Abstract
BACKGROUND:
The Balance Evaluation Systems Test (BESTest) was recently created to allow the development of treatments according to the specific balance system affected in each patient. The Brazilian version of the BESTest has not been specifically tested after stroke.
OBJECTIVE:
To evaluate the intra- and inter-rater reliability and concurrent and convergent validity of the total score of the BESTest and BESTest sections for adults with hemiparesis after stroke.
METHOD:
The study included 16 subjects (61.1±7.5 years) with chronic hemiparesis (54.5±43.5 months after stroke). The BESTest was administered by two raters in the same week and one of the raters repeated the test after a one-week interval. Intraclass correlation coefficient (ICC) was calculated to assess intra- and interrater reliability. Concurrent validity with the Berg Balance Scale (BBS) and convergent validity with the Activities-specific Balance Confidence scale (ABC-Brazil) were assessed using Pearson's correlation coefficient.
RESULTS:
Both the BESTest total score (ICC=0.98) and the BESTest sections (ICC between 0.85 and 0.96) have excellent intrarater reliability. Interrater reliability for the total score was excellent (ICC=0.93) and, for the sections, it ranged between 0.71 and 0.94. The correlation coefficient between the BESTest and the BBS and ABC-Brazil were 0.78 and 0.59, respectively.
CONCLUSIONS:
The Brazilian version of the BESTest demonstrated adequate reliability when measured by sections and could identify what balance system was affected in patients after stroke. Concurrent validity was excellent with the BBS total score and good to excellent with the sections. The total scores but not the sections present adequate convergent validity with the ABC-Brazil. However, other psychometric properties should be further investigated.
stroke; psychometric properties; outcome; rehabilitation
Introduction
Hemiparesis after stroke often results in deficits in balance and risk of falls. In
these patients, balance stability is generally decreased due to muscle weakness, sensory
loss, and visuospatial impairments. The maintenance of static and dynamic balance
stability involves activity integration of the sensory and motor systems, usually
affected in these individuals11 Oliveira CB, Medeiros IRT, Ferreira NAF, Greters ME, Conforto AB.
Balance control in hemiparetic stroke patients: main tools for evaluation. J Rehabil
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2 Pollock AS, Durward BR, Rowe PJ, Paul JP. What is balance? Clin Rehabil.
2000;14(4):402-6. PMid:10945424. http://dx.doi.org/10.1191/0269215500cr342oa
http://dx.doi.org/10.1191/0269215500cr34...
-
33 Horak FB. Clinical measurement of postural control in adults. Phys Ther.
1987;67(12):1881-5. PMid:3685116..
Balance impairments are associated with lower ambulatory activity, physical
deconditioning, and high risk of falls in this population44 Michael KM, Allen JK, Macko RF. Reduced ambulatory activity after
stroke: the role of balance, gait, and cardiovascular fitness. Arch Phys Med Rehabil.
2005;86(8):1552-6. PMid:16084807. http://dx.doi.org/10.1016/j.apmr.2004.12.026
http://dx.doi.org/10.1016/j.apmr.2004.12...
,
55 Lamb SE, Ferrucci L, Volapto S, Fried LP, Guralnik JM. Risk factors for
falling in home-dwelling older women with stroke: the Women's Health and Aging Study.
Stroke. 2003;34(2):494-501. PMid:12574566.
http://dx.doi.org/10.1161/01.STR.0000053444.00582.B7
http://dx.doi.org/10.1161/01.STR.0000053...
, affecting the performance of many activities of daily living66 Sackley CM. Falls, sway, and symmetry of weight-bearing after stroke.
Int Disabil Stud. 1991;13(1):1-4. PMid:1917796.
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. Therefore, balance assessment is important for the proper prescription of
auxiliary devices, development of treatment interventions, and identification of safe
and unsafe activities for people with stroke. Consequently, it is important that
clinicians have reliable measures to detect changes that occur during the rehabilitation
process77 Blum L, Bitensky NK. Usefulness of the Berg Balance Scale in stroke
rehabilitation: a systematic review. Phys Ther. 2008;88(5):559-66. PMid:18292215.
http://dx.doi.org/10.2522/ptj.20070205
http://dx.doi.org/10.2522/ptj.20070205...
.
