Comparison of the Berg Balance Scale and the Mini-Bestest in Ambulatory People with Multiple Sclerosis

Background: Balance is complex and prevelant in People with Mulitple Sclerosis (PwMS). The Berg Balance Scale (BBS) is a commonly used and the Mini-BESTest (MBT) is a newer alternative. Comparisons of these measures in other populations have demonstrated more favorable results for the MBT, though this hasn’t been evaluated exclusively in PwMS.

Objectives:  To compare the BBS and the MBT ability to detect balance changes in ambulatory PwMS.

Methods:  52 PwMS receiving out-patient physiotherapy were recruited. All had a primary diagnosis of MS mobilised independently with or without and aid. Each participant gave demographic details, self-reported history of falls and near falls, completed the MBT, the Multiple Sclerosis Impact Scale -29 (MSIS-29),The Multiple Sclerosis Walking Scale -12 (MSWS-12), the BBS, The Modified Fatigue Impact Scale (MFIS) and the six-minute walking test (6MWT) pre and post eight weeks of routine physiotherapy.

Results: The following effect sizes (ES)(BBS=0.37;MBT=0.70), standard response mean values (SRM)(BBS=0.74;MBT=1.52), statistically significant changes in BBS (-1.4(1.9)) (p=0.01) and MBT (-5.31(3.5)) (p=0.01) scores were demonstrated post treatment. 38% (n=20) started with a baseline BBS maximum score of 56. No participant started with a baseline MBT maximum score of 28. The areas under the curve (AUC) for the MBT and BBS were (0.88 (p>0.01); 0.77(p=0.01) for detecting mobility device use and (0.88 (p>0.01); 0.75(p=0.03) for self report near falls. The MBT demonstrated higher correlation coefficients for each secondary measure than the BBS.

Conclusions: The MBT demonstrated less ceiling effects, greater responsiveness and performed slightly better at detecting near fallers and mobility aid users compared to the BBS. These findings suggest that the MBT may be a better outcome measure for detecting balance improvements in ambulatory PwMS.