Balance Error Scoring System: Difference between revisions

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'''Original Editor '''- [[User:Sinead Greenan|Sinead Greenan]]


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== Objective<br>  ==
== Objective<br>  ==


The '''Balance Error Scoring System''' is&nbsp;an objective measure of assessing static postural stability (designed for the mild head injury population, to assist in return to sports play decisions).  
The '''Balance Error Scoring System''' is&nbsp;an objective measure of assessing static postural stability (designed for the mild head injury population, to assist in return to sports play decisions).  
[[Category:Outcome_Measures]]


== Intended Population<br>  ==
== Intended Population<br>  ==


Those diagnosed with concussion, mild traumatic brain injury, vestibular disorders
Those diagnosed with concussion, mild traumatic brain injury, vestibular disorders  


== Method of Use  ==
== Method of Use  ==
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=== Reliability  ===
=== Reliability  ===


<u>Test-retest Reliability</u>
<u>Test-retest Reliability</u>  


<u></u>Athletes:<br>(Bell et al, 2011)&nbsp;<ref name="Bell et al">Bell, D. R., Guskiewicz, K. M., et al. "Systematic review of the balance error scoring system." Sports Health 2011 3(3): 287-295</ref>
<u></u>Athletes:<br>(Bell et al, 2011)&nbsp;<ref name="Bell et al">Bell, D. R., Guskiewicz, K. M., et al. "Systematic review of the balance error scoring system." Sports Health 2011 3(3): 287-295</ref>  


*Adequate test retest reliability in youth participants aged 9-14 (ICC = 0.70)
*Adequate test retest reliability in youth participants aged 9-14 (ICC = 0.70)


<u>Interrater/Intrarater Reliability</u>
<u>Interrater/Intrarater Reliability</u>  


<u></u>Athletes (without neurological / orthopedic injury):<br>(Susco et al, 2004; n = 34 subset of subjects)&nbsp;<ref name="Susco et al">Susco, T. M., Valovich McLeod, T. C., et al. "Balance Recovers Within 20 Minutes After Exertion as Measured by the Balance Error Scoring System." J Athl Train 2004 39(3): 241-246</ref>
<u></u>Athletes (without neurological / orthopedic injury):<br>(Susco et al, 2004; n = 34 subset of subjects)&nbsp;<ref name="Susco et al">Susco, T. M., Valovich McLeod, T. C., et al. "Balance Recovers Within 20 Minutes After Exertion as Measured by the Balance Error Scoring System." J Athl Train 2004 39(3): 241-246</ref>  


*Adequate to Excellent intrarater reliability (ICC from 0.62-0.82)
*Adequate to Excellent intrarater reliability (ICC from 0.62-0.82)  
*Excellent: Double support / firm surface (ICC = 0.82)
*Excellent: Double support / firm surface (ICC = 0.82)  
*Adequate: Double support / firm surface (ICC = 0.63)
*Adequate: Double support / firm surface (ICC = 0.63)


Athletes:
Athletes:  


(Bell et al, 2011; n = 18 college athletes)&nbsp;<ref name="Bell et al">Bell, D. R., Guskiewicz, K. M., et al. "Systematic review of the balance error scoring system." Sports Health 2011 3(3): 287-295</ref>
(Bell et al, 2011; n = 18 college athletes)&nbsp;<ref name="Bell et al">Bell, D. R., Guskiewicz, K. M., et al. "Systematic review of the balance error scoring system." Sports Health 2011 3(3): 287-295</ref>  


*Excellent interrater reliability (ICC = 0.78-0.96)
*Excellent interrater reliability (ICC = 0.78-0.96)  
*Adequate-excellent interrater reliability (ICC = 0.57-0.85 for total score (systematic review looking at 8 studies)
*Adequate-excellent interrater reliability (ICC = 0.57-0.85 for total score (systematic review looking at 8 studies)  
*Adequate-excellent intrarater reliability for total score (ICC = 0.60-0.92)
*Adequate-excellent intrarater reliability for total score (ICC = 0.60-0.92)


=== Validity  ===
=== Validity  ===


<u>Criterion Validity (Predictive/Concurrent)</u>
<u>Criterion Validity (Predictive/Concurrent)</u>  


