Volume 18, Issue 4 (Winter 2018)                   Vol. , No. , Season & Year , Serial No. | Back to browse issues page


XML Persian Abstract Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Kamalian Lari S, Haghgoo H A, Farzad M, Hosseinzadeh S. Investigation of the Validity and Reliability of Balance Evaluation Systems Test (BESTest) in Assessment of Balance Disorders in People With Multiple Sclerosis. jrehab. 2018; 18 (4) :288-295
URL: http://rehabilitationj.uswr.ac.ir/article-1-2166-en.html
1- Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
2- PhD Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. , haghgooh@gmail.com
3- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
Abstract:   (773 Views)

Objective Balance system and postural control are one of the major problems in people with multiple sclerosis. Therefore, the assessment of the balance system and postural control is very essential. Identification and use of standard tools can be a practical solution for more purposeful plan in this issue. Several tools have been used to investigate the balance disorders in these patients, which solely able to screen equilibrium problems, and only predict the risk of falling in the elderly. These questionnaires cannot help the therapist to diagnose the underlying causes of imbalance and also are not useful in directing the purposeful therapeutic process. The Balance Evaluation Systems Test (BESTest) was designed from 1990 to 1999 by Dr. Horak in the Continues Medical Education System. This questionnaire is based on the Bernstein’s theory of motor control, and the test evaluates Biomechanical, Stability Limits, Postural Responses, Anticipatory Postural Adjustments, Sensory Orientation, and Dynamic Balance through 36 questions. The objective of this study was to determine the validity and reliability of the BESTest evaluation system in patients with multiple sclerosis after providing a coherent version of the questionnaire in Persian.
Materials & Methods This is a methodological and non-experimental study. The BESTest questionnaire was translated by the researcher. The face validity of the questionnaire was evaluated by a survey of 21 patients with multiple sclerosis. The content validity of the questionnaire was further evaluated by a survey of 6 specialists in the field of rehabilitation (three occupational therapists and three specialists in the field of physiotherapy). After that, the BESTest questionnaire and Berg questionnaire were completed by two researchers (the author and another examiner) for 110 people diagnosed as multiple sclerosis, considering inclusion and exclusion criteria, from north, south, east, west, and center of Tehran in the years 2016-2017. After one week, 36 patients from the first stage were reevaluated in with a BESTest questionnaire by the researcher to evaluate the test-retest reliability. The internal consistency with Cronbach’s alpha coefficient, test-retest reliability by intra-class correlation coefficients traces, inter-rater reliability coefficients of correlation between the traces, and convergent validity between the two questionnaires (BESTest and Berg) with Pearson correlation coefficient were investigated.
Results The content validity of the questionnaire (the comprehensibility, relevance of the questions, and the cultural matching of words), which were measured by the CVR and CVI statistical methods, were approved by the specialist (CVI>0.79 and CVR>0.99). Pearson correlation coefficient between all the domains of the BESTest questionnaire (except for the second domain) with the score of the Berg questionnaire was between 0.79 and 0.93. Given that the numbers are above the minimum acceptable value of 0.70 indicates a good convergence between these two questionnaires. By removing a part of a 6th item from the second domain, the Cronbach’s alpha coefficient calculated in all domains were between 0.71 and 0.93, which were much higher than the minimum acceptable value of 0.70. These results indicate an excellent internal consistency. Correlation coefficients between two testers in six domains were reported 0.76 to 0.98. Therefore, these coefficients were above 0.70 in all domains, which indicates the good reliability between two examiners. Furthermore, the Intra-sectional correlation coefficient for two repetitions of the questionnaire for the test-retest reliability of the test were 0.84 to 0.99, which were higher than 0.70 (minimum acceptable), which shows that the questionnaire has an excellent test-retest reliability. 
Conclusion  After changing and removing part of question 6 of the second domain, results demonstrated that the questionnaire BESTest is a valid and reliable test for assessing balance performance in multiple sclerosis patients. It can be used as an accurate tool, both in the areas of clinical (to evaluate the patients’ equilibrium status and purposeful therapy planning) and to apply for scientific research in patients with multiple sclerosis.

Full-Text [PDF 3745 kb]   (254 Downloads) |   |   Full-Text (HTML)  (64 Views)  
Type of Study: Original | Subject: Neurology
Received: 2/07/2017 | Accepted: 12/10/2017 | Published: 22/12/2017

