Responsiveness and Minimal Important Change of the Mini- and Brief-Balance Evaluation Systems Tests in People with Incomplete Cervical Spinal Cord Injury: A Prospective Cohort Study.

Abstract

Background/objectives: Responsiveness and minimal important change (MIC) are key metrics that vary across conditions and should be determined for specific populations. However, these metrics have not yet been established for the Mini-Balance Evaluation Systems Test (Mini-BESTest) and Brief-BESTest in people with subacute traumatic incomplete cervical spinal cord injury (iCSCI). In this study, we aimed to determine the responsiveness and MIC of the Mini-BESTest and Brief-BESTest in people with subacute iCSCI.

Methods: This study included people with iCSCI who could maintain the standing position for 30 s without assistance within 7 days of injury at the university hospital's advanced critical care center. Responsiveness was assessed by correlating Mini-BESTest and Brief-BESTest change scores with the Berg Balance Scale (BBS). MIC values were determined using the global rating of change scale as an anchor, employing receiver operating characteristic curve methods (MIC_ROC) and predictive modeling methods adjusted for the proportion of improved participants (MIC_adjusted).

Results: Fifty people with iCSCI were included in the analysis. Changes in BBS scores were moderately positively correlated with changes in Mini-BESTest and Brief-BESTest scores. MIC_adjusted values were 3.7 for the Mini-BESTest and 2.2 for the Brief-BESTest. The MIC_ROC, based on an improvement rate of 64%, was deemed less appropriate for interpreting meaningful changes due to the high proportion of improved participants.

Conclusions: MIC_adjusted benchmarks can help clinicians measure significant improvements in dynamic balance, design effective interventions, and evaluate rehabilitation outcomes in people with iCSCI.