<u></u>Athletes:<br>(Bell et al, 2011)&nbsp;<ref name="Bell et al">Bell, D. R., Guskiewicz, K. M., et al. "Systematic review of the balance error scoring system." Sports Health 2011 3(3): 287-295</ref>
<u></u>Athletes:<br>(Bell et al, 2011)&nbsp;<ref name="Bell et al">Bell, D. R., Guskiewicz, K. M., et al. "Systematic review of the balance error scoring system." Sports Health 2011 3(3): 287-295</ref>  


*Adequate-excellent correlations with target sway in male athletes
*Adequate-excellent correlations with target sway in male athletes  
*Significant correlations for 5 of the 6 stances (r = 0.31-0.79, p &lt; 0.01)
*Significant correlations for 5 of the 6 stances (r = 0.31-0.79, p &lt; 0.01)


Concussion:
Concussion:  


(Barlow et al, 2011 retrospective chart review of middle and high school students; n = 106; mean age = 15.38(1.7) years; mean days between testing = 15.5(14.1) days)&nbsp;<ref name="Barlow et al">Barlow, M., Schlabach, D., et al. "Differences in change scores and the predictive validity of three commonly used measures following concussion in the middle school and high school aged population." Int J Sports Phys Ther 2011 6(3): 150-157</ref>
(Barlow et al, 2011 retrospective chart review of middle and high school students; n = 106; mean age = 15.38(1.7) years; mean days between testing = 15.5(14.1) days)&nbsp;<ref name="Barlow et al">Barlow, M., Schlabach, D., et al. "Differences in change scores and the predictive validity of three commonly used measures following concussion in the middle school and high school aged population." Int J Sports Phys Ther 2011 6(3): 150-157</ref>  


*Adequate correlation with ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing)Impulse control (r = -0.31)
*Adequate correlation with ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing)Impulse control (r = -0.31)  
*Adequate correlation with ImPACT verbal score (r = 0.37)
*Adequate correlation with ImPACT verbal score (r = 0.37)  
*Poor correlation with ImPACT visual motor speed change (r = -0.33)
*Poor correlation with ImPACT visual motor speed change (r = -0.33)  
*Poor correlation with ImPACT reaction time (r = -0.02)
*Poor correlation with ImPACT reaction time (r = -0.02)  
*Poor correlation with PCSS (r = 0.15)
*Poor correlation with PCSS (r = 0.15)


Athletes (controls without neurological / orthopedic injury):
Athletes (controls without neurological / orthopedic injury):  


(Susco et al, 2004)&nbsp;<ref name="Susco et al">Susco, T. M., Valovich McLeod, T. C., et al. "Balance Recovers Within 20 Minutes After Exertion as Measured by the Balance Error Scoring System." J Athl Train 2004 39(3): 241-246</ref>
(Susco et al, 2004)&nbsp;<ref name="Susco et al">Susco, T. M., Valovich McLeod, T. C., et al. "Balance Recovers Within 20 Minutes After Exertion as Measured by the Balance Error Scoring System." J Athl Train 2004 39(3): 241-246</ref>  


*Positive correlation with RPW score (r = 0.542)
*Positive correlation with RPW score (r = 0.542)


<u>Construct Validity (Convergent/Discriminant)</u>
<u>Construct Validity (Convergent/Discriminant)</u>  


<u></u>Athletes:<br>(Bell et al, 2011)&nbsp;<ref name="Bell et al">Bell, D. R., Guskiewicz, K. M., et al. "Systematic review of the balance error scoring system." Sports Health 2011 3(3): 287-295</ref>
<u></u>Athletes:<br>(Bell et al, 2011)&nbsp;<ref name="Bell et al">Bell, D. R., Guskiewicz, K. M., et al. "Systematic review of the balance error scoring system." Sports Health 2011 3(3): 287-295</ref>  


