Comparison of the Berg Balance Scale and the Mini-BESTest for Assessing Balance in Ambulatory People With Spinal Cord Injury: Validation Study

Background. The Berg Balance Scale (BBS) has several constraints-ceiling effect, low responsiveness, and uncertain predictability of falls-in neurological populations. The -Mini-BESTest, which has not yet been validated in spinal cord injury (SCI) populations, has shown no ceiling effect, slightly better responsiveness, and could in some neurological populations predict falls. Objective. Validate and compare psychometric performances of the BBS and -Mini-BESTest in individuals with chronic SCI. Design. Cross-sectional validation study. Methods. Forty-six individuals able to walk 10 meters (85% American Spinal Injury Association Impairment Scale grade D) with mean age of 55 +/- 17 years and median 7 years (range: 1-41) postinjury were included. Floor/ceiling effects were inspected; internal consistency, construct validity, and receiver operating characteristics were analyzed. Results. The Mini-BESTest had no ceiling effect; 28% of participants achieved the maximum score on the BBS. Both scales showed excellent internal consistency (alpha > .93). Strong correlations between both scales (r(s) = 0.90, P < .001) and between both scales and Timed Up and Go (r(s) > .70), Spinal Cord Independence Measure-mobility items (r(s) > .80), and 10-Meter Walk Test (r(s) > .80) support high construct validity. Both scales could differentiate community walkers without walking aids from participants using aids (AUC > .86) and individuals with low/high concerns about falling (AUC > 0.79) but not recurrent (> 2 falls/year) and infrequent fallers (AUC < 0.55). The BBS and Mini-BESTest separated 2 and more than 3 different levels of balance control, respectively. Limitations. Small sample. Conclusions. Both the BBS and Mini-BESTest were found to be valid scales for assessing balance control in individuals with chronic SCI. The Mini-BESTest may be preferable for this group primarily due to the lack of a ceiling effect.