Reliability, Validity, and Responsiveness of the Mini-Balance Evaluation Systems Test (Mini-BESTest) in Individuals with Multiple Sclerosis
Rachel Bowling, SPT; Brittany Oppland, SPT; Ashley Stone, SPT; Lindsey Wolf, SPT; Ashley Wooldridge SPT
Faculty Mentor: Kirsten Potter​, PT, DPT, MS

Purpose/Hypothesis:
The Mini-Balance Evaluation Systems Test (Mini-BESTest) was developed to identify factors contributing to imbalance and may be a valuable measure for persons with multiple sclerosis (pwMS), as pwMS have impairments of various systems underlying balance control. Data supporting the use of the Mini-BESTest for pwMS is lacking. The purpose of this study was to determine the reliability, validity, and minimal detectable change (MDC) of the Mini-BESTest in pwMS.
 
Subjects: 32 persons with MS
 
Materials/Methods: 
Individuals with MS were recruited through the Mid America Chapter of the MS Society. In the first session demographic data was collected and each subject completed a questionnaire of disease severity and the Activities-specific Balance Confidence Scale (ABC).  The Mini-BESTest, administered by two trained raters. The Mini-BESTEST was re-administered by one of the previous raters one week later at the same time of day.
 
Results: 
32 ambulatory subjects with MS (mean disease severity = 3.6; range 0-7) participated. Inter-rater reliability of the total Mini-BESTest was ICC = 0.98 with subscales ranging 0.92 (reactive) to 0.97 (gait). Test-retest reliability for the total Mini-BESTest was ICC = 0.97 with subscales ranging 0.85 (anticipatory) to 0.92 (gait and sensory). Internal consistency among the 4 subscales of the Mini-BESTest was Chronbach’s alpha = 0.89. The MDC score for the total Mini-BESTest was 3.74; subscale MDC scores were 1.43 (anticipatory), 1.90 (reactive), 0.98 (sensory), and 2.38 (gait). Spearman correlation coefficients relating individual subsection scores to the total Mini-BESTest ranged 0.82 (reactive) to 0.93 (anticipatory). Correlations between individual subsections were moderate, ranging 0.65 (anticipatory to reactive) to 0.83 (anticipatory to gait). Correlations between the Mini-BESTest (total and subsections) and disease severity and ABC scores were moderate, but weak when related the number of falls in the past 6 months. No significant floor effects were found. Significant ceiling effects were found for all subsections (ranging 15.6% for anticipatory and gait to 53.1% for sensory). No significant ceiling effect was found for the total Mini -BESTest.
 
Conclusions:
The Mini-BESTest is a reliable and valid test in pwMS. Moderate correlations among individual subsection scores indicate that each assesses a unique aspect of balance, supporting its construct validity. The ceiling effects for subsections may reflect the high functioning subjects and variability among subjects in various aspects of balance performance. The MDC scores will enable PTs to assess the treatment effectiveness.
Discussion: To date, no other studies have reported on the reliability, validity, and responsiveness of the Mini-BESTest in persons with MS.  This study supports the use of the Mini-BESTest in pwMS. Because the total Mini-BESTest score demonstrated higher reliability and a lack of a ceiling effect as compared to subsection scores, we recommend that PTs use the Mini-BESTest in its entirety.
 
Acknowledge:
We would like to thank Doug Denney, PhD (Professor Emeritus, University of Kansas, Department of Psychology) for his assistance with statistical analysis.