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)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: August 03, 2016
Footnotes
Supported in part by Fundo Europeu de Desenvolvimento Regional through Programa Operacional Fatores de Competitividade and Fundação para a Ciência e Tecnologia (FCT) under project UID/BIM/04501/2013, and by National Funds through FCT, in the context of the projects UID/CEC/00127/2013 and Incentivo/EEI/UI0127/2014.
Disclosures: none.
Identification
Copyright
© 2016 Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
