Psychometric Properties of the Mini-Balance Evaluation Systems Test (Mini-BESTest) in Community-Dwelling Individuals With Chronic Stroke

BackgroundThe Mini-Balance Evaluation Systems Test (Mini-BESTest) is a new balance assessment, but its psychometric properties have not been specifically tested in individuals with stroke.ObjectivesThe purpose of this study was to examine the reliability and validity of the Mini-BESTest and its accuracy in categorizing people with stroke based on fall history.DesignAn observational measurement study with a test-retest design was conducted.MethodsOne hundred six people with chronic stroke were recruited. Intrarater reliability was evaluated by repeating the Mini-BESTest within 10 days by the same rater. The Mini-BESTest was administered by 2 independent raters to establish interrater reliability. Validity was assessed by correlating Mini-BESTest scores with scores of other balance measures (Berg Balance Scale, one-leg-standing, Functional Reach Test, and Timed “Up & Go” Test) in the stroke group and by comparing Mini-BESTest scores between the stroke group and 48 control participants, and between fallers (≥1 falls in the previous 12 months, n=25) and nonfallers (n=81) in the stroke group.ResultsThe Mini-BESTest had excellent internal consistency (Cronbach alpha=.89–.94), intrarater reliability (intraclass correlation coefficient [3,1]=.97), and interrater reliability (intraclass correlation coefficient [2,1]=.96). The minimal detectable change at 95% confidence interval was 3.0 points. The Mini-BESTest was strongly correlated with other balance measures. Significant differences in Mini-BESTest total scores were found between the stroke and control groups and between fallers and nonfallers in the stroke group. In terms of floor and ceiling effects, the Mini-BESTest was significantly less skewed than other balance measures, except for one-leg-standing on the nonparetic side. The Berg Balance Scale showed significantly better ability to identify fallers (positive likelihood ratio=2.6) than the Mini-BESTest (positive likelihood ratio=1.8).LimitationsThe results are generalizable only to people with mild to moderate chronic stroke.ConclusionsThe Mini-BESTest is a reliable and valid tool for evaluating balance in people with chronic stroke.

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Intrarater and Interrater Reliability of Infrared Image Analysis of Forearm Acupoints before and after Moxibustion

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2020/6328756 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Jiali Lou ◽

Yongliang Jiang ◽

Hantong Hu ◽

Xiaoyu Li ◽

Yajun Zhang ◽

...

Keyword(s):

Image Analysis ◽

Correlation Coefficient ◽

Temperature Change ◽

Intraclass Correlation Coefficient ◽

Interrater Reliability ◽

Intraclass Correlation ◽

Infrared Image ◽

Infrared Images ◽

Intrarater Reliability ◽

Before And After

The objective of this study was to determine the intrarater and interrater reliabilities of infrared image analysis of forearm acupoints before and after moxibustion. In this work, infrared images of acupoints in the forearm of 20 volunteers (M/F, 10/10) were collected prior to and after moxibustion by infrared thermography (IRT). Two trained raters performed the analysis of infrared images in two different periods at a one-week interval. The intraclass correlation coefficient (ICC) was calculated to determine the intrarater and interrater reliabilities. With regard to the intrarater reliability, ICC values were between 0.758 and 0.994 (substantial to excellent). For the interrater reliability, ICC values ranged from 0.707 to 0.964 (moderate to excellent). Given that the intrarater and interrater reliability levels show excellent concordance, IRT could be a reliable tool to monitor the temperature change of forearm acupoints induced by moxibustion.

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Interrater Reliability of the Berg Balance Scale When Used by Clinicians of Various Experience Levels to Assess People With Lower Limb Amputations

Physical Therapy ◽

10.2522/ptj.20130182 ◽

2014 ◽

Vol 94 (3) ◽

pp. 371-378 ◽

Cited By ~ 21

Author(s):

Christopher K. Wong

Keyword(s):

