Intra- and Inter-Rater Reliability of the Mini-Balance Evaluation Systems Test in Individuals with Stroke

Abstract

Objective: The aim of this study was to assess intra- and inter-rater reliability of the ‘The Mini-Balance Evaluation Systems Test (Mini-BESTest)’ in adults with stroke, based on video recordings of their test performances. Methods: We included 24 adults with stroke classified at four different ambulatory levels, ranging from the ability to ambulate within the household only, to normal ambulation. Mini-BESTest performance of the participants were filmed and then scored by three raters twice, with four weeks between the sessions. None of the raters had used the test prior to the study, but attended a three-hour training session to become familiar with the test and scoring instructions just before study-start. Relative reliability was investigated for by calculating intraclass correlation coefficients (ICC1.1 and ICC3.1). Absolute reliability was assessed by calculating within-subject standard deviation (sw) and smallest detectable difference (SDD). For each individual items of the Mini-BESTest, Cohen’s kappa (k) was calculated. Results: The study showed that the Mini-BESTest had excellent intra-rater reliability (ICC1.1=0.94−0.99 and ICC3.1=0.97−0.99) and inter-rater reliability (ICC1.1=0.97−0.99 and ICC3.1=0.97−0.99). Kappa values for the individual items ranged between 0.21 and 1.00. The majority of items (intra-rater=88%, inter-rater=78%) showed very good or good agreement. The smallest detectable change at 95% confidence interval was ≤4 points for intra-rater assessments and ≤ 3 points for inter-rater assessments. Conclusions: We conclude that the reliability of the Mini-BESTest based on video recordings of adults with stroke is excellent, even though the ratings are performed by novice assessors.