Construct validity of the BESTest, mini-BESTest and briefBESTest

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Gait & Posture xxx (2015) xxx–xxx
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Construct validity of the BESTest, mini-BESTest and briefBESTest
in adults aged 50 years and older
Sachi O’Hoski a, Kathryn M. Sibley b,c, Dina Brooks a,b,c, Marla K. Beauchamp a,d,*
a West Park Healthcare Centre, Respiratory Medicine, 82 Buttonwood Avenue, Toronto, ON, M6M 2J5, Canada
b University of Toronto, Department of Physical Therapy, Faculty of Medicine, 500 University Avenue, Toronto, ON M5G 1V7, Canada
c Toronto Rehabilitation Institute – University Health Network, 550 University Avenue, Toronto, ON M5G 2A2, Canada
d Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Cambridge, MA, USA
A R T I C L E I N F O
Article history:
Received 22 November 2014
Received in revised form 5 June 2015
Accepted 15 June 2015
Keywords:
Postural balance
Geriatric assessment
Outcomes assessment
Aged
A B S T R A C T
Background: The Balance Evaluation Systems Test (BESTest) and its two abbreviated versions (mini-
BESTest and briefBESTest) are functional balance tools that have yet to be validated in middle aged and
elderly people living in the community.
Objective: Determine the construct validity of the three BESTest versions by comparing them with
commonly-used measures of balance, balance confidence and physical activity, and examining their
ability to discriminate between groups with respect to falls and fall risk.
Methods: This was a secondary analysis of data from 79 adults (mean age 68.7 � 10.57 years). Pearson
correlation coefficients were used to examine the relationships between each BESTest measure and the
Activities-Specific Balance Confidence (ABC) scale, the Physical Activity Scale for the Elderly (PASE), the
Timed Up and Go (TUG) and the Single Leg Stance (SLS) test. Independent t-tests were used to examine
differences in balance between fallers (�1 fall in previous year) and non-fallers and individuals classified at
low versus high fall risk using the Elderly Falls Screening Test (EFST).
Results: The BESTest measures showed moderate associations with the ABC scale and TUG (r = 0.62–0.67
and �0.60 to �0.68 respectively), fair associations (r = 0.33–0.40) with the PASE and moderate to high
associations (r = 0.67–0.77) with the SLS. Fallers showed a trend (p = 0.054) for lower scores on the
original BESTest, and people at high risk for falls had significantly lower scores on all BESTest versions.
Conclusions: These findings support the construct validity of the BESTest, mini-BESTest and briefBESTest
in adults over 50 years old.
� 2015 Published by Elsevier B.V.
Contents lists available at ScienceDirect
Gait & Posture
jo u rn al h om ep age: ww w.els evier .c o m/lo c ate /g ai tp os t
Falls in later adulthood are a significant public health problem
[1]. While numerous fall risk factors have been identified, balance
impairment is recognized as one of the most important modifiable
risk factors for falls [2]. The ability to maintain balance is a complex
skill that requires the integration of information from multiple
physiological systems [3], many of which are impaired with age
[2]. Clinical measures of balance with sound psychometric
properties are needed to screen for balance problems in order to
guide treatment and inform fall prevention strategies.
The Balance Evaluation Systems Test (BESTest) is a clinical
balance tool that targets six subsystems of postural control (see
Box 1) in order to identify the underlying impairments contributing
* Corresponding author at: Department of Physical Medicine and Rehabilitation,
Harvard Medical School, Spaulding Outpatient Center Cambridge, 1575 Cambridge
St., Cambridge, MA 02138, USA. Tel.: +1 617 952 6954; fax: +1 617 952 6965.
E-mail addresses: mkbeauchamp@partners.org, marlabeauchamp@gmail.com
(M.K. Beauchamp).
