Comparison of Reliability, Validity, and Responsiveness of the Mini-BESTest and Berg Balance Scale in Patients With Balance Disorders
TL;DR: The Mini-BESTest appears to have a lower ceiling effect, slightly higher reliability levels, and greater accuracy in classifying individual patients who show significant improvement in balance function.
Abstract: Background Recently, a new tool for assessing dynamic balance impairments has been presented: the 14-item Mini-BESTest.
Objective Aim of this study was to compare the psychometric performance of Mini-BESTest vs. Berg Balance Scale (BBS).
Methods Ninety-three subjects (mean age 66.2; 53 females) with balance deficits were recruited. Interrater (3 raters) and test-retest (1-3 days) reliability were calculated using intraclass correlation coefficients (ICCs). Responsiveness and minimal important change (MIC) were assessed (after 10 sessions of physical therapy) using both distribution-based and anchor-based methods (external criterion: a 15-point Global Rating of Change [GRC] scale).
Results At baseline, neither floor nor ceiling effects were found in either scale. After treatment, the maximum score was found in 12 patients (12.9%) with BBS and in 2 (2.1%) with Mini-BESTest. Test-retest reliability for total scores was significantly higher in Mini-BESTest (ICC=0.96) than in BBS (ICC=0.92), whereas interrater reliability was similar (ICC=0.98 vs. 0.97). The standard error of measurement (SEM) was 1.26 and minimum detectable change at the 95% confidence level (MDC95) 3.5 points for Mini-BESTest, whereas SEM was 2.18 and MDC95 6.2 points for BBS. In receiver operating characteristic (ROC) curves, the area under the curve was 0.92 for Mini-BESTest and 0.91 for BBS. The best Minimal Important Change (MIC) was 4 points for Mini-BESTest and 7 for BBS. After treatment, 38 patients at Mini-BESTest vs. only 23 at BBS (out of the 40 subjects who had a GRC ≥3.5) showed a score change equal or greater than MICs.
Conclusions The two scales behave similarly, but the Mini-BESTest scale seems to have a lesser ceiling effect, slightly higher reliability levels, and greater accuracy in classifying individual patients who show significant improvement in balance function.
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TL;DR: The Mini-BESTest is a reliable and valid tool for evaluating balance in people with chronic stroke and its accuracy in categorizing people with stroke based on fall history is found to be accurate.
Abstract: Background The Mini-Balance Evaluation Systems Test (Mini-BESTest) is a new balance assessment, but its psychometric properties have not been specifically tested in individuals with stroke.
Objectives The purpose of this study was to examine the reliability and validity of the Mini-BESTest and its accuracy in categorizing people with stroke based on fall history.
Design An observational measurement study with a test-retest design was conducted.
Methods One hundred six people with chronic stroke were recruited. Intrarater reliability was evaluated by repeating the Mini-BESTest within 10 days by the same rater. The Mini-BESTest was administered by 2 independent raters to establish interrater reliability. Validity was assessed by correlating Mini-BESTest scores with scores of other balance measures (Berg Balance Scale, one-leg-standing, Functional Reach Test, and Timed “Up & Go” Test) in the stroke group and by comparing Mini-BESTest scores between the stroke group and 48 control participants, and between fallers (≥1 falls in the previous 12 months, n=25) and nonfallers (n=81) in the stroke group.
Results The Mini-BESTest had excellent internal consistency (Cronbach alpha=.89–.94), intrarater reliability (intraclass correlation coefficient [3,1]=.97), and interrater reliability (intraclass correlation coefficient [2,1]=.96). The minimal detectable change at 95% confidence interval was 3.0 points. The Mini-BESTest was strongly correlated with other balance measures. Significant differences in Mini-BESTest total scores were found between the stroke and control groups and between fallers and nonfallers in the stroke group. In terms of floor and ceiling effects, the Mini-BESTest was significantly less skewed than other balance measures, except for one-leg-standing on the nonparetic side. The Berg Balance Scale showed significantly better ability to identify fallers (positive likelihood ratio=2.6) than the Mini-BESTest (positive likelihood ratio=1.8).
Limitations The results are generalizable only to people with mild to moderate chronic stroke.
Conclusions The Mini-BESTest is a reliable and valid tool for evaluating balance in people with chronic stroke.
178 citations
TL;DR: The potential role of body-worn movement monitors for balance and gait assessment and treatment in rehabilitation and the opportunity for immediate biofeedback provided to patients that can focus attention and enhance performance are discussed.
Abstract: This perspective article will discuss the potential role of body-worn movement monitors for balance and gait assessment and treatment in rehabilitation. Recent advances in inexpensive, wireless sensor technology and smart devices are resulting in an explosion of miniature, portable sensors that can quickly and accurately quantify body motion. Practical and useful movement monitoring systems are now becoming available. It is critical that therapists understand the potential advantages and limitations of such emerging technology. One important advantage of obtaining objective measures of balance and gait from body-worn sensors is impairment-level metrics characterizing how and why functional performance of balance and gait activities are impaired. Therapy can then be focused on the specific physiological reasons for difficulty in walking or balancing during specific tasks. A second advantage of using technology to measure balance and gait behavior is the increased sensitivity of the balance and gait measures to document mild disability and change with rehabilitation. A third advantage of measuring movement, such as postural sway and gait characteristics, with body-worn sensors is the opportunity for immediate biofeedback provided to patients that can focus attention and enhance performance. In the future, body-worn sensors may allow therapists to perform telerehabilitation to monitor compliance with home exercise programs and the quality of their natural mobility in the community. Therapists need technological systems that are quick to use and provide actionable information and useful reports for their patients and referring physicians. Therapists should look for systems that provide measures that have been validated with respect to gold standard accuracy and to clinically relevant outcomes such as fall risk and severity of disability.
