marcus A, Cole L. Using Body-Worn Sensors to Detect Changes in Balance and Mobility After Acute Aerobic Exercise in Adults with Multiple Sclerosis. Int J MS Care 2020; 22:1-6. [PMID: 32123522 DOI: 10.7224/1537-2073.2018-073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Current mobility and functional assessments do not capture the subtle changes in balance and gait that may predispose people with multiple sclerosis (MS) to falling. The purpose of this study was to use clinical and instrumented measures to examine the effects of an acute bout of aerobic exercise on balance and gait in individuals with MS. Methods Ten adults with MS performed 15 minutes of moderate-intensity recumbent cycling or 15 minutes of rest. Exercise and rest visit order was randomized and separated by 1 week. Balance and mobility were assessed before, immediately after, and 2 hours after each test condition. Results There were no significant differences across measurement periods for Timed 25-Foot Walk test times or Brief Balance Evaluation Systems Test scores. Significant improvements in mean sway radius and sway velocity when standing on foam and in percentage of stance stride time variability were found immediately after exercise compared with immediately after rest. Conclusions This study lends further evidence that individuals with MS can safely engage in single bouts of aerobic exercise without detrimental short-term effects on function and may actually receive some short-term benefit regarding standing postural sway and gait variability. Future research should examine the dose-dependent relationship of varying types, intensities, or timing of exercise necessary to elicit short-term functional benefit and long-term health outcomes.
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Godi M, Giardini M, Arcolin I, Ferrante S, Nardone A, Corna S, Colombo R. Is the Brief-BESTest Brief Enough? Suggested Modifications Based on Structural Validity and Internal Consistency. Phys Ther 2019; 99:1562-1573. [PMID: 31348513 DOI: 10.1093/ptj/pzz103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 02/01/2019] [Accepted: 02/21/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND The Brief Balance Evaluation Systems Test (Brief-BESTest) could be a useful tool for balance assessment. Although some psychometric characteristics have been examined, others still need to be clarified. OBJECTIVE The objective was to assess the structural validity, convergent validity, discriminant validity, and internal consistency of the Brief-BESTest in neurological patients. DESIGN This was a cross-sectional study. METHODS Data were from 416 patients with neurological disease and related balance disorders. Patients were assessed with the 5-levels Activities-Specific Balance Confidence Scale (ABC 5-levels), Brief-BESTest, and some simple balance tests (ie, 1-leg stance, Timed "Up & Go" test, functional reach, and a fall history questionnaire). Three Brief-BESTest models were examined through confirmatory factor analysis, and the following indexes were calculated: Comparative Fit Index, Tucker-Lewis Index, and root-mean-square error of approximation. Convergent validity was assessed by calculating the correlation between Brief-BESTest and ABC 5-levels total scores. Receiver operating characteristics assessed the ability of each model to differentiate between people with falls and those without falls. Internal consistency was measured with Cronbach α and coefficient ω. RESULTS Confirmatory factor analysis showed model 3 (Comparative Fit Index = 0.97; Tucker-Lewis Index = 0.95; root-mean-square error of approximation = 0.05), with item 1 removed and error covariance between items 3 and 4 and between items 5 and 6, to have a significantly better structure than models 1 and 2. The correlation between Brief-BESTest and ABC 5-levels was 0.61 (Spearman ρ) for all 3 models. The area under the curve of the receiver operating characteristics showed an acceptable accuracy (0.72) in distinguishing patients with a history of falls from those without a history of falls (95% confidence interval = 0.66-0.78) for all models and was superior to the areas under the curve of other simple balance tests (1-leg stance, Timed "Up & Go" test, functional reach). Cronbach α was good for Brief-BESTest models 1 (0.92) and 3 (0.92), but ω was greater than 0.80 only for model 3. LIMITATIONS The sample was heterogeneous. CONCLUSIONS The Brief-BESTest, after some changes, shows good validity and internal consistency in patients affected by different balance disorders.