Please cite this article in press as: O’Hoski S, et al. Construct validit
50 years and older. Gait Posture (2015), http://dx.doi.org/10.1016/j.
http://dx.doi.org/10.1016/j.gaitpost.2015.06.006
0966-6362/� 2015 Published by Elsevier B.V.
to dysfunctional balance [4]. In a recent review, it was identified as
the only standardized balance measure that evaluates all compo-
nents of balance consistent with established conceptual models
[5]. The BESTest has been used in a variety of populations [4,6] and
has been shown to have strong psychometric properties in people
with Parkinson’s disease [7]. However, few studies have reported
on its use in a general population of middle-aged and older adults
[4,6,8].
Two abbreviated versions of the BESTest (mini-BESTest and
briefBESTest) have been developed as alternatives to the original
test. These abbreviated versions take 10–20 min to complete [9,10],
considerably less than the 30–60 min to administer the BESTest
[4,9,10], time that is not feasible in many clinical settings. The mini-
BESTest was developed using factor analysis to identify the items of
the BESTest that represented dynamic balance. Rasch analysis was
then used to improve the rating categories and eliminate some items
[10]. The result was a 14 item test of dynamic balance [10]. The mini-
BESTest has been used in several clinical populations [10] and
evidence for its psychometric properties has been shown in people
y of the BESTest, mini-BESTest and briefBESTest in adults aged
gaitpost.2015.06.006
http://dx.doi.org/10.1016/j.gaitpost.2015.06.006
mailto:mkbeauchamp@partners.org
mailto:marlabeauchamp@gmail.com
http://dx.doi.org/10.1016/j.gaitpost.2015.06.006
http://www.sciencedirect.com/science/journal/09666362
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http://dx.doi.org/10.1016/j.gaitpost.2015.06.006
Box 1. Description of categories and items of the Balance
Evaluation Systems Test.
Category Description and examples of tasks
Biomechanical constraints Evaluates constraints on standing balance
including postural alignment, ankle range
of motion and hip strength
Stability limits/verticality Evaluates ability to move the body over its
base of support by leaning forward and
laterally and evaluates ability to return to
gravitational vertical
Anticipatory postural
adjustments
Evaluates active movement of the center of
mass in anticipation of performing sit to
stand, Single Leg Stance, and stair tap
Postural responses Evaluates in-place and compensatory
stepping responses to external
perturbations from the front, side and back
Sensory orientation Evaluates increases in postural sway under
different sensory conditions such as
standing on flat ground or foam with eyes
open or closed
Stability in gait Evaluates stability while walking under
different conditions such as changing
speed, looking from side to side and
stepping over an obstacle
S. O’Hoski et al. / Gait & Posture xxx (2015) xxx–xxx2
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with Parkinson’s disease [7]. Unlike the mini-BESTest, the brief-
BESTest maintains the original theoretical basis of the BESTest; it
was created using item-total correlations to identify the most
representative item from each subsection of the BESTest [9]. The
brief-BESTest has similar inter-rater reliability to the BESTest and
mini-BESTest and is better able to discriminate between fallers and
non-fallers with and without a neurological diagnosis [9].
The construct validity of the BESTest, mini-BESTest and brief-
BESTest has not yet been examined in a general community-based
sample. Therefore, our primary objective was to determine the
associations between the BESTest and its abbreviated versions and
measures of other theoretically related constructs (i.e., convergent
validity) including measures of balance, balance confidence and
physical activity in adults aged over 50 years living in the
community. We hypothesized that all three BESTest scores would
have high correlations with self-reported balance confidence and
other performance-based measures of balance and moderate
correlations with physical activity. In addition, while the BESTest,
mini-BESTestand briefBESTest have been shown to discriminate
between fallers and non-fallers with Parkinson’s disease [7,11], this
has not been examined in those without neurological conditions.
Therefore, our secondary objective was to determine the ability of
the BESTest, mini-BESTest and briefBESTest to discriminate between
groups with respect to fall history and risk of falls and to compare the
discriminative ability of the BESTest measures with that of
commonly used balance measures [12]; the self-reported Activi-
ties-Specific Balance Confidence (ABC) scale [13], and the Timed Up-
and-Go (TUG) test [14] and Single Leg Stance (SLS) test [14]. We
hypothesized that fallers and those classified as being at high risk of
falls would score significantly lower on all balance measures.
