Systematic Review of the Balance Error Scoring System

Context: The Balance Error Scoring System (BESS) is commonly used by researchers and clinicians to evaluate balance. A growing number of studies are using the BESS as an outcome measure beyond the scope of its original purpose. Objective: To provide an objective systematic review of the reliability and validity of the BESS. Data Sources: PubMed and CINHAL were searched using Balance Error Scoring System from January 1999 through December 2010. Study Selection: Selection was based on establishment of the reliability and validity of the BESS. Research articles were selected if they established reliability or validity (criterion related or construct) of the BESS, were written in English, and used the BESS as an outcome measure. Abstracts were not considered. Results: Reliability of the total BESS score and individual stances ranged from poor to moderate to good, depending on the type of reliability assessed. The BESS has criterion-related validity with force plate measures; more difficult stances have higher agreement than do easier ones. The BESS is valid to detect balance deficits where large differences exist (concussion or fatigue). It may not be valid when differences are more subtle. Conclusions: Overall, the BESS has moderate to good reliability to assess static balance. Low levels of reliability have been reported by some authors. The BESS correlates with other measures of balance using testing devices. The BESS can detect balance deficits in participants with concussion and fatigue. BESS scores increase with age and with ankle instability and external ankle bracing. BESS scores improve after training.