Which Balance Evaluation Systems Test sections best distinguish levels of post-stroke functional walking status?

Abstract

Objective: To determine which sections of the Balance Evaluation Systems Test (BESTest) distinguish levels of post-stroke functional walking status and to establish their cut-off scores. Design: A retrospective cross-sectional study. Subjects and methods: The BESTest was administered to 87 stroke patients who were able to walk without physical assistance upon discharge from the hospital. Subjects were divided into 3 functional walking status groups: namely, household ambulators, limited community ambulators, and unlimited community ambulators. The receiver operating characteristic curve was determined and the cut-off score and area under the receiver operating characteristic curve (AUROC) of each section calculated. Results: In the comparison of household and limited community ambulators, the accuracies of all BESTest sections were moderate (AUROC>0.7), and the cut-off scores were 36.1–78.6%. In the comparison of limited and unlimited community ambulators, one section (stability in gait) had high accuracy (AUROC=0.908, cut-off scores=73.8%) and 3 sections (biomechanical constraints, anticipatory postural adjustments, and postural response) had moderate accuracy (AUROC=0.8120–0.834, cut-off scores=75.0–83.4%). Conclusion: This study demonstrated that different sections of the BESTest had different abilities to discriminate levels of post-stroke functional walking status, and identified cut-off values for targeted improvement.

Keywords

• stroke
• walking speed
• postural balance
• bestest.