1. Methods
This was a secondary analysis of a previous study; the methods
have been described in detail elsewhere [8]. Briefly, the study
protocol was approved by the University Research Ethics Board and
written informed consent was obtained at the beginning of each
data collection session. Individuals who met the following criteria
were recruited: (1) age between 50 and 89 years, (2) residing
independently in the community, (3) able to understand and follow
three-step instructions, (4) able to walk 6 m independently
Please cite this article in press as: O’Hoski S, et al. Construct validi
50 years and older. Gait Posture (2015), http://dx.doi.org/10.1016/j.
(without a gait aid). Participants were excluded if they reported:
(1) a history of dizziness or fainting, (2) the presence of any
cardiorespiratory, neurological or musculoskeletal condition that
severely affected their balance (e.g., chronic obstructive pulmonary
disease, stroke, recent hip or knee replacement), or (3) the use of
medication(s) that they felt caused dizziness or affected their
balance (e.g., antidepressants). Data were collected between
January and July 2012 by raters trained in the administration of
the BESTest. Demographic data (sex, age, height, weight) and all
written questionnaires were collected before administering the
BESTest. Two testers were present for each testing session; one to
observe and score the items and one to supervise for safety. Scoring
of the abbreviated tests was completed after the data collection
session based on performance of the original BESTest tasks.
1.1. Outcome measures
1.1.1. Balance Evaluation Systems Test (BESTest)
The BESTest is a 36 item test comprised of six subsections that
contribute to postural control (see Box 1) [4]. Each item is scored
from 0 to 3 points based on time or performance criteria resulting
in a total possible score of 108 points, which is converted to a
percentage score. Higher scores indicate better balance.
1.1.2. mini-BESTest
The mini-BESTest is a 14-item test of dynamic balance that
includes tasks from the BESTest subsystems ‘anticipatory postural
adjustments’, ‘postural responses’, ‘sensory orientation’ and
‘stability in gait’ [10]. Each item is scored from 0 to 2 points
resulting in a total score out of 28 points with higher scores
indicating better balance.
1.1.3. briefBESTest
The briefBESTest is an eight-item test comprised of one item
from each subsection of the BESTest, with two items (SLS and
functional reach forward) scored bilaterally [9]. Each item is scored
from 0 to 3 points with a total possible score out of 24 points
(higher scores for better balance).
1.1.4. Activities-Specific Balance Confidence (ABC) scale
The ABC scale is a 16-item self-report questionnaire requiring
individuals to indicate their confidence in completing progres-
sively difficult tasks without becoming unsteady or losing their
balance (0% = no confidence; 100% = completely confident)
[13]. The percentage assigned for each task is summed and
divided by 16 in order to obtain the overall score. The ABC scale has
good test–retest reliability, convergent and criterion validity [13]
and the ability to discriminate between fallers and non-fallers in
community-dwelling elderly (cut-off score 67%) [15].
1.1.5. Physical Activity Scale for the Elderly (PASE)
The PASE consists of 26 questions that assess an individual’s
physical activity level over the previous 7 days [16]. Subscale
categories include leisure time, household and occupational
physical activity. The frequency (never, seldom, sometimes, often)
and duration (hours) of physical activity is recorded. Responses to
individual items are weighted and summed to calculate the sub-
scores and total score, which can range from 0 to 400 points. A high
score is indicative of a high level of physical activity. The PASE has
good test–retest reliability [16] and good construct validity when
scores are compared to measures of static balance [16] and
accelerometer data [17].
1.1.6. Timed Up and Go (TUG) test
Participants are instructed to stand up from a chair, walk 3 m at
their usual walking speed, turn 1808, walk back to the chair and sit
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Table 1
Participant characteristics.
