Comparison of measurement properties of three shortened versions of the balance evaluation system test (BESTest) in people with subacute stroke

Winairuk, Thitimard; Pang, Marco Yiu Chung; Saengsirisuwan, Vitoon; Horak, Fay B.; Boonsinsukh, Rumpa

doi:10.2340/16501977-2589

Cited by 27 publications

(23 citation statements)

References 38 publications

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“…There exist more specialised tests to assess balance performance in stroke subjects such as the Berg Balance Scale (BBS) or the Balance Evaluation Systems Test (BEST) [37]. However, these tests are lengthy and require considerable time to administer.…”

Section: Limitations Of the Studymentioning

confidence: 99%

Assessment of dynamic balancing responses following perturbations during slow walking in relation to clinical outcome measures for high-functioning post-stroke subjects

Zadravec

Olenšek

Rudolf

et al. 2020

J NeuroEngineering Rehabil

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Background: Generating appropriate balancing reactions in response to unexpected loss of balance during walking is important to prevent falls. The purpose of this study was to assess dynamic balancing responses following pushes to the pelvis in groups of post-stroke and healthy subjects. Methods: Forty-one post-stroke subjects and forty-three healthy subjects participated in the study. Dynamic balancing responses to perturbations triggered at heel strike of the left or right leg, directed in the forward, backward, inward and outward directions during slow treadmill walking were assessed. Responses of the healthy group provided reference values used to classify responses of the post-stroke group into two subgroups; one within the reference responses ("inside" subgroup) and the other that falls out ("outside" subgroup). A battery of selected clinical outcome measures (6-Minute Walk Test, 10-Meter Walk Test, Timed-Up-and-Go test, Four Square Step Test, Functional Gait Assessment, Functional Independence Measure and One-legged stance test) was additionally assessed in the post-stroke group. Results: The "inside" subgroup of post-stroke subjects was able to appropriately modulate centre-of-pressure and ground-reaction-force both under the impaired and non-impaired leg in response to perturbations. The "outside" subgroup of post-stroke subjects showed limited modulation of centre-of-pressure and ground-reaction-force under the impaired leg; instead stepping strategy was used in which the non-impaired leg was placed such as to make a longer step (forward perturbation), to make a shorter step (backward perturbation) or to make a cross-step (outward perturbation). Consequently, peak centre-of-mass displacements following perturbations were significantly higher in the "outside" subgroup compared to the "inside" subgroup. Responses in both subgroups following inward perturbations did not differ. Majority of clinical outcome measures moderately correlated with the peak centre-of-mass displacements for forward perturbations and exhibited weak correlations for other perturbation directions.

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Section: Limitations Of the Studymentioning

confidence: 99%

Assessment of dynamic balancing responses following perturbations during slow walking in relation to clinical outcome measures for high-functioning post-stroke subjects

Zadravec

Olenšek

Rudolf

et al. 2020

J NeuroEngineering Rehabil

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show abstract

“…Responsiveness is the detection of change over time in the construct to be measured, and score changes over time as derived from the assessment instruments should be compared and correlated to those of a gold-standard or an external criterion 22 ) . Recent studies examined the responsiveness of the 3 versions of the BESTest 12 , 23 , 24 , 25 ) . They recruited participants with balance disorders including PD or stroke 12 ) , subacute stroke 23 , 24 ) , and musculoskeletal disease 25 ) .…”

Section: Introductionmentioning

confidence: 99%

“…Recent studies examined the responsiveness of the 3 versions of the BESTest 12 , 23 , 24 , 25 ) . They recruited participants with balance disorders including PD or stroke 12 ) , subacute stroke 23 , 24 ) , and musculoskeletal disease 25 ) . They then used the Global Rating of Change (GRC) 12 , 23 ) , BBS 23 , 24 ) , and Functional Gait Assessment (FGA) 25 ) as external criteria.…”

Section: Introductionmentioning

confidence: 99%

“…They recruited participants with balance disorders including PD or stroke 12 ) , subacute stroke 23 , 24 ) , and musculoskeletal disease 25 ) . They then used the Global Rating of Change (GRC) 12 , 23 ) , BBS 23 , 24 ) , and Functional Gait Assessment (FGA) 25 ) as external criteria. However, they did not investigate responsiveness of the 3 versions of the BESTest in ambulatory independent patients with subacute stroke.…”

Section: Introductionmentioning

confidence: 99%

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Sensitivity to change and responsiveness of the Balance Evaluation Systems Test (BESTest), Mini-BESTest, and Brief-BESTest in patients with subacute cerebral infarction

