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

Abstract

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.

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

“…These findings were similar to the results of a recent study that found an AUC of 0.82% at a cut-off score of 5.5 (sensitivity: 73%; specificity: 93%) determined by the ambulatory independence with or without an assisting device (external criterion); but the average duration between two assessments was longer as 78 days (more than 2 months). 24 The change score in the present study was higher than in previous studies that used the GRC as an external criterion. Godi et al 20 found the Mini-BESTest change score of 4 points and an AUC of >80% in mixed neurological diseases, while the study of Winairuk et al 24 found the Mini-BESTest change score of 3.5 with an AUC of >60% in cerebral infarction.…”

“… 24 The change score in the present study was higher than in previous studies that used the GRC as an external criterion. Godi et al 20 found the Mini-BESTest change score of 4 points and an AUC of >80% in mixed neurological diseases, while the study of Winairuk et al 24 found the Mini-BESTest change score of 3.5 with an AUC of >60% in cerebral infarction. Moreover, using patient-rated and therapist-rated GRC scores were used as external criterion, the change score of the Mini-BESTest was ranged from 3.4 to 4 points and an AUC from 75% to 82% in Parkinson’s diseases.…”

“…The distribution-based approach was detected by the significant change scores showing that it was highly sensitive to change and the ES and SRM values also presented large changes in the current study. These results were larger than the previous studies on balance disorders, 20 subacute cerebral infarction, 24 Parkinson's disease 23 and subacute stroke. 21,22 In addition, the current study also reported smaller SEM (0.73) and MDC 95 (2.03) values than the previous studies where SEM was 1.26 and MDC 95 in the range of 3.0-3.5.…”

“…[17][18][19] The Mini-BESTest demonstrated its excellent reliability, validity and responsiveness with the minimal important change (MIC) in a variety of brain diseases such as stroke, Parkinson's disease, and mixed neurological diseases with different origins. 18,[20][21][22][23][24] Nevertheless, the study of the Mini-BESTest was very limited for use in peripheral nerve disorders such as the DPN in type 2 DM patients; however, it has been proven as a standardized balance measure with the excellent reliability and validity in type 2 DM patients with DPN. 25 Its responsiveness and the MIC are still needed to study in DPN population which is a representation of the peripheral nerve disorder.…”