Measure (units) Mean (SD) Min, Max
Age (y) 68.7 (10.57) 50, 87
Height (m) 1.7 (0.1) 1.5, 1.9
Weight (kg) 71.5 (13.9) 50.5, 116.0
BMI (kg/m2) 25.5 (4.0) 18.6, 40.1
BESTest (0–100%) 88.1 (8.8) 55.6, 99.1
mini-BESTest (0–28 points) (n = 76) 25.9 (4.7) 11.0, 32.0
briefBESTest (0–24 points) 19.3 (4.2) 7.0, 24.0
ABC (0–100%) 94.0 (6.5) 69.4, 100
PASE (0–400 points) 161.9 (83.2) 6.4, 447.0
TUG (s) (n = 75) 8.7 (1.9) 5.4, 14.9
SLS (s) (n = 74) 22.8 (10.2) 3.0, 30.0
n = 79 unless otherwise specified.
BMI = body mass index; BESTest = Balance Evaluation Systems Test; ABC = activities-
specific balance confidence; PASE = Physical Activity Scale for the Elderly;
TUG = Timed Up and Go; SLS = Single Leg Stance. For the BESTest, mini-BESTest,
briefBESTest, PASE and SLS, higher scores indicate better performance. For the TUG,
lower values indicate better performance.
Table 2
Pearson correlations between BESTest, mini-BESTest and briefBESTest and balance
confidence, physical activity level and other measures of balance (p < 0.001 unless
otherwise stated).
BESTest mini-BESTest briefBESTest
ABC 0.67 0.62 0.66
PASE 0.39 0.33* 0.40
TUG �0.68 �0.66 �0.60
SLS 0.67 0.68 0.77
ABC = Activities-Specific Balance Confidence; PASE = Physical Activity Scale for the
Elderly; TUG = Timed Up and Go; SLS = Single Leg Stance.
* p = 0.004.
Table 3
Difference in test scores between fallers and non-fallers; mean (SD).
Measure (units) Fallers Non-fallers p Mean difference
(95% CI)
BESTest (0–100%) 85.8 (9.8) 89.2 (8.2) 0.054 3.4 (�0.77–7.62)
mini-BESTest
(0–28 points)
25.2 (5.2) 26.3 (4.5) 0.17 1.1 (�1.18–3.46)
briefBESTest
(0–24 points)
18.4 (4.6) 19.8 (4.0) 0.08 1.4 (�0.58–3.43)
ABC (0–100%) 91.6 (6.5) 95.1 (6.3) 0.013 3.5 (0.43–6.48)
TUG (s) 9.0 (2.2) 8.5 (1.7) 0.12 �0.5 (�1.43–0.37)
SLS (s) 20.8 (11.0) 24.0 (9.6) 0.10 3.2 (�1.75–8.15)
BESTest = Balance Evaluation Systems Test; ABC = activities-specific balance confi-
dence; TUG = Timed Up and Go; SLS = Single Leg Stance. For the BESTest, mini-
BESTest, briefBESTest, and SLS higher scores indicate better performance. For the
TUG, lower values indicate better performance.
Table 4
Difference in test scores between participants at high risk and low risk of falls; mean
(SD).
Measure (units) High risk Low risk p Mean difference
(95% CI)
BESTest (0–100%) 80.0 (12.7) 89.8 (6.7) 0.007 9.8 (2.42–17.36)
mini-BESTest
(0–28 points)
22.2 (6.1) 26.8 (4.0) 0.009 4.6 (0.94–8.18)
briefBESTest
(0–24 points)
16.2 (5.5) 20.0 (3.6) 0.014 3.8 (0.48–7.03)
ABC (0–100%) 89.6 (6.1) 94.9 (6.2) 0.003 5.3 (1.64–8.89)
TUG (s) 9.9 (2.5) 8.5 (1.6) 0.026 �1.4 (�2.95–0.02)
SLS (s) 14.8 (10.4) 24.8 (9.2) <0.001 10.0 (4.32–15.75)
BESTest = Balance Evaluations Systems Test; ABC = Activities-Specific Balance
Confidence; TUG = Timed Up and Go; SLS = Single Leg Stance. For the BESTest,
mini-BESTest, briefBESTest and SLS, higherscores indicate better performance. For
the TUG, lower values indicate better performance.