The Berg Balance Scale (BBS) was created to assess the risk of falls in the elderly. It
has been the main tool used to identify and evaluate balance impairment in different
populations88 Miyamoto ST, Junior IL, Berg KO, Ramos LR, Natour J. Brazilian version
of the Berg Balance Scale. Braz J Med Biol Res. 2004;37(9):1411-21. PMid:15334208.
http://dx.doi.org/10.1590/S0100-879X2004000900017
http://dx.doi.org/10.1590/S0100-879X2004...
, however it has floor and ceiling effects and therefore cannot detect
significant changes when used to assess stroke patients with severe or mild impairment,
respectively77 Blum L, Bitensky NK. Usefulness of the Berg Balance Scale in stroke
rehabilitation: a systematic review. Phys Ther. 2008;88(5):559-66. PMid:18292215.
http://dx.doi.org/10.2522/ptj.20070205
http://dx.doi.org/10.2522/ptj.20070205...
,
99 Kornetti DL, Fritz SL, Chiu YP, Light KE, Velozo CA. Rating scale
analysis of the Berg Balance Scale. Arch Phys Med Rehabil. 2004;85(7):1128-35.
PMid:15241763. http://dx.doi.org/10.1016/j.apmr.2003.11.019
http://dx.doi.org/10.1016/j.apmr.2003.11...
.
The balance section of the Fulg-Meyer Scale evaluates some limitations in performing
tasks involving change in body position and maintenance1010 Maki TI, Quagliato EMAB, Cacho EWA, Paz LPS, Nascimento NH, Inoue MMEA,
et al. Reliability study on the application of the Fugl-Meyer scale in Brazil. Rev
Bras Fisioter. 2006;10(2):177-83. http://dx.doi.org/10.1590/S1413-35552006000200007
http://dx.doi.org/10.1590/S1413-35552006...
. Just as the BBS, this section may not be appropriate for use in patients who
are severely affected or to detect improvement in those who are slightly affected
initially1111 Mao HF, Hsueh IP, Tang PF, Sheu CF, Hsieh CL. Analysis and comparison of
the psychometric properties of three balance measures for stroke patients. Stroke.
2002;33(4):1022-7. PMid:11935055.
http://dx.doi.org/10.1161/01.STR.0000012516.63191.C5
http://dx.doi.org/10.1161/01.STR.0000012...
.
In addition to balance performance, confidence in performing tasks without falling is
essential to preserving autonomy in daily activities. The Activities-specific Balance
Confidence scale (ABC) was developed to numerically quantify the level of confidence in
balance and essentially evaluate a person's perception of their ability to perform
specific activities without falling or becoming unsteady1212 Powell LE, Myers AM. The Activities-specific Balance Confidence (ABC)
Scale. J Gerontol A Biol Sci Med Sci. 1995;50(1):28-34.
http://dx.doi.org/10.1093/gerona/50A.1.M28
http://dx.doi.org/10.1093/gerona/50A.1.M...
. The ABC has good accuracy to detect people with stroke with a history of
multiple falls1313 Beninato M, Portney LG, Sullivan PE. Using the International
Classification of Functioning, Disability and Health as a framework to examine the
association between falls and clinical assessment tools in people with stroke. Phys
Ther. 2009;89(8):816-25. PMid:19520733. http://dx.doi.org/10.2522/ptj.20080160
http://dx.doi.org/10.2522/ptj.20080160...
.
The standardized clinical tools for assessing balance can predict the risk of falls,
especially in elderly people, but in general they cannot identify which balance system
has been affected. Therefore, the Balance Evaluation Systems Test (BESTest) was
developed in 2009. It consists of 27 tasks (items), divided into six sections, grouped
in order to reveal the function or dysfunction of a specific balance control system
(biomechanical constraints, stability limits/verticality, anticipatory postural
adjustments, postural responses, sensory orientation, and stability in gait).
Identifying which balance control system is impaired helps to specifically direct the
treatment1414 Horak FB, Wrisley DM, Frank J. The Balance Evaluation Systems Test
(BESTest) to differentiate balance deficits. Phys Ther. 2009;89(5):484-98.
PMid:19329772 PMCid:PMC2676433. http://dx.doi.org/10.2522/ptj.20080071
http://dx.doi.org/10.2522/ptj.20080071...
. This scale is used to assess balance in elderly individuals and various
diseases, but it has not been specifically validated for people with stroke. The study
by Tsang et al.1515 Tsang CS, Liao LR, Chung RC, Pang MY. Psychometric properties of the
Mini-Balance Evaluation Systems Test (Mini-BESTest) in community-dwelling individuals
with chronic stroke. Phys Ther. 2013;93(8):1102-15. PMid:23559522.
http://dx.doi.org/10.2522/ptj.20120454
http://dx.doi.org/10.2522/ptj.20120454...
examined the reliability and validity of the English version of the Mini-BESTest
in people with hemiparesis, but this short version of the BESTest excluded sections I
and II, i.e. Biomechanical Constraints and Stability limits/Verticality, respectively.