*Convergent validity: BESS and sensory organization test (SOT), validated in a concussed population. More errors seen at day 1 post injury compared to healthy individuals, but returned to baseline at 3 and 5 days post injury. Average errors 9(4) for control, 15(8) for concussed, effect size 1.0.
*Convergent validity: BESS and sensory organization test (SOT), validated in a concussed population. More errors seen at day 1 post injury compared to healthy individuals, but returned to baseline at 3 and 5 days post injury. Average errors 9(4) for control, 15(8) for concussed, effect size 1.0.  
*Discriminant: BESS does not discriminate between concussed athletes with and without a headache (p = 0.87)
*Discriminant: BESS does not discriminate between concussed athletes with and without a headache (p = 0.87)  
*BESS performance worsens after 50 years of age (p &lt; 0.01), r = 0.36
*BESS performance worsens after 50 years of age (p &lt; 0.01), r = 0.36  
*Increase in total BESS score (poorer performance) after whole-body or central fatigue (p &lt; 0.01)
*Increase in total BESS score (poorer performance) after whole-body or central fatigue (p &lt; 0.01)  
*Barefoot BESS performance better than braced BESS (p = 0.04), before walking, better than braced (p=.03 or taped (p = 0.04) after walking. Differences not seen in SOT between conditions.
*Barefoot BESS performance better than braced BESS (p = 0.04), before walking, better than braced (p=.03 or taped (p = 0.04) after walking. Differences not seen in SOT between conditions.


Healthy adults:
Healthy adults:  


(Iverson et al, 2008)&nbsp;<ref name="Iverson et al">Iverson, G. L., Kaarto, M. L., et al. "Normative data for the balance error scoring system: implications for brain injury evaluations." Brain Inj 2008 22(2): 147-152</ref>
(Iverson et al, 2008)&nbsp;<ref name="Iverson et al">Iverson, G. L., Kaarto, M. L., et al. "Normative data for the balance error scoring system: implications for brain injury evaluations." Brain Inj 2008 22(2): 147-152</ref>  


*Adequate correlation between BESS and age(r = 0.36)
*Adequate correlation between BESS and age(r = 0.36)  
*Poor correlation between BESS and height (r = -0.03)
*Poor correlation between BESS and height (r = -0.03)  
*Poor correlation between BESS and weight (r = 0.16)
*Poor correlation between BESS and weight (r = 0.16)  
*Poor correlation between BESS and waist circumference (r = 0.26)
*Poor correlation between BESS and waist circumference (r = 0.26)  
*Poor correlation between BESS and BMI (r = 0.23)<br>
*Poor correlation between BESS and BMI (r = 0.23)<br>


=== Responsiveness  ===
=== Responsiveness  ===


Not established
Not established  


=== Miscellaneous<br>  ===
=== Miscellaneous<br>  ===
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== Links  ==
== Links  ==


[http://theconcussionblog.files.wordpress.com/2011/02/bessprotocolnata09.pdf Balance Error Scoring System (BESS)]
[http://theconcussionblog.files.wordpress.com/2011/02/bessprotocolnata09.pdf Balance Error Scoring System (BESS)]  


== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
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References will automatically be added here, see [[Adding References|adding references tutorial]].  
References will automatically be added here, see [[Adding References|adding references tutorial]].  


<references />
<references />  
 
[[Category:Outcome_Measures]]

Revision as of 12:15, 4 September 2014

 

Original Editor - Sinead Greenan

Top Contributors - Sinead Greenan, Lucinda hampton, Evan Thomas, Oyemi Sillo, 127.0.0.1, WikiSysop and Kim Jackson  

Objective
[edit | edit source]

The Balance Error Scoring System is an objective measure of assessing static postural stability (designed for the mild head injury population, to assist in return to sports play decisions).

Intended Population
[edit | edit source]

Those diagnosed with concussion, mild traumatic brain injury, vestibular disorders

Method of Use[edit | edit source]

Equipment Required:

  • Foam pad
  • Stopwatch
  • An assistant to act as a spotter
  • BESS testing protocol (instructions to be read to subject during testing)
  • BESS score card

Description:

  • 6 conditions each tested barefoot, eyes closed for 20 seconds each:

Double leg stance (feet together) – firm / foam surfaces
Single leg stance (non-dominant foot) – firm / foam surfaces
Tandem stance (non-dominant foot in back) – firm / foam

  • Score of 0-60 (lower scores indicate better balance and less errors).
  • Each trial is scored by counting errors (deviations from the proper stance). If multiple errors occur at the same time, only one is counted. The maximum number of errors for a single condition is 10.
  • Errors include moving hands off of iliac crests, opening eyes, step stumble or fall, abduction or flexion of the hip beyond 30 degrees, lifting forefoot or heel off testing surface, remaining out of the proper testing position for > 5 seconds.
  • Number of errors in each trial are added together to obtain a total score (out of 60).
  • Read instructions to subject as they are written in the testing protocol.