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down [18]. The entire task is timed and a lower time to completion
indicates better mobility [18]. The TUG has been shown to have
excellent intra- and inter-rater reliability and good convergent
validity with other measures of balance [14]. While the traditional
cut-off (13.5 s) has good specificity for ‘‘ruling in’’ falls, a recent meta-
analysis noted it had low sensitivity and limited ability to
discriminate between prospective fallers and non-fallers in commu-
nity-dwelling older adults (area under the curve (AUC) = 0.57) [19].
1.1.7. Single Leg Stance (SLS) test
For this task, participants are asked to place their hands on their
hips, lift one foot off the floor and hold that position for as long as
possible. Higher times indicate better balance performance. The
best time on each leg was recorded but only the highest time
achieved was used for data analysis. SLS time has been shown to
have excellent test–retest reliability [14] and to be able to
discriminate between fallers and non-fallers in community
dwelling elderly (AUC = 0.64) [14].
1.1.8. Elderly Falls Screening Test (EFST)
The EFST is a five-item test that combines self-reported fall
questions with a gait evaluation (quality and speed) to determine
fall risk [20]. Respondents are asked to indicate whether or not
they have experienced a fall in the last year, defined as finding
themselves ‘‘suddenly on the ground, without intending to get
there, after [they] were in either a lying, sitting or standing
position’’. For this study we classified ‘fallers’ as those who
responded ‘‘yes’’ and ‘non-fallers’ as those who responded ‘‘no’’.
The EFST total score ranges between 0 (low fall risk) and 5 (high fall
risk), with participants receiving one point for each of the
following: (1) two or more falls in the past year, (2) any injury
from a fall, (3) occasional or frequent near falls, (4) taking longer
than 10 s to walk 5 m, and (5) uneven, shuffling, wide-based, or
unsteady gait. Those with total score of �2 points are considered at
high-risk of future falls [20]. The EFST has good criterion and
predictive validity for falls in the elderly [20].
1.2. Data analysis
Descriptive statistics (mean, SD, range) were calculated for age,
height, weight, body mass index and each of the measures. Pearson
correlation coefficients were calculated to examine the relation-
ship between the BESTest, mini-BESTest, and briefBESTest, and the
ABC, PASE, TUG, and SLS. By convention, a correlation of 0.00–0.25
was interpreted to indicate little or no relationship, 0.25–0.5 as a
fair relationship, 0.5–0.75 as moderate, and above 0.75 as a very
good to excellent relationship. Independent t-tests were used to
examine differences between fallers versus non-fallers and
individuals at low versus high fall risk based on the EFST. All
analyses were conducted with SPSS (version 19.0 for Windows;
SPSS Inc.; Chicago, United States).
2. Results
A total of 79 participants completed the study. Descriptive
characteristics of the participants and scores on all balance tests
and questionnaires are provided in Table 1.
All three BESTest measures showed moderate association with
the ABC scale (r = 0.62–0.675, p < 0.001), and the TUG (r = �0.60 to
�0.68, p < 0.001), and a fair association with the PASE (r = 0.33–
0.40, p < 0.005) (Table 2). The BESTest and the mini-BESTest had a
moderate association with the SLS (r = 0.67 and 0.68 respectively,
p < 0.001), whereas the briefBESTest had a high association with
the SLS (r = 0.77, p < 0.001) (Table 2).
Twenty-six of 78 participants (33.3%) were classified as fallers
as they reported having one or more falls within the previous year.
Please cite this article in press as: O’Hoski S, et al. Construct validity of the BESTest, mini-BESTest and briefBESTest in adults aged
50 years and older. Gait Posture (2015), http://dx.doi.org/10.1016/j.gaitpost.2015.06.006
http://dx.doi.org/10.1016/j.gaitpost.2015.06.006
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The difference in balance scores between fallers and non-fallers
was borderline statistically significant for the BESTest (p = 0.054)
but not for the mini-BESTest (p = 0.17) or briefBESTest (p = 0.08).
