Evaluating validity of the Kids-Balance Evaluation Systems Test (Kids-BESTest) Clinical Test of Sensory Integration of Balance (CTSIB) criteria to categorise stance postural control of ambulant children with CP

Abstract

Purpose

Evaluate the validity of the Clinical Test of Sensory Integration of Balance (CTSIB) scored using Kids-Balance Evaluation Systems Test (Kids-BESTest) criteria compared to laboratory measures of postural control.

Method

Participants were 58 children, 7–18 years, 17 with ambulant cerebral palsy (CP) (GMFCS I–II), and 41 typically developing (TD). Postural control in standing was assessed using CTSIB items firm and foam surfaces, eyes open (EO) then closed (EC). Face validity was evaluated comparing clinical Kids-BESTest scores between groups. Correlating force plate centre-of-pressure (CoP) data and clinical scores allowed evaluation of concurrent and content validity.

Results

Face validity: TD children scored higher for all CTSIB conditions when compared to children with CP. Concurrent validity: the agreement between clinical and CoP derived scores was poor to excellent (Firm-EO = 76%, Firm-EC = 76%, Foam-EO = 59%, Foam-EC = 94%). Clinical scores of “2-unstable” and “3-stable” were not distinguished reliably by force plate measures. Content validity: significant correlations were found between clinical scores and CoP data for the two intermediate conditions (Firm-EC: r_s −0.40 to −0.72; Foam-EO: r_s −0.12 to −0.50), but not the easier (Firm-EO: r_s −0.41 to −0.36) or harder conditions (Foam-EC: r_s −0.25 to −0.27).

Conclusion

Face validity of Kids-BESTest CTSIB criteria was supported. Content and concurrent validity were partially supported. Improved Kids-BESTest scoring terms were recommended to describe postural characteristics of “2-unstable.”

IMPLICATIONS FOR REHABILITATION

• Face validity of the Kids-BESTest criteria for the CTSIB was confirmed.

• The Kids-BESTest criteria for the CTSIB can identify children with atypical postural control.

• Concurrent validity and content validity were partially supported, since children with CP resorted to a range of different balance strategies when “unstable.”

• To improve CTSIB Kids-BESTest criteria, new terms were recommended to better describe postural characteristics of “2-unstable.”

Keywords:

• Cerebral palsy
• Kids-BESTest
• CTSIB
• postural balance
• school-aged population
• validation studies

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research was financially supported by the Research Foundation, Cerebral Palsy Alliance (grant no. PG4114) through the Children’s Motor Control Research Collaboration.