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Reliability, Validity, and Ability to Identify Fall Status of the Balance Evaluation Systems Test, Mini–Balance Evaluation Systems Test, and Brief–Balance Evaluation Systems Test in Older People Living in the Community

  • Alda Marques
    Correspondence
    Corresponding author Alda Marques, PhD, Senior Lecturer, Lab 3R–Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Agras do Crasto–Campus Universitário de Santiago, Edifício 30, 3810-193 Aveiro, Portugal.
    Affiliations
    Lab 3R–Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal

    Institute for Research in Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
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  • Sara Almeida
    Affiliations
    Lab 3R–Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal
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  • Joana Carvalho
    Affiliations
    Lab 3R–Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal
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  • Joana Cruz
    Affiliations
    Lab 3R–Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal

    Institute for Research in Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
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  • Ana Oliveira
    Affiliations
    Lab 3R–Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal

    Institute for Research in Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
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  • Cristina Jácome
    Affiliations
    Lab 3R–Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal
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Published:August 03, 2016DOI:https://doi.org/10.1016/j.apmr.2016.07.011

      Highlights

      • The Berg Balance Scale (BBS), Balance Evaluation Systems Test (BESTest), Mini-BESTest, and Brief-BESTest are reliable in older people living in the community.
      • Minimal detectable change values were established for the BBS, BESTest, Mini-BESTest, and Brief-BESTest.
      • The 4 balance tests are able to differentiate between community-living older people with and without a history of falls.
      • Test selection depends on balance impairment level, purpose, and time availability.

      Abstract

      Objectives

      To assess the reliability, validity, and ability to identify fall status of the Balance Evaluation Systems Test (BESTest), Mini-BESTest, and Brief-BESTest, compared with the Berg Balance Scale (BBS), in older people living in the community.

      Design

      Cross-sectional.

      Setting

      Community centers.

      Participants

      Older adults (N=122; mean age ± SD, 76±9y).

      Interventions

      Not applicable.

      Main Outcome Measures

      Participants reported on falls history in the preceding year and completed the Activities-Specific Balance Confidence (ABC) Scale. The BBS, BESTest, and the Five Times Sit-To-Stand Test were administered. Interrater (2 physiotherapists) and test-retest relative (48–72h) and absolute reliabilities were explored with the intraclass correlation coefficient (ICC) equation ((2), (1)) and the Bland and Altman method. Minimal detectable changes at the 95% confidence level (MDC95) were established. Validity was assessed by correlating the balance tests with each other and with the ABC Scale (Spearman correlation coefficients–ρ). Receiver operating characteristics assessed the ability of each balance test to differentiate between people with and without a history of falls.

      Results

      All balance tests presented good to excellent interrater (ICC=.71–.93) and test-retest (ICC=.50–.82) relative reliability, with no evidence of bias. MDC95 values were 4.6, 9, 3.8, and 4.1 points for the BBS, BESTest, Mini-BESTest, and Brief-BESTest, respectively. All tests were significantly correlated with each other (ρ=.83–.96) and with the ABC Scale (ρ=.46–.61). Acceptable ability to identify fall status (areas under the curve, .71–.78) was found for all tests. Cutoff points were 48.5, 82, 19.5, and 12.5 points for the BBS, BESTest, Mini-BESTest, and Brief-BESTest, respectively.

      Conclusions

      All balance tests are reliable, valid, and able to identify fall status in older people living in the community. Therefore, the choice of which test to use will depend on the level of balance impairment, purpose, and time availability.

      Keywords

      List of abbreviations:

      ABC (Activities-Specific Balance Confidence), AUC (area under the curve), BBS (Berg Balance Scale), BESTest (Balance Evaluation Systems Test), FTSTS (Five Times Sit-to-Stand), ICC (intraclass correlation coefficient), MDC (minimal detectable change), MDC95 (minimal detectable change at the 95% confidence level)
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