Reliability, Validity, and Ability to Identity Fall Status of the Berg Balance Scale, Balance Evaluation Systems Test (BESTest), Mini-BESTest, and Brief-BESTest in Older Adults Who Live in Nursing Homes

Abstract

Background and Purpose: In any given year, 28% to 35% of older adults experience falls. In nursing home environments, the annual rate of falls increases to 30% to 50%. Our objective was to verify and compare the reliability, validity, and ability to identify falls of the Berg Balance Scale (BBS), Balance Evaluation Systems Test (BESTest), Mini-BESTest, and Brief-BESTest for older adults who live in nursing homes. Methods: This was a cross-sectional study. Older adults (n = 49; aged 62-90 years; mean = 77.8; standard deviation = 7.2) were recruited from a nonprofit nursing home. All participants were assessed by 2 physiotherapists using the BBS, BESTest, Mini-BESTest, and Brief-BESTest. The interrater and test-retest (7-14 days) reliability were assessed using intraclass correlation coefficients (ICCs [2, 1]). Minimal detectable changes at the 95% confidence level were established. To analyze each test's ability to identify fall status, we used receiver operating characteristic (ROC) curves, whose statistical significance we verified using the area under the ROC curve (AUC) and respective 95% confidence intervals (CIs). The diagnostic likelihood ratios (positive and negative) and 95% CI were used to verify posttest probability. We used Fagan's nomogram to show the posttest probability of each balance test. Validity was assessed using kappa coefficients and the prevalence-adjusted bias-adjusted kappa (PABAK). Results: Interrater and test-retest reliability for the total scores were good to excellent across all 4 tests (ICC interrater value = 0.992-0.994 and ICC test-retest value = 0.886-0.945). All tests were also able to identify fall status (AUC = 0.712-0.762) and were in good agreement with each other (kappa coefficient for individuals with fall risk = 0.679-0.957 and individuals with no fall risk = 0.135-0.143; PABAK = 83.7%-98%). Conclusion: All balance tests presented similar reliability, reproducibility, and validity. This suggests that any of these tests can be used in clinical practice. However, the Brief-BESTest is the quickest and easiest test to perform.

Impacto de um programa de fortalecimento muscular dos membros inferiores no equilíbrio e na performance funcional de idosos institucionalizados: um estudo controlado e randomizado

“…Além disso, segundo Viveiro et. al 32 pontuações menores que 47 na EEB em idosos institucionalizados indicam um maior risco de quedas. Apesar do GE não apresentar uma mudança significativa após a intervenção, nota-se que ambos os grupos GE e GC apresentaram pontuações acima de 47, portanto um baixo risco de quedas.…”

Minimal Clinically Important Difference of Four Commonly Used Balance Assessment Tools in Individuals after Total Knee Arthroplasty: A Prospective Cohort Study

“…In addition, an MCID of 3 points has been produced for the BBS in individuals with multiple sclerosis, 7 points in individuals with neurological disorders, and 3.5 to 7.1 points in individuals with chronic obstructive pulmonary disease . Other work has established the minimal detectable change (MDC) for the various versions of the BESTest and BBS, and found greater values for the Mini‐BESTest and Brief‐BESTest than the MCID estimates calculated in the current study . There are several reasons for the difference in findings.…”

“…36 Other work has established the minimal detectable change (MDC) for the various versions of the BESTest and BBS, and found greater values for the Mini-BESTest and Brief-BESTest than the MCID estimates calculated in the current study. 39,40 There are several reasons for the difference in findings. First, their studies measured MDC, which represents a minimal change required to distinguish a real performance change from a change due to measurement error or variability in performance with repeated testing.…”

Combining cognitive stimulation therapy and fall prevention exercise (CogEx) in older adults with mild to moderate dementia: a feasibility randomised controlled trial

“…There is a lack of normative values in outcome measures for older adults living in RAC as most work to date has been on healthy older adults living in the community [ 54 ]. An example of this is of the outcome measures used in this study only three have had a minimal detectable change identified: MoCA 4 points [ 36 ]; Brief BESTest 4 points [ 55 ]; SPPB total 1 point [ 56 ]; however, only the Brief BESTest established this for a population of older adults living in RAC. Consideration should be given to this when selecting measures for future studies.…”