Section I, for example, evaluates base of support and hip and ankle strength and section
II, lateral lean as well as functional reaching. We hypothesize that those items may be
important to assess in individuals with hemiparesis.
The BESTest and Mini-BESTest were translated and cross-culturally adapted to Brazilian
Portuguese by Maia et al.1616 Maia AC, Rodrigues-de-Paula F, Magalhães LC, Teixeira RL. Cross-cultural
adaptation and analysis of the psychometric properties of the Balance Evaluation
Systems Test and MiniBESTest in the elderly and individuals with Parkinson's disease:
application of the Rasch model. Braz J Phys Ther. 2013;17(3):195-217. PMid:23966138.
http://dx.doi.org/10.1590/S1413-35552012005000085
http://dx.doi.org/10.1590/S1413-35552012...
and their reliability was assessed in elderly people and individuals with
Parkinson's Disease. The reliability and validity of the translated version have not
been evaluated in patients with hemiparesis. This group has particular characteristics
that differ from other populations, therefore it is important and necessary to adapt
some tasks of the BESTest for this group. Thus, the aim of this study was to evaluate
the intra- and interrarter reliability and concurrent and convergent validity of the
BESTest and BESTest sections for adults with hemiparesis.
Method
This study obtained ethical approval from the Human Research Ethics Committee (ETIC 227/2010) of Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil.
Adaptation of the administration of the Brazilian version of the BESTest16 for adults with hemiparesis
A translated version was produced by our research group and then a Brazilian version
was published by Maia et al.1616 Maia AC, Rodrigues-de-Paula F, Magalhães LC, Teixeira RL. Cross-cultural
adaptation and analysis of the psychometric properties of the Balance Evaluation
Systems Test and MiniBESTest in the elderly and individuals with Parkinson's disease:
application of the Rasch model. Braz J Phys Ther. 2013;17(3):195-217. PMid:23966138.
http://dx.doi.org/10.1590/S1413-35552012005000085
http://dx.doi.org/10.1590/S1413-35552012...
. A committee of practicing physical therapists analyzed both versions, and
because only minor differences were detected, we decided to adopt the published
version and only adapt the administration of this version for the study population.
The adaptations were based on differences presented by individuals with hemiparesis
and are adopted to standardize the form of administration. All adaptations were
decided in conjuction by the committee.
Participants
This study included 16 adult and elderly patients (49 to 73 years old) with chronic hemiparesis (3 to 150 months after stroke) recruited from the UDESC physical therapy clinic and extension programs (Table 1).
We included individuals who met the following inclusion criteria: hemiparesis
resulting from stroke affecting one of the cerebral hemispheres, ability to
understand the instructions (cutoff score according to educational level on the
Mini-Mental State Examination)1717 Bertolucci P, Brucki SMD, Campacci SR, Juliano Y. O mini-exame do estado
mental em uma população geral: impacto da escolaridade. Arq Neuropsiquiatr.
1994;52(1):1-7. PMid:8002795. http://dx.doi.org/10.1590/S0004-282X1994000100001
http://dx.doi.org/10.1590/S0004-282X1994...
,
1818 Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH.
Sugestões para o uso do mini-exame do estado mental no Brasil. Arq Neuropsiquiatr.
2003;61(3):777-81. PMid:14595482. http://dx.doi.org/10.1590/S0004-282X2003000500014
http://dx.doi.org/10.1590/S0004-282X2003...
, and ability to stand confidently without assistance for at least 2 minutes.
We excluded patients with other neurological diseases and cerebellar stroke. All
participants signed an informed consent form to participate in this study.
Intra- and interrater reliability of the BESTest-Brazil
The interrater reliability was tested by comparing the evaluations of two independent raters (R1 and R2) who conducted the assessment on the same day. The intrarater reliability (test-retest) was tested by the same rater by comparing the results of repeated assessments (R1T1 and R1T2) with a one-week interval.