Lower Limb ◽

Interrater Reliability ◽

Clinical Training ◽

Intraclass Correlation ◽

Berg Balance Scale ◽

Intrarater Reliability ◽

Rater Reliability ◽

Study Objective ◽

Balance Scale ◽

Scale Scores

Background People with lower limb amputations frequently have impaired balance ability. The Berg Balance Scale (BBS) has excellent psychometric properties for people with neurologic disorders and elderly people dwelling in the community. A Rasch analysis demonstrated the validity of the BBS for people with lower limb amputations of all ability strata, but rater reliability has not been tested. Objective The study objective was to determine the interrater reliability and intrarater reliability of BBS scores and the differences in scores assigned by testers with various levels of experience when assessing people with lower limb amputations. Design This reliability study of video-recorded single-session BBS assessments had a cross-sectional design. Methods From a larger study of people with lower limb amputations, 5 consecutively recruited participants using prostheses were video recorded during an in-person BBS assessment. Sixteen testers independently rated the video-recorded assessments. Testers were 3 physical therapists, 1 occupational therapist, 3 third-year and 4 second-year doctor of physical therapy (DPT) students, and 5 first-year DPT students without clinical training. Rater reliability was calculated using intraclass correlation coefficients (ICC [2,k]). Differences in scores assigned by testers with various levels of experience were determined by use of an analysis of variance with Tukey post hoc tests. Results The average age of the participants was 53.0 years (SD=15.7). Amputations had occurred at the ankle disarticulation, transtibial, and transfemoral levels because of vascular, trauma, and medical etiologies an average of 8.2 years earlier (SD=7.9). Berg Balance Scale scores spanned all ability strata. Interrater reliability (ICC [2,k]=.99) and intrarater reliability of scores determined in person and through video-recorded assessments by the same testers (ICC [2,k]=.99) were excellent. For participants with the lowest levels of ability, licensed professionals assigned lower scores than did DPT students without clinical training. Limitations Intrarater reliability calculations were based on 2 testers. Conclusions Berg Balance Scale scores assigned to people using prostheses by testers with various levels of clinical experience had excellent interrater reliability and intrarater reliability.

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

Physical Therapy ◽

10.2522/ptj.20150391 ◽

2016 ◽

Vol 96 (11) ◽

pp. 1807-1815 ◽

Cited By ~ 35

Author(s):

Cristina Jácome ◽

Joana Cruz ◽

Ana Oliveira ◽

Alda Marques

Keyword(s):

Interrater Reliability ◽

Intraclass Correlation ◽

Berg Balance Scale ◽

Performance Validity ◽

Operating Characteristics ◽

Intrarater Reliability ◽

Balance Test ◽

Balance Scale ◽

Balance Tests ◽

Abc Scale

Abstract 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.

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Reliability of Measurement of Glenohumeral Internal Rotation, External Rotation, and Total Arc of Motion in 3 Test Positions

Journal of Athletic Training ◽

10.4085/1062-6050-49.3.31 ◽

2014 ◽

Vol 49 (5) ◽

pp. 640-646 ◽

Cited By ~ 10

Author(s):

Mark A. Kevern ◽

Michael Beecher ◽

Smita Rao

Keyword(s):

Internal Rotation ◽

Correlation Coefficient ◽

Intraclass Correlation Coefficient ◽

Interrater Reliability ◽

External Rotation ◽

Intraclass Correlation ◽

Test Procedure ◽

Intrarater Reliability ◽

Testing Procedures ◽

Test Position

Context: Athletes who participate in throwing and racket sports consistently demonstrate adaptive changes in glenohumeral-joint internal and external rotation in the dominant arm. Measurements of these motions have demonstrated excellent intrarater and poor interrater reliability. Objective: To determine intrarater reliability, interrater reliability, and standard error of measurement for shoulder internal rotation, external rotation, and total arc of motion using an inclinometer in 3 testing procedures in National Collegiate Athletic Association Division I baseball and softball athletes. Design: Cross-sectional study. Setting: Athletic department. Patients or Other Participants Thirty-eight players participated in the study. Shoulder internal rotation, external rotation, and total arc of motion were measured by 2 investigators in 3 test positions. The standard supine position was compared with a side-lying test position, as well as a supine test position without examiner overpressure. Results: Excellent intrarater reliability was noted for all 3 test positions and ranges of motion, with intraclass correlation coefficient values ranging from 0.93 to 0.99. Results for interrater reliability were less favorable. Reliability for internal rotation was highest in the side-lying position (0.68) and reliability for external rotation and total arc was highest in the supine-without-overpressure position (0.774 and 0.713, respectively). The supine-with-overpressure position yielded the lowest interrater reliability results in all positions. The side-lying position had the most consistent results, with very little variation among intraclass correlation coefficient values for the various test positions. Conclusions: The results of our study clearly indicate that the side-lying test procedure is of equal or greater value than the traditional supine-with-overpressure method.

