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Title: Assessing balance function in patients with total knee arthroplasty
Authors: Chan, ACM
Pang, MYC 
Issue Date: 1-Oct-2015
Source: Physical therapy, 1 Oct. 2015, v. 95, no. 10, p. 1397-1407
Abstract: Background. The Balance Evaluation Systems Test (BESTest) is a relatively new balance assessment tool. Recently, the Mini-BESTest and the Brief-BESTest, which are shortened versions of the BESTest, were developed.
Objective. The purpose of this study was to estimate interrater and intrarater-interoccasion reliability, internal consistency, concurrent and convergent validity, and floor and ceiling effects of the 3 BESTests and other related measures, namely, the Berg Balance Scale (BBS), Functional Gait Assessment (FGA), and Activities-specific Balance Confidence (ABC) Scale, among patients with total knee arthroplasty (TKA).
Design. This was an observational measurement study.
Methods. To establish interrater reliability, the 3 BESTests were administered by 3 independent raters to 25 participants with TKA. Intrarater-interoccasion reliability was evaluated in 46 participants with TKA (including the 25 individuals who partic-ipated in the interrater reliability experiments) by repeating the 3 BESTests, BBS, and FGA within 1 week by the same rater. Internal consistency of each test also was assessed with Cronbach alpha. Validity was assessed in another 46 patients with TKA by correlating the 3 BESTests with BBS, FGA, and ABC. The floor and ceiling effects also were examined.
Results. The 3 BESTests demonstrated excellent interrater reliability (intraclass correlation coefficient [ICC] [2,1] .96–.99), intrarater-interoccasion reliability (ICC [2,1] .92–.96), and internal consistency (Cronbach alpha .96–.98). These values were comparable to those for the BBS and FGA. The 3 BESTests also showed moderate-to-strong correlations with the BBS, FGA, and ABC (r .35–.81), thus dem-onstrating good concurrent and convergent validity. No significant floor and ceiling effects were observed, except for the BBS.
Limitations. The results are generalizable only to patients with TKA due to end-stage knee osteoarthritis.
Conclusions. The 3 BESTests have good reliability and validity for evaluating balance in people with TKA. The Brief-BESTest is the least time-consuming and may be more useful clinically.
Publisher: Oxford University Press
Journal: Physical therapy 
ISSN: 0031-9023
EISSN: 1538-6724
DOI: 10.2522/ptj.20140486
Rights: © 2015 American Physical Therapy Association
This is a pre-copyedited, author-produced version of an article accepted for publication in Physical Therapy following peer review. The version of record Andy C.M. Chan, Marco Y.C. Pang, Assessing Balance Function in Patients With Total Knee Arthroplasty, Physical Therapy, Volume 95, Issue 10, 1 October 2015, Pages 1397–1407 is available online at:
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