Convergent and concurrent validity
The convergent and concurrent validity of the Brazilian version of the BESTest was
assessed with the ABC-Brazil and the BBS. The ABC-Brazil contains 16 questions and
measures the balance confidence of individuals while performing specific activities,
including tasks outside home. The response is evaluated by a visual analog scale
ranging from 0 to 100, with 0=no confidence and 100=complete confidence1919 Marques AP, Mendes YC, Taddei U, Pereira CAB, Assumpção A.
Brazilian-portuguese translation and cross cultural adaptation of the
Activities-specific Balance Confidence (abc) scale. Braz J Phys Ther.
2013;17(2):170-8. PMid:23778771. http://dx.doi.org/10.1590/S1413-35552012005000072
http://dx.doi.org/10.1590/S1413-35552012...
.
The Brazilian version of the BBS consists of 14 items that assess static and dynamic
balance. Each item is scored on a five-point scale from 0 (unable to perform) to 4
(normal performance). The highest possible score is 56, with higher scores indicating
better balance88 Miyamoto ST, Junior IL, Berg KO, Ramos LR, Natour J. Brazilian version
of the Berg Balance Scale. Braz J Med Biol Res. 2004;37(9):1411-21. PMid:15334208.
http://dx.doi.org/10.1590/S0100-879X2004000900017
http://dx.doi.org/10.1590/S0100-879X2004...
.
Statistical analysis
We used intraclass correlation coefficient (ICC) and a confidence interval (CI) of 95% to evaluate intrarater (test-retest) and interrater reliability. The following classification was used for the ICC values: poor reliability ICC<0.40, moderate reliability ICC<0.75, and excellent reliability ICC>0.752020 Fleiss JL. Statistical methods for rates & proportions. New York: Wiley and Sons; 2004..
The convergent and concurrent validity of the scores of each session and total score
of the BESTest with the total BBS and ABC-Brazil was assessed using Pearson's
correlation coefficient. The following classification was used for correlation:
<0.49 poor, 0.50 to 0.69 moderate, and >0.70 strong2121 Terwee CB, Bot SD, De Boer MR, Van der Windt DA, Knol DL, Dekker J, et
al. Quality criteria were proposed for measurement properties of health status
questionnaires. J Clin Epidemiol. 2007;60(1):34-42. PMid:17161752.
http://dx.doi.org/10.1016/j.jclinepi.2006.03.012
http://dx.doi.org/10.1016/j.jclinepi.200...
.
Results
To consider the specificity of the individuals with hemiparesis, the expert committee
adopted some adaptations in the form of administering the BESTest (Table 2). In the instructions for administration of
the original version of the BESTest1414 Horak FB, Wrisley DM, Frank J. The Balance Evaluation Systems Test
(BESTest) to differentiate balance deficits. Phys Ther. 2009;89(5):484-98.
PMid:19329772 PMCid:PMC2676433. http://dx.doi.org/10.2522/ptj.20080071
http://dx.doi.org/10.2522/ptj.20080071...
, item 2 considers abnormal segmental postural alignment such as scoliosis or
kyphosis or asymmetries. Our adapted version considers the paretic upper limb abnormal
alignment because it is frequent in individuals with hemiparesis. In item 7, the patient
is instructed to reach forward with both arms straight without touching the ruler or the
wall. In our adapted version, the non-paretic upper limb was positioned near the wall
because it is difficult for patients to raise their paretic arms in the position
recommended by the test. In items 10, 11, 12, 19, and 20 of the original version, the
patients are asked to place hands on hips, but in our version they were allowed to place
their arms along the body because almost all patients were unable to do this with their
paretic limb due to upper limb paresis and absence of distal movements. Finally, in item
13 of the original version, the task required was to lift a weight with both hands up to
shoulder level, however patients with hemiparesis had difficulty lifting the weight with
their paretic upper limb, so they were allowed to lift it only with the non-paretic
upper limb and decrease the weight if necessary.
Among the BESTest sections, the participants with hemiparesis showed a better performance in Sensory Orientation. Most participants achieved the maximum score on all items in this section, and item 19D (Eyes closed, foam surface) was the only in which some participants had difficulties. The lowest scores were in the sections Biomechanical Constraints and Anticipatory Postural Adjustments (Table 3). In these sections, the lower scores were in item 4 (Hip/trunk lateral strength) and item 11 (stand on one leg), respectively.
The intrarater reliability was excellent (between 0.85 and 0.98) in all sections and in the total score. The interrater reliability was also excellent for sections I, III, VI, and the total score, and moderate for sections II, IV, and V (Table 3).
