Psychometric Properties of the Mini-Balance Evaluation Systems Test (Mini-BESTest) in Community-Dwelling Individuals With Chronic Stroke
Tóm tắt
The Mini-Balance Evaluation Systems Test (Mini-BESTest) is a new balance assessment, but its psychometric properties have not been specifically tested in individuals with stroke.
The purpose of this study was to examine the reliability and validity of the Mini-BESTest and its accuracy in categorizing people with stroke based on fall history.
An observational measurement study with a test-retest design was conducted.
One hundred six people with chronic stroke were recruited. Intrarater reliability was evaluated by repeating the Mini-BESTest within 10 days by the same rater. The Mini-BESTest was administered by 2 independent raters to establish interrater reliability. Validity was assessed by correlating Mini-BESTest scores with scores of other balance measures (Berg Balance Scale, one-leg-standing, Functional Reach Test, and Timed “Up & Go” Test) in the stroke group and by comparing Mini-BESTest scores between the stroke group and 48 control participants, and between fallers (≥1 falls in the previous 12 months, n=25) and nonfallers (n=81) in the stroke group.
The Mini-BESTest had excellent internal consistency (Cronbach alpha=.89–.94), intrarater reliability (intraclass correlation coefficient [3,1]=.97), and interrater reliability (intraclass correlation coefficient [2,1]=.96). The minimal detectable change at 95% confidence interval was 3.0 points. The Mini-BESTest was strongly correlated with other balance measures. Significant differences in Mini-BESTest total scores were found between the stroke and control groups and between fallers and nonfallers in the stroke group. In terms of floor and ceiling effects, the Mini-BESTest was significantly less skewed than other balance measures, except for one-leg-standing on the nonparetic side. The Berg Balance Scale showed significantly better ability to identify fallers (positive likelihood ratio=2.6) than the Mini-BESTest (positive likelihood ratio=1.8).
The results are generalizable only to people with mild to moderate chronic stroke.
The Mini-BESTest is a reliable and valid tool for evaluating balance in people with chronic stroke.
Từ khóa
Tài liệu tham khảo
The global burden of disease: 2004 update. World Health Organization Health Statistics and Information website. Available at: http://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/index.html. Accessed January 10, 2012.
de Haart, 2004, Recovery of standing balance in postacute stroke patients: a rehabilitation cohort study, Arch Phys Med Rehabil, 85, 886, 10.1016/j.apmr.2003.05.012
Perlmutter, 2010, Quantitative analysis of static sitting posture in chronic stroke, Gait Posture, 32, 53, 10.1016/j.gaitpost.2010.03.005
Pang, 2005, Relationship between ambulatory capacity and cardiorespiratory fitness in chronic stroke: influence of stroke-specific impairments, Chest, 127, 495, 10.1378/chest.127.2.495
Harley, 2006, Disruption of sitting balance after stroke: influence of spoken output, J Neurol Neurosurg Psychiatry, 77, 674, 10.1136/jnnp.2005.074138
Desrosiers, 2002, Predictors of handicap situations following post-stroke rehabilitation, Disabil Rehabil, 24, 774, 10.1080/09638280210125814
Lamb, 2003, Risk factors for falling in home-dwelling older women with stroke: the Women's Health and Aging Study, Stroke, 34, 494, 10.1161/01.STR.0000053444.00582.B7
Lin, 2001, Predicting long-term care institution utilization among post-rehabilitation stroke patients in Taiwan: a medical centre-based study, Disabil Rehabil, 23, 722, 10.1080/09638280110051376
de Haart, 2005, Restoration of weight-shifting capacity in patients with postacute stroke: a rehabilitation cohort study, Arch Phys Med Rehabil, 86, 755, 10.1016/j.apmr.2004.10.010
Pang, 2005, A community-based fitness and mobility exercise program for older adults with chronic stroke: a randomized, controlled trial, J Am Geriatr Soc, 53, 1667, 10.1111/j.1532-5415.2005.53521.x
