Psychometric Properties of the Mini-Balance Evaluation Systems Test (Mini-BESTest) in Community-Dwelling Individuals With Chronic Stroke

Background. 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. Objectives. 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. Design. An observational measurement study with a test-retest design was conducted. Methods. 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. Results. 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). Limitations. The results are generalizable only to people with mild to moderate chronic stroke. Conclusions. The Mini-BESTest is a reliable and valid tool for evaluating balance in people with chronic stroke.