Reliability and validity of Mini Balance Evaluation Systems Test in evaluating balance performance in individuals with stroke

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Reliability and validity of Mini Balance Evaluation Systems Test in evaluating balance performance in individuals with stroke


Author: Tsang, Sau-lan
Title: Reliability and validity of Mini Balance Evaluation Systems Test in evaluating balance performance in individuals with stroke
Degree: M.Sc.
Year: 2012
Subject: Cerebrovascular disease -- Patients -- Health risk assessment.
Equilibrium (Physiology) -- Testing.
Falls (Accidents) -- Prevention.
Hong Kong Polytechnic University -- Dissertations
Department: Dept. of Rehabilitation Sciences
Pages: xviii, 153 leaves : ill. ; 30 cm.
Language: English
InnoPac Record:
Abstract: Objectives: The ultimate objective of this study was to evaluate the reliability and validity of mini Balance Evaluation Systems Test (mini-BESTest) in evaluating balance performance and predicting falls among community-dwelling individuals with stroke. Design: Prospective cohort design. Subjects: 106 non-demented community-dwelling individuals with chronic stroke and 48 age- and gender-matched community-dwelling healthy adults. Method: Construct validity was evaluated by correlation between the mini-BESTest and established balance and mobility measures (convergent validity) and measures that evaluated other attributes (discriminant validity) in the same session. Then, the mini-BESTest was retested in-between physiotherapy treatments for the test-retest reliability. Two independent raters were involved concurrently in the retest session for the inter-rater reliability. Internal consistency of the mini-BESTest administered by the raters among subjects with stroke was also analyzed. The healthy controls received mini-BESTest once. The results were compared with those collected in the stroke group for establishing the known-groups validity. Known-groups validities were also assessed between (1) the dependent and independent walkers and (2) subjects who needed an adaptive walking aid and those did not among the subjects with stroke. Any incidences of fall among the subjects with stroke will be followed up prospectively for 12 months to establish the predictive validity.
Results: Reliability: Mini-BESTest is suggested to be a reliable tool in assessing balance performance in individuals with chronic stroke with high internal consistency (Cronbach's alpha=.888-.935), test-retest [ICC (3,1) =.987, p<.001] and inter-rater reliabilities [ICC (2,1) = .948, p<.001]. The reliability results remain satisfactory when individual items were analyzed. Validity: Mini-BESTest is also suggested to be valid tool with good construct and predictive validity in assessing balance performance in individuals with chronic stroke. Very strong relationship with BBS (p=.833, p<.001) and OLS of the weak side (p=.893, p<.001); strong relationship with TUG (p=-.741, p<.001), TUG with dual task (p=-.682, p<.001), 6MWT (p=.776, p<.001) and FAC (p=.623, p<.001); and moderate relationship with FR (p=.551, p<.001), OLS of the strong side (p=.448, p<.001), 10MWT (p=-.563, p<.001) and ABC (p=.499, p<.001) (good convergent validity); and non-significant relationships with age, gender, BMI, AMT, post-stroke duration, hemiplegic side, depression and social history (good discriminant validity) were found. Good known-groups validity in discriminating (a) healthy individuals from people with stroke, (b) dependent from independent walkers among people with stroke and (c) people with stroke that need adaptive walking aids and those do not were also found. Among the various balance and mobility measures used in this study, mini-BESTest was the only test that could significantly predict the incidence of fall(s) in the 12-months prospective follow-up period among the individuals with stroke. Clinical implications and Conclusion: Mini-BESTest is (1) a significant and modifiable fall predictor for fall prevention and (2) a reliable, valid, relatively comprehensive and clinically applicable assessment tool for assessing balance in individuals with stroke. It also helps to detect specific balance deficits for directing specific and more cost-effective rehabilitation treatments and strategies for individuals with stroke.

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