berg balance scale versus balance evaluation systems test
TRANSCRIPT
Berg Balance Scale Versus Balance Evaluation Systems Test
By Jwanika Vansiya
Objectives
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What is Berg Balance Scale(BBS)?
.Berg_Balance_Scale (1).pdf
What is Balance Evaluation Systems-Test (BESTest)?
• BESTest_ScoreSheet.pdf
BBS versus BESTest
Berg Balance scale Balance evaluation systems test
Acronym BBS BESTest
Purpose 14 item objective measure designed to assess static balance and fall risk in adults.
(BESTest) serves as a 36-item clinical balance assessment tool, developed to assess balance impairments across six contexts of postural control
Areas of assessment
Balance non vestibular,Functional mobility.
Balance Non-Vestibular; Gait; Strength
BBS versus BESTestBerg Balance Scale Balance evaluation systems test
Description 14 items
Total scores 56 pointsItem level scores range from 0-4 determined by ability to perform the assessed activity.
36 itemsGrouped into 6 systems (biomechanical constraints, stability limits/verticality, anticipatory postural adjustments, postural responses, sensory orientation, stability in gait),Total score 108 pointsItem-level scores range from 0 (severe impairment) to 3 (no impairment).
ICF domain Activity Body Structure; Body Function; Activity
BBS versus BESTestBerg Balance Scale Balance Evaluation systems Test
Assessment type Performance measure Performance measure
Time to administer 15-20 minutes 20-30 minutes
Equipment required Stop watch, chair with arm rests, measure tape, object to pick up off the floor, step stool
Stop watch, Measuring tape mounted on wall, Approximately 60 cm x 60 cm block of 4 inch, medium density, Tempur® foam, 10 degree incline ramp (at least 2 x 2 ft), Stair step, 15 cm (6 inches) in height, 2 stacked shoe boxes (for 9 inch obstacle height), 2.5 kg (5-lb) free weight,Firm chair with arms with 3 meters in front marked with tape, Masking tape to mark 3 m and 6 m lengths on the floor
BBS versus BESTestBerg Balance Scale Balance Evaluation Systems Test
Training required Not necessary Workshops are available to become skilled in using the BESTest to differentiate complex balance disorders in neurological patients. Workshop participants develop the ability to design a more specific rehabilitation plan of care for balance retraining.
Age range adults: 18-64 years,Elderly: 65+
Elderly-65+
BBS versus BESTest Berg Balance Scale Balance Evaluation Systems
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Population tested Brain injuryCommunity dwelling elderlyMultiple sclerosisOrthopedic surgeryOsteoarthritisParkinson’s diseaseSCIStrokeTraumatic and acquired brain injury
Balance deficitsCerebellar InfarctParkinson's Disease (PD)Peripheral neuropathySubacute StrokeMultiple Sclerosis
BBS versus BESTestBerg Balance Scale Balance Evaluation
Systems TestCut-off score Elderly
No History of falls and BBS < 51 or history of falls and BBS < 42 predictive of falls (91% sensitivity, 82% specificity) Score of < 40 on BBS associated with almost 100% fall risk StrokeCut-off score = 45 out of 56SCINo significant relationship between total falls and obtained BBS scores were foundNo cutoff score was found that effectively discriminated fallers
Balance deficit69% cut off score differentiated fallers from nonfallers, and healthy from those with neurologic diagnoses.Parkinson’s disease69% cut off score to detect fallersSubacute stroke>49% indicates those with high functional ability
BBS versus BESTestBerg Balance Scale Balance Evaluation Systems
Test
Normative data OsteoarthritisMean BBS score one week postoperative = 34 (8); 5-7 weeks postoperative = 50 (6)SCIMean BBS score: 47.9 (10.7)Parkinson’s diseaseMean BBS score = 40.22 (8.48)Range = 21 to 53
Subacute Stroke Mean (SD) BESTest score for all participants = 41.7 (28.19)
Test-retest reliability Elderly = Excellent test-retest reliability (ICC = 0.91)Parkinson’s disease= Excellent test-retest reliability (ICC = 0.80)Stroke= Excellent test-retest reliability (ICC = 0.98)
Parkinson’s disease= Excellent test-retest reliability for total BEST score (ICC = 0.88)
