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Title: Comparison of measurement properties of three shortened versions of the balance evaluation system test (BESTest) in people with subacute stroke
Authors: Winairuk, T
Pang, MYC 
Saengsirisuwan, V
Horak, FB
Boonsinsukh, R
Issue Date: Oct-2019
Source: Journal of rehabilitation medicine, Oct. 2019, v. 51, no. 9, p. 683-691
Abstract: Objectives: To examine the reliability, validity and responsiveness of 3 different short versions of the Balance Evaluation Systems Test (BESTest: S-BESTest, Brief-BESTest and Mini-BESTest) in patients with subacute stroke.
Design: A prospective cohort study.
Participants: Patients with subacute stroke.
Methods: Patients were assessed using the full BESTest. Scores of 3 short-form BESTests were later extracted. The intra-rater and inter-rater reliability (n = 12) were gathered from 5 raters. Concurrent validity was assessed with the Berg Balance Scale (BBS). Floor/ceiling effect, internal responsiveness and external responsiveness with the BBS (n = 70) were assessed at baseline, 2 weeks and 4 weeks post-rehabilitation.
Results and conclusion: All short-form BESTests demonstrated excellent intra-rater and inter-rater reliability (intraclass correlation coefficient (ICC) = 0.95-0.99) and excellent concurrent validity (r = 0.93-0.96). Unlike the Brief-BESTest and Mini-BESTest, the S-BESTest and BESTest had no significant floor/ceiling effects (< 20%). The standardized response mean of all 4 BESTest versions were large, ranging between 1.19 and 1.57, indicating sufficient internal responsiveness. The area under the curve of the S-BESTest and BESTest were significantly higher than the Brief-BESTest and Mini-BESTest, reflecting better accuracy of the S-BESTest and BESTest in identifying patients with subacute stroke who had balance improvement using the minimal clinically important difference of 6 and 16 points, respectively. These findings suggest that the S-BESTest is a short-form BESTest that is appropriate for assessing balance impairments in patients with subacute stroke.
Keywords: Psychometric
Physical therapist
Postural balance
Minimal clinically important difference
Patient-reported outcome measures
Cerebrovascular disease
Publisher: Foundation for Rehabilitation Information
Journal: Journal of rehabilitation medicine 
ISSN: 1650-1977
EISSN: 1651-2081
DOI: 10.2340/16501977-2589
Rights: This is an open access article under the CC BY-NC license.
Creative Commons Attribution-NonCommercial 4.0 International License (
Journal Compilation © 2019 Foundation of Rehabilitation Information.
The following publication Winairuk, T., Pang, M. Y. C., Saengsirisuwan, V., Horak, F. B., & Boonsinsukh, R. (2019). Comparison of measurement properties of three shortened versions of the balance evaluation system test (BESTest) in people with subacute stroke. Journal of Rehabilitation Medicine, 51(9), 683-691 is available at
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