Fallers had significantly lower ABC scores (p = 0.013) but there was
no significant difference in their SLS (p = 0.12) or TUG performance
(p = 0.10) (Table 3). Sixty-five of 79 participants (82.3%) were
classified as low risk for falls based on their EFST score. The
16 people who were classified as high risk (�2 out of 5 points) had
significantly lower scores on the BESTest, mini-BESTest, and
briefBESTest. These participants also had significantly lower scores
on the ABC, TUG and SLS tests (see Table 4).
3. Discussion
This is the first study to examine the construct validity of the
BESTest, mini-BESTest and briefBESTest in a community-based
sample of middle-aged and elderly people. Our results showed that
all three BESTest measures had moderate to high associations with
other balance measures and fair associations with physical
activity, with all three BESTest measures performing similarly.
In addition, in this sample, we found that the BESTest and its
abbreviated versions performed similarly to other commonly used
balance measures for discriminating between those at low and
high risk of falls. These findings support the construct validity of
the BESTest, mini-BESTest and briefBESTest for assessing balance
in adults aged over 50 years. Ultimately, the selection of the most
appropriate BESTest version should be based on the purpose of and
time available for the assessment.
In accordance with our primary hypothesis, all three BESTest
scores showed higher correlations with balance confidence and with
other measures of balance and lower correlations with physical
activity. A moderate association between the ABC scale and other
measures of balance has been shown previously in community-
dwelling elderly (r = 0.54) [21]. Our results are also in line with
research describing the relationship between the BESTest and the
ABC scale in a variety of clinical populations (r = 0.69) [4] and with
work showing a similar association (r = 0.66) between scores on the
mini-BESTest and ABC scale in people with Parkinson’s disease [22].
Two of the most commonly used balance assessments in
physical therapy are the TUG and the SLS [12]. We found all three
BESTest measures to correlate moderately with the TUG (r = �0.60
to �0.68) which falls within the range of correlations previously
demonstrated between other performance-based balance tests and
the TUG in older adults (r = �0.69 to �0.83) [23]. We also found
moderate to high correlations between the BESTest measures and
the SLS (r = 0.67–0.77), consistent with previous work showing a
similar associations between the SLS and another multi-item
dynamic balance test in older adults with chronic stroke (r = 0.65–
0.79) [24]. The full BESTest and brief-BESTest have not previously
been studied in relation to the TUG or SLS, but the mini-BESTest has
been shown to be associated with both in individuals with chronic
stroke [25]. Our findings for the relationship between BESTest
scores and physical activity (r = 0.33–0.40) were also similar to
previous reports of the association between the PASE and measures
of balance in older adults (r = 0.33–0.38) [16,21] and in patients
with COPD, in which the PASE showed similar correlations with the
BESTest (r = 0.40) [6].
Our second hypothesis was that participants with a self-
reported fall history would score significantly lower on all three of
the BESTest measures. Although there was a trend (p = 0.054) for
the BESTest to distinguish between fallers and non-fallers, neither
of the abbreviated versions discriminated between groups. These
results are in contrast with a prior study in whichall three versions
of the BESTest discriminated between fallers and non-fallers in
people with and without a neurological diagnosis [9], and with a
study in which the full BESTest and mini-BESTest discriminated
Please cite this article in press as: O’Hoski S, et al. Construct validi
50 years and older. Gait Posture (2015), http://dx.doi.org/10.1016/j.
