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.

Download full-text


Available from: Michael S. Ferrara
    • "The test–retest reliability of the BESS has been reported in youth athletes (Intraclass Correlation Coefficient [ICC] = 0.70) [5] and young adults (G = 0.64) [6]. The intrarater reliability of BESS has been reported in high school football players (ICC = 0.60) [7], youth athletes (ICC = 0.98) [8], colleges students (ICC = 0.63–0.82) [9]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The Balance Error Scoring System (BESS) is a commonly used test in adolescents and young adults. Affordability and portability of newer force plates has led to instrumentation of many clinical balance tests including the BESS. Despite the higher precision of force plate measures compared with clinical scoring, it is unclear if the instrumented BESS demonstrate concurrent validity and reliability when compared with the original BESS. The purpose of this study was to examine the reliability and concurrent validity of instrumented BESS testing using a commercially available force plate system. Thirty-six participants participated in the initial testing day (17 male/19 female, M = 15.9 years, SD = 1.5 years). The test-retest sample consisted of 26 participants who completed the same testing procedure after 1 week. For all testing sessions, participants performed the BESS while standing on a portable force plate system. Number of errors and sway velocity were obtained. Concurrent validity was established through correlation analysis examining the relationship between the original and the instrumented BESS scores. Reliability was established using Intraclass Correlation Coefficient (ICC3,1) computed for the instrumented and the original BESS. A significant moderate relationship exists between the total scores of the original and the instrumented BESS (rs = 0.54, p = 0.001). Despite a range of reliability scores for the different conditions in the instrumented BESS (ICC3,1 = 0.19-0.61) and the clinically scored BESS (ICC3,1 = 0.13-0.71), the reliability score for the total test score was the same for the instrumented and the clinical test (ICC3,1 = 0.74). Although the instrumented BESS may appear to demonstrate concurrent validity against the original BESS, instrumentation did not improve its reliability. Future research should examine if the instrumented BESS demonstrates validity against laboratory level force plates and if it is able to overcome the ceiling effect reported for the clinical BESS test.
    No preview · Article · Jun 2015 · The Physician and sportsmedicine
  • Source
    • ". 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. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Aim: To use the King–Devick (K–D) test in senior amateur rugby union and rugby league players over a domestic competition season to see if it could identify witnessed and unwitnessed episodes of concussion that occurred from participation in competition matches over three years. Methods: A prospective observational cohort study was conducted on a club level senior amateur rugby union team (n = 36 players in 2012 and 35 players in 2013) and a rugby league team (n = 33 players in 2014) during competition seasons in New Zealand. All 104 players completed two trials 10 min apart of the K–D at the beginning of their competition season. Concussions (witnessed or unwitnessed) were only recorded if they were formally diagnosed by a health practitioner. Results: A total of 52 (8 witnessed; 44 unwitnessed) concussive events were identified over the duration of the study resulting in a concussion injury incidence of 44 (95% CI: 32 to 56) per 1000 match participation hours. There was a six-fold difference between witnessed and unwitnessed concussions recorded. There were observable learning effects observed between the first and the second K–D test baseline testing (50 vs. 45 s; z = −8.81; p b 0.001). For every 1 point reduction in each of the post-injury SAC components there was a corresponding increase (worsening) of K–D test times post-match for changes in orientation (2.9 s), immediate memory (1.8 s) concentration (2.8 s), delayed recall (2.0 s) and SAC total score (1.7 s). Discussion: The rate of undetected concussion was higher than detected concussions by using the K–D test routinely following matches. Worsening of the K–D test post-match was associated with reduction in components of the SAC. The appeal of the K–D test is in the rapid, easy manner of its administration and the reliable, objective results it provides to the administrator. The K–D test helped identify cognitive impairment in players without clinically observable symptoms.
    Full-text · Article · Mar 2015 · Journal of Neurological Sciences
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Although a majority of patients following minor traumatic brain injury recover to their pre-morbid functional level, persistent activity and participation limitations can occur in the refractory patient. These long-term consequences of brain injury may only become apparent months to years after the injury. In order to quantify these long-term sequella, laboratory, clinical and functional outcome measures may not only identify needed areas of treatment, but may also assist in determining the impact of the treatment on the individuals function. The aim of this manuscript is to review the clinical utility of vestibular laboratory testing and the bedside vestibular examination in patients following mild traumatic brain injury. In addition, the validity and inter-observer reliability of functional outcome measures commonly used in individuals with mTBI will also be reviewed. Because of the diffuse pathology seen with mTBI, multiple tests are needed to determine the resultant impairment and their impact on the patient's activity level and participation level. Laboratory test and bedside tests of vestibular impairment are reviewed. Functional outcome measures including the Dynamic Gait Index, the Functional Gait Assessment, the Balance Error Scoring System, and Dual Task Performance are reviewed for their appropriateness in quantifying the effect of mTBI at activity level and participation level of the individual. TBI rehabilitation services are increasingly exemplified by the needs of patients, rather than by the underlying pathology or diagnosis. Basing treatment decisions and treatment timing on laboratory, clinical, and functional testing can optimize the rehabilitation outcome.
    Full-text · Article · May 2013 · Neurorehabilitation
Show more