Reference
[edit | edit source]

Evidence[edit | edit source]

Reliability[edit | edit source]

Test-retest Reliability

Athletes:
(Bell et al, 2011) [1]

  • Adequate test retest reliability in youth participants aged 9-14 (ICC = 0.70)

Interrater/Intrarater Reliability

Athletes (without neurological / orthopedic injury):
(Susco et al, 2004; n = 34 subset of subjects) [2]

  • Adequate to Excellent intrarater reliability (ICC from 0.62-0.82)
  • Excellent: Double support / firm surface (ICC = 0.82)
  • Adequate: Double support / firm surface (ICC = 0.63)

Athletes:

(Bell et al, 2011; n = 18 college athletes) [1]

  • Excellent interrater reliability (ICC = 0.78-0.96)
  • Adequate-excellent interrater reliability (ICC = 0.57-0.85 for total score (systematic review looking at 8 studies)
  • Adequate-excellent intrarater reliability for total score (ICC = 0.60-0.92)

Validity[edit | edit source]

Criterion Validity (Predictive/Concurrent)

Athletes:
(Bell et al, 2011) [1]

  • Adequate-excellent correlations with target sway in male athletes
  • Significant correlations for 5 of the 6 stances (r = 0.31-0.79, p < 0.01)

Concussion:

(Barlow et al, 2011 retrospective chart review of middle and high school students; n = 106; mean age = 15.38(1.7) years; mean days between testing = 15.5(14.1) days) [3]

  • Adequate correlation with ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing)Impulse control (r = -0.31)
  • Adequate correlation with ImPACT verbal score (r = 0.37)
  • Poor correlation with ImPACT visual motor speed change (r = -0.33)
  • Poor correlation with ImPACT reaction time (r = -0.02)
  • Poor correlation with PCSS (r = 0.15)

Athletes (controls without neurological / orthopedic injury):

(Susco et al, 2004) [2]

  • Positive correlation with RPW score (r = 0.542)

Construct Validity (Convergent/Discriminant)

Athletes:
(Bell et al, 2011) [1]

  • Convergent validity: BESS and sensory organization test (SOT), validated in a concussed population. More errors seen at day 1 post injury compared to healthy individuals, but returned to baseline at 3 and 5 days post injury. Average errors 9(4) for control, 15(8) for concussed, effect size 1.0.
  • Discriminant: BESS does not discriminate between concussed athletes with and without a headache (p = 0.87)
  • BESS performance worsens after 50 years of age (p < 0.01), r = 0.36
  • Increase in total BESS score (poorer performance) after whole-body or central fatigue (p < 0.01)
  • Barefoot BESS performance better than braced BESS (p = 0.04), before walking, better than braced (p=.03 or taped (p = 0.04) after walking. Differences not seen in SOT between conditions.

Healthy adults:

(Iverson et al, 2008) [4]

  • Adequate correlation between BESS and age(r = 0.36)
  • Poor correlation between BESS and height (r = -0.03)
  • Poor correlation between BESS and weight (r = 0.16)
  • Poor correlation between BESS and waist circumference (r = 0.26)
  • Poor correlation between BESS and BMI (r = 0.23)

Responsiveness[edit | edit source]

Not established

Miscellaneous
[edit | edit source]

Links[edit | edit source]

Balance Error Scoring System (BESS)

Recent Related Research (from Pubmed)[edit | edit source]

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References[edit | edit source]

References will automatically be added here, see adding references tutorial.

  1. ↑ 1.0 1.1 1.2 1.3 Bell, D. R., Guskiewicz, K. M., et al. "Systematic review of the balance error scoring system." Sports Health 2011 3(3): 287-295
  2. ↑ 2.0 2.1 Susco, T. M., Valovich McLeod, T. C., et al. "Balance Recovers Within 20 Minutes After Exertion as Measured by the Balance Error Scoring System." J Athl Train 2004 39(3): 241-246
  3. ↑ Barlow, M., Schlabach, D., et al. "Differences in change scores and the predictive validity of three commonly used measures following concussion in the middle school and high school aged population." Int J Sports Phys Ther 2011 6(3): 150-157
  4. ↑ Iverson, G. L., Kaarto, M. L., et al. "Normative data for the balance error scoring system: implications for brain injury evaluations." Brain Inj 2008 22(2): 147-152
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