difference between BBS and Bestest and helps to decide which is more suitable, less time consuming and less effort required.

1. Berg Balance Scale Versus
Balance Evaluation Systems Test
By Jwanika Vansiya

2. Objectives
.

3. What is Berg Balance Scale(BBS)?
.Berg_Balance_Scale (1).pdf

4. What is Balance Evaluation Systems-
Test (BESTest)?
• BESTest_ScoreSheet.pdf

5. BBS versus BESTest
Berg Balance scale Balance evaluation systems test
Acronym BBS BESTest
Purpose 14 item objective measure
designed to assess static balance
and fall risk in adults.
(BESTest) serves as a 36-item
clinical balance assessment tool,
developed to assess balance
impairments across six contexts of
postural control
Areas of
assessment
Balance non vestibular,
Functional mobility.
Balance Non-Vestibular; Gait;
Strength

6. BBS versus BESTest
Berg Balance Scale Balance evaluation systems test
Description 14 items
Total scores 56 points
Item level scores range from 0-4
determined by ability to perform
the assessed activity.
36 items
Grouped into 6 systems
(biomechanical constraints, stability
limits/verticality, anticipatory
postural adjustments, postural
responses, sensory orientation,
stability in gait),
Total score 108 points
Item-level scores range from 0
(severe impairment) to 3 (no
impairment).
ICF domain Activity Body Structure; Body Function;
Activity

7. BBS versus BESTest
Berg Balance Scale Balance Evaluation systems Test
Assessment type Performance measure Performance measure
Time to administer 15-20 minutes 20-30 minutes
Equipment required Stop watch, chair with
arm rests, measure tape,
object to pick up off the
floor, step stool
Stop watch, Measuring tape mounted on
wall, Approximately 60 cm x 60 cm block
of 4 inch, medium density, Tempur®
foam, 10 degree incline ramp (at least 2 x
2 ft), Stair step, 15 cm (6 inches) in
height, 2 stacked shoe boxes (for 9
inch obstacle height), 2.5 kg (5-lb) free
weight,
Firm chair with arms with 3 meters in
front marked with tape, Masking tape to
mark 3 m and 6 m lengths on the floor

8. BBS versus BESTest
Berg Balance Scale Balance Evaluation Systems Test
Training required Not necessary Workshops are available to
become skilled in using the BESTest
to differentiate complex balance
disorders in neurological patients.
Workshop participants develop the
ability to design a more specific
rehabilitation plan of care for
balance retraining.
Age range adults: 18-64 years,
Elderly: 65+
Elderly-65+

9. BBS versus BESTest
Berg Balance Scale Balance Evaluation Systems
Test
Population tested Brain injury
Community dwelling elderly
Multiple sclerosis
Orthopedic surgery
Osteoarthritis
Parkinson’s disease
SCI
Stroke
Traumatic and acquired brain
injury
Balance deficits
Cerebellar Infarct
Parkinson's Disease (PD)
Peripheral neuropathy
Subacute Stroke
Multiple Sclerosis

10. BBS versus BESTest
Berg Balance Scale Balance Evaluation
Systems Test
Cut-off score Elderly
No History of falls and BBS < 51 or
history of falls and BBS < 42
predictive of falls (91% sensitivity,
82% specificity)
Score of < 40 on BBS associated with
almost 100% fall risk
Stroke
Cut-off score = 45 out of 56
SCI
No significant relationship between
total falls and obtained BBS scores
were found
No cutoff score was found that
effectively discriminated fallers
Balance deficit
69% cut off score
differentiated fallers from
nonfallers, and healthy
from those with neurologic
diagnoses.
Parkinson’s disease
69% cut off score to detect
fallers
Subacute stroke
>49% indicates those with
high functional ability

11. BBS versus BESTest
Berg Balance Scale Balance Evaluation Systems
Test
Normative data Osteoarthritis
Mean BBS score one week
postoperative = 34 (8); 5-7 weeks
postoperative = 50 (6)
SCI
Mean BBS score: 47.9 (10.7)
Parkinson’s disease
Mean BBS score = 40.22 (8.48)
Range = 21 to 53
Subacute Stroke
Mean (SD) BESTest score for
all participants = 41.7 (28.19)
Test-retest reliability Elderly = Excellent test-retest
reliability (ICC = 0.91)
Parkinson’s disease= Excellent test-
retest reliability (ICC = 0.80)
Stroke= Excellent test-retest
reliability (ICC = 0.98)
Parkinson’s disease=
Excellent test-retest
reliability for total BEST score
(ICC = 0.88)

