A comparison of three balance-assessment scales for patients after stroke with various levels of balance disorder

It is often difficult for the clinician to choose the most appropriate balance-assessment measure. We wanted to facilitate this decision based on the stroke patient’s functional abilities. The aim of our study was to compare three established scales [Berg Balance Scale (BBS), mini-BESTest (MBT) and Functional Gait Assessment (FGA)] in terms of responsiveness, floor and ceiling effects at different levels of ambulation as defined by the Functional Ambulation Classification (FAC). The 18-month prospective study included 88 patients after cerebral stroke, who were able to walk independently or with assistance of one person (FAC 2–6). BBS showed the highest relative gain in the FAC 2–3 group (17% of maximum scale score); in the other two groups (FAC 4–5 and FAC 6), MBT showed the highest relative gain (16 and 13%, respectively), followed by FGA (11 and 10%, respectively). Among the patients with initial FAC 2–3, a floor effect occurred with FGA, while a ceiling effect occurred with BBS among patients with initial FAC 6. Gain in FGA correlated slightly more with improvement detected by MBT (r= 0.60) than with BBS (r= 0.50). We can conclude that BBS seems to be suitable for stroke patients with initial FAC 2–5, whereas MBT and FGA for those with FAC 4–6.