A prospective study to establish the minimal clinically important difference of the Mini-BESTest in individuals with stroke

Abstract

Objective: To determine the minimal clinically important difference of the Mini-BESTest in individuals' post-stroke.

Design: Prospective cohort study.

Setting: Outpatient stroke rehabilitation.

Subjects: Fifty outpatients with stroke with a mean (SD) age of 60.8 (9.4).

Intervention: Outpatients with stroke were assessed with the Mini-BESTest before and after a course of conventional rehabilitation. Rehabilitation sessions occurred one to two times/week for one hour and treatment duration was 1.3-42 weeks (mean (SD) = 17.4(10.6)).

Main measures: We used a combination of anchor- and distribution-based approaches including a global rating of change in balance scale completed by physiotherapists and patients, the minimal detectable change with 95% confidence, and the optimal cut-point from receiver operating characteristic curves.

Results: The average (SD) Mini-BESTest score at admission was 18.2 (6.5) and 22.4 (5.2) at discharge (effect size: 0.7) (P = 0.001). Mean change scores on the Mini-BESTest for patient and physiotherapist ratings of small change were 4.2 and 4.3 points, and 4.7 and 5.3 points for substantial change, respectively. The minimal detectable change with 95% confidence for the Mini-BESTest was 3.2 points. The minimally clinical importance difference was determined to be 4 points for detecting small changes and 5 points for detecting substantial changes.

Conclusions: A change of 4-5 points on the Mini-BEST is required to be perceptible to clinicians and patients, and beyond measurement error. These values can be used to interpret changes in balance in stroke rehabilitation research and practice.

Keywords: MCID; Mini-BESTest; Stroke.

Figure 1.

Participant recruitment flowchart.

Figure 2.

Receiver operating characteristic curve for discrimination between improved and unchanged participants on the Mini-BESTest according to physiotherapist perception.