This cross-sectional study was approved by the Research Council of the Neuromusculoskeletal Research Center and the Ethics Committee of Iran University of Medical Sciences (ethics code: IR.IUMS.REC1396.311411). The procedure was completely explained to each patient, and written informed consent for participation in the study was obtained. This study was performed in accordance with the Helsinki Declaration of 1964 and its later amendments.
A group of patients with chronic stroke participated in the study. Each patient was matched with a healthy adult in terms of age and gender. Our inclusion criteria for the patient group were: (1) diagnosis of stoke, (2) ability to live independently in the community, (3) ability to speak Persian, (4) ability to follow a three-step command, (5) ability to walk 6 m without aid, (6) no history of pathologic vertigo, (7) no history of pathologic faint, (8) no history of other vascular, musculoskeletal or neurologic problems that affect the balance and (9) no use of drugs affecting the balance in the past 48 h. Patients were excluded if they did not complete the test or did not agree to participate in the study.
Our inclusion criteria for the neurologic healthy group were: (1) living independently in the community, (2) ability to speak Persian, (3) ability to perform the commands, (4) ability to walk 6 m without aid, (5) giving consent, no history of pathologic faint or vertigo, (6) no use of drugs that affect balance in the past 48 h and (7) no history of medical conditions such as neurologic or musculoskeletal disorders that affect balance.
The study took place in the neurologic physiotherapy clinic of the rehabilitation faculty of Tehran University of Medical Sciences. The environment was quiet and separated from other patients. Before performing the test, the demographic characteristics of each patient were recorded.
Two physical therapists and a medical student participated in the study. Prior to the study initiation, raters participated in an educational session on the Mini-BESTest held by the first author. The session included a review of the study procedure, watching the BESTest training video provided by Prof. Horak, reading the testing instructions and practicing.
For the inter-rater reliability, two trained physical therapists scored the test for each patient in a session. For assessing each patient, one rater administered the test. After the patients had performed each item, the raters independently scored the performance on the test item according to the Mini-BESTest criteria. Inter-rater reliability was determined for the total scores and section scores. The raters were blinded to their ratings, and no discussion of the scores assigned was allowed.
To evaluate whether the Persian Mini-BESTest can distinguish between healthy adults and stroke patients (discriminative validity), each patient was matched with a healthy adult according to age and gender. A medical student administered the test and rated the performance of all the healthy subjects. For assessing the discriminative validity, the total Mini-BESTest scores of patients and healthy subjects were compared. The total Mini-BESTest scores assigned for patients in the inter-rater reliability phase of the study were used, and scores provided by one of the raters were randomly selected for comparison.
The Mini-BESTest is a clinical balance test consisting of 4 sections and 14 items (Table 1). Each item is scored from 0 (worst performance) to 2 (best performance). The total score is 28.
Sample Size and Data Analysis
According to the guidelines we included 30 patients with stroke and 30 neurologically healthy subjects for reliability and discriminative validity assessment . The percentage of male and females among patients was calculated. Mean and standard deviation (SD) for demographic and outcome variables were calculated. Kolmogorov-Smirnov test was used to determine normality. Pearson’s correlation coefficients were used to assess the inter-rater reliability. Correlation values < 0.4 were interpreted as poor, between 0.4 and 0.75 as moderate and > 0.75 as excellent . To assess the discriminative validity, the independent T test or the Mann-Whitney U test was used depending on the normality of the data. SPSS software (version 16 for Windows, SPSS Inc., Chicago, Il) was used for analyses.