Hasegawa

Matsui²,

Kishi³

et al. 2021

J Phys Ther Sci

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To compare the sensitivity to change and responsiveness of the Balance Evaluation Systems Test, Mini-Balance Evaluation Systems Test, and Brief-Balance Evaluation Systems Test in patients with subacute cerebral infarction. [Participants and Methods] Thirty patients with subacute cerebral infarction participated in this study. The Balance Evaluation Systems Test, Mini-Balance Evaluation Systems Test, Brief-Balance Evaluation Systems Test, Berg Balance Scale, and ambulatory ability were assessed on admission and discharge. Sensitivity to change was calculated using the effect size, standardized response mean, and relative efficiency. Responsiveness was analyzed by comparing the ability of the difference between the scores of the balance assessments at admission and discharge in classifying the participants' ambulatory independence. [Results] All assessments showed significant improvement from admission to discharge. The effect size of the three versions of the Balance Evaluation Systems Test ranged from 0.41 to 0.69. The standardized response mean ranged from 0.75 to 1.28. The cutoff score was 16.7% for the Balance Evaluation Systems Test, 5.5 points for the Mini-Balance Evaluation Systems Test, 1.5 points for the Brief-Balance Evaluation Systems Test, and 3.5 points for the Berg Balance Scale. [Conclusion] The sensitivity to change of the three versions of the Balance Evaluation Systems Test was high or moderate. However, the Mini-Balance Evaluation Systems Test had the highest responsiveness, as determined with the extent of ambulatory independence.

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“…The battery of clinical outcome measures used in this study consisted only of tests that can be applied in a reliable and timely manner in everyday clinical practice. There exist more specialised tests to assess balance performance in stroke subjects such as the Berg Balance Scale (BBS) or the Balance Evaluation Systems Test (BEST) [37]. However, these tests are lengthy and require considerable time to administer.…”

Section: Limitations Of the Studymentioning

confidence: 99%

Assessment of dynamic balancing responses following perturbations during slow walking in relation to clinical outcome measures for high-functioning post-stroke subjects

Zadravec

Olenšek

Rudolf

et al. 2020

Preprint

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Abstract Background : Generating appropriate balancing reactions in response to unexpected loss of balance during walking is important to prevent falls. The purpose of this study was to assess dynamic balancing responses following pushes to the pelvis in groups of post-stroke and healthy subjects. Methods : Forty-one post-stroke subjects and forty-three healthy subjects participated in the study. Dynamic balancing responses to perturbations triggered at heel strike of the left or right leg, directed in the forward, backward, inward and outward directions during slow treadmill walking were assessed. Responses of the healthy group provided reference values used to classify responses of the post-stroke group into two subgroups; one within the reference responses (“inside” subgroup) and the other that falls out (“outside” subgroup). A battery of selected clinical outcome measures (6-Minute Walk Test, 10-Meter Walk Test, Timed-Up-and-Go test, Four Square Step Test, Functional Gait Assessment, Functional Independence Measure and One-legged stance test) was additionally assessed in the post-stroke group. Results : The “inside” subgroup of post-stroke subjects was able to appropriately modulate centre-of-pressure and ground-reaction-force both under the impaired and non-impaired leg in response to perturbations. The “outside” subgroup of post-stroke subjects showed limited modulation of centre-of-pressure and ground-reaction-force under the impaired leg; instead a stepping strategy was used in which the non-impaired leg was placed such as to make a longer step (forward perturbation), to make a shorter step (backward perturbation) or to make a cross-step (outward perturbation). Consequently, peak centre-of-mass displacements following perturbations were significantly higher in the “outside” subgroup compared to the “inside” subgroup. Responses in both subgroups following inward perturbations did not differ. Majority of clinical outcome measures moderately correlated with the peak centre-of-mass displacements for forward perturbations and exhibited weak correlations for other perturbation directions. Conclusions : Substantial number of post-stroke subjects, that were considered to be independent walkers, have reduced capabilities to execute appropriate balancing responses following perturbations commencing on the hemiparetic leg and may thus benefit from perturbation-based training. Selected clinical outcome measures may provide an indication on the abilities of each subject to counteract unexpected loss of balance. However, a reliable assessment should be done through perturbation-based measures.

show abstract

Comparison of measurement properties of three shortened versions of the balance evaluation system test (BESTest) in people with subacute stroke

Cited by 27 publications

References 38 publications

Assessment of dynamic balancing responses following perturbations during slow walking in relation to clinical outcome measures for high-functioning post-stroke subjects

Assessment of dynamic balancing responses following perturbations during slow walking in relation to clinical outcome measures for high-functioning post-stroke subjects

Sensitivity to change and responsiveness of the Balance Evaluation Systems Test (BESTest), Mini-BESTest, and Brief-BESTest in patients with subacute cerebral infarction

Assessment of dynamic balancing responses following perturbations during slow walking in relation to clinical outcome measures for high-functioning post-stroke subjects

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