The Reliability of the Modified Balance Error Scoring System

School of Allied Medical Professions, The Ohio State University, Columbus, Ohio 43221, USA.
Clinical journal of sport medicine: official journal of the Canadian Academy of Sport Medicine (Impact Factor: 2.27). 11/2009; 19(6):471-5. DOI: 10.1097/JSM.0b013e3181c12c7b
Source: PubMed


Study 1 investigated the intraclass reliability and percent variance associated with each component within the traditional Balance Error Scoring System (BESS) protocol. Study 2 investigated the reliability of subsequent modifications of the BESS.
Prospective cross-sectional examination of the traditional and modified BESS protocols.
Schools participating in Georgia High School Athletics Association.
The modified BESS consisted of 2 surfaces (firm and foam) and 2 stances (single-leg and tandem-leg stance) repeated for a total of three 20-second trials.
Participants consisted of 2 independent samples of high school athletes aged 13 to 19 years.
Percent variance for each condition of the BESS was obtained using GENOVA 3.1. An intraclass reliability coefficient and repeated measures analysis of variance were calculated using SPSS 13.0.
Study 1 obtained an intraclass correlation coefficient (r = 0.60) with stance accounting for 55% of the total variance. Removing the double-leg stance increased the intraclass correlation coefficient (r = 0.71). Study 2 found a statistically significant difference between trials 1 and 2 (F(1.65,286) = 4.890, P = 0.013) and intraclass reliability coefficient of r = 0.88 for 3 trials of 4 conditions.
The variance associated with the double-leg stance was very small, and when removed, the intraclass reliability coefficient of the BESS increased. Removal of the double-leg stance and addition of 3 trials of 4 conditions provided an easily administered, cost-effective, time-efficient tool that provides reliable objective information for clinicians to base clinical decisions upon.

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Available from: Michael S. Ferrara, Oct 13, 2015
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    • ". Only the BESS double stance and tandem stance tests [31] were completed as baseline and post-incident tests. All players completed the SCAT3 baseline assessment prior to participating in any match activity. "
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    • "Intra class reliability for the traditional protocol of the BESS (1 trial of 6 conditions) had a reliability of r = 0.60. When the double-leg stance was removed for both the firm and foam surfaces, the reliability coefficient increased to 0.71 (Hunt 2009). Finoff et al. (2009) determined that the total BESS score is not reliable (inter rater ICC = 0.57, intra rater ICC = 0.74); however, certain subcategories of the BESS have adequate reliability (inter rater ICC from 0.44 to 0.83; intra rater ICC from 0.50 to 0.88) to be used in the evaluation of postural stability after concussion. "
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