References
1. Pedretti LW, Early MB. Occupational therapy: Practice skills for physical dysfunction. London: Mosby; 2001.
2. Ross E, Purtill H, Uszynski M, Hayes S, Casey B, Browne C, et al. Cohort study comparing the Berg Balance Scale and the Mini-BESTest in people who have Multiple Sclerosis and are ambulatory. Physical Therapy. 2016; 96(9):1448–55. doi: 10.2522/ptj.20150416 [DOI:10.2522/ptj.20150416]
3. Burks J, Bigley G, Hill H. Rehabilitation challenges in Multiple Sclerosis. Annals of Indian Academy of Neurology. 2009; 12(4):296. doi: 10.4103/0972-2327.58273 [DOI:10.4103/0972-2327.58273]
4. Mehraban S, Bahmani B, Azimian M, Rezasoltani P. The effectiveness of cognitive behavioral based stress management training on anxiety in female MS patients. Iranian Rehabilitation Journal. 2015; 13(3):49-53.
5. Kosari Nejad M, Noorizadeh Dehkordi S, Dadgoo M, Hassani Mehraban A, Nabavi M. The association between urinary disorder, hypertonia and assistive device usage with falling in individual with Multiple Sclerosis. Physical Treatments-Specific Physical Therapy Journal. 2014; 3(4):24-8.
6. Cattaneo D, Jonsdottir J, Repetti S. Reliability of four scales on balance disorders in persons with Multiple Sclerosis. Disability and Rehabilitation. 2007; 29(24):1920–5. doi: 10.1080/09638280701191859 [DOI:10.1080/09638280701191859]
7. Smrtka J, Brown T, Bjorklund G. Loss of mobility and the patient burden of Multiple Sclerosis: expert opinion on relevance to daily clinical practice. Postgraduate Medicine. 2015; 128(1):145–51. doi: 10.1080/00325481.2016.1120162 [DOI:10.1080/00325481.2016.1120162]
8. Rodrigues LC, Marques AP, Barros PB, Michaelsen SM. Reliability of the balance evaluation systems test (BESTest) and BESTest sections for adults with hemiparesis. Brazilian Journal of Physical Therapy. 2014; 18(3):276–81. doi: 10.1590/bjpt-rbf.2014.0033 [DOI:10.1590/bjpt-rbf.2014.0033]
9. Chinsongkram B, Chaikeeree N, Saengsirisuwan V, Viriyatharakij N, Horak FB, Boonsinsukh R. Reliability and validity of the balance evaluation systems test (BESTest) in people with subacute stroke. Physical Therapy. 2014; 94(11):1632–43. doi: 10.2522/ptj.20130558 [DOI:10.2522/ptj.20130558]
10. Daneshmandi H. [Corrective exercises (Identification and practice) (Persian)]. Tehran: SAMT; 2004.
11. Staff MC. Balance problems [Internet]. 2016 [Updated 4 February 2016]. Available from: http://www.mayoclinic.org/diseases-conditions/balance-problems/home/ovc-20166187
12. Ghaffari S, Ahmadi F, Nabavi SM, Kazem Nezhad A. Effects of applying hydrotherapy on quality of life in women with Multiple Sclerosis. Archives of Rehabilitation. 2008; 9(3):43-50.
13. Masoudi R, Kheiri F, Ahmadi F, Mohammadi I. [The effect of self care program base on the Orem frame work on fatigue and activity of daily living in Multiple Sclerosis patients (Persian)]. Archives of Rehabilitation. 2009; 10(3).
14. Farhadian M, Bozorgi J, Asghar A, Ahmadi Fakhreh M, Morovati Z, Qafarizadeh F. Effect of gait retraining on balance, activities of daily living, quality of life and depression in stroke patients. Iranian Rehabilitation Journal. 2015; 13(4):116-9.
15. Caceres V. How to cope with MS walking challenges [Internet]. 2016 [Updated 4 February 2016]. Available from: http://www.everydayhealth.com/hs/multiple-sclerosis-symptoms/multiple-sclerosis-coping-with-walking-problems/
16. Hines M, Blum JJ. Three dimensional mechanics of eukaryotic flagella. Biophysical Journal. 1983; 41(1):67–79. doi: 10.1016/s0006-3495(83)84406-3 [DOI:10.1016/S0006-3495(83)84406-3]
17. Amiri B. [The effect of 10 weeks of central body exercises on the balance and quality of life of women with Multiple Sclerosis with emphasis on Expanded Disability Status Scale (EDSS) (Persian)] [MSc. thesis]. Kerman: Shahid Bahonar University of Kerman; 2016.
18. Akbari Kamrani AA, Zamani Sani SH, Fathi Rezaie Z, Aghdasi MT. Concurrent validity of functional gait assessment, timed up and go, and gait speed tests in the Persian community-dwelling elderly. Iranian Rehabilitation Journal. 2010; 8(2):15-20.
19. Cattaneo D, Regola A, Meotti M. Validity of six balance disorders scales in persons with Multiple Sclerosis. Disability and Rehabilitation. 2006; 28(12):789–95. doi: 10.1080/09638280500404289 [DOI:10.1080/09638280500404289]
20. Masoudi R, Kheiri F, Ahmadi F, Mohammadi I. [The effect of self-care program base on the Orem frame work on fatigue and activity of daily living in Multiple Sclerosis patients (Persian)]. Archives of Rehabilitation. 2009; 10(3).
21. Horak FB, Wrisley DM, Frank J. The balance evaluation systems test (BESTest) to differentiate balance deficits. Physical Therapy. 2009; 89(5):484–98. doi: 10.2522/ptj.20080071 [DOI:10.2522/ptj.20080071]
22. Jacobs JV, Kasser SL. Balance impairment in people with Multiple Sclerosis: Preliminary evidence for the Balance Evaluation Systems Test. Gait & Posture. 2012; 36(3):414–8. doi: 10.1016/j.gaitpost.2012.03.026 [DOI:10.1016/j.gaitpost.2012.03.026]
23. Leddy AL, Crowner BE, Earhart GM. Utility of the mini-BESTest, BESTest, and BESTest sections for balance assessments in individuals with Parkinson disease. Journal of Neurologic Physical Therapy. 2011; 35(2):90–7. doi: 10.1097/npt.0b013e31821a620c [DOI:10.1097/NPT.0b013e31821a620c]

Add your comments about this article : Your username or Email:
Write the security code in the box

Send email to the article author


© 2015 All Rights Reserved | Archives of Rehabilitation

Designed & Developed by : Yektaweb