Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

The Reliability of the Modified Balance Error Scoring System

Hunt, Tamerah N PhD, ATC, CSCS; Ferrara, Michael S PhD, ATC; Bornstein, Robert A PhD, ABPP; Baumgartner, Ted A PhD

Clinical Journal of Sport Medicine: November 2009 - Volume 19 - Issue 6 - p 471-475
doi: 10.1097/JSM.0b013e3181c12c7b
Original Research

Objective: Study 1 investigated the intraclass reliability and percent variance associated with each component within the traditional Balance Error Scoring System (BESS) protocol. Study 2 investigated the reliability of subsequent modifications of the BESS.

Design: Prospective cross-sectional examination of the traditional and modified BESS protocols.

Setting: Schools participating in Georgia High School Athletics Association.

Intervention: The modified BESS consisted of 2 surfaces (firm and foam) and 2 stances (single-leg and tandem-leg stance) repeated for a total of three 20-second trials.

Participants: Participants consisted of 2 independent samples of high school athletes aged 13 to 19 years.

Main Outcome Measures: Percent variance for each condition of the BESS was obtained using GENOVA 3.1. An intraclass reliability coefficient and repeated measures analysis of variance were calculated using SPSS 13.0.

Results: Study 1 obtained an intraclass correlation coefficient (r = 0.60) with stance accounting for 55% of the total variance. Removing the double-leg stance increased the intraclass correlation coefficient (r = 0.71). Study 2 found a statistically significant difference between trials 1 and 2 (F(1.65,286) = 4.890, P = 0.013) and intraclass reliability coefficient of r = 0.88 for 3 trials of 4 conditions.

Conclusions: The variance associated with the double-leg stance was very small, and when removed, the intraclass reliability coefficient of the BESS increased. Removal of the double-leg stance and addition of 3 trials of 4 conditions provided an easily administered, cost-effective, time-efficient tool that provides reliable objective information for clinicians to base clinical decisions upon.

From *School of Allied Medical Professions, The Ohio State University, Columbus, Ohio; †Department of Kinesiology, University of Georgia, Athens, Georgia; and ‡Department of Psychiatry, The Ohio State University, Columbus, Ohio.

Submitted for publication June 5, 2009; accepted September 14, 2009.

The authors state that they have no financial interest in the products mentioned within this article.

Reprints: Tamerah N. Hunt, PhD, ATC, CSCS, Ohio State University Sports Medicine Center, The Ohio State University, 2050 Kenny Rd, Ste 3100, Columbus, OH 43221 (

Copyright © 2009 Wolters Kluwer Health, Inc. All rights reserved.