Automated Versus Traditional Scoring Agreeability During the Balance Error Scoring System

Abstract

Context: The Balance Error Scoring System (BESS) is a commonly used clinical tool to evaluate postural control that is traditionally performed through visual assessment and subjective evaluation of balance errors. The purpose of this study was to evaluate an automated computer-based scoring system using an instrumented pressure mat compared to the traditional human-based manual assessment. Design: A descriptive cross-sectional study design was used to evaluate the performance of the automated versus human BESS scoring methodology in healthy individuals. Methods: Fifty-one healthy active participants performed BESS trials following standard BESS procedures on an instrumented pressure mat (MobileMat, Tekscan Inc). Trained evaluators manually scored balance errors from frontal and sagittal plane video recordings for comparison to errors scored using center of force measurements and an automated scoring software (SportsAT, version 2.0.2, Tekscan Inc). A linear mixed model was used to determine measurement discrepancies across the 2 methods. Bland–Altman analyses were conducted to determine limit of agreement for the automated and manual scoring methods. Results: Significant differences between the automated and manual errors scored were observed across all conditions (P < .05), excluding bilateral firm stance. The greatest discrepancy between scoring methods was during the tandem foam stance, while the smallