Psychometric properties of Brief-Balance Evaluation Systems Test (Brief-BESTest) in evaluating balance performance in individuals with chronic stroke

Abstract

Objective: To examine the psychometric properties of the Brief-Balance Evaluation Systems Test (Brief-BESTest) in individuals with chronic stroke. Materials and Methods: This was an observational study with repeated measurements involving 50 participants with chronic stroke [mean (SD) age: 59.2 (7.3) years]. Each participant with stroke was evaluated with the Brief-BESTest, Berg balance scale (BBS), Postural Assessment Scale for Stroke Patients (PASS), Fugl-Meyer Motor Assessment (FMA), Chedoke-McMaster Stroke Assessment (CMSA), Montreal Cognitive Assessment (MoCA), and Geriatric Depression Scale (GDS). Two raters (rater 1 and 2) provided the Brief-BESTest scores of the first 27 participants independently to establish inter-rater reliability. After 15 min of rest, the same 27 participants were evaluated with the Brief-BESTest again by rater 1 to establish intra-rater reliability. The Brief-BESTest scores of the stroke group were also compared with those of the control group [n = 27, mean (SD) age: 56.7 (7.7) years]. Results: The Brief-BESTest had no substantial floor and ceiling effects, good intra-rater (ICC2,1 = 0.974) and inter-rater (ICC2,1 = 0.980) reliability and internal consistency (Cronbach's alpha = 0.818). The minimal detectable change at 95% confidence level was 2 points. The Brief-BESTest showed moderate to very strong correlations with other balance (BBS and PASS) and motor impairment (FMA, CMSA) measures (rs =.547–.911, p <.001), thus revealing good concurrent and convergent validity. Its correlation with measures that evaluated other constructs was weaker (MoCA: rs =.437, p =.002) or non-significant (GDS: rs = −0.152, p =.292), thus showing good discriminant validity. Good known-groups validity was established, as the Brief-BESTest was effective in distinguishing participants with stroke from controls (cutoff score: <18, area under curve: 0.942), and individuals with stroke who required assistive device for their outdoor mobility from those who did not (cutoff score <14, area under curve: 0.810). Conclusions: The Brief-BESTest has good reliability and validity in assessing balance function in individuals with chronic stroke.