Responsiveness of the Balance Evaluation Systems Test (BESTest) in People With Subacute Stroke.

BACKGROUND: The reliability and convergent validity of the Balance Evaluation Systems Test (BESTest) in people with subacute stroke have been established, but its responsiveness to rehabilitation has not been examined. OBJECTIVE: The study objective was to compare the responsiveness of the BESTest with those of other clinical balance tools in people with subacute stroke. DESIGN: This was a prospective cohort study. METHODS: Forty-nine people with subacute stroke (mean age=57.8 years, SD=11.8) participated in this study. Five balance measures-the BESTest, the Mini-BESTest, the Berg Balance Scale, the Postural Assessment Scale for Stroke Patients, and the Community Balance and Mobility Scale (CB&M)-were used to measure balance performance before and after rehabilitation or before discharge from the hospital, whichever came first. The internal responsiveness of each balance measure was classified with the standardized response mean (SRM); changes in Berg Balance Scale scores of greater than 7 were used as the external standard for determining the external responsiveness. Analysis of the receiver operating characteristic curve was used to determine the accuracy and cutoff scores for identifying participants with balance improvement. RESULTS: Participants received 13.7 days (SD=9.3, range=5-44) of physical therapy rehabilitation. The internal responsiveness of all balance measures, except for the CB&M, was high (SRM=0.9-1.2). The BESTest had a higher SRM than the Mini-BESTest and the CB&M, indicating that the BESTest was more sensitive for detecting balance changes than the Mini-BESTest and the CB&M. In addition, compared with other balance measures, the BESTest had no floor, ceiling, or responsive ceiling effects. The results also indicated that the percentage of participants with no change in scores after rehabilitation was smaller with the BESTest than with the Mini-BESTest and the CB&M. With regard to the external responsiveness, the BESTest had higher accuracy, sensitivity, specificity, and posttest accuracy than the Postural Assessment Scale for Stroke Patients and the CB&M for identifying participants with balance improvement. Changes in BESTest scores of 10% or more indicated changes in balance performance. LIMITATIONS: A limitation of this study was the difference in the time periods between the first and the second assessments across participants. CONCLUSIONS: The BESTest was the most sensitive scale for assessing balance recovery in participants with subacute stroke because of its high internal and external responsiveness and lack of floor and ceiling effects.

Interaction of age and foam types used in Clinical Test for Sensory Interaction and Balance (CTSIB).

Clinical Test for Sensory Interaction and Balance (CTSIB) is a simplified method for investigating the organization of multiple sensory inputs in postural control. The accuracy of the test is based partly on the foam types. Several types of foam are available, but the validity of these foams on CTSIB and the interaction of age and foam types have not been addressed. In this study, postural sway of young (21.6 ± 3.3 years) and older (53.2 ± 4.9 years) participants were assessed while standing on four types of foam: NeuroCom(®), sponge, Ethylene Vinyl Acetate (EVA), and memory foams. Postural sway during stance on solid floor and foams with eyes open and eyes closed were quantified by root-mean-square (RMS) of center of body mass acceleration in the mediolateral (ML) and anteroposterior (AP) directions using the acceleration-based OPAL system. Physical properties of foams including density, Young's modulus, and indentation force deflection (IFD) were determined. Results demonstrated that RMS-ML in older subjects was larger than younger subjects (p ≤ 0.001), especially when standing on the NeuroCom(®) foam with eyes closed (p = 0.001). There was an interaction of age and foam types as larger differences in RMS-ML were observed between young and older subjects on the NeuroCom(®) and EVA foams, but not the other foams. The sway characteristics were largest when standing on the NeuroCom(®) foam which demonstrated high density and high compliance. Our findings suggested the importance of foam selection in CTSIB on accurate postural sway analysis and balance assessment.

Reliability and validity of the Balance Evaluation Systems Test (BESTest) in people with subacute stroke.

BACKGROUND: The Balance Evaluation Systems Test (BESTest) is a new clinical balance assessment tool, but it has never been validated in patients with subacute stroke. OBJECTIVE: The purpose of this study was to examine the reliability and validity of the BESTest in patients with subacute stroke. DESIGN: This was an observational reliability and validity study. METHODS: Twelve patients participated in the interrater and intrarater reliability study. Convergent validity was investigated in 70 patients using the Berg Balance Scale (BBS), Postural Assessment Scale for Stroke (PASS), Community Balance and Mobility Scale (CB&M), and Mini-BESTest. The receiver operating characteristic curve was used to calculate the sensitivity, specificity, and accuracy of the BESTest, Mini-BESTest, and BBS in classifying participants into low functional ability (LFA) and high functional ability (HFA) groups based on Fugl-Meyer Assessment motor subscale scores. RESULTS: The BESTest showed excellent intrarater reliability and interrater reliability (intraclass correlation coefficient=.99) and was highly correlated with the BBS (Spearman r=.96), PASS (r=.96), CB&M (r=.91), and Mini-BESTest (r=.96), indicating excellent convergent validity. No floor or ceiling effects were observed with the BESTest. In contrast, the Mini-BESTest and CB&M had a floor effect in the LFA group, and the BBS and PASS demonstrated responsive ceiling effects in the HFA group. In addition, the BESTest showed high accuracy as the BBS and Mini-BESTest in separating participants into HFA and LFA groups. LIMITATION: Whether the results are generalizable to patients with chronic stroke is unknown. CONCLUSION: The BESTest is reliable, valid, sensitive, and specific in assessing balance in people with subacute stroke across all levels of functional disability.