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Utility of the Mini-BESTest, BESTest, and BESTest Sections for Balance Assessments in Individuals With Parkinson Disease

Leddy, Abigail L. BS; Crowner, Beth E. PT, DPT, NCS, MPPA; Earhart, Gammon M. PT, PhD

Journal of Neurologic Physical Therapy: June 2011 - Volume 35 - Issue 2 - p 90–97
doi: 10.1097/NPT.0b013e31821a620c
Research Articles

Background and Purpose: The Balance Evaluation Systems Test(BESTest) has been shown to be a reliable and valid measure of balance in individuals with Parkinson disease (PD). A less time-consuming assessment may increase clinical utility. We compared the discriminative fall risk ability of the Mini-BESTest with that of the BESTest and determined the reliability and normal distribution of scores for each section of the BESTest and the Mini-BESTest in individuals with PD.

Methods: Eighty individuals with idiopathic PD were assessed using the BESTest and Mini-BESTest. A faller was defined as an individual with 2 or more falls in the prior 6 months. Subsets of individuals were used to determine interrater (n = 15) and test-retest reliability (n = 24).

Results: The Mini-BESTest, total BESTest score, and all sections of the BESTest showed a significant difference between the average scores of fallers and nonfallers. For both the Mini-BESTest and BESTest, interrater (intraclass correlation ICC ≥ 0.91) and test-retest (ICC ≥ 0.88) reliability was high. The Mini-BESTest and BESTest were highly correlated (r = 0.955). Accuracy of identifying a faller was comparable for the Mini-BESTest and BESTest (area under the receiver operating characteristic plots = 0.86 and 0.84, respectively).

Discussion: No specific section of the BESTest captured the primary balance deficit for individuals with PD. The posttest probabilities for discriminating fallers versus nonfallers were comparable-to-slightly stronger when using the Mini-BESTest.

Conclusion: Although the Mini-BESTest has fewer than half of the items in the BESTest and takes only 15 minutes to complete, it is as reliable as the BESTest and has comparable-to-slightly greater discriminative properties for identifying fallers in individuals with PD.

Washington University School of Medicine, St Louis.

Correspondence: Gammon Earhart, PT, PhD, Campus Box 8502, 4444 Forest Park Blvd., St. Louis, MO 63108 (

Parts of this manuscript have previously been presented in abstract at the World Parkinson Congress, Glasgow, Scotland, UK, 2010, the National Pre-doctoral Clinical Research Training Program Meeting, St Louis, Missouri, 2010, and the Missouri Physical Therapy Association Meeting, St Louis, Missouri, 2010.

© 2011 Neurology Section, APTA