Responsiveness of the Mini-Balance Evaluation System Test in Type 2 Diabetic Patients with Peripheral Neuropathy

Abstract

Background: Mini-BESTest is an instrument for assessing the balance impairment; however, the use of the Mini-BESTest in type 2 diabetic patients with peripheral neuropathy is not well documented in the literature. The aim of this study was to examine the responsiveness and the minimal important change (MIC) of the Mini-BESTest after four weeks of the balance exercises. Methods: A prospective single group pretest-posttest design was applied, and forty-eight type 2 diabetic patients with peripheral neuropathy were participated (mean age of 59.04 ± 7.533 years; 3 males and 45 females). All participants were given an intervention program including foot care and balance exercises (50-minute sessions, three times a week for four weeks). The responsiveness of the Mini-BESTest was determined using two approaches: 1) the distribution-based method evaluating the change scores (pre-and postintervention), the effect size (ES), the standard response mean (SRM), the standard error of measurement (SEM) and the minimum detectable change (MDC 95 ) and 2) the anchor-based method evaluating the MIC using the Global Rating of Change scale (GRC) as an external criterion. Results: After the balance exercises treatment, the Mini-BESTest scores significantly improved (p < 0.001) with an ES of 3.9 and SRM of 4.32. SEM was 0.73 and MDC 95 was 2.03 points. The area under the receiver operating characteristic (ROC) curve corresponded to 81%. The cutoff point of the Mini-BESTest was ≥5 points corresponding to the GRC ≤3 versus >3 for the discrimination of the Mini-BESTest between improvement and no improvement after exercises. Conclusion:The Mini-BESTest can be demonstrated as high responsiveness according to the determination of the distribution-based and the anchor-based methods. The MIC of the Mini-BESTest was taken as ≥5 points and could be used as an outcome measure for the discriminated evaluation of type 2 diabetic patients with peripheral neuropathy.

Construct validity of the Mini-BESTest in individuals with chronic pain in specialized pain care

“…Mini-BESTest has excellent test-retest reliability and inter-rater reliability in individuals with different, mainly neurological, conditions [ 11 ], as well as high concurrent validity with other balance measures in individuals with stroke and Parkinson’s disease [ 33 ]. To estimate the minimal clinically important difference for different conditions, for example, Type 2 diabetes patients with peripheral neuropathy, and patients with different neurological conditions, a change between 3 and 5 points has been suggested [ 34 – 37 ]. For the Swedish version, good test-retest reliability and inter-rater reliability are found in a clinical setting for individuals having Parkinson’s disease [ 38 ].…”

Analysis of the Relation Between Balance Control Subsystems: A Structural Equation Modeling Approach

“…Zhu et al utilized Mini-BESTest to assess balance in patients with bilateral vestibular lesions and found that the SO subsystem degrades with age in these patients [18]. Phyu et al demonstrated the high responsiveness of Mini-BESTest in evaluating balance exercise training in patients with type 2 diabetes and peripheral neuropathy [19]. According to King et al, individuals with Parkinson's disease may exhibit abnormal RPC but a normal SO subsystem, allowing them to maintain balance with their eyes closed on an unstable surface.…”