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Interrater and Intrarater Reliability of Cranial Anthropometric Measurements in Infants with Positional Plagiocephaly

Children ◽

10.3390/children7120306 ◽

2020 ◽

Vol 7 (12) ◽

pp. 306

Author(s):

Iñaki Pastor-Pons ◽

María Orosia Lucha-López ◽

Marta Barrau-Lalmolda ◽

Iñaki Rodes-Pastor ◽

Ángel Luis Rodríguez-Fernández ◽

...

Keyword(s):

Correlation Coefficient ◽

Intraclass Correlation Coefficient ◽

Interrater Reliability ◽

Intraclass Correlation ◽

Anthropometric Measurements ◽

Intrarater Reliability ◽

Positional Plagiocephaly ◽

Altman Plot ◽

Bland Altman Plot ◽

Cranial Asymmetry

(1) Background: anthropometric measurements with calipers are used to objectify cranial asymmetry in positional plagiocephaly but there is controversy regarding the reliability of different methodologies. Purpose: to analyze the interrater and intrarater reliability of direct anthropometric measurements with caliper on defined craniofacial references in infants with positional plagiocephaly. (2) Methods: 62 subjects (<28 weeks), with a difference of at least 5 mm between cranial diagonal diameters. Maximal cranial circumference, length and width and diagonal cranial diameters were measured. Intrarater (2 measurements) and interrater (2 raters) reliability was analyzed. (3) Results: intra- and interrater reliability of the maximal cranial length and width and right cranial diagonal was excellent: intraclass correlation coefficient (ICC) > 0.9. Intrarater and interrater reliability for the left cranial diagonal was excellent: ICC > 0.9 and difference in agreement in the Bland-Altman plot 0.0 mm, respectively. Intrarater and interrater reliability for the maximal cranial circumference was good: differences in agreement in Bland-Altman plots: intra: −0.03 cm; inter: −0.12 cm. (4) Conclusions: anthropometric measurements in a sample of infants with moderate positional plagiocephaly have shown excellent intra- and interrater reliability for maximal cranial length, maximal cranial width, and right and left cranial diagonals, and good intra- and interrater reliability in maximal cranial circumference measurement.

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Reliability Assessment of Scores From Video-Recorded TGMD-3 Performances

Journal of Motor Learning and Development ◽

10.1123/jmld.2016-0007 ◽

2017 ◽

Vol 5 (1) ◽

pp. 59-68 ◽

Cited By ~ 16

Author(s):

Pauli Olavi Rintala ◽

Arja Kaarina Sääkslahti ◽

Susanna Iivonen

Keyword(s):

Motor Development ◽

Interrater Reliability ◽

Intraclass Correlation ◽

Kappa Statistic ◽

Intrarater Reliability ◽

Gross Motor ◽

Gross Motor Development ◽

Percent Agreement ◽

Two Samples ◽

Ball Skills

This study examined the intrarater and interrater reliability of the Test of Gross Motor Development—3rd Edition (TGMD-3). Participants were 60 Finnish children aged between 3 and 9 years, divided into three separate samples of 20. Two samples of 20 were used to examine the intrarater reliability of two different assessors, and the third sample of 20 was used to establish interrater reliability. Children’s TGMD-3 performances were video-recorded and later assessed using an intraclass correlation coefficient, a kappa statistic, and a percent agreement calculation. The intrarater reliability of the locomotor subtest, ball skills subtest, and gross motor total score ranged from 0.69 to 0.77, and percent agreement ranged from 87 to 91%. The interrater reliability of the locomotor subtest, ball skills subtest, and gross motor total score ranged from 0.56 to 0.64. Percent agreement of 83% was observed for locomotor skills, ball skills, and total skills, respectively. Hop, horizontal jump, and two-hand strike assessments showed the most difference between the assessors. These results show acceptable reliability for the TGMD-3 to analyze children’s gross motor skills.

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Psychometric Properties of the MyotonPRO in Dementia Patients with Paratonia

Gerontology ◽

10.1159/000485462 ◽

2017 ◽

Vol 64 (4) ◽

pp. 401-412 ◽

Cited By ~ 5

Author(s):

Hans Drenth ◽

Sytse U. Zuidema ◽

Wim P. Krijnen ◽

Ivan Bautmans ◽

Cees van der Schans ◽

...