between fallers and non-fallers with Parkinson’s disease [7]. How-
ever, similar to the BESTest results, in this sample of adults over
50 years, the TUG and SLS also failed to discriminate between
fallers and non-fallers. These results are consistent with a recent
meta-analysis that showed that the TUG score had limited ability
to discriminate between prospective fallers and non-fallers [19]
but differ from a previous study in which the SLS characterized
fallers in community-dwelling elderly [14]. There are several
reasons that our findings may not be consistent with previous
literature. First, participants in this study were likely higher
functioning than in previous work. Indeed, mean performance on
the balance measures in our study was better than that reported
previously for fallers and non-fallers in studies of older adults
(mean TUG 8.7 versus 11.4–14.6 s and mean SLS 22.8 versus 8.3 s)
[14,23]. In addition, the fall rate in our sample was lower than in
previous work [23] and the self-reported physical activity level
was higher [17]. Second, although the mean age of our sample was
68.7 years, it is possible that inclusion of middle-aged participants
(age 50–60 years (n = 20, 25.3%)) affected the results since most
prior work included adults over the age of 65. Third, it is difficult to
compare to previous work as a result of differing definitions of
fallers. We classified any participant with self-reported falls in the
previous year as a faller, but other work used time periods such as
3 months [9] or 6 months [7] or classified fallers as those reporting
two or more falls within the timeframe [7]. Taking these factors into
consideration, it is likely that the fallers in our study actually had
better balance than participants in previous studies. It has been
previously noted that those who are more physically active (and
therefore are likely to have better balance) [26] may in fact fall due
to increased exposure to extrinsic fall risk factors rather than deficits
in balance [2,27]. Therefore, in higher functioning adults, individu-
als who fall may not be characterized by deficits in balance. Our
findings showing that poorer performance on all three versions of
the BESTest – along with the ABC, TUG, and SLS – characterized the
smaller proportion of participants (20%) classified as having high
risk of falls based on their EFST score supports this hypothesis. The
EFST includes not only fall history but also self-reported near falls
and an objective evaluation of gait to identify lower-functioning
patients at high risk of falling because of their physical functional
deficits [20]. Thus despite negative findings related to identifying
those with a history of one or more falls, our results support the
known-groups validity of the BESTest and abbreviated versions
with respect to fall risk categorized using more stringent criteria.
4. Study limitations
Our study has three main limitations. First, our findings are only
generalizable to Canadians between 50 and 89 years of age living in
urban areas. A second limitation is that participants were classified
as fallers based on self-report and their responses were subject to
recall bias. Third, since all balance tests were scored concurrently
based on a single performance of each task, it is not surprising that
the tests performed similarly in our analyses. However, given this
consistency in the scoring of the tasks, we can be confident that any
differences in test performance are due to the inclusion of different
balance tasks as opposed to differences in performance or scoring.
5. Conclusion
While our results support the construct validity of the BESTest,
mini-BESTest and briefBESTest in adults aged over 50 years, further
research is required to determine the predictive validity and
responsiveness to change of these tests. Given that the BESTest,
mini-BESTest and briefBESTest have comparable construct validi-
ty, the choice of test should be based on the time allowed for
administration and the purpose of the assessment. Use of the full
ty of the BESTest, mini-BESTest and briefBESTest in adults aged
gaitpost.2015.06.006
http://dx.doi.org/10.1016/j.gaitpost.2015.06.006
S. O’Hoski et al. / Gait & Posture xxx (2015) xxx–xxx 5
G Model
GAIPOS-4507; No. of Pages 5
BESTest is appropriate when there is time to complete a
comprehensive balance assessment; when shorter tests are
required, the briefBESTest may be preferred as a tool to guide
treatment planning while the mini-BESTest may be more suitable
as a dynamic balance screening tool.
Acknowledgments
We would like to acknowledge the assistance of Bonnie
Winship, Lauren Herridge and Taimoor Agha with participant
recruitment and data collection. Marla Beauchamp is supported by
a fellowship from the Canadian Institutes of Health Research (grant
#201202).
Conflict of interest
The authors have no conflicts of interest to declare.
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gaitpost.2015.06.006
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http://dx.doi.org/10.1016/j.gaitpost.2015.06.006
	Construct validity of the BESTest, mini-BESTest and briefBESTest in adults aged 50 years and older
	1 Methods
	1.1 Outcome measures
	1.1.1 Balance Evaluation Systems Test (BESTest)
	1.1.2 mini-BESTest
	1.1.3 briefBESTest
	1.1.4 Activities-Specific Balance Confidence (ABC) scale
	1.1.5 Physical Activity Scale for the Elderly (PASE)
	1.1.6 Timed Up and Go (TUG) test
	1.1.7 Single Leg Stance (SLS) test
	1.1.8 Elderly Falls Screening Test (EFST)
	1.2 Data analysis
	2 Results
	3 Discussion
	4Study limitations
	5 Conclusion
	Conflict of interest
	Acknowledgments