Section of the Balance Evaluation Systems Test (BESTest) Cutoff Values for Walking Speed Level in Older Women With Hip Fracture

Abstract

Background and Purpose: Hip fracture is a common injury in older adults, with a high proportion of hip fractures affecting women. After a hip fracture, the recovery of the patient's walking speed is very important; one of the key determinants of walking speed is balance. The Balance Evaluation Systems Test (BESTest), a clinical balance measure, categorizes balance into 6 postural control systems. However, the relationship between the walking speed level and the sections of the BESTest has not been explored for older women with hip fracture. Our objective was to establish section scores for the BESTest cutoff values for walking speed in older women with hip fracture. Methods: This was an observational study involving 46 older women 65 years or older with hip fracture. The BESTest was administered to all participants upon their discharge from the hospital. Participants were divided into groups on the basis of their walking speed levels, and receiver operating characteristic curves were determined for each section of the BESTest. We calculated the cutoff value, area under the curve (AUC), sensitivity, and specificity of each. Results: Section IV-Stability in Gait showed the highest AUC (0.92) compared with the other sections, and the cutoff value determined for the fast and slow walker groups was 64.3% (sensitivity = 0.82, specificity = 0.83). The sections with moderate AUC (0.7-0.9) were I-Biomechanical Constraints (cutoff = 70.0%), III-Anticipatory Postural Adjustments (cutoff = 66.5%), IV-Postural Responses (cutoff = 69.4%), and V-Sensory Orientation (cutoff = 83.4%). The sections with the highest sensitivity (0.82) were I-Biomechanical Constraints and VI-Stability in Gait, and that with the highest specificity (0.88) was II-Stability Limits and Verticality. Conclusions: Five of the BESTest sections (I-Biomechanical Constraints, III-Anticipatory Postural Adjustments, IV-Postural Responses, V-Sensory Orientation, and IV-Stability in Gait) were able to differentiate between fast and slow walkers among older women with hip fracture. Balance during gait and anticipatory postural adjustments were shown to be important components of balance, and their cutoff values were indicators of the balance required to reach fast walking levels.

Which Balance Evaluation Systems Test sections best distinguish levels of post-stroke functional walking status?

“…The stability in gait section showed good accuracy in discriminating between groups, with a good combination of sensitivity and specificity, and the positive predictive value was also high. This finding was in line with previous studies that analysed walking speed in relation to BESTest or Brief-BESTest section scores in older adults ( 14 , 27 ). It is interesting that the stability in gait section is strongly related to walking speed regardless of subject characteristics.…”

“…walking): progression, postural control, and adaptation. A relationship between each of these 3 essentials of walking and specific sections of the BESTest has been suggested, with progression corresponding to biomechanical constraints; postural control corresponding to stability limits and verticality, anticipatory postural adjustments, postural response, and sensory orientation; and adaptation corresponding to anticipatory postural adjustments, postural response, and stability in gait ( 14 ). Also, the cut-off scores obtained between household ambulators or limited community ambulators in these 3 sections were low, from 36.1% to 50.0%.…”

“…Although previous research has demonstrated that specific sections of the BESTest are able to differentiate between slow and fast walking speeds in older adults with hip fractures ( 14 ), studies have not yet examined which section(s) of the BESTest can best identify functional walking status in individuals with stroke. A better understanding of the relationship between functional walking status and the sections of the BESTest can guide the selection of interventions that address problems in specific aspects of postural control to improve the walking ability of individuals with stroke.…”

Sections of the Brief-Balance Evaluation Systems Test Relevant for Discriminating Fast Versus Slow Walking Speeds in Community-Dwelling Older Women

“…In our previous study, we indicated the cutoff scores of 5 BESTest sections that could differentiate the walking speed of older women with hip fracture and classify them as fast or slow walkers. 28 However, for these community-dwelling older adults, no previous study has used individual sections of the BESTest or the Brief-BESTest to evaluate the balance deficits, or indicated the cutoff scores of each section related to the walking speed. The cutoff scores for discriminating walking speed are clinically useful because they can serve as targets in physical therapy to improve walking speed or prevent a decline in walking speed for community-dwelling older adults.…”

Response to letter to the editor from Franco Franchignoni and Andrea Giordano

“…Therefore, the selection of the balance assessment scale is important for appropriate evaluation and intervention in the subject. It is desirable to be able to translate the results of the assessment into interventions that have been reported in recent years (11,12).…”