Reliability and Validity of the Balance Evaluation Systems Test (BESTest) in People With Subacute Stroke

The Balance Evaluation Systems Test (BESTest) is a novel clinical balance assessment tool, but it has never been validated in patients with subacute stroke. The reason for this study was to assess the reliability and validity of the BESTest in patients with subacute stroke. 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. 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. The BESTest also displayed high accuracy as the BBS and Mini-BESTest in separating participants into HFA and LFA groups.

The BESTest is reliable, valid, sensitive, and specific in assessing balance in patients with subacute stroke across all levels of functional impairment.

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