• The Mini-BESTest is a short version of the BESTest (Balance Evaluation Systems Test) designed to comprehensively assess various components of standing balance.
  • It is more clinically applicable than its longer version (15 minutes vs. 45 minutes), and assesses 14 items coming from 4 of the 6 BESTest components of standing (dynamic) balance.

Clinical Considerations

The Mini-BESTest may help clinicians to identify the postural control components causing balance impairment and establish targeted interventions, especially for people with higher functional levels.

ICF Domain

Activity ▶ Mobility

Administration

Clinician-administered.

Length

Approximately 15 minutes.

Number of Items

14 items:

  • Anticipatory postural control (subscale I: 3 items)
  • Reactive postural control (subscale II: 3 items)
  • Sensory orientation (subscale III: 3 items)
  • Dynamic gait (subscale IV: 5 items)

Equipment

  • Temper® foam (or T-foam™ 4 inches thick, medium density T41 firmness rating)
  • Chair without arm rests or wheels
  • Incline ramp
  • Stopwatch
  • Box (9” height)
  • 3-meter distance measured out and marked on the floor with tape [from chair].

Scoring

  • Each item is scored on a 3-level ordinal scale (0 = “lowest level of function” to 2 = “highest level of function”)
  • Two items have right and left assessments in which the lower score is used within the total score (directions specify which to use)
  • Total Score: 28 (or 32 if both left and right data are used in two items)

Languages

English.

Training Required

No formal training required. However, visiting https://www.bestest.us/training/ is recommended.

Availability

The Mini-BESTest worksheet can be found:

Measurement Property Summary

# of studies reporting psychometric properties: 5

Interpretability

  • MCID: Minimal Important Change adjusted: 3.7

(Morooka et al. 2025; n=50; 37 males, 13 females; mean age: 68.3 years; ASIA D; injury level: cervical; mean time since injury to assessment: 5.0 days)

  • SEM: 1.13-1.38

(Morooka et al. 2024; n=20; 14 males, 6 females; mean age: 64.3 years; ASIA D; mean time since injury: 19.6 days)

  • MDC: 3.14-4 points

(Morooka et al. 2024; n=20; 14 males, 6 females; mean age: 64.3 years; ASIA D; mean time since injury: 19.6 days)
(Roy et al. 2021; n=23; 17 males, 6 females; mean age 55.2 years; AIS B (n = 1), AIS D (n = 22); tetraplegia (n = 13), paraplegia (n = 10); and mean time since injury 49.3 days)

Typical Values

  • The median sum score for the Mini-BESTest was 20 (range: 0–28).

(Jørgensen et al. 2017; n=46; 32 males, 14 females; AIS A, B, C (n = 7), AIS D (n = 39); duration of injury (range): 6.5 years (1-41))

Reliability – High

  • Internal consistency is High (IC = 0.95).

(Jørgensen et al. 2017; n=46; 32 males, 14 females; AIS A, B, C (n = 7), AIS D (n = 39); duration of injury (range): 6.5 years (1-41))

  • Test-retest reliability is High (ICC = 0.94-0.98)

(Chan et al. 2019; n=21; 7 males, 14 females; mean age 56.9 years; level of injury: C1-L5; incomplete and chronic SCI)
(Roy et al. 2021; n=23; 17 males, 6 females; mean age 55.2 years; AIS B (n = 1), AIS D (n = 22); tetraplegia (n = 13), paraplegia (n = 10); and mean time since injury 49.3 days)

  • Inter-rater reliability is High (ICC = 0.96-0.97)

(Roy et al. 2021; n=23; 17 males, 6 females; mean age 55.2 years; AIS B (n = 1), AIS D (n = 22); tetraplegia (n = 13), paraplegia (n = 10); and mean time since injury 49.3 days)
(Morooka et al. 2024; n=20; 14 males, 6 females; mean age: 64.3 years; ASIA D; mean time since injury: 19.6 days)

  • Intra-rater reliability is High (ICC = 0.98)

(Morooka et al. 2024; n=20; 14 males, 6 females; mean age: 64.3 years; ASIA D; mean time since injury: 19.6 days)

Validity – High

  • High (inverse) correlation with center of pressure velocity when standing with eyes open: r = 0.54-0.71
  • High correlation with lower extremity strength:  r = 0.73

(Chan et al. 2019; n=21; 7 males, 14 females; mean age 56.9 years; level of injury: C1-L5; incomplete and chronic SCI)

  • High correlation with BBS: r = 0.90
  • High correlation with Timed Up and Go (TUG) assessment: r = -0.75
  • High correlation with Spinal Cord Independence Measure version III (SCIM)-mobility items: r = 0.88
  • High correlation with 10-MWT: r = -088
  • High correlation with WISCI-II: r = 0.63

(Jørgensen et al. 2017; n=46; 32 males, 14 females; AIS A, B, C (n = 7), AIS D (n = 39); duration of injury (range): 6.5 years (1-41))

Responsiveness

No values were reported for the responsiveness of the Mini-BESTest for the SCI population.

Floor/Ceiling Effect

No floor or ceiling effects were observed.

(Jørgensen et al. 2017; n=46; 32 males, 14 females; AIS A, B, C (n = 7), AIS D (n = 39); duration of injury (range): 6.5 years (1-41))
(Morooka et al. 2024; n=20; 14 males, 6 females; mean age: 64.3 years; ASIA D; mean time since injury: 19.6 days)

Reviewers

Dr. Janice Eng, Dr. Carlos L. Cano-Herrera, Matthew Querée

Date Last Updated

31 December 2024

Chan K, Unger J, Lee JW, Johnston G, Constand M, Masani K, Musselman KE. Quantifying balance control after spinal cord injury: Reliability and validity of the mini-BESTest. J Spinal Cord Med. 2019; 42: 141-148. doi: 10.1080/10790268.2019.1647930.
https://pubmed.ncbi.nlm.nih.gov/31573459/

Jørgensen V, Opheim A, Halvarsson A, Franzén E, Roaldsen KS. Comparison of the Berg Balance Scale and the Mini-BESTest for Assessing Balance in Ambulatory People With Spinal Cord Injury: Validation Study. Phys Ther. 2017; 97: 677-687. doi: 10.1093/ptj/pzx030.
https://pubmed.ncbi.nlm.nih.gov/28371940/

Morooka Y, Takakura Y, Kunisawa Y, Okubo Y, Araki S, Obayashi S. Reliability of the Mini-BESTest and Brief-BESTest for assessing patients with incomplete spinal cord injury. Spinal Cord. 2024; 62: 676-682. doi: 10.1038/s41393-024-01032-2.
https://pubmed.ncbi.nlm.nih.gov/39271798/

Morooka Y, Kunisawa Y, Obayashi S, Takakura Y. Responsiveness and Minimal Important Change of the Mini- and Brief-Balance Evaluation Systems Tests in People with Incomplete Cervical Spinal Cord Injury: A Prospective Cohort Study. Neurol Int. 2025 Mar 18;17(3):43. doi: 10.3390/neurolint17030043.
https://pubmed.ncbi.nlm.nih.gov/40137465/

Roy A, Higgins J, Nadeau S. Reliability and minimal detectable change of the mini-BESTest in adults with spinal cord injury in a rehabilitation setting. Physiother Theory Pract. 2021; 37: 126-134. doi: 10.1080/09593985.2019.1622161.
https://pubmed.ncbi.nlm.nih.gov/31156010/

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