REVIEW ARTICLE (META-ANALYSIS)
Psychometric Properties of Brief-Balance Evaluation Systems Test Among Multiple Populations: A Systematic Review and Meta-analysis

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Abstract

Objective

To synthesize evidence regarding the psychometric properties of the Brief-Balance Evaluation Systems Test (BESTest) in assessing postural controls across various populations.

Data Sources

Articles were searched in 9 databases from inception to March 2020.

Study Selection

Two reviewers independently screened titles, abstracts, and full-text articles to include studies that reported at least 1 psychometric property of the Brief-BESTest. There were no language restrictions.

Data Extraction

The 2 independent reviewers extracted data (including psychometric properties of Brief-BESTest) from the included studies. The methodological quality of the included studies was appraised by the Consensus-based Standards for the Selection of Health Status Measurement Instruments checklist, and the quality of statistical outcomes was assessed by the Terwee et al method. A best-evidence synthesis for each measurement property of the Brief-BESTest in each population was conducted.

Data Synthesis

Twenty-four studies encompassing 13 populations were included. There was moderate to strong positive evidence to support the internal consistency (Cronbach α>0.82), criterion validity (ρ≥0.73, r≥0.71), and construct validity (ρ≥0.66, r≥0.50, area under curve>0.72) of the Brief-BESTest in different populations. Moderate to strong positive evidence supported the responsiveness of the Brief-BESTest in detecting changes in postural controls of patients 4 weeks after total knee arthroplasty or patients with subacute stroke after 4-week rehabilitation. However, there was strong negative evidence for the structural validity of this scale in patients with various neurologic conditions. The evidence for the reliability of individual items and measurement errors remains unknown.

Conclusions

The Brief-BESTest is a valid (criterion- and construct-related) tool to assess postural control in multiple populations. However, further studies on the reliability of individual items and minimal clinically important difference of the Brief-BESTest are warranted before recommending it as an alternative to the BESTest and Mini-BESTest in clinical research/practice.

Section snippets

Methods

This review protocol has been registered at PROSPERO (CRD42018107961). We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses to guide the reporting of the current review.22

Results

Of 138 identified citations, 39 were duplicates (fig 1). Twenty-four articles, with 19 English, 1 Chinese, 3 Japanese, and 1 Persian articles, from 13 populations were included. Those populations included patients with TKA (n=4),13,20,32,33 stroke (n=4),15,19,34,35 various neurologic diseases other than stroke (n=3),12,36,37 and chronic obstructive pulmonary disease (COPD) (n=3),38, 39, 40 as well as community-dwelling older people (n=3)10,41,42 (table 1). The remaining populations were

Discussion

To our knowledge, this is the first systematic review to summarize evidence regarding various psychometric properties of the Brief-BESTest used in assessing postural controls across 13 different populations. The Brief-BESTest displayed moderate to strong positive evidence for criterion validity and construct validity for postural control assessments. However, there was strong negative evidence for structural validity of this scale when accessing postural control capacity in patients with

Conclusions

The Brief-BESTest is a valid (concurrent-related, convergent-related, and known-group-related) scale for measuring the postural control capacity in different populations. However, the internal structure and uniqueness of the Brief-BESTest for assessing multiple dimensions of postural control may be improved by modifying item 1. Future research should determine the reliability of individual items, MCIDs, and responsiveness of the Brief-BESTest in different populations to guide its use in

Supplier

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    MedCalc Software version 16.4.3; MedCalc Software.

Acknowledgments

We thank Loretta Chan, BA, for helping in the assessment of the methodology and quality of statistical findings of the Brief-BESTest. We thank Junichi Tajino, PhD, and Peyman Asad, PhD, for screening and extracting data from Japanese and Persian articles in the current review, respectively.

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  • Cited by (0)

    Supported by The Hong Kong Polytechnic University Start-up fund (grant no. 1-ZE4G).

    Disclosures: none.

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