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Sideline Performance of the Balance Error Scoring System during a Live Sporting Event

Rahn, Carrie MS*; Munkasy, Barry A. PhD; Barry Joyner, A. PhD; Buckley, Thomas A. EdD, ATC§

Clinical Journal of Sport Medicine: May 2015 - Volume 25 - Issue 3 - p 248–253
doi: 10.1097/JSM.0000000000000141
Original Research

Objective: The purpose was to examine the influence of a live sporting sideline environment on balance error scoring system (BESS) performance.

Design: Prospective longitudinal cohort study.

Setting: The BESS was performed by all participants at 3 locations: (1) quiet laboratory, (2) football stadium sidelines, and (3) basketball arena sidelines.

Participants: The experimental group had 38 participants (age: 20.1 ± 1.1 years; height: 170.0 ± 7.7 cm; mass: 66.7 ± 9.5 kg) who were female intercollegiate student-athletes (SA). The control group consisted of 38 recreationally active female college students (age: 20.8 ± 1.1 years; height: 162.6 ± 6.0 cm; mass: 63.7 ± 10.6 kg).

Interventions: The 2 groups performed the tests at the same locations, the SA group during live sporting events and the control group when no event was occurring.

Main Outcome Measures: The dependent variable was the total BESS score. Separate 2 × 3 mixed methods analyses of variance investigated the influence of the environment and practice effect.

Results: There was a significant interaction for group by environment (P = 0.004), and the SA group committed more errors at both the football and the basketball settings than the control group. The SA group also committed more errors at football (P = 0.028) than baseline. The control group demonstrated a likely practice effect with fewer errors during each administration.

Conclusions: The BESS score deteriorated when performed on the sidelines of a live sporting event potentially challenging the clinical utility of the BESS. Clinicians need to consider the role of the local environment when performing the BESS test and should perform postinjury tests in the same environment as the baseline test.

Clinical Relevance: When performing balance testing of patients with suspected concussions, clinicians need to consider the environment in which the test is performed and attempt to match the preseason testing environment.

*Department of Intercollegiate Athletics, Georgia Southwestern State University, Americus, Georgia;

Department of Health and Kinesiology, Georgia Southern University, Statesboro, Georgia;

College of Health and Human Sciences, Georgia Southern University, Statesboro, Georgia; and

§Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Deleware.

Corresponding Author: Thomas A. Buckley, EdD, ATC, Department of Kinesiology and Applied Physiology, 144 Human Performance Lab, University of Delaware, Newark, DE 19716 (

Supported, in part, by a National Institutes of Health/National Institute of Neurological Disorders and Stroke Grant (1R15NS070744–01A1). Dr. Buckley and Dr. Munkasy are the primary investigators on the grant. The funding agency had no role in the development of the manuscript, the interpretation of the results, or the decision where to submit the manuscript.

The authors report no conflicts of interest.

Received September 30, 2013

Accepted July 17, 2014

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.