12. BBS versus BESTest
Berg Balance Scale Balance Evaluation Systems
Test
Interrater/Intrarater
Reliability
Community dwelling
elderly= Excellent intrarater
reliability (ICC = 0.97)
Parkinsons’s disease=
Excellent interrater reliability
(ICC = 0.95)
SCI= Excellent interrater
reliability (ICC = 0.95)
Stroke= Excellent interrater
and intrarater reliability in
individuals 2,4,6 & 12 weeks
post onset (ICC = 0.98; ICC =
0.97)
Community dwelling adults=
Excellent interrater reliability
for total score (ICC = 0.91)
Parkinson’s disease=
Excellent inter-rater
reliability ICC = 0.96
Subacute stroke=
Excellent interrater
reliability: ICC= .99
Excellent intrarater
reliability: ICC= .99

13. BBS versus BESTest
Berg Balance Scale Balance Evaluation Systems
Test
Criterion Validity
(Predictive/Concurrent)
Elderly population= Excellent
correlation with Dynamic Gait
Index (r = 0.67)
Stroke = Excellent
correlations with the balance
subscale of the Fugl-Meyer at
14, 30, 90 and 180 days post
stroke (r = 0.90 to 0.92)
Excellent correlations with
Postural Assessment Scale for
Stroke patients (PASS) (r =
0.92 to 0.95)
Community dwelling elderly=
Excellent correlation between
total BESTest and Activities-
specific Balance Confidence
Scale (ABC) (r = 0.636, p < 0.01)
Parkinson’s disease=
Excellent correlation between
total BESTest and ABC (r =
0.757)
Excellent correlation between
total BESTest and Berg Balance
Scale (r = 0.873)
Excellent correlation between
total BESTest and Functional
Gait Assessment (r = 0.882)

14. BBS versus BESTest
Berg Balance Scale Balance Evaluation Systems Test
Construct Validity
(Convergent/Discrim
inant)
Stroke
Adequate correlation with
Timed Up and Go scores (r = -
0.48)
Excellent correlation with
mobility items of the Barthel
Index (r = 0.67)
Osteoarthritis = Correlation
Coefficients between Original
and Reduced versions of the
BBS: 0.92 (0.86, 0.95) 1 week
postoperative, and 0.97 (0.95,
0.98) 5-7 weeks postoperative
Community dwelling adults =
Subjects with balance deficits score
significantly lower than healthy
controls (p = 0.36)
Parkinson’s disease =
Excellent correlation with:
Modified Hoehn and Yahr Scale
(r = -0.736)
MDS-UPDRS-3 (r = -0.758)
MDS-UPDRS (r = -0.780)
Subacute stroke =
Excellent correlation with the BBS (r
= 0.96)
Excellent correlation with the PASS
(r = 0.96)
Excellent correlation with the
Mini-BEST (r = 0.96)

15. BBS versus BESTest
Berg Balance Scale Balance Evaluation
Systems Test
Content Validity Items were selected based
on interviews with 12
geriatric clients and 10
clinical professionals
Resultant items were then
pretested and revised
Not Established
Face Validity Not established Not Established

16. BBS versus BESTest
Berg Balance Scale Balance Evaluation Systems
Test
Floor/Ceiling Effects Stroke = Poor floor effects at
14 days post stroke (35%)
SCI = Poor ceiling effects
(37.5%)
Parkinson’s disease =
Excellent, no floor effects
were observed with the
BESTest
Subacute stroke
= Excellent, no floor effects
were observed with the
BESTest
Excellent, no ceiling effects
were observed with the
BESTest

17. REFERENCES
• 1. Chinsongkram B, Chaikeeree N, Saengsirisuwan V,
Viriyatharakij N, Horak FB, Boonsinsukh R. Reliability and
validity of the Balance Evaluation Systems Test (BESTest) in
people with subacute stroke. Physical therapy.
2014;94(11):1632-43.
• 2. Major MJ, Fatone S, Roth EJ. Validity and reliability of the
Berg Balance Scale for community-dwelling persons with
lower-limb amputation. Archives of physical medicine and
rehabilitation. 2013;94(11):2194-202.
• 3. Rodrigues LC, Marques AP, Barros PB, Michaelsen SM.
Reliability of the Balance Evaluation Systems Test (BESTest)
and BESTest sections for adults with hemiparesis. Brazilian
Journal of Physical Therapy. 2014;18(3):276-81.

18. REFERENCES
• 4. Blum L, Korner-Bitensky N. Usefulness of the Berg Balance
Scale in stroke rehabilitation: a systematic review. Physical therapy.
2008;88(5):559-66.
• 5. Horak FB, Wrisley DM, Frank J. The Balance Evaluation
Systems Test (BESTest) to Differentiate Balance Deficits. Physical
therapy. 2009;89(5):484-98.
• 6. Susan o’B Sulivan
• 7.Rehab measures

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