Brief Balance Evaluation Systems Test

Last Updated

June 03, 2013

Purpose

The Brief BESTest is a clinical balance assessment tool. It is an abbreviated version of Balance Evaluation Systems Test (BESTest), designed to assess 6 different aspects contributing to postural control in standing and walking.

Link to Instrument

Instrument Details

Acronym Brief BESTest

Area of Assessment

Balance – Non-vestibular
Functional Mobility

Assessment Type

Performance Measure

Administration Mode

Paper & Pencil

Cost

Free

Cost Description

Test is free; Training DVD for BESTest full test is $200.00

Diagnosis/Conditions

Multiple Sclerosis
Parkinson's Disease & Movement Disorders
Stroke Recovery

Parkinson's Disease

Mixed Populations

This is a 6-item revised version of the BESTest, designed to improve the clinical utility and to preserve the construct validity of BESTest.
One item from each of the BESTest system subsections (biomechanical constraints, stability limits/verticality, anticipatory postural adjustments, postural responses, sensory orientation, stability in gait) was selected for the Brief BESTest based on highest item correlation coefficients with their respective system section.
Each item is scored: 0 - 3 points (0 representing severe impairment and 3 representing no balance impairment).
Total score = 24 points (2 items include both a R/L component).
Scoring form and test available in original article by Padgett (2012).
Six categories included in the Brief BESTest (8 scored):
1) Biomechanical constraints: Hip strength
2) Stability limits/verticality: Reach forward
3) Anticipatory postural responses: Stand on one limb: left and right each scored
4) Postural responses: Compensatory Stepping right and left each scored
5) Sensory orientation: Stance on foam with eyes closed
6) Stability in gait: Get up and Go test
Please see BESTest.us for more information

Number of Items

Medium density 4-inch foam pad
Stop watch
Meter stick
Space to complete the TUG
Stable chair

10 minutes

Required Training

Reading an Article/Manual

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Cathy Harro MS, PT, NCS and the PD EDGE Task Force of Neurology Section of the APTA.

ICF Domain

Body Function
Activity

Measurement Domain

Motor
Sensory

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit: http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

Abbreviations:
HR	Highly Recommend
R	Recommend
LS / UR	Reasonable to use, but limited study in target group / Unable to Recommend
NR	Not Recommended

Recommendations for use based on acuity level of the patient:

Acute

(CVA < 2 months post)

(SCI < 1 month post)

(Vestibular < 6weeks post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

(Vestibular > 6 weeks post)

VEDGE

Recommendations Based on Parkinson Disease Hoehn and Yahr stage:

	I	II	III	IV	V
PD EDGE	LS/UR	R	R	R	NR

Recommendations based on vestibular diagnosis

	Peripheral	Central	Benign Paroxysmal Positional Vertigo (BPPV)	Other
VEDGE	LS	LS	LS	LS

Recommendations for entry-level physical therapy education and use in research:

	Students should learn to administer this tool? (Y/N)	Students should be exposed to tool? (Y/N)	Appropriate for use in intervention research studies? (Y/N)	Is additional research warranted for this tool (Y/N)
PD EDGE	No	No	No

Considerations

REVISED version of BESTest with goal of improving clinical utility. Limited psychometric studies (2 published). Time to complete testing (10 minutes) is more feasible in clinical setting that complete BESTest. Consider MiniBESTest as another option of valid and reliable revised version of BESTest that has good clinical utility.

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Cut-Off Scores

Parkinson’s Disease:

(Duncan, et al, 2013; n = 80 with idiopathic PD, mean age = 68.2 (9.7), mean MDS-UPDRS 41.3 (14.7), H & Y stage [1 = 4, 2 = 27, 2.5 = 30, 3 = 13, 4 = 6]; retrospective fallers n = 25 (31%), 6 month prospective fallers n= 14 (27.5%), 12 month prospective fallers n = 13 (32.5%))

Fall risk Cut score < 11/24 points; Adequate detection of retrospective fallers in PD cohort, (AUC = 0.82, sensitivity = 0.76, specificity = 0.84, LR+ = 4.64, LR- = 0.29)

Normative Data

Parkinson’s Disease:

