Mini-BESTest

Objective

The Mini-BESTest was developed to provide clinicians with a universal measure of balance in patients at risk of falls (1). The purpose is to help therapists determine which specific balance control system is most affected (postural responses, anticipatory postural adjustments, sensory orientation, or dynamic balance control during gait).

Interpretation

The score is inversely proportional to fall risk: a high score indicates a low risk of falling. Overall, the cutoff score used to establish an increased risk of falling lies between 16 and 21 depending on the population studied, while the minimal detectable change (MDC) is 4 points (2, 3).

Execution

The Mini-BESTest is a balance test made up of 14 items assessing transfers, static and dynamic balance, and gait across a range of conditions (unstable surface, extrinsic perturbations, stepping over obstacles, head turns, dual tasking, and others).

Each item is scored 0 (severely impaired), 1 (moderately impaired), or 2 (normal), for a maximum total score of 28 points (1, 8).

Duration

10 to 15 minutes (8), as opposed to the full-length BESTest, which requires 30–35 minutes (9).

Equipment

A foam surface, a chair without armrests or wheels, an incline ramp (10°, at least 60 × 60 cm [approx. 2 ft × 2 ft]), a stopwatch, a box (23 cm [approx. 9 in] high), and a 3-meter (approx. 10 ft) distance measured out from the chair and marked on the floor.

The subject should be tested with flat-heeled shoes or shoes and socks off.

Clinical Value

This scale is generally considered reliable, reproducible, and responsive (2). Its reliability appears high both intrarater (intraclass correlation coefficient [ICC] of 0.96) and interrater (ICC of 0.98) in patients with balance disorders arising from a neurological condition (4).

As for its clinical accuracy, the study by Yingyongyudha and colleagues identified a cutoff score of 16 corresponding to an increased risk of falls in older adults, with a sensitivity of 85% and a specificity of 75% (5), while the minimal detectable change is 4 points (2). This scale is reportedly more accurate at identifying fallers than the BESTest, the Berg Balance Scale, or the Timed Up and Go (5).

In patients with Parkinson disease, a score of 20 out of 28 (total score) is reported to be associated with an increased risk of falling at 6 months, with a sensitivity of 0.86 and a specificity of 0.78 (6), while other authors report a cutoff score of 21.5 out of 28 with a sensitivity of 70% and a specificity of 55% (7). The Mini-BESTest is also considered an appropriate tool for assessing changes in dynamic balance, as it can distinguish patients who have progressed in rehabilitation from those who have not. Here again, according to Godi and colleagues, the minimal clinically important difference (MCID) is 4 points in patients with Parkinson disease or another neurological disorder (3, 4).

Acknowledgements

The Mini-BESTest was developed by Prof. Fay B. Horak, PhD, PT (Oregon Health & Science University).

© 2005–2013 Oregon Health & Science University. All rights reserved.

The instrument is reproduced without modification. We would like to thank Prof. Fay B. Horak for allowing us to make the Mini-BESTest available on Fullphysio.

The official version and its authorized translations are available at bestest.us.

1. Franchignoni F, Horak F, Godi M, Nardone A, Giordano A. Using psychometric techniques to improve the Balance Evaluation Systems Test: the mini-BESTest. J Rehabil Med. 2010;42(4):323–31.

2. Di Carlo S, Bravini E, Vercelli S, Massazza G, Ferriero G. The Mini-BESTest: a review of psychometric properties. Int J Rehabil Res. Jun 2016;39(2):97–105.

3. Godi M, Arcolin I, Giardini M, Corna S, Schieppati M. Responsiveness and minimal clinically important difference of the Mini-BESTest in patients with Parkinson’s disease. Gait Posture. Jul 2020;80:14–9.

4. Godi M, Franchignoni F, Caligari M, Giordano A, Turcato AM, Nardone A. Comparison of Reliability, Validity, and Responsiveness of the Mini-BESTest and Berg Balance Scale in Patients With Balance Disorders. Phys Ther. Feb 1, 2013;93(2):158–67.

5. Yingyongyudha A, Saengsirisuwan V, Panichaporn W, Boonsinsukh R. The Mini-Balance Evaluation Systems Test (Mini-BESTest) Demonstrates Higher Accuracy in Identifying Older Adult Participants With History of Falls Than Do the BESTest, Berg Balance Scale, or Timed Up and Go Test. J Geriatr Phys Ther. Apr 2016;39(2):64–70.

6. Duncan RP, Leddy AL, Earhart GM. Five Times Sit to Stand Test Performance in Parkinson Disease. Arch Phys Med Rehabil. Sep 2011;92(9):1431–6.

7. Lopes LKR, Scianni AA, Lima LO, De Carvalho Lana R, Rodrigues-De-Paula F. The Mini-BESTest is an independent predictor of falls in Parkinson Disease. Braz J Phys Ther. Sep 2020;24(5):433–40.

8. King L, Horak F. On the Mini-BESTest: Scoring and the Reporting of Total Scores. Phys Ther. Apr 1, 2013;93(4):571–5.

9. Duncan RP, Leddy AL, Cavanaugh JT, Dibble LE, Ellis TD, Ford MP, et al. Accuracy of Fall Prediction in Parkinson Disease: Six-Month and 12-Month Prospective Analyses. Park Dis. 2012;2012:1–7.