Evaluation Of Clinician Position During Bess Tandem Stances

The Balance Error Scoring System (BESS) is a common concussion balance assessment. The BESS includes six conditions (C), including the tandem stance on firm (C3) and foam surfaces (C6). Typically, the clinician stands directly in front of the patient (center) performing the BESS; however, we believe that may not be the best position. PURPOSE: To determine the best clinician position for grading the BESS tandem stances. METHODS: Together, four researchers viewed and scored videos of 28 healthy college-aged females (n = 21) and males (n = 7) performing the BESS tandem stances twice (n = 336 videos) from three different viewing positions: lateral side of the dominant foot, center, and medial side of the dominant foot. Intraclass coefficients (ICCs) were calculated using Microsoft Excel for each viewing position by condition (x6) and for all views by condition (x2) and overall (x1). RESULTS: Condition 3 exhibited high variability in the error scores across all three positions. Condition 6 had less variability overall and across the three positions. See Table for additional results. CONCLUSION: There was greater variability in error scores in C3 versus C6, leading to higher ICCs, most likely due to C6 being a more difficult condition. As expected, error scores were higher for all views for C6 versus C3. The variability was lowest for C6, when the researchers were viewing the medial aspect of the dominant foot, indicating this position may afford clinicians the best opportunity for accurate scoring. Table. BESS Tandem Stance Intraclass Correlations by Clinician Viewing Position - Condition Firm Tandem Stance (C3) Foam Tandem Stance (C6) C3 & C6 Clinician viewing position All Lateral Center Medial All Lateral Center Medial All ICC 0.69 0.61 0.79 0.70 0.44 0.44 0.55 0.12* 0.84 Trials with identical error scores for all 44 16 14 14 130 37 44 49* 174 Total trials 168 56 56 56 168 56 56 56 336 Average errors 3.02 3.50 2.72 2.84 9.37 9.04 9.32 9.75 6.19 Average error range 0-10 0-10 0-10 0-10 3.5-10 3.5-10 4-10 6.75-10 0-10 Intraclass correlation (ICC). Condition (C): Tandem stance on firm surface (C3) and Tandem stance on foam surface (C6). Viewing Positions: Lateral side of dominant foot, Medial side of dominant foot, and Center (directly in front of the patient). *Only 7 of the 56 videos in this analysis (12.5%) were not scored the same, leading to low variability and ICC.