Validity, Reliability, and Ability to Identify Fall Status of the Berg Balance Scale, BESTest, Mini-BESTest, and Brief-BESTest in Patients With COPD

Phys Ther. 2016 Nov;96(11):1807-1815. doi: 10.2522/ptj.20150391. Epub 2016 Apr 14.


Background: The Berg Balance Scale (BBS), Balance Evaluation Systems Test (BESTest), Mini-BESTest, and Brief-BESTest are useful in the assessment of balance. Their psychometric properties, however, have not been tested in patients with chronic obstructive pulmonary disease (COPD).

Objective: This study aimed to compare the validity, reliability, and ability to identify fall status of the BBS, BESTest, Mini-BESTest, and the Brief-BESTest in patients with COPD.

Design: A cross-sectional study was conducted.

Methods: Forty-six patients (24 men, 22 women; mean age=75.9 years, SD=7.1) were included. Participants were asked to report their falls during the previous 12 months and to fill in the Activity-specific Balance Confidence (ABC) Scale. The BBS and the BESTest were administered. Mini-BESTest and Brief-BESTest scores were computed based on the participants' BESTest performance. Validity was assessed by correlating balance tests with each other and with the ABC Scale. Interrater reliability (2 raters), intrarater reliability (48-72 hours), and minimal detectable changes (MDCs) were established. Receiver operating characteristics assessed the ability of each balance test to differentiate between participants with and without a history of falls.

Results: Balance test scores were significantly correlated with each other (Spearman correlation rho=.73-.90) and with the ABC Scale (rho=.53-.75). Balance tests presented high interrater reliability (intraclass correlation coefficient [ICC]=.85-.97) and intrarater reliability (ICC=.52-.88) and acceptable MDCs (MDC=3.3-6.3 points). Although all balance tests were able to identify fall status (area under the curve=0.74-0.84), the BBS (sensitivity=73%, specificity=77%) and the Brief-BESTest (sensitivity=81%, specificity=73%) had the higher ability to identify fall status.

Limitations: Findings are generalizable mainly to older patients with moderate COPD.

Conclusions: The 4 balance tests are valid, reliable, and valuable in identifying fall status in patients with COPD. The Brief-BESTest presented slightly higher interrater reliability and ability to differentiate participants' fall status.

MeSH terms

  • Accidental Falls / prevention & control*
  • Aged
  • Disability Evaluation*
  • Female
  • Humans
  • Male
  • Postural Balance / physiology*
  • Psychometrics
  • Pulmonary Disease, Chronic Obstructive / physiopathology*
  • Reproducibility of Results
  • Risk Factors