Smania, 2008, Rehabilitation of sensorimotor integration deficits in balance impairment of patients with stroke hemiparesis: a before/after pilot study, Neurol Sci, 29, 313, 10.1007/s10072-008-0988-0
Shumway-Cook, 2000, Attentional demands and postural control: the effect of sensory context, J Gerontol A Biol Sci Med Sci, 55, M10, 10.1093/gerona/55.1.M10
Pollock, 2011, Clinical measurement of walking balance in people post stroke: a systematic review, Clin Rehabil, 25, 693, 10.1177/0269215510397394
de Oliveira, 2008, Balance control in hemiparetic stroke patients: main tools for evaluation, J Rehabil Res Dev, 45, 1215, 10.1682/JRRD.2007.09.0150
Berg, 1995, The Balance Scale: reliability assessment with elderly residents and patients with an acute stroke, Scand J Rehabil Med, 27, 27
Duncan, 1990, Functional reach: a new clinical measure of balance, J Gerontol, 45, M192, 10.1093/geronj/45.6.M192
Podsiadlo, 1991, The timed “Up & Go”: a test of basic functional mobility for frail elderly persons, J Am Geriatr Soc, 39, 142, 10.1111/j.1532-5415.1991.tb01616.x
Flansbjer, 2012, The reproducibility of Berg Balance Scale and the Single-leg Stance in chronic stroke and the relationship between the two tests, PM R, 4, 165, 10.1016/j.pmrj.2011.11.004
Bohannon, 1993, Ordinal and timed balance measurements: reliability and validity in patients with stroke, Clin Rehabil, 7, 9, 10.1177/026921559300700102
Franchignoni, 2010, Using psychometric techniques to improve the Balance Evaluation Systems Test: the mini-BESTest, J Rehabil Med, 42, 323, 10.2340/16501977-0537
Leroux, 2006, Task-oriented intervention in chronic stroke: changes in clinical and laboratory measures of balance and mobility, Am J Phys Med Rehabil, 85, 820, 10.1097/01.phm.0000233179.64769.8c
Mao, 2002, Analysis and comparison of the psychometric properties of three balance measures for stroke patients, Stroke, 33, 1022, 10.1161/01.STR.0000012516.63191.C5
Tyson, 2004, Development of the Brunel Balance Assessment: a new measure of balance disability post stroke, Clin Rehabil, 18, 801, 10.1191/0269215504cr744oa
Blum, 2008, Usefulness of the Berg Balance Scale in stroke rehabilitation: a systematic review, Phys Ther, 88, 559, 10.2522/ptj.20070205
Belgen, 2006, The association of balance capacity and falls self-efficacy with history of falling in community-dwelling people with chronic stroke, Arch Phys Med Rehabil, 87, 554, 10.1016/j.apmr.2005.12.027
Beninato, 2009, Using the International Classification of Functioning, Disability and Health as a framework to examine the association of falls and clinical assessment tools in people with stroke, Phys Ther, 89, 816, 10.2522/ptj.20080160
Harris, 2005, Relationship between balance and mobility to fall incidence in people with chronic stroke, Phys Ther, 85, 150, 10.1093/ptj/85.2.150
Fugl-Meyer, 1975, The post stroke hemiplegic patient, I: a method of evaluation of physical performance, Scand J Rehabil Med, 7, 13, 10.2340/1650197771331
Horak, 2009, The Balance Evaluation Systems Test (BESTest) to differentiate balance deficits, Phys Ther, 89, 484, 10.2522/ptj.20080071
Godi, 2013, Comparison of reliability, validity, and responsiveness of the Mini-BESTest and Berg Balance Scale in patients with balance disorders, Phys Ther, 93, 158, 10.2522/ptj.20120171
King, 2012, Comparing the Mini-BESTest with the Berg Balance Scale to evaluate balance disorders in Parkinson's disease, Parkinsons Dis, 2012, 375419
Leddy, 2011, Utility of the Mini-BESTest, BESTest, and BESTest sections for balance assessments in individuals with Parkinson disease, J Neurol Phys Ther, 35, 90, 10.1097/NPT.0b013e31821a620c
Duncan, 2012, Accuracy of fall prediction in Parkinson disease: six-month and 12-month prospective analyses, Parkinson Dis, 2012, 237673
Duncan, 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, 542, 10.2522/ptj.20120302