BBS versus BESTestBerg Balance Scale Balance Evaluation Systems
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Interrater/Intrarater Reliability
Community dwelling elderly= Excellent intrarater reliability (ICC = 0.97)Parkinsons’s disease= Excellent interrater reliability (ICC = 0.95)SCI= Excellent interrater reliability (ICC = 0.95) Stroke= Excellent interrater and intrarater reliability in individuals 2,4,6 & 12 weeks post onset (ICC = 0.98; ICC = 0.97)
Community dwelling adults= Excellent interrater reliability for total score (ICC = 0.91)Parkinson’s disease= Excellent inter-rater reliability ICC = 0.96Subacute stroke= Excellent interrater reliability: ICC= .99Excellent intrarater reliability: ICC= .99
BBS versus BESTestBerg Balance Scale Balance Evaluation Systems
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Criterion Validity (Predictive/Concurrent)
Elderly population= Excellent correlation with Dynamic Gait Index (r = 0.67)Stroke = Excellent correlations with the balance subscale of the Fugl-Meyer at 14, 30, 90 and 180 days post stroke (r = 0.90 to 0.92) Excellent correlations with Postural Assessment Scale for Stroke patients (PASS) (r = 0.92 to 0.95)
Community dwelling elderly= Excellent correlation between total BESTest and Activities-specific Balance Confidence Scale (ABC) (r = 0.636, p < 0.01)Parkinson’s disease= Excellent correlation between total BESTest and ABC (r = 0.757)Excellent correlation between total BESTest and Berg Balance Scale (r = 0.873)Excellent correlation between total BESTest and Functional Gait Assessment (r = 0.882)
BBS versus BESTestBerg Balance Scale Balance Evaluation Systems Test
Construct Validity (Convergent/Discriminant)
Stroke Adequate correlation with Timed Up and Go scores (r = -0.48) Excellent correlation with mobility items of the Barthel Index (r = 0.67) Osteoarthritis = Correlation Coefficients between Original and Reduced versions of the BBS: 0.92 (0.86, 0.95) 1 week postoperative, and 0.97 (0.95, 0.98) 5-7 weeks postoperative
Community dwelling adults = Subjects with balance deficits score significantly lower than healthy controls (p = 0.36)Parkinson’s disease = Excellent correlation with:
Modified Hoehn and Yahr Scale (r = -0.736)MDS-UPDRS-3 (r = -0.758)MDS-UPDRS (r = -0.780)
Subacute stroke = Excellent correlation with the BBS (r = 0.96) Excellent correlation with the PASS (r = 0.96) Excellent correlation with the Mini-BEST (r = 0.96)
BBS versus BESTestBerg Balance Scale Balance Evaluation
Systems Test
Content Validity Items were selected based on interviews with 12 geriatric clients and 10 clinical professionalsResultant items were then pretested and revised
Not Established
Face Validity Not established Not Established
BBS versus BESTestBerg Balance Scale Balance Evaluation Systems
Test
Floor/Ceiling Effects Stroke = Poor floor effects at 14 days post stroke (35%) SCI = Poor ceiling effects (37.5%)
Parkinson’s disease = Excellent, no floor effects were observed with the BESTestSubacute stroke = Excellent, no floor effects were observed with the BESTest Excellent, no ceiling effects were observed with the BESTest
REFERENCES• 1. Chinsongkram B, Chaikeeree N, Saengsirisuwan V,
Viriyatharakij N, Horak FB, Boonsinsukh R. Reliability and validity of the Balance Evaluation Systems Test (BESTest) in people with subacute stroke. Physical therapy. 2014;94(11):1632-43.
• 2. Major MJ, Fatone S, Roth EJ. Validity and reliability of the Berg Balance Scale for community-dwelling persons with lower-limb amputation. Archives of physical medicine and rehabilitation. 2013;94(11):2194-202.
• 3. Rodrigues LC, Marques AP, Barros PB, Michaelsen SM. Reliability of the Balance Evaluation Systems Test (BESTest) and BESTest sections for adults with hemiparesis. Brazilian Journal of Physical Therapy. 2014;18(3):276-81.
REFERENCES• 4. Blum L, Korner-Bitensky N. Usefulness of the Berg
Balance Scale in stroke rehabilitation: a systematic review. Physical therapy. 2008;88(5):559-66.
• 5. Horak FB, Wrisley DM, Frank J. The Balance Evaluation Systems Test (BESTest) to Differentiate Balance Deficits. Physical therapy. 2009;89(5):484-98.
• 6. Susan o’B Sulivan• 7.Rehab measures
