Balance assessment tools and their psychometric properties among individuals post-stroke: a systematic review

Abstract Background and purpose Balance assessment following stroke is a significant part of the rehabilitation program. The Berg Balance Scale (BBS), the Postural Assessment Scale for Stroke (PASS) and the Balance Evaluation Systems Test (BESTest) are multi-item balance scales commonly used for assessing balance for people post-stroke. The purpose of our systematic review is to identify and appraise the literature on the psychometric properties of these balance measures (BBS, PASS and BESTest) in studies involving people post-stroke. Methods A comprehensive electronic literature search was performed in five databases PubMed, CINAHL, Embase, Scopus and Web of Science; in addition to hand searching of relevant references. Two independent reviewers screened the literature search results to include studies that were: written in the English language and published in peer-reviewed journals; participants were adults (>18 years) and had a diagnosis of stroke; Balance of participants was assessed using one (or more) of the following measures: BBS, PASS, BESTest or a shortened version of these measures; and the study reported at least one psychometric property for the balance measure. Two independent reviewers extracted the data using a standardized form. Quality of included studies was assessed using a critical appraisal tool. Results A total of 65 studies met our inclusion criteria and were included in our review. The majority of studies reported on the psychometric properties of the BBS, followed by the PASS and then the BESTest. Results of the critical appraisal scale showed that the overall quality of studies was good. A variety of psychometric properties were reported, with validity being the most reported property followed by reliability. Discussion The BBS, BESTest and PASS and their variants show overall excellent psychometric properties when used among people post-stroke. However, further research is needed to investigate the responsiveness of these measures following rehabilitation programs.