Portney, 2009, Foundations of Clinical Research: Applications to Practice, 3rd ed
Hyndman, 2002, Fall events among people with stroke living in the community: circumstances of falls and characteristics of fallers, Arch Phys Med Rehabil, 83, 165, 10.1053/apmr.2002.28030
Jorgensen, 2002, Higher incidence of falls in long-term stroke survivors than in population controls: depressive symptoms predict falls after stroke, Stroke, 33, 542, 10.1161/hs0202.102375
Forster, 1995, Incidence and consequences of falls due to stroke: a systematic inquiry, BMJ, 311, 83, 10.1136/bmj.311.6997.83
Wolf, 1999, Establishing the reliability and validity of measurements of walking time using the Emory Functional Ambulation Profile, Phys Ther, 79, 1122, 10.1093/ptj/79.12.1122
Flansbjer, 2005, Reliability of gait performance tests in men and women with hemiparesis after stroke, J Rehabil Med, 37, 75, 10.1080/16501970410017215
Knorr, 2010, Validity of the Community Balance and Mobility Scale in community-dwelling persons after stroke, Arch Phys Med Rehabil, 91, 890, 10.1016/j.apmr.2010.02.010
Gowland, 1993, Measuring physical impairment and disability with the Chedoke-McMaster Stroke Assessment, Stroke, 24, 58, 10.1161/01.STR.24.1.58
Gregson, 1999, Reliability of the Tone Assessment Scale and the modified Ashworth scale as clinical tools for assessing poststroke spasticity, Arch Phys Med Rehabil, 80, 1013, 10.1016/S0003-9993(99)90053-9
Mak, 2007, Validation of the Chinese translated Activities-specific Balance Confidence scale, Arch Phys Med Rehabil, 88, 496, 10.1016/j.apmr.2007.01.018
Hsu, 2006, Reliability of the Chinese version of the Activities-specific Balance Confidence Scale, Disabil Rehabil, 28, 1287, 10.1080/09638280600638414
Botner, 2005, Measurement properties of the Activities-specific Balance Confidence Scale among individuals with stroke, Disabil Rehabil, 27, 156, 10.1080/09638280400008982
Bamford, 2000, The role of the clinical examination in the subclassification of stroke, Cerebrovasc Dis, 10, 2, 10.1159/000047582
Lindley, 1993, Interobserver reliability of a clinical classification of acute cerebral infarction, Stroke, 24, 1801, 10.1161/01.STR.24.12.1801
Selvarajah, 2009, Classification of minor stroke: intra- and inter-observer reliability, Cerebrovasc Dis, 27, 209, 10.1159/000196817
Chu., 1995, Validation of the Abbreviated Mental Test (Hong Kong version) in the elderly medical patient, Hong Kong Med J, 1, 207
Lam, 2010, Reliability and validity of the Abbreviated Mental Test (Hong Kong version) in residential care homes, J Am Geriatr Soc, 58, 2255, 10.1111/j.1532-5415.2010.03129.x
Sheikh, 1986, Geriatric Depression Scale (GDS): recent evidence and development of a shorter version, J Aging Ment Health, 5, 165
Sivrioglu, 2009, Reliability and validity of the Geriatric Depression Scale in detection of poststroke minor depression, J Clin Exp Neuropsychol, 31, 999, 10.1080/13803390902776878
Landis, 1977, An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers, Biometrics, 33, 363, 10.2307/2529786
DeLong, 1988, Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach, Biometrics, 44, 837, 10.2307/2531595
Confidence interval calculator. Available at: http://www.pedro.org.au/wp-content/uploads/CIcalculator.xls. Accessed February 26, 2013.
Pang, 2008, Falls-related self-efficacy, but not balance and mobility performance, is related to accidental falls in chronic stroke survivors with low bone mineral density, Osteoporos Int, 19, 919, 10.1007/s00198-007-0519-5
Eng, 2008, Balance, falls, and bone health: Role of exercise in reducing fracture risk after stroke, J Rehabil Res Dev, 45, 297, 10.1682/JRRD.2007.01.0014
Benaim, 1999, Validation of a standardized assessment of postural control in stroke patients: the Postural Assessment Scale for Stroke Patients (PASS), Stroke, 30, 1862, 10.1161/01.STR.30.9.1862
Franchignoni, 1997, Trunk Control Test as an early predictor of stroke rehabilitation outcome, Stroke, 28, 1382, 10.1161/01.STR.28.7.1382