Intra- and inter-rater reliability of the Mini-Balance Evaluation Test (Mini-BESTest) in individuals with stroke

Abstract

ABSTRACT Background: Mini-Balance Evaluation Systems Test (Mini-BESTest) is a new and promising measure for evaluation of dynamic balance, but intra- and inter-rater reliability in individuals with stroke have not yet been examined. Objective: The aim of this study was to assess the within raters’ (intra-rater) and between raters’ (inter-rater) reliability of the Mini-BESTest in adults with stroke. Design: Measurement study of intra- and inter-rater reliability. Methods: Thirty adults, twenty-five with stroke and five without were strategically recruited according to six different ambulatory levels. Mini-BESTest performance of participants were filmed and then scored by three raters twice, with four weeks between the sessions. For total scores on the Mini-BESTest, relative reliability was investigated for by calculating Intraclass correlation coefficients (ICC1.1 and ICC3.1). Absolute reliability was investigated for by calculating Bland-Altman plots, within-subject standard deviation (sw) and smallest detectable difference (SDD). For individual items, Cohen’s kappa (k) and percentages agreement were calculated. Results: For both intra- and inter-rater assessments very high relative reliability (ICCs≥.98) and absolute reliability (agreement of scores in Bland-Altman plots, and low sw and SDD) of the Mini-BESTest total score were shown. Kappa values for the individual items ranged between 0.33-1.00. The majority of items (intra-rater=95.6%, inter-rater=73.4%) showed very good or good agreement (k≥.63). Only one item (inter-rater=2.2%) showed fair agreement (k=.33). Limitations: Results should not be generalized to individuals with major cognitive impairments, as they were not included in this study. Conclusions: This study shows a very high intra- and inter-rater reliability of the Mini-BESTest in adults with stroke. The majority of the individual items showed very good or good agreement, some moderate and one item fair agreement. Key words: Intra- and inter-rater reliability, balance, balance measure, Mini-BESTest, stroke