Keyword(s):

Psychometric Properties ◽

Correlation Coefficient ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Functional Mobility ◽

Future Research ◽

Minimal Detectable Change ◽

Muscle Properties ◽

Dementia Patients ◽

Longitudinal Outcome

Background: Paratonia is a distinctive form of hypertonia, causing loss of functional mobility in early stages of dementia to severe high muscle tone and pain in the late stages. For assessing and evaluating therapeutic interventions, objective instruments are required. Objective: Determine the psychometric properties of the MyotonPRO, a portable device that objectively measures muscle properties, in dementia patients with paratonia. Methods: Muscle properties were assessed with the MyotonPRO by 2 assessors within one session and repeated by the main researcher after 30 min and again after 6 months. Receiver operating characteristic curves were constructed for all MyotonPRO outcomes to discriminate between participants with (n = 70) and without paratonia (n = 82). In the participants with paratonia, correlation coefficients were established between the MyotonPRO outcomes and the Modified Ashworth Scale for paratonia (MAS-P) and muscle palpation. In participants with paratonia, reliability (intraclass correlation coefficient) and agreement values (standard error of measurement and minimal detectable change) were established. Longitudinal outcome from participants with paratonia throughout the study (n = 48) was used to establish the sensitivity for change (correlation coefficient) and responsiveness (minimal clinical important difference). Results: Included were 152 participants with dementia (mean [standard deviation] age of 83.5 [98.2]). The area under the curve ranged from 0.60 to 0.67 indicating the MyotonPRO is able to differentiate between participants with and without paratonia. The MyotonPRO explained 10-18% of the MAS-P score and 8-14% of the palpation score. Interclass correlation coefficients for interrater reliability ranged from 0.57 to 0.75 and from 0.54 to 0.71 for intrarater. The best agreement values were found for tone, elasticity, and stiffness. The change between baseline and 6 months in the MyotonPRO outcomes explained 8-13% of the change in the MAS-P scores. The minimal clinically important difference values were all smaller than the measurement error. Conclusion: The MyotonPRO is potentially applicable for cross-sectional studies between groups of paratonia patients and appears less suitable to measure intraindividual changes in paratonia. Because of the inherent variability in movement resistance in paratonia, the outcomes from the MyotonPRO should be interpreted with care; therefore, future research should focus on additional guidelines to increase the clinical interpretation and improving reproducibility.

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Influence of Rater Training on Inter- and Intrarater Reliability When Using the Rat Grimace Scale

Journal of the American Association for Laboratory Animal Science ◽

10.30802/aalas-jaalas-18-000044 ◽

2019 ◽

Vol 58 (2) ◽

pp. 178-183 ◽

Cited By ~ 8

Author(s):

Emily Q Zhang ◽

Vivian SY Leung ◽

Daniel SJ Pang

Keyword(s):

Acute Pain ◽

Interrater Reliability ◽

Intraclass Correlation ◽

Training Group ◽

Intrarater Reliability ◽

Rater Training ◽

Trainee Group ◽

Pain Models ◽

Ongoing Pain ◽

And Performance

Rodent grimace scales facilitate assessment of ongoing pain. Reported rater training using these scales varies considerably and may contribute to the observed variability in interrater reliability. This study evaluated the effect of training on interrater reliability with the Rat Grimace Scale (RGS). Two training sets (42 and 150 images) were prepared from acute pain models. Four trainee raters progressed through 2 rounds of training, scoring 42 images (set 1) followed by 150 images (set 2a). After each round, trainees reviewed the RGS and any problematic images with an experienced rater. The 150 images were then rescored (set 2b). Four years later, trainees rescored the 150 images (set 2c). A second group of raters (no-training group) scored the same image sets without review with the experienced rater. Inter- and intrarater reliability were evaluated by using the intraclass correlation coefficient (ICC), and ICC values were compared by using the Feldt test. In the trainee group, interrater reliability increased from moderate to very good between sets 1 and 2b and increased between sets 2a and 2b. Action units with the highest and lowest ICC at set 2b were orbital tightening and whiskers, respectively. In comparison to an experienced rater, the ICC for all trainees improved, ranging from 0.88 to 0.91 at set 2b. Four years later, very good interrater reliability was retained, and intrarater reliability was good or very good). The interrater reliability of the no-training group was moderate and did not improve from set 1 to set 2b. Training improved interrater reliability, with an associated reduction in 95%CI. In addition, training improved interrater reliability with an experienced rater, and performance was retained.

