balance evaluation systems test (bestest) and the mini

Balance Evaluation Systems Test (BESTest) and the Mini-BESTest: reproducibility in school-aged children Rosalee DEWAR 1 , Andrew P CLAUS 1 , Kylie TUCKER 2, , Robert WARE 3 , Leanne M JOHNSTON 1 1 School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, AUSTRALIA; 2 School of Biomedical Sciences, The University of Queensland, Brisbane, AUSTRALIA; 3 Griffith University, Menzies Health Institute Queensland, AUSTRALIA Deficits in postural control systems contribute to activity limitations experienced by children with disabilities. There is no comprehensive postural control clinical assessment for children 1 . The Balance Evaluation Systems Test (Full-BESTest), and the short form Mini- BESTest, were developed to assess postural control of adults with brain injury 2 . There is a need to establish psychometric data and clinical utility for the BESTest and Mini-BESTest in children before it can be used clinically. AIM: to evaluate the reproducibility (agreement and reliability) of the Full- BESTest and Mini-BESTest when assessing postural control in children. Participants: • Children 7-17 years • n=34 for intra-rater and inter-rater evaluation • n=22 for test-retest evaluation @ 2 weeks Outcome measure: • Full-BESTest - 36 items, 6 domains, 108 points • mini-BESTest -14 items, 4 domains, 28 points Design: • Video assessment: intra-rater, inter-rater and test-retest reproducibility • Real-time: test-retest reproducibility Data Analysis: Reproducibility measured via: • Agreement - % exact agreement, Limits of Agreement and Smallest Detectable Change. • Reliability - Intra-class Correlation Coefficients. Reliability (ICC) for total scores • Full-BESTest - excellent for all data collection conditions (all ICCs>0.82 • Mini-BESTest - ranged from fair to excellent across data collection conditions (ICC=0.56 to 0.86). Reliability for domain scores • Full-BESTest – high percentage of domain scores with good-excellent reliability (66% with ICCs >0.60) • Mini-BESTest – slightly lower percentage of domain scores with good-excellent reliability (59%). Agreement for total scores • Full-BESTest - good to excellent Smallest Detectable Change scores (2% to 6%) across conditions • Mini-BESTest – again, good to excellent Smallest Detectable Change (5% to 10%) across conditions. Both the Full-BESTest and Mini-BESTest can discriminate postural control abilities within and between days in school-aged children. The Full-BESTest has slightly better reproducibility and a broader range of items, which suggests it could be the most useful version for treatment planning. We now propose a protocol for the Kids-BESTest which includes some slightly modified items to accommodate development and improve reproducibility in children. Future psychometric research is recommended for specific paediatric clinical populations. References: 1. Dewar R, Claus AP, Tucker K, Johnston LM. Perspectives on Postural Control Dysfunction to Inform Future Research: A Delphi Study for Children With Cerebral Palsy. Arch Phys Med Rehab 2017; 98: 463-79. 2. Horak FB, Wrisley DM, Frank J. The balance evaluation systems test (BESTest) to differentiate balance deficits. Phys Ther 2009; 89: 484-98. Contact: For full paper and copy of the Kids-BESTest [email protected] Acknowledgements Background / Aims Methods Results Conclusions Stability in Gait Sensory Orientation Anticipatory Anticipatory Stability Limits and Verticality Biomechanical Constraints Biomechanical Constraints BESTest domains Reactive

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Page 1: Balance Evaluation Systems Test (BESTest) and the Mini

Balance Evaluation Systems Test (BESTest) and the Mini-BESTest: reproducibility in school-aged children

Rosalee DEWAR1, Andrew P CLAUS 1, Kylie TUCKER

2,, Robert WARE 3 , Leanne M JOHNSTON 1

1School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, AUSTRALIA; 2School of Biomedical Sciences, The University of Queensland,

Brisbane, AUSTRALIA; 3Griffith University, Menzies Health Institute Queensland, AUSTRALIA

Deficits in postural control systems contribute to activity limitations experienced by children with disabilities. There is no comprehensive postural control clinical assessment for children 1.

The Balance Evaluation Systems Test (Full-BESTest), and the short form Mini-BESTest, were developed to assess postural control of adults with brain injury 2. There is a need to establish psychometric data and clinical utility for the BESTest and Mini-BESTest in children before it can be used clinically.

AIM: to evaluate the reproducibility (agreement and reliability) of the Full-BESTest and Mini-BESTest when assessing postural control in children.

Participants: •  Children 7-17 years •  n=34 for intra-rater and inter-rater evaluation •  n=22 for test-retest evaluation @ 2 weeks

Outcome measure: •  Full-BESTest - 36 items, 6 domains, 108 points •  mini-BESTest -14 items, 4 domains, 28 points

Design: •  Video assessment: intra-rater, inter-rater and

test-retest reproducibility •  Real-time: test-retest reproducibility

Data Analysis: Reproducibility measured via: •  Agreement - % exact agreement, Limits of

Agreement and Smallest Detectable Change. •  Reliability - Intra-class Correlation Coefficients.

Reliability (ICC) for total scores •  Full-BESTest - excellent for all data

collection conditions (all ICCs>0.82

•  Mini-BESTest - ranged from fair to excellent across data collection conditions (ICC=0.56 to 0.86).

Reliability for domain scores

•  Full-BESTest – high percentage of domain scores with good-excellent reliability (66% with ICCs >0.60)

•  Mini-BESTest – slightly lower percentage of domain scores with good-excellent reliability (59%).

Agreement for total scores •  Full-BESTest - good to excellent Smallest

Detectable Change scores (2% to 6%) across conditions

•  Mini-BESTest – again, good to excellent Smallest Detectable Change (5% to 10%) across conditions.

Both the Full-BESTest and Mini-BESTest can discriminate postural control abilities within and between days in school-aged children.

The Full-BESTest has slightly better reproducibility and a broader range of items, which suggests it could be the most useful version for treatment planning.

We now propose a protocol for the Kids-BESTest which includes some slightly modified items to accommodate development and improve reproducibility in children. Future psychometric research is recommended for specific paediatric clinical populations.

References: 1.  Dewar R, Claus AP, Tucker K, Johnston LM. Perspectives on Postural Control Dysfunction to Inform Future Research: A Delphi Study for

Children With Cerebral Palsy. Arch Phys Med Rehab 2017; 98: 463-79. 2.  Horak FB, Wrisley DM, Frank J. The balance evaluation systems test (BESTest) to differentiate balance deficits. Phys Ther 2009; 89: 484-98.

Contact: For full paper and copy of the Kids-BESTest [email protected]

Acknowledgements

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