Division of Physical Medicine and Rehabilitation, ICS Maugeri SPA SB, IRCCS, Institute of Veruno, Italy.
ICS Maugeri SPA SB, IRCCS, Institute of Pavia, Italy.
Gait Posture. 2020 Jul;80:14-19. doi: 10.1016/j.gaitpost.2020.05.004. Epub 2020 May 17.
Balance problems in Parkinson's Disease (PD) require appropriate evaluation. While the Mini-BESTest is commonly used to assess dynamic balance, some of its psychometric properties have not yet been addressed.
What is the responsiveness and the Minimal Clinically Important Difference (MCID) of the Mini-BESTest in patients with PD?
One-hundred forty-eight patients with PD underwent a treatment specific for balance skills (1-h session, three times/week for four weeks). All patients were initially evaluated with the Mini-BESTest and Activities-Specific Balance Confidence scale 5-levels (ABC-5L). Post-treatment, patients were assessed with the Mini-BESTest, ABC-5L and Global Rating of Change (GRC, both patient- and physiotherapist-rated). Responsiveness to treatment and MCID were calculated with distribution and anchor-based methods: effect size, area under the curve (AUC) of receiver operating characteristics (ROC), and correlations between evaluations (change in score of Mini-BESTest, ABC-5L, GRC). Eleven a priori hypotheses were formulated for testing responsiveness.
The effect size of treatment measured with the Mini-BESTest was 0.44, revealing moderate responsiveness. AUCs were 0.75, 0.82 and 0.59 for the patient-rated GRC, physiotherapist-rated GRC and ABC-5L, respectively. There was a moderate correlation between changes in the Mini-BESTest and patient-rated (r = 0.42) or physiotherapist-rated (r = 0.62) GRC scores. Conversely, a low correlation (r = 0.17) was found between changes in the Mini-BESTest and ABC-5L. Consequently, 72.7% of hypotheses were met. The Mini-BESTest MCID was between 3.4 and 4.0 when calculated with distribution and anchor-based methods, respectively.
The Mini-BESTest showed moderate responsiveness for detecting treatment-related improvement in dynamic balance. A 4.0-point MCID value is useful to identify clinical effects of balance rehabilitation in a single patient with PD. Values ranging from 3.4 and 4.0 are recommended for interpretation of results at a group level.
帕金森病（PD）的平衡问题需要进行适当的评估。虽然 Mini-BESTest 常用于评估动态平衡，但它的一些心理测量特性尚未得到解决。
Mini-BESTest 在 PD 患者中的反应性和最小临床重要差异（MCID）是多少？
148 名 PD 患者接受了针对平衡技能的特定治疗（1 小时课程，每周 3 次，持续四周）。所有患者最初均接受 Mini-BESTest 和活动特异性平衡信心量表 5 级（ABC-5L）评估。治疗后，患者接受 Mini-BESTest、ABC-5L 和总体变化评级（患者和物理治疗师评定的 GRC）评估。使用分布和锚定方法计算治疗反应性和 MCID：效应大小、受试者工作特征曲线（ROC）的曲线下面积（AUC）以及评估之间的相关性（Mini-BESTest、ABC-5L、GRC 评分的变化）。制定了 11 个预先设定的假设来检验反应性。
使用 Mini-BESTest 测量的治疗效果大小为 0.44，表明反应性中等。患者评定的 GRC、物理治疗师评定的 GRC 和 ABC-5L 的 AUC 分别为 0.75、0.82 和 0.59。Mini-BESTest 与患者评定（r = 0.42）或物理治疗师评定（r = 0.62）GRC 评分的变化之间存在中度相关性。相反，Mini-BESTest 与 ABC-5L 的变化之间相关性较低（r = 0.17）。因此，有 72.7%的假设得到了满足。使用分布和锚定方法分别计算 Mini-BESTest 的 MCID 在 3.4 到 4.0 之间。
Mini-BESTest 显示出对检测动态平衡治疗相关改善的中等反应性。4.0 点 MCID 值可用于识别单个 PD 患者平衡康复的临床效果。建议在组水平上解释 3.4 到 4.0 之间的值。
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