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Affiliation(s)
- Marco Godi
- Division of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno, Italy
| | - Marica Giardini
- Division of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno, Italy
| | - Ilaria Arcolin
- Division of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno, Italy
| | - Simona Ferrante
- Department of Electronics, Information and Bioengineering, Neuroengineering and Medical Robotics Laboratory, Politecnico di Milano, Milan, Italy
| | - Antonio Nardone
- Division of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Stefano Corna
- Division of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno, Italy
| | - Roberto Colombo
- Division of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno, Italy
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Sahin IE, Guclu-Gunduz A, Yazici G, Ozkul C, Volkan-Yazici M, Nazliel B, Tekindal MA. The sensitivity and specificity of the balance evaluation systems test-BESTest in determining risk of fall in stroke patients. NeuroRehabilitation 2019; 44:67-77. [PMID: 30814369 DOI: 10.3233/nre-182558] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Balance disorders cause disability in stroke and increase risk of falls. The Balance Evaluation Systems Test (BESTest), examines balance, determines parameters causing balance disorders, provides information on risk factors for falls. OBJECTIVE To investigate the sensitivity and specificity of the BESTest in determining the risk of falls in stroke patients. METHODS Fifty patients with chronic stroke were included in the study. Balance was assessed using BESTest, Berg Balance Scale (BBS), Activity Specific Balance Confidence scale (ABC) and Biodex-BioSway Balance System. To examine the content validity of BESTest, the relationship between BESTest and other balance assessment methods was examined. The internal consistency reliability of BESTest was evaluated by Cronbach's α coefficient. Analysis of receiver operating characteristics (ROC) was performed to determine cut-off point, sensitivity and specificity. RESULTS BESTest, BBS, ABC and Biodex-BioSway Balance System results of faller stroke patients were worse than that of non-faller (p <0.05). Internal consistency of BESTest was found to be Cronbach's α = 0.960. The BESTest value of area under curve (AUC) was 0.844, with a cut-off point of 69.44%, a sensitivity of 75% and a specificity of 84.6% (p < 0.01). CONCLUSION BESTest is reliable and valid with high sensitivity and specificity in determining the risk of fall in stroke patients.
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Affiliation(s)
- Ilknur Ezgi Sahin
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Baskent University, Ankara, Turkey
| | - Arzu Guclu-Gunduz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Gokhan Yazici
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Cagla Ozkul
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Melek Volkan-Yazici
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Yuksek Ihtisas University, Ankara, Turkey
| | - Bijen Nazliel
- Department of Neurology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Mustafa Agah Tekindal
- Department of Biostatistics, Faculty of Veterinary Medicine, Selcuk University, Konya, Turkey.,Department of Biostatistics, Faculty of Veterinary Medicine, Selcuk University, Konya, Turkey
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Johns E, Wamsley C, Whiting A. Using the Brief-BESTest paired with a novel algorithm to provide targeted balance interventions for people with subacute stroke: a feasibility study. Top Stroke Rehabil 2018; 26:32-38. [PMID: 30417740 DOI: 10.1080/10749357.2018.1517493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Balance is a common mobility limitation following stroke, but determination of the most effective balance-related plan of care can be difficult due to multiple balance impairments that vary between individuals. The Brief-BESTest is a validated outcome measure for balance based on six systems of postural control. It may also be a useful tool to guide clinicians in their balance plan of care design. OBJECTIVE The objective of this study was to determine the feasibility of a quantitative balance plan of care for patients with subacute stroke, using a novel algorithm that utilizes the scoring design of the Brief-BESTest. The authors hypothesized that this plan of care could create targeted balance interventions among this population. METHODS Eligible patients with subacute stroke at an inpatient rehab facility completed the Brief-BESTest within 1 week of admission. The subjects participated in specific interventions based on test section scores during their rehab stay. RESULTS Five subjects completed testing and participated in targeted balance interventions, addressing three to five systems of postural control. Subjects demonstrated improved Brief-BESTest overall scores by 2, 1, 7, 4, and 6 points from admission to discharge. Improvements in section scores were primarily seen in the systems of postural control identified by the algorithm. All subjects improved in Functional Independence Measure (FIM™)30 scores for locomotion (walking and stairs) by 5, 6, 7, 6, and 9 points, respectively. All subjects were discharged to the community. CONCLUSION Our observational study found this method of assessment and intervention to be feasible in the subacute stroke population and was associated with improved balance scores and improved functional mobility. Further study is warranted to determine effectiveness and efficiency.
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Affiliation(s)
- Eric Johns
- a Division of Therapy , Good Shepherd Penn Partners , Philadelphia , PA , USA
| | - Carol Wamsley
- a Division of Therapy , Good Shepherd Penn Partners , Philadelphia , PA , USA
| | - Anne Whiting
- a Division of Therapy , Good Shepherd Penn Partners , Philadelphia , PA , USA
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