Comparative utility of the BESTest, mini-BESTest, and brief-BESTest for predicting falls in individuals with Parkinson disease: a cohort study

Abstract

Background: The newly developed brief-balance evaluation system test (brief-BESTest) may be useful for measuring balance and predicting falls in individuals with Parkinson disease (PD).

Objectives: The purposes of this study were: (1) to describe the balance performance of those with PD using the brief-BESTest, (2) to determine the relationships among the scores derived from the 3 versions of the BESTest (i.e., full BESTest, mini-BESTest, and brief-BESTest), and (3) to compare the accuracy of the brief-BESTest with that of the mini-BESTest and BESTest in identifying recurrent fallers among people with PD.

Design: This was a prospective cohort study.

Methods: Eighty participants with PD completed a baseline balance assessment. All participants reported a fall history during the previous 6 months. Fall history was again collected 6 months (n=51) and 12 months (n=40) later.

Results: At baseline, participants had varying levels of balance impairment, and brief-BESTest scores were significantly correlated with mini-BESTest (r=.94, P<.001) and BESTest (r=.95, P<.001) scores. Six-month retrospective fall prediction accuracy of the Brief-BESTest was moderately high (area under the curve [AUC]=0.82, sensitivity=0.76, and specificity=0.84). Prospective fall prediction accuracy over 6 months was similarly accurate (AUC=0.88, sensitivity=0.71, and specificity=0.87), but was less sensitive over 12 months (AUC=0.76, sensitivity=0.53, and specificity=0.93).

Limitations: The sample included primarily individuals with mild to moderate PD. Also, there was a moderate dropout rate at 6 and 12 months.

Conclusions: All versions of the BESTest were reasonably accurate in identifying future recurrent fallers, especially during the 6 months following assessment. Clinicians can reasonably rely on the brief-BESTest for predicting falls, particularly when time and equipment constraints are of concern.

Figure 1.

Flow diagram describing number of participants evaluated and reasons for loss at designated time points.

Figure 2.

Receiver operating characteristic (ROC) curves for the Brief-BESTest, Mini-BESTest, and BESTest for retrospective fall prediction over 6 months (A) and prospective fall prediction over 6 months (B) and 12 months (C).