168 citations
TL;DR: People with various levels of cognitive impairment can benefit from supervised multi-modal exercise for about 60minutes a day, 2 to 3 days a week to improve physical function and quality of life.
135 citations
TL;DR: Older adults and individuals with PD were able to successfully use immersive VR during walking without adverse effects, providing systematic evidence supporting the safety of immersive VR for gait training in these populations.
Abstract: Virtual reality (VR) has recently been explored as a tool for neurorehabilitation to enable individuals with Parkinson’s disease (PD) to practice challenging skills in a safe environment. Current technological advances have enabled the use of affordable, fully immersive head-mounted displays (HMDs) for potential therapeutic applications. However, while previous studies have used HMDs in individuals with PD, these were only used for short bouts of walking. Clinical applications of VR for gait training would likely involve an extended exposure to the virtual environment, which has the potential to cause individuals with PD to experience simulator-related adverse effects due to their age or pathology. Thus, our objective was to evaluate the safety of using an HMD for longer bouts of walking in fully immersive VR for older adults and individuals with PD. Thirty-three participants (11 healthy young, 11 healthy older adults, and 11 individuals with PD) were recruited for this study. Participants walked for 20 min while viewing a virtual city scene through an HMD (Oculus Rift DK2). Safety was evaluated using the mini-BESTest, measures of center of pressure (CoP) excursion, and questionnaires addressing symptoms of simulator sickness (SSQ) and measures of stress and arousal. Most participants successfully completed all trials without any discomfort. There were no significant changes for any of our groups in symptoms of simulator sickness or measures of static and dynamic balance after exposure to the virtual environment. Surprisingly, measures of stress decreased in all groups while the PD group also increased the level of arousal after exposure. Older adults and individuals with PD were able to successfully use immersive VR during walking without adverse effects. This provides systematic evidence supporting the safety of immersive VR for gait training in these populations.
130 citations
Cites methods from "Comparison of Reliability, Validity..."
...We then performed baseline measures of dynamic balance using the Mini-Balance Evaluations Systems Test (Mini-BESTest), a 14-item balance assessment for dynamic balance and gait, which has been shown to be reliable for assessing balance disorders and fall risk in individuals with PD [52]....
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TL;DR: The test-retest reliability and sensitivity to group differences regarding the time-limit (TLimit) of one-leg standing and selected balance parameters obtained with a force platform in older and young adults were found to be acceptable and sensitive to differences in balance performance between older andYoung adults.
118 citations
References
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TL;DR: A nonparametric approach to the analysis of areas under correlated ROC curves is presented, by using the theory on generalized U-statistics to generate an estimated covariance matrix.
Abstract: Methods of evaluating and comparing the performance of diagnostic tests are of increasing importance as new tests are developed and marketed. When a test is based on an observed variable that lies on a continuous or graded scale, an assessment of the overall value of the test can be made through the use of a receiver operating characteristic (ROC) curve. The curve is constructed by varying the cutpoint used to determine which values of the observed variable will be considered abnormal and then plotting the resulting sensitivities against the corresponding false positive rates. When two or more empirical curves are constructed based on tests performed on the same individuals, statistical analysis on differences between curves must take into account the correlated nature of the data. This paper presents a nonparametric approach to the analysis of areas under correlated ROC curves, by using the theory on generalized U-statistics to generate an estimated covariance matrix.
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TL;DR: An approach to elucidating the significance of changes in score in quality of life instruments by comparing them to global ratings of change is developed, and a plausible range within which the minimal clinically important difference (MCID) falls is established.
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TL;DR: The mini-HAQ score as mentioned in this paper is a measure of impairment developed for patients with cervical myelopathy, which has 10 items (table 1)) recording the degree of difficulty experienced in carrying out daily activities.
Abstract: Many quantities of interest in medicine, such as anxiety or degree of handicap, are impossible to measure explicitly. Instead, we ask a series of questions and combine the answers into a single numerical value. Often this is done by simply adding a score from each answer. For example, the mini-HAQ is a measure of impairment developed for patients with cervical myelopathy.1 This has 10 items (table 1)) recording the degree of difficulty experienced in carrying out daily activities. Each item is scored from 1 (no difficulty) to 4 (can't do). The scores on the 10 items are summed to give the mini-HAQ score.
View this table:
Table 1
Mini-HAQ scale in 249 severely impaired subjects
When items are used to form a scale they need to have internal consistency. The …
3,673 citations
Journal Article•
TL;DR: Balance scores predicted the occurrence of multiple falls among elderly residents and were strongly correlated with functional and motor performance in stroke patients.
Abstract: This study assessed the validity of the Balance Scale by examining: how Scale scores related to clinical judgements and self-perceptions of balance, laboratory measures of postural sway and external criteria reflecting balancing ability; if scores could predict falls in the elderly; and how they related to motor and functional performance in stroke patients. Elderly residents (N = 113) were assessed for functional performance and balance regularly over a nine-month period. Occurrence of falls was monitored for a year. Acute stroke patients (N = 70) were periodically rated for functional independence, motor performance and balance for over three months. Thirty-one elderly subjects were assessed by clinical and laboratory indicators reflecting balancing ability. The Scale correlated moderately with caregiver ratings, self-ratings and laboratory measures of sway. Differences in mean Scale scores were consistent with the use of mobility aids by elderly residents and differentiated stroke patients by location of follow-up. Balance scores predicted the occurrence of multiple falls among elderly residents and were strongly correlated with functional and motor performance in stroke patients.
2,742 citations