The correlation coefficient showed a strong correlation between the BBS and sections II, III, IV, VI, and total score of the BESTest. In contrast, the correlation coefficient between the ABC-Brazil and BESTest was moderate only for section III and the total score, and for the other sections the correlations were poor (Table 4).
Discussion
The present study determined the validity and reliability of the BESTest translated to
Brazilian Portuguese and adapted for individuals with hemiparesis after stroke. The
interrater reliability for individuals with hemiparesis showed similar values to those
reported for the original version by Horak et al.1414 Horak FB, Wrisley DM, Frank J. The Balance Evaluation Systems Test
(BESTest) to differentiate balance deficits. Phys Ther. 2009;89(5):484-98.
PMid:19329772 PMCid:PMC2676433. http://dx.doi.org/10.2522/ptj.20080071
http://dx.doi.org/10.2522/ptj.20080071...
. Although this study was conducted with individuals with various diseases, such
as Parkinson's, vestibular dysfunction, peripheral neuropathy, and hip arthroplasty, it
also found excellent interrater reliability (ICC=0.91) for the total score. Similarly,
in the present study, the interrater reliability for sections I, III, and VI was
excellent for participants with hemiparesis. Section VI, which evaluates stability
during gait, showed excellent interrater reliability as in the results found by
Jonsdottir and Cattaneo2222 Jonsdottir J, Cattaneo D. Reliability and validity of the dynamic gait
index in persons with chronic stroke. Arch Phys Med Rehabil. 2007;88(11):1410-5.
PMid:17964880. http://dx.doi.org/10.1016/j.apmr.2007.08.109
http://dx.doi.org/10.1016/j.apmr.2007.08...
, who assessed the reliability of the Dynamic Gait Index in individuals after
stroke.
In our sample, sections II, IV, and V showed only moderate reliability, but ICC was
>0.70 for all sections. In section IV, moderate reliability could be explained by the
examiner's perception in relation to the patient's responses. Section V (remain standing
on a stable and unstable surface with eyes open and closed) showed moderate reliability,
unlike the original scale in which the timed results showed higher reliability1414 Horak FB, Wrisley DM, Frank J. The Balance Evaluation Systems Test
(BESTest) to differentiate balance deficits. Phys Ther. 2009;89(5):484-98.
PMid:19329772 PMCid:PMC2676433. http://dx.doi.org/10.2522/ptj.20080071
http://dx.doi.org/10.2522/ptj.20080071...
. In this section, most of the patients had scores of 3 (stable) or 2 (unstable),
therefore the patients remained in the standing position for 30 seconds. The differences
between two examiners may be due to the different perception of stability.
In patients with hemiparesis, the short version of the BESTest, known as the
Mini-BESTest1515 Tsang CS, Liao LR, Chung RC, Pang MY. Psychometric properties of the
Mini-Balance Evaluation Systems Test (Mini-BESTest) in community-dwelling individuals
with chronic stroke. Phys Ther. 2013;93(8):1102-15. PMid:23559522.
http://dx.doi.org/10.2522/ptj.20120454
http://dx.doi.org/10.2522/ptj.20120454...
, showed strong correlation with the BBS. Strong correlations between the BESTest
and BBS are also reported for patients with Parkinson's disease2323 Leddy AL, Crowner BE, Earhart GM. Functional gait assessment and balance
evaluation system test: reliability, validity, sensitivity and functional gait
assessment and balance evaluation disease who fall specificity for identifying
individuals with Parkinson. Phys Ther. 2011;91(1):102-13. PMid:21071506
PMCid:PMC3017321. http://dx.doi.org/10.2522/ptj.20100113
http://dx.doi.org/10.2522/ptj.20100113...
. Bergström et al.2424 Bergström M, Lenholm E, Franzén E. Translation and validation of the
Swedish version of the mini-BESTest in subjects with Parkinson's disease or stroke: a
pilot study. Physiother Theory Pract. 2012;28(7):509-14. PMid:22288658.
http://dx.doi.org/10.3109/09593985.2011.653707
http://dx.doi.org/10.3109/09593985.2011....
translated the Mini-BESTest to Swedish and validated it to individuals with
Parkinson's disease and stroke. They also showed a strong correlation between the
mini-BESTest and BBS for patients with stroke. The high correlation between the BESTest
and the BBS can be explained because they evaluate the same construct and some items are
similar in both scales although the scale steps differ. Despite this high correlation,
in patients with hemiparesis, the BBS showed ceiling effects while the Mini-BESTest did
not1515 Tsang CS, Liao LR, Chung RC, Pang MY. Psychometric properties of the
Mini-Balance Evaluation Systems Test (Mini-BESTest) in community-dwelling individuals
with chronic stroke. Phys Ther. 2013;93(8):1102-15. PMid:23559522.
http://dx.doi.org/10.2522/ptj.20120454
http://dx.doi.org/10.2522/ptj.20120454...