(Duncan , et al., 2013; n = 80 with PD varied stages (see above cohort description))

mean Brief BESTest = 13.2 (55%) sd = 5.5

Criterion Validity (Predictive/Concurrent)

Parkinson’s Disease:

(Duncan , et al., 2013)

Cut score < 11/24; Prospective prediction of fall risk in PD cohort
- (n = 51) 6-month adequate predictive validity (AUC = 0.88, sensitivity = 0.71, specificity = 0.87, LR+ = 5.29, LR- = 0.50);
- n = 40 12-month adequate predictive validity (AUC = 0.76, sensitivity = 0.53, specificity = 0.93, LR+7.27, LR- = 0.50)

Content Validity

Parkinson’s Disease:

(Duncan , et al., 2013)

Brief BESTest demonstrated excellent correlation with

BESTest (r = 0.94) and Mini BESTest (r = 0.95)

*Each item on Brief BESTest correlated with its respective section on BESTest as follows:

adequate correlation (anticipatory postural adjustments r = 0.89, postural responses r = 0.91, sensory orientation r = 0.78, stability in gait r = 0.78);
poor correlation (biomechanical constraints r = 0.61, stability limits/verticality r = 0.69)

Face Validity

Supported by the theoretical construct of BESTest six subsections, Brief BESTest includes the strongest psychometric item from each section.

Interrater/Intrarater Reliability

Balance Deficits:

(Padgett, Jacobs, & Kasser, 2012; 1^st cohort: n = 20 varied Dx (4 PD, 1 CVA, 4 MS, 1 PN, 1 tremor) and 9 healthy; 5 with positive fall history. 2^nd cohort: n = 13 with MS, mean age 50, EDSS < 6 (range 0 - 4.5), 7 fallers)

Excellent inter-rater reliability ICC = 0.994 (0.986 - 0.997) with three trained raters concurrently rating Brief BESTest

Internal Consistency

Balance Deficits:

(Padgett, Jacobs, & Kasser, 2012)

Excellent internal consistency 1^st cohort Cronbach Alpha = 0.917 with average item correlation = 0.737; 2^nd cohort Cronbach Alpha = 0.856, with average item correlation = 0.617

Construct Validity

Balance Deficits:

(Padgett, Jacobs, & Kasser, 2012)

Brief BESTest significantly differentiated those with neurologic conditions from healthy subjects for all three raters (1^st cohort)
Rater 1: neurologic conditions (mean score = 59 (CI 39-79)) and healthy subjects (mean score = 91 (CI 83-100))
Rater 2: neurologic conditions (mean score = 57 (38-76)) and healthy subjects (mean score = 84 (80-87))
Rater 3: neurologic conditions (mean score = 61 (43-80)) and healthy subjects (mean score = 90 (82-97))
Excellent discriminative validity in MS cohort (2^nd cohort), able to distinguish fallers (Mean score = 59% (45 - 73)) from nonfallers (mean score = 95% (92 - 98)); Sensitivity to detect fallers = 100%, specificity = 100%, accuracy = 100%.

Face Validity

Supported by the theoretical construct of BESTest six subsections, Brief BESTest includes the strongest psychometric item from each section.

Bibliography

Duncan, R. P., Leddy, A. L., et al. (2013). "Comparative utility of the BESTest, mini-BESTest, and brief-BESTest for predicting falls in individuals with Parkinson disease: a cohort study." Phys Ther 93(4): 542-550. Find it on PubMed

Padgett, P. K., Jacobs, J. V., et al. (2012). "Is the BESTest at its best? A suggested brief version based on interrater reliability, validity, internal consistency, and theoretical construct." Phys Ther 92(9): 1197-1207. Find it on PubMed

Last Updated

Purpose

Link to Instrument

Area of Assessment

Assessment Type

Administration Mode

Cost

Cost Description

Diagnosis/Conditions

Number of Items

Required Training

Instrument Reviewers

ICF Domain

Measurement Domain

Professional Association Recommendation

Considerations

Cut-Off Scores

Normative Data

Criterion Validity (Predictive/Concurrent)

Content Validity

Face Validity

Interrater/Intrarater Reliability

Internal Consistency

Construct Validity

Face Validity

Bibliography

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