Balance Evaluation Systems Test: BESTest (Horak, et al. 2009)

The original BESTest contains 36 test items that are categorized into 6 underlying systems that may contribute to balance impairment:

  1. Biomechanical Constraints
  2. Stability Limits and Verticality
  3. Anticipatory Postural Adjustments, Transitions
  4. Reactive Postural Responses
  5. Sensory Orientation
  6. Dynamic Balance during Gait and Cognitive Effects.

The web portal provided by Fay B. Horak, Ph.D., P.T. provides instructional videos and scoring samples of all the tasks used in the (original) BESTest. For example, here is a link to "Compensatory Stepping Correction - Lateral" (Underlying System #4: Reactive Postural  Control, item #18)  

Download instructions and scoring sheets for the BESTest from the researcher's website

Horak FB, Wrisley DM, Frank J. (2009). The Balance Evaluation Systems Test (BESTest) to Differentiate Balance Deficits. Phys Ther. 89(5):484-498.

Hass CJ, Bloem BR, Okun MS. (2008). Pushing or pulling to predict falls in Parkinson disease? Nature clinical practice neurology 4(10):530-531

Mini-BESTest (Franchignoni, et al. 2012)

This shortened version of the original BESTest has selected 14 test items from 4 underlying systems (anticipatory, reactive postural control, sensory orientation, dynamic gait) of the original 6 balance system categories. The instructions are the same.

The web portal provided by Fay B. Horak, Ph.D., P.T. provides instructional videos and scoring samples of all the tasks used in the (original) BESTest as well as the subset of tests that comprise the Mini-BESTest.  
For example, here is a link to item # 6 of the Mini-BESTest, "Compensatory Stepping Correction - Lateral"

In an April 2013 Letter to the Editor in PT Journal, King and Horak clarified an error in the scoring of the Mini-BESTest as proposed by Franchignoni et al. in 2012.  King and Horak state that the total possible score should be 28 (not 32) from 14 items (not 16). A rationale is given, and an Appendix with instructions and a scoring form is included.

King L, Horak FB. (2013). Letter to the editor: On the Mini-BESTest: scoring and the reporting of total scores. Phys Ther. 93:571–575.

Franchignoni F, Horak F, Godi M, Nardone A, Giordano A. (2010). Using psychometric techniques to improve the Balance Evaluation Systems Test: the mini-BESTest. J Rehabil Med. 42(4):323-31.

Brief-BESTest (Padgett, et al. 2012)

This shortened version of the original BESTest has selected one test item from each of the original 6 underlying balance systems. There are a total of 8 test items (since 2 of them are performed bilaterally).
The items that were chosen from each category were the ones that had the highest correlation with the overall/complete score using the original BESTest.

Instructions and scoring (ordinal, 0-3) are given as an appendix in the research article by Padgett. However the scoring form is not in the public domain, and requires permission from the author.

Padgett PK, Jacobs JV, Kasser SL. (2012). Is the BESTest at its best? A suggeste brief version based on interrater reliability, validity, internal consistency and theoretical construct. Phys Ther. 92(9):1197-1207.

Norms for the 3 versions (healthy older adults):

O'Hoski S, Winship B, Herridge L, Agha T, Brooks D, Beauchamp MK, Sibley KM. (2014).  
Increasing the Clinical Utility of the BESTest, Mini-BESTest, and Brief-BESTest: Normative Values in Canadian Adults Who Are Healthy and Aged 50 Years or Older  Phys Ther. 94(3):334-42.

G-codes (recommended tests are listed on pages 6-7) Section on Geriatrics Recommended Outcome Measures for Medicare Functional Limitation/Severity Reporting




Updated Oct. 15, 2018