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Jørgensen V.1,2, Opheim A.1,3, Halvorsson A.2,4, Franzén E.2,4, Skavberg Roaldsen K.1,2,5
1Sunnaas Rehabilitation Hospital, Research Department, Nesoddtangen, Norway, 2Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Stockholm, Sweden, 3University of Gothenburg, Rehabilitation Medicine, Salgrenska Academy, Gothenburg, Sweden, 4Karolinska Institutet University Hospital, Allied Health Professionals Function, Stockholm, Sweden, 5Oslo and Akershus University College of Applied Sciences, Oslo, Norway
Background: The Berg Balance Scale (BBS) is at present the recommended tool for assessing balance control in individuals with spinal cord injury (SCI). However, several constraints including ceiling effect, low responsiveness, and uncertain predictability of falls has been showed. The Mini Balance Evaluation Systems Test (Mini-BESTest) is a new and promising alternative test of dynamic balance which also assesses more aspects of balance control than the BBS (i.e. postural reactions and balance during gait).
Purpose: To examine the validity of the Mini-BESTest in individuals with chronic SCI.
Methods: Forty-six individuals able to walk at least 10 meters, with a mean age of 55 (SD17) years and median 7 (range: 141) years post-injury, were included. Participants were tested with the Mini-BESTest, the BBS, the Timed Up and Go (TUG), 10 meter walk test (10MWT), Falls Efficacy Scale-International (FES-I) and the Spinal Cord Independence Measure-mobility items (SCIM). Floor and ceiling effects were inspected on visual plots. Internal consistency of the Mini-BESTest, construct validity, and receiver operating characteristics were analyzed.
Results: The Mini-BESTest showed no ceiling or floor effect, and excellent internal consistency (α=0.95). The Mini-BESTest had a strong correlation with the BBS (rs = 0.90), the TUG (rs = ‒0.75), 10MWT (rs > 0.88) and SCIM (rs = 0.80), . Further, the Mini-BESTest could differentiate walkers not using walking aids from participants using aids (cut-off >19/28 points, AUC = 0.89), and participants with low from high concerns of falling (cut off ≤19/28points, AUC = 0.79). The Mini-BESTest could not differentiate between recurrent fallers (>2 falls/year) and non-recurrent fallers (AUC=0.54). Rash analysis showed that the Mini-BESTest could differentiate more than three different levels of balance control (separation index = 2.95, person reliability value = 0.74).
Conclusion(s): Construct validity of the Mini-BESTest was supported by strong correlations with other measures for balance control (BBS, TUG), physical function (SCIM mobility items) and gait (10MWT). The test appears be a good alternative to BBS due to its broader assessment of balance control and good psychometric properties.
Implications: The Mini-BESTest can replace BBS for assessing balance control in ambulatory individuals with chronic SCI.
Funding acknowledgements: We acknowledge Sunnaas Rehabilitation Hospital for financing this study.
Topic: Neurology: spinal cord injury
Ethics approval: The Regional Ethics Committee for Medical Research Ethics in South East Norway (Dnr 2012/531)
All authors, affiliations and abstracts have been published as submitted.