.
In contrast, the ABC-Brazil showed a moderate correlation with the total score of the
BESTest and section II, but a poor correlation with the isolated sections. This is
consistent with previous studies that assess the correlation between performance
measures and self-related measures2525 Botner EM, Miller WC, Eng JJ. Measurement properties of the
Activities-specific Balance Confidence Scale among individuals with stroke. Disabil
Rehabil. 2005;27(4):156-63. PMid:15824045.
http://dx.doi.org/10.1080/09638280400008982
http://dx.doi.org/10.1080/09638280400008...
, and with the original BESTtest14 14 Horak FB, Wrisley DM, Frank J. The Balance Evaluation Systems Test
(BESTest) to differentiate balance deficits. Phys Ther. 2009;89(5):484-98.
PMid:19329772 PMCid:PMC2676433. http://dx.doi.org/10.2522/ptj.20080071
http://dx.doi.org/10.2522/ptj.20080071...
as well as the Mini-BESTest administered to individuals with hemiparesis1515 Tsang CS, Liao LR, Chung RC, Pang MY. Psychometric properties of the
Mini-Balance Evaluation Systems Test (Mini-BESTest) in community-dwelling individuals
with chronic stroke. Phys Ther. 2013;93(8):1102-15. PMid:23559522.
http://dx.doi.org/10.2522/ptj.20120454
http://dx.doi.org/10.2522/ptj.20120454...
. The BESTest is a test based on performance, and perceptions (as measured by the
ABC) rarely predict the full variance of an actual performance2525 Botner EM, Miller WC, Eng JJ. Measurement properties of the
Activities-specific Balance Confidence Scale among individuals with stroke. Disabil
Rehabil. 2005;27(4):156-63. PMid:15824045.
http://dx.doi.org/10.1080/09638280400008982
http://dx.doi.org/10.1080/09638280400008...
. Horak et al.14 14 Horak FB, Wrisley DM, Frank J. The Balance Evaluation Systems Test
(BESTest) to differentiate balance deficits. Phys Ther. 2009;89(5):484-98.
PMid:19329772 PMCid:PMC2676433. http://dx.doi.org/10.2522/ptj.20080071
http://dx.doi.org/10.2522/ptj.20080071...
found a moderate correlation between the total score of the BESTest and ABC
(r=0.68). The section II scores had the best correlation with the ABC (r=0.78) and
section III, the worst correlation (r=0.41). This was similar to our study, which found
the worst correlation in sections III and IV. In individuals with hemiparesis, the
Mini-BESTest also correlated only moderately with the ABC1515 Tsang CS, Liao LR, Chung RC, Pang MY. Psychometric properties of the
Mini-Balance Evaluation Systems Test (Mini-BESTest) in community-dwelling individuals
with chronic stroke. Phys Ther. 2013;93(8):1102-15. PMid:23559522.
http://dx.doi.org/10.2522/ptj.20120454
http://dx.doi.org/10.2522/ptj.20120454...
. Because the ABC evaluates perceived low and high-risk activities and low
self-efficacy can result in avoiding such tasks, it is important to use it in
conjunction with the BESTest and not as a replacement.
One limitation of our study was the small sample and the predominance of subjects with left hemiparesis (81%) and relatively good balance (score >43 on the BBS). However, the results of this study show that the Brazilian version of the BESTest demonstrated adequate reliability for the total score and when evaluated by sections. The small sample limits the generalizability of the findings, but the adaptations to the form of administration of the BESTest resulted in excellent concurrent validity with the BBS with the advantage of identifying what balance system is affected and then provide information for the development of a specific treatment. However, this scale is unable to identify which daily task presents the highest risk of falls and, if this is the objective of the assessment, it can be used in conjunction with the ABC, but not as a replacement. Additionally, other psychometric properties should be further investigated.
References
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» http://dx.doi.org/10.1682/JRRD.2007.09.0150 -
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Publication Dates
-
Publication in this collection
24 June 2014 -
Date of issue
July 2014
History
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Received
07 Sept 2013 -
Reviewed
20 Dec 2013 -
Accepted
05 Feb 2014