Journal of Neurologic Physical Therapy:
REVIEWS: Departments: Reviews
Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, Florida
The Balance Evaluation Systems Test (BESTest)1 is a recently developed clinical assessment tool to identify the postural control systems responsible for deficits in functional balance. Six postural control systems (biomechanical constraints, stability limits/verticality, postural transitions, reactive postural responses, sensory orientation, and dynamic stability during gait) are examined. Each system examined has several associated test items based on both novel and known balance measures. Items are scored using a 4-point ordinal scale with 0 being the lowest score and 3 being the highest score. Percentage scores are computed and reported for each system and for the total assessment. The purpose of the BESTest training DVD is to assist clinicians in learning proper administration and scoring of this new assessment tool. The DVD is available for purchase from through the technology transfer web site of the Oregon Health & Sciences University at http://www.ohsu.edu/tech-transfer/portal/technology.php?technology_id=217191 .
The training DVD is easy to load and navigate, and can be used on either PC or Mac platforms. Once loaded, the main menu screen contains icons for playing an introduction video clip, printing a copy of the BESTest, reviewing acknowledgments from the authors, and beginning the interactive tutorial for administering and scoring the test. At any time, the user can jump to a specific section or test, get help using the icons, or quit the tutorial. A video clip introduction on the theoretical background and use of the BESTest and the training DVD is provided by Dr. Fay Horak, developer of the BESTest.
The interactive tutorial consists of 3 sets of video instructions: examiner, patient, and scoring. The video clips embedded in the tutorial provide a visual demonstration of an examiner performing each item with a patient. The examiner section provides an audiovisual demonstration on how to safely and consistently administer each item. Emphasis in this section is placed on examiner and patient positioning, how the test is performed, and what equipment is required to complete the test item. The patient section provides audiovisual instructions for the examiner to give to the patient for each of the test items. Emphasis is placed on verbal instructions given by the examiner. The scoring criteria section provides written descriptions of how to discriminate performance using the 0- to 3-point scoring scale. Video clips demonstrating performance for a given score can be accessed simply by clicking on the icon related to that score. Written descriptions and video clips can be viewed concurrently.
This training video and downloadable written material provide a comprehensive learning experience for the clinician, researcher, or student. Directions for administration and scoring are straightforward and the video clips provide a good vantage point for the examiner to discriminate between the 0 and 3 scoring criteria. It is best to download and print a copy of the BESTest from the main menu, while reviewing the training video. These materials include a list of equipment required, administration instructions, and scoring sheets. The BESTest has reported an intraclass correlation coefficient for interrater reliability of 0.91 for the entire test with a range from 0.79 to 0.96 for the subtests in adults with balance deficits.1 Use of this training DVD should enhance examiner proficiency and reliability in administration and scoring of the tool.
James Moore, PT, PhD, NCS
Department of Physical Therapy
University of Miami Miller School of Medicine
Coral Gables, Florida
1. Horak FB, Wrisley DM, Frank J. The Balance Evaluation Systems Test (BESTest) to differentiate balance deficit. Phys Ther. 2009;89:484–498.