Comparison of measurement properties of three shortened versions of the balance evaluation system test (BESTest) in people with subacute stroke

Thitimard Winairuk, Marco Y.C. Pang, Vitoon Saengsirisuwan, Fay B. Horak, Rumpa Boonsinsukh

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Objectives: To examine the reliability, validity and responsiveness of 3 different short versions of the Balance Evaluation Systems Test (BESTest: SBESTest, Brief-BESTest and Mini-BESTest) in patients with subacute stroke. Design: A prospective cohort study. Participants: Patients with subacute stroke. Methods: Patients were assessed using the full BESTest. Scores of 3 short-form BESTests were later extracted. The intra-rater and inter-rater reliability (n = 12) were gathered from 5 raters. Concurrent validity was assessed with the Berg Balance Scale (BBS). Floor/ceiling effect, internal responsiveness and external responsiveness with the BBS (n = 70) were assessed at baseline, 2 weeks and 4 weeks post-rehabilitation. Results and conclusion: All short-form BESTests demonstrated excellent intra-rater and inter-rater reliability (intraclass correlation coefficient (ICC) = 0.95-0.99) and excellent concurrent validity (r = 0.93-0.96). Unlike the Brief-BESTest and Mini-BESTest, the S-BESTest and BESTest had no significant foor/ceiling effects (< 20%). The standardized response mean of all 4 BESTest versions were large, ranging between 1.19 and 1.57, indicating sufficient internal responsiveness. The area under the curve of the S-BESTest and BESTest were significantly higher than the Brief-BESTest and Mini-BESTest, reflecting better accuracy of the S-BESTest and BESTest in identifying patients with subacute stroke who had balance improvement using the minimal clinically important difference of 6 and 16 points, respectively. These findings suggest that the S-BESTest is a short-form BESTest that is appropriate for assessing balance impairments in patients with subacute stroke.

Original languageEnglish (US)
Pages (from-to)683-691
Number of pages9
JournalJournal of Rehabilitation Medicine
Issue number9
StatePublished - 2019


  • Cerebrovascular disease
  • Minimal clinically important difference
  • Patient-reported outcome measures
  • Physical therapist
  • Postural balance
  • Psychometric

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation


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