Disclosures: Joshua E. Lider, DO: No financial relationships or conflicts of interest

Objective: Investigate the reliability of Balance Error Scoring System (BESS) measurements when performed by novice raters compared to experienced clinicians. Furthermore, identify whether completion of a focused, online training module to properly administer the BESS would increase the inter-rater reliability among novice raters.

Design: Prospective reliability study Setting : 5 novice volunteers were asked to independently rate BESS tests from 50 random prerecorded BESS videos of normal healthy subjects aged 5-14. Participants : 5 volunteers without prior experience of administering the BESS.

Interventions: Formal training for the novice raters consisted of a balance testing module delivered in an online format.

Main Outcome Measures: The novices’ scores before and after the formal training were compared to one another and then the scores were compared to 4 expert pre-graded scores. Intraclass correlation with 95% confidence intervals and percent agreements were calculated and compared across groups.

Results: The majority of intraclass correlation (ICC) values across the groups were between 0.75 and 1.00, which is considered good to excellent inter-reliability (Koo and Li 2016). The exceptions were foam stance-single leg in the untrained novice and trained novice group with ICCs of 0.452 and 0.641 respectively. Furthermore, all the ICCs in the expert raters were considered good to excellent inter-reliability (Koo and Li 2016), with the smallest ICC of 0.828 for foam stance-double leg. The firm stance-double leg of which inter-rater reliability was examined using percent agreement, the agreements were near perfect (0.958-0.970). Conclusions: BESS testing by novice raters with only written instruction and no formal training yields good inter-rater reliability. In contrast, BESS testing by expert raters yields excellent reliability. A focused training for novice raters conferred a small improvement in the reliability of the scoring of the single leg stance on foam condition but not a significant difference to the overall BESS score.

Level of Evidence: Level II

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/novice-versus-expert-rater-reliability-of-the-balance-error-scoring-system-in-children-between-the-ages-of-5-and-14/