Diagnostic Accuracy Of The Bestest To Assess Balance In Persons With Multiple Sclerosis

Background:

While research has lead to the discovery and routine use of disease modifying medications, individuals with Multiple Sclerosis (MS) continue to experience limitations in physical function that are attributed to pain, fatigue, weakness and poor balance. Despite these potential impairments, the majority of persons with MS are ambulatory and desire to be active in their homes and communities. As a result, the incidence of falls in this population is over 50%. Half of those falls result in physical injury and lead to activity restriction. Physical therapists are able to identify persons at risk for falling; however current physical therapy practice has not significantly reduced the incidence of falls in this population. One of the reasons is the lack of a balance test sensitive enough to identify the aspect(s) of postural control contributing to imbalance, leading to the use of generic balance rehabilitation programs. The BESTest, a newer functional balance tool, was designed to assist the examiner in identifying the deficit body system(s) contributing to imbalance and/or falls. The use of the BESTest with persons with MS is limited.

Objectives:

The purpose of this research study was to evaluate the feasibility, reliability and validity of the BESTest to assess balance in individuals with MS, and to compare the sensitivity of the BESTest and the Berg Balance Scale to identify persons with MS who are fallers. We hypothesized that the BESTest would be a reliable and valid functional balance tool, but may be too fatiguing for this patient population.

Methods:

This study recruited 20 ambulatory persons with MS during routine visits to an urban university based MS Clinic. Interested participants were educated about the study and scheduled for the balance assessments. Consented participants answered several questions regarding age, onset of disease and number of falls in the past month. Disease severity was assessed using the Expanded Disability Status Scale. Balance assessment was completed using the BESTest and the Berg Balance Scale (BBS). Twelve participants were retested to determine test-retest reliability of the BESTest.

Results:

100% of participants were able to complete the BESTest. The BESTest demonstrated strong test-retest reliability [ICC (2, 1) 0.966 p = 0.0] and was highly correlated with the BBS (r = 0.886, p= 0.01). Using a score of <45/56 as indicator of fall risk, the BBS demonstrated poor sensitivity (0.43) to identify fallers. Using a score of 69%, the BESTest had moderate sensitivity (0.73) to identify fallers.

Conclusions:

Ambulatory persons with MS possess the stamina to complete the BESTest. The BESTest has strong test-retest reliability and is highly correlated with the BBS when used as a measure of functional balance in persons with MS. The BESTest more accurately identified persons with MS with a recent fall history than the BBS.  The BESTest is a valid measure of comprehensive balance for ambulatory persons with MS.