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Could Residents Adequately Assess the Severity of Hidradenitis Suppurativa? Interrater and Intrarater Reliability Assessment of Major Scoring Systems

Dermatology ◽

10.1159/000501771 ◽

2019 ◽

Vol 236 (1) ◽

pp. 8-14 ◽

Cited By ~ 1

Author(s):

Katarzyna Włodarek ◽

Aleksandra Stefaniak ◽

Łukasz Matusiak ◽

Jacek C. Szepietowski

Keyword(s):

Interrater Reliability ◽

Hidradenitis Suppurativa ◽

Intraclass Correlation ◽

Scoring Systems ◽

Staging System ◽

Severity Index ◽

Assessment Tools ◽

Intrarater Reliability ◽

Global Assessment Scale ◽

Interrater Variability

A wide variety of assessment tools have been proposed for hidradenitis suppurativa (HS) until now, but none of them meets the criteria for an ideal score. Because there is no gold standard scoring system, the choice of the measure instrument depends on the purpose of use and even on the physician’s experience in the subject of HS. The aim of this study was to assess the intrarater and interrater reliability of 6 scoring systems commonly used for grading severity of HS: the Hurley Staging System, the Refined Hurley Staging, the Hidradenitis Suppurativa Severity Score System (IHS4), the Hidradenitis Suppurativa Severity Index (HSSI), the Sartorius Hidradenitis Suppurativa Score and the Hidradenitis Suppurativa Physician’s Global Assessment Scale (HS-PGA). On the scoring day, 9 HS patients underwent a physical examination and disease severity assessment by a group of 16 dermatology residents using all evaluated instruments. Then, intrarater reliability was calculated using intraclass correlation coefficient (ICC), and interrater variability was evaluated using the coefficient of variation (CV). In all 6 scorings the ICCs were >0.75, indicating high intrarater reliability of all presented scales. The study has also demonstrated moderate agreement between raters in most of the evaluated measure instruments. The most reproducible methods, according to CVs, seem to be the Hurley staging, IHS4, and HSSI. None of the 6 evaluated scoring systems showed a significant advantage over the other when comparing ICCs, and all the instruments seem to be very reliable methods. The interrater reliability was usually good, but the most repeatable results between researchers were obtained for the easiest scales, including Hurley scoring, IHS4 and HSSI.

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Validity and reliability testing of the Spanish version of the BESTest and mini-BESTest in healthy community-dwelling elderly

BMC Geriatrics ◽

10.1186/s12877-020-01724-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Pilar Dominguez-Olivan ◽

Angel Gasch-Gallen ◽

Esmeralda Aguas-Garcia ◽

Ana Bengoetxea

Keyword(s):

Psychometric Properties ◽

Correlation Coefficient ◽

Internal Consistency ◽

Elderly Women ◽

Pearson Correlation ◽

Strong Association ◽

Intraclass Correlation ◽

Community Dwelling ◽

Validity And Reliability ◽

Convenience Sample

Abstract Background The Balance Evaluation Systems Test (BESTest) and its abbreviated version, the Mini-BESTest are clinical examination of balance impairment, but its psychometric properties have not yet been tested in European Spanish. We aimed to assess the psychometric properties of BESTest and Mini-BESTest in Spanish in community-dwelling elderly people. Methods We designed a cross-sectional transcultural adaptation and validation study. Convenience sample of thirty (N-30) adults aged 65 to 89 years old without balance problems were recruited. Two physiotherapists assessed participants at the same time. Internal consistency of Spanish BESTest and Mini-BESTest was carried out by obtaining the Cronbach Alpha. The reproducibility between raters was studied with the Intraclass Correlation Coefficient. The Pearson correlation coefficient was calculated by comparing the relationship between the BESTest, mini-BESTest, Berg Balance Scale (BBS) and Falls Efficacy Scale-International (FES-I). Results BESTest and Mini-BESTest showed good internal consistency. BESTest and Mini-BESTest total scores showed an excellent inter-rater agreement. There was a significant correlation between total score of the BESTest and the Mini-BESTest (r = 0.65; p < 0.001). BESTest had a moderate association with BBS and a strong association with FES-I. Mini-BESTest had a fair correlation with BBS and FES-I. Total scores obtained by women at BESTest and at Mini-BESTest were significantly lower than those reached by men. The differences observed in all the test when disaggregating data by sex require further research. Conclusions Spanish versions of BESTest and Mini-BESTest are comprehensible for new raters. They are reliable tools to provide information on which particular balance systems show impairment in community dwelling older adults. Elderly women had a worse quality of balance and a greater perception of their risk of falling. Trial registration This study was registered in ClinicalTrials.gov with NCT 03403218 on 2018/01/17.

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