Test-retest Reliability of Balance Error Scoring System in Individuals with Osteoarthritis Knee: A Cross-sectional Study

Introduction: Osteoarthritis (OA) of the knee is a degenerative joint disease that leads to changes not only in the articular cavity but also in the ligaments, tendons and muscles. These structures play an important role in human balance, which is important for daily activities. Due to the degeneration of ligaments, tendons and muscles, OA of the knee results in balance impairment. Aim: To evaluate the test-retest reliability of the Balance Error Scoring System (BESS) in patients with OA of the knee. Materials and Methods: This cross-sectional study was conducted at Department of Physiotherapy, MMIPR, MMDU, Ambala, Haryana, India, from March 2023 to April 2024. A total of 20 participants were recruited for the study and balance was evaluated using BESS on a firm surface, first in double limb stance, then in single limb stance and finally in tandem stance, both with eyes open and closed. A single rater conducted the same process twice on a foam surface. Descriptive statistics were used to represent the demographic characteristics of the participants. Reliability was examined using both Intraclass Correlation Coefficients (ICCs) and Cronbach’s alpha was executed to check internal consistency. Results: The mean age of the participants in the present study was 49.4±10.6 years and the Body Mass Index (BMI) was 26.2±4.2. Both males 9 (45%) and females 11 (55%) were recruited for the present study. When comparing the demographic characteristics between males and females using an independent t-test, it revealed that no significant difference exists between them. The reliability analysis demonstrated excellent reliability for all parameters of BESS (ICC: 0.9). Cronbach’s alpha for all parameters was also 0.9. The limits of agreement plotted with the Bland-Altman plot indicated an excellent level of agreement, as the maximum scores fell within the 95% Confidence Interval (CI). Conclusion: Based on the findings o the present study, the authors can conclude that BESS is a reliable tool for balance assessment in patients with OA of the knee.