Insights into the Mini-BESTest Scoring System: Comparison of 6 Different Structural Models

Phys Ther. 2021 Aug 2:pzab180. doi: 10.1093/ptj/pzab180. Online ahead of print.


OBJECTIVE: The Mini-BESTest is a balance scale common to clinical practice, but different scoring has been proposed, that is, total score and/or subsections. This study aimed to investigate Mini-BESTest validity by comparing 6 structural models and to establish the best model for discriminating fallers from nonfallers, ie, those who did or did not report at least two falls in the six months before evaluation.

METHODS: In this cross-sectional validation study, data from 709 individuals with idiopathic Parkinson disease (Hoehn and Yahr stages 1-3) were analyzed. Individuals were evaluated with the Mini-BESTest, and fall history was recorded. Construct, convergent, and discriminant validity and reliability of the 6 models were analyzed. The ability of the models to adequately identify individuals with or without a history of falls was tested with receiving operating characteristic curves.

RESULTS: Confirmatory factor analysis showed that the unidimensional models and the 4-factor solutions showed the best fit indexes. Conversely, second-order models, which allowed reporting of both total and subsections, did not converge. Most models and factors showed a low convergent validity (average variance extracted values of <0.5). Correlations among the anticipatory postural adjustments factor with both the sensory orientation and the dynamic gait factors of multidimensional models were high (r ≥ 0.85). Unidimensional model reliability was good, whereas low values were found in half of the subsections. Finally, both unidimensional models showed a large area under the receiving operating characteristic curve (0.81).

CONCLUSIONS: The original unidimensional Mini-BESTest model-with a total score of 28-showed the highest validity and reliability and was best at discriminating fallers from nonfallers. Conversely, its 4 subsections should not be reported separately, since they were highly correlated and had low reliability; therefore, they are not actually capable of measuring different aspects of balance.

IMPACT: This study shows that the Mini-BESTest should be used only with the original unidimensional scoring system in people with Parkinson disease.

PMID:34339510 | DOI:10.1093/ptj/pzab180

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