Original Research

Reliability Testing of the Balance Error Scoring System in Children Between the Ages of 5 and 14

Hansen, Colby MD; Cushman, Dan MD; Chen, Wei PhD; Bounsanga, Jerry BS; Hung, Man PhD

^*Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah;

^†Division of Epidemiology, University of Utah, Salt Lake City, Utah; and

^‡Department of Orthopedics, University of Utah, Salt Lake City, Utah.

Corresponding Author: Colby Hansen, MD, 590 Wakara Way, Salt Lake City, UT 84108 ([email protected]).

This investigation was supported by the University of Utah, Division of PM&R pilot research grant fund, the University of Utah Department of Orthopedics, the Center for Outcomes Research and Assessment and the Study Design and Biostatistics Center, with funding in part from the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant 8UL1TR000105.

The authors report no conflicts of interest.

Received February 18, 2015

Accepted November 24, 2015

Clinical Journal of Sport Medicine 27(1):p 64-68, January 2017. | DOI: 10.1097/JSM.0000000000000293

Abstract

Objective:

Pediatric concussion is an extensive public health concern with a complex clinical presentation. Balance assessment has been well-studied in the adult population, but has been limited in children. We aimed to assess the reliability and minimum detectable change (MDC) of the Balance Error Scoring System (BESS) in healthy children.

Design:

This prospective observational study included 373 healthy children aged 5 to 14. Interrater reliability was assessed by having 4 assessors review videos of 50 random subjects distributed evenly by age and sex across the entire cohort. Intrarater reliability was performed by having assessors review videos of other assessors' live evaluations. Test–retest reliability was obtained by comparing BESS scores as recorded live at the 2 separate time points by the same rater.

Setting:

Local elementary and junior high schools.

Participants:

Three hundred and seventy three healthy children between the ages of 5 and 14.

Interventions:

The BESS was performed on all children.

Main Outcome Measures:

Intraclass Correlation Coefficients (ICCs) and MDC Scores.

Results:

The overall interrater ICC was determined to be 0.93 [95% confidence interval (CI), 0.79-0.97] and intrarater ICC was 0.96 (95% CI, 0.95-0.97) with individual intrarater ICCs ranging between 0.69 and 0.99. The test–retest reliability was 0.90 (95% CI, 0.88-0.92). The MDCs were 9.6, 4.6, and 7.3 points at the 95% CIs for interrater, intrarater, and test–retest comparisons, respectively. No learning effect was seen.

Conclusions:

The BESS demonstrates excellent reliability in the pediatric population without evidence of a learning effect.

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Reliability Testing of the Balance Error Scoring System in Children Between the Ages of 5 and 14