A comparison study: Balance error scoring system using real-time and slow-motion video playback

Abstract

The Balance Error Scoring System (BESS) is a subjective clinical balance assessment frequently used by various healthcare providers. The test consists of three different stances (feet together, tandem, and single leg) that are each 20 seconds long. An administrator carefully observes and records the number of pre-defined balance or stability errors committed by the test subject. However, it is unclear if test administrators are able to observe all errors committed by the subject in real-time. PURPOSE: The purpose of this study was to analyze the difference in scoring a balance assessment with the assistance of video playback and slow-motion playback to identify if errors were all noted. METHODS: 66 NCAA Division I athletes ages 19.68 plus/minus 1.27 years old were scored in person and recorded on video for slow-motion access while performing two series of BESS trials by an experienced BESS rater. Age, sex, orthopedic injuries, past concussions, height, and weight were also recorded. Errors were recorded using the BESS Error Criteria (BEC) with a maximum score of 10 errors and Total Errors Scored (TES) the accumulative errors scored in 20 seconds. RESULTS: Significant differences between means in both measures scored in real-time and slow-motion playback (TES: 6.0 plus/minus 4.3 and 6.8 plus/minus 5.2; BEC: 6.0 plus/minus 4.3 and 6.7 plus/minus 4.9 errors, respectively) were reported. CONCLUSION: Results of this study suggest that experienced BESS raters capture more balance errors when viewed in slow-motion. However, Cohen's d effect size (TES: 0.2 and BEC: 0.1) suggests that clinically this is not meaningful, therefore; healthcare providers should still score BESS in real time.