Mini-BESTest Template

What is the Mini BESTest?

The Mini Balance Evaluation Systems Test, or the Mini-BESTest for short, is a clinical assessment developed by the Oregon Health & Science University for physical therapists and similar professionals to evaluate older adults and those who have suffered neurological conditions regarding their balance deficits and capabilities like Parkinson's Disease, multiple sclerosis, and stroke. It's one of the many balance assessments that such professionals can use when treating such patients.

The Mini-BESTest is composed of 14 items, with each item featuring a specific activity that the patient must perform for the assessor to determine how negatively impacted their patient’s balance is and assess their fall risk.

What does the Mini Balance Evaluation Systems Test assess?

As mentioned earlier, the Mini BESTest seeks to evaluate a patient in terms of their balancing deficits and capabilities, specifically the following aspects:

• Anticipatory postural adjustment
• Reactive postural control
• Sensory orientation
• Dynamic gait

These are assessed through a series of balance and ambulation tests.

Under anticipatory postural adjustment, the patient must adjust their position from sitting to standing, rise as high as possible onto their toes, and stand on one leg.

Under reactive postural control, patients must protect themselves from falling when their assessor lets go of them. They must do so by adjusting their steps. They will do this three times (forward, backward, and lateral).

Under sensory orientation, patients must keep themselves stable in three ways: two of these ways require them to keep their feet together while standing on a firm surface and a foam surface; the last one needs them to stand on an incline with their toes directed towards the top also while their eyes are closed.

Under dynamic gait, patients must walk at their normal speed. Throughout this part, they must go through a functional gait assessment that needs them to change their gait speed, walk with head turns, walk with pivot turns, and step over obstacles. They will also perform the Timed Up & Go Test where they have to stand up from a chair, walk up to a marker at their normal speed, turn around, and walk back to the chair and sit.

These tests should give the assessor enough information to rate a patient’s static and dynamic balance.

What is the difference between the Mini-BESTest and the BESTest?

The Balance Evaluation Systems Test (BESTest) is the more extended version of the two. It’s composed of 27 items that need to be accomplished by the patient to measure balance by examining the primary balance deficit, balance impairment, balance control systems, anticipatory postural adjustments, postural responses, stability limits, and biomechanical constraints through various activities, some of which are performed in the Mini-BESTest.

The Mini Balance Evaluation Systems Test (Mini BESTest) is the shortened version of the two. Since this requires the patient to do less than the regular BESTest, conducting this is friendlier to patients since they will be doing less and will make them feel less tired.

The Mini BESTest can be used for clinical and research purposes. While it's often used as a clinical balance assessment tool, it has been used to conduct research, like seeing how effective it is for determining the functional mobility and fall risk in older adults over other assessments like the BESTest, Timed Up & Go Test by itself, and the Berg Balance Scale.

A research paper entitled The Mini-Balance Evaluation Systems Test (Mini-BESTest) Demonstrates Higher Accuracy in Identifying Older Adult Participants With History of Falls Than Do the BESTest, Berg Balance Scale, or Timed Up and Go Test written by Anyamanee Yingyongyudha, Vitoon Saengsirisuwan, Wanvisa Panichaporn, and Rumpa Boonsinsukh has shown that the Mini BESTest is more desirable to use for clinical utilization because it was shown to be a more significant predictor for fall risk in older adults compared to other assessments.

They were able to determine this by conducting this test alongside other similar assessments on 200 older adults with a mean age of 70 years. Participants were divided into two groups: one with a history of falls and one without.

If you're looking for assessments that are good for predicting falls in patients who have balance disorders, this is one of the best to use.

There’s another version of this test called the Brief BESTest, which has eight items and four answer choices per item.

How to interpret the results of the Mini BESTest:

The Mini BESTest has 14 items. Each item has three possible scores:

• 0 = severe
• 1 = moderate
• 2 = normal

Some items require two scores. An example would be Item 3, a right and left assessment. This item needs patients to stand on one leg, so they must do this for both legs.

Each answer set will have different parameters based on the specific activity the patient is supposed to do, so a rating of 2 for one item will have a different set of guidelines from another.

Mini BESTest scores are divided into four sections, not including the total score. The maximum score of the Mini BESTest is 28. Unlike other assessments that predict falls, this one doesn’t have cutoff score ranges and designations. As a rule of thumb, the higher the score, the more normal the patient’s balancing capabilities are. The lower it is, the higher the risk of falling.

It would be best to zoom into the different sections of the Mini BESTest to determine what's best for the patient after they take the test. If their anticipatory postural adjustment, sensory orientation, and dynamic gait score relatively well but their reactive postural control score is low, then you might want to tweak the patient's treatment plan to include exercises that can help them attain better reactive postural control.

It would also be best to conduct other tests, especially those that cover similar aspects that the Mini BESTest covers, like the Dynamic Gait index, Falls Efficacy Scale, the Berg Balance Scale, and more, for consistency and to cover as much ground as possible. A Mini BESTest score should not be the only defining factor for analyzing a patient's balancing deficits and capabilities.

Suppose your patient has Parkinson's disease or some other neurological condition. In that case, you have to consider if the negative impact on their balance is permanent and can only be addressed to a certain extent.

When is it best to administer the Mini BESTest?

When a patient presents a retrospective fall report.

If a patient or their guardian reports that the patient has suffered a fall recently, the Mini BESTest can be conducted to determine how negatively impacted their balancing capabilities are. Other fall risk assessments can be conducted for internal consistency and to determine what support the patient needs and how they can be rehabilitated if rehabilitation is still possible.

When monitoring a patient over time.

The Mini BESTest has great test-retest reliability. A paper written by Andreas Wallin, Marie Kierkegaard, Erika Franzén, and Sverker Johansson entitled Test–Retest reliability of the Mini-BESTest in people with mild to moderate multiple sclerosis shows that this assessment served well during retests (they conducted each test one week apart from each other), especially for patients with moderate multiple sclerosis. Given this, the test can be conducted again and again. As to how frequently they need to be conducted will be up to the professional and their findings related to their patient's balance.

After a patient accomplishes the Mini BESTest for the first time, you can schedule them for another clinical test to see any changes in their balance capabilities, especially if you created a treatment and rehabilitation plan for them. You can have them take this test once a week, twice a month, or once a month. It's up to you.

Additionally, you can use the Timed Up and Go Test Template to assess mobility and balance, which helps in evaluating the risk of falls. The Berg Balance Scale Template provides a thorough assessment of static balance and stability through various tasks. Employ the Dynamic Gait Index Template to evaluate gait and balance during dynamic movements. The Falls Efficacy Scale Template measures the fear of falling and its impact on daily activities. Lastly, the Functional Movement Screen Template offers a comprehensive evaluation of movement patterns and identifies potential risks for injury.

References

Wallin, A., Kierkegaard, M., Franzén, E., & Johansson, S. (2021). Test–Retest reliability of the Mini-BESTest in people with mild to moderate multiple sclerosis. Physical Therapy, 101(5). https://doi.org/10.1093/ptj/pzab045

Yingyongyudha, A., Saengsirisuwan, V., Panichaporn, W., & Boonsinsukh, R. (2016). The Mini-Balance Evaluation Systems Test (Mini-BESTEST) demonstrates higher accuracy in identifying older adult participants with history of falls Than do the BESTEst, Berg Balance Scale, or Timed up and Go Test. Journal of Geriatric Physical Therapy, 39(2), 64–70. https://doi.org/10.1519/jpt.0000000000000050