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Reliability of the Mini-BESTest and Brief-BESTest for assessing patients with incomplete spinal cord injury

Spinal Cord volume 62, pages 676–682 (2024)Cite this article

Subjects

Abstract

Study design

Single institution observational study.

Objectives

To investigate the ceiling and floor effects of the Berg Balance Scale (BBS), Mini-Balance Evaluation Systems Test (BESTest), and Brief-BESTest, as well as to determine the intra- and inter-rater reliabilities and minimal detectable change (MDC) of the Mini-BESTest and Brief-BESTest in patients with acute and subacute incomplete cervical spinal cord injury (SCI) classified as AIS D.

Setting

Advanced critical care center of our university hospital.

Methods

Twenty patients with incomplete cervical SCI who could stand without assistance were recruited. The floor and ceiling effects were evaluated by plotting histograms from the distribution of scores on the BBS, Mini-BESTest and Brief-BESTest, and calculating skewness. The Mini-BESTest and Brief-BESTest were evaluated and videotaped simultaneously, and intra- and inter-rater reliabilities were assessed. The MDC was also calculated.

Results

The skewness of the BBS was −1.57, and the full score was 35%, indicating a ceiling effect. However, no ceiling or floor effect was observed for the Mini-BESTest and the Brief-BESTest. Intraclass correlation coefficients for intra-rater and inter-rater reliabilities were 0.98 and 0.97 for the Mini-BESTest and Brief-BESTest, respectively. Individual item reliability was moderate or better for the Mini-BESTest and excellent or better for the Brief-BESTest. The MDC of total scores ranged 3.14–3.84 and 2.92–3.60 for the Mini-BESTest and Brief-BESTest, respectively.

Conclusions

The Mini-BESTest and Brief-BESTest are reliable assessment tools for patients with acute and subacute incomplete SCI classified as AIS D. Clarified error ranges aid in estimating the treatment effect on balance abilities.

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Fig. 1: Histogram of total scores for each balance assessment.
Fig. 2: Bland-Altman plots for intra-session and inter-rater of the Mini-BESTest and Brief-BESTest.

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Data availability

Mini-BESTest, Brief-BESTest, and BBS data generated and analyzed during this study are included in this published article (see Supplementary Table 3). Due to privacy concerns, demographic and clinical data are not publicly accessible but are available from the corresponding author upon reasonable request.

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Acknowledgements

We would like to thank Yuki Ishikawa, Yasuhiro Saito, and Koya Katsumi of the Saitama Medical Center for their cooperation in the recruitment process, especially the participants in the study.

Funding

This study was supported by the SMU-FHMC Grant 17-008.

Author information

Authors and Affiliations

  1. Saitama Medical University, Faculty of Health and Medical Care, Department of Physical Therapy, Iruma-gun, Japan

    Yusuke Morooka, Yasuyuki Takakura & Yosuke Kunisawa

  2. Saitama Medical University, Saitama Medical Center, Department of Rehabilitation Medicine, Kawagoe, Japan

    Yuya Okubo, Shinta Araki & Shigeru Obayashi

Authors
  1. Yusuke Morooka
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  2. Yasuyuki Takakura
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  3. Yosuke Kunisawa
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  4. Yuya Okubo
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  5. Shinta Araki
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  6. Shigeru Obayashi
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Contributions

All authors conceptualized and designed the study, interpreted the data, read and critically revised the draft, and approved the final manuscript. YM collected and analyzed the data, wrote the manuscript, and obtained funding. YK wrote the manuscript. YO and SA recruited participants and served as evaluators. YT and SO managed this project.

Corresponding author

Correspondence to Yusuke Morooka.

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Competing interests

The authors declare no competing interests.

Ethical approval

This study was conducted after obtaining approval (S22-079) from the Research Ethics Committee of the Saitama Medical University Hospital.

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Morooka, Y., Takakura, Y., Kunisawa, Y. et al. Reliability of the Mini-BESTest and Brief-BESTest for assessing patients with incomplete spinal cord injury. Spinal Cord 62, 676–682 (2024). https://doi.org/10.1038/s41393-024-01032-2

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