The Mini-BESTest - a clinically reproducible tool for balance evaluations in mild to moderate Parkinson’s disease?

Abstract

BackgroundThe Mini-BESTest is a clinical balance test that has shown a high sensitivity in detecting balance impairments in elderly with Parkinson's disease (PD). However, its reproducibility between different raters and between test occasions has yet to be investigated in a clinical context. Moreover, no one has investigated the reproducibility of the Mini-BESTest's subcomponents (i.e. anticipatory postural adjustments; postural responses; sensory orientation and dynamic gait).We aimed to investigate the inter-rater and test-retest reproducibility (reliability as well as agreement) of the Mini-BESTest, as well as its subcomponents, in elderly with mild to moderate PD, performed under conditions assimilating clinical practice.MethodThis was an observational measurement study with a test-retest design.Twenty-seven individuals with idiopathic PD (66 - 80 years, mean age: 73; Hoehn & Yahr: 2-3; 1-15 years since diagnosis) were included. Two test administrators, having different experiences with the Mini-BESTest, administered the test individually, in separate rooms in a hospital setting. For the test-retest assessment, all participants returned 7 days after the first test session to perform the Mini-BESTest under similar conditions. Intra-class correlation coefficients (ICC2.1), standard error of measurement (SEMagreement), and smallest real difference (SRD) were analyzed.ResultsThe Mini-BESTest showed good reliability for both inter-rater and test-retest reproducibility (ICC = 0.72 and 0.80). Regarding agreement, the measurement error (SRD) was found to be 4.1 points (accounting for 15% of the maximal total score) for inter-rater reproducibility and 3.4 points (12% of the maximal total score) for test-retest reproducibility. The investigation of the Mini-BESTest's subcomponents showed a similar pattern for both inter-rater and test-retest reproducibility, where postural responses had the largest proportional measurement error, and sensory orientation showed the highest agreement.ConclusionsOur findings indicate that the Mini-BESTest is able to distinguish between individuals with mild to moderate PD; however, when used in clinical balance assessments, the large measurement error needs to be accounted for.

Reliability, validity and minimal detectable change of the Mini-BESTest in Greek participants with chronic stroke

“…Furthermore, the Mini-BESTest GR showed excellent internal consistency which is in agreement with other studies as well (Godi et al, 2013;Löfgren et al, 2014;Tsang, Liao, Chung, and Pang, 2013). Overall, these results highlight the stability, consistency and reproducibility of the scale in measurements taken by different raters and at different time points under the same conditions.…”

“…Bland-Altman analysis has been conducted by only one study in individuals with Parkinson's diseases (Löfgren et al, 2014). In contrast to that study, our study presented very good agreement in the measurements between raters and their differences did not differ from zero.…”

“…The absolute reliability was assessed via Bland Altman plot of the mean differences between test-retest measurements (Myles and Cui, 2007). The internal consistency was also evaluated to demonstrate how the different items of the Greek version of the Mini-BESTest scale measured the same thing in accordance with similar studies for ordinal data (Godi et al, 2013;Löfgren et al, 2014;Tsang, Liao, Chung, and Pang, 2013). In addition, the Minimum Detectable Change at 95% of confidence interval (MDC 95% ) and the Standard Error of Measurement (SEM) based on the reliability of the scale and the standard deviation of the population were tested to evaluate the smallest change in score that reflects a true change in the balance ability of the patient rather than an error in measurement (De Vet et al, 2006).…”

“…Reliability in total scores also agrees with the study of Dahl and Jørgensen (2014) in stroke patients, even though in their study each patient was assessed by 3 examiners, which provides an advantage compared to our study; and the reassessment took place after 4 weeks compared to the 7-10 days timeframe of our study. The use of two examiners and assessement based on live observation instead of observation of video recordings in our study was chosen because of being a commonly used methodological procedure for this kind of research, and of being a common way of assessment in clinical settings (Löfgren et al, 2014; Maia, Rodrigues-de-Paula, Magalhães, and Teixeira, 2013; Tsang, Liao, Chung, and Pang, 2013;Βillis et al, 2011). Furthermore, a relatively big interval between the two assessments was not considered as methodologically correct for our study, given that 4 weeks is enough time for alterations in the environment or health status, and eventually in the performance of the participant to occur.…”

Implementation of the HiBalance training program for Parkinson’s disease in clinical settings: A feasibility study

“…Despite the small sample size, both groups improved their balance performance by at least one point on the Mini‐BESTest, which is also the minimal detectable change in mild–moderate PD (Löfgren, Lenholm, Conradsson, Ståhle, & Franzén, 2014). Similar positive trends were found for secondary outcomes, that is, gait speed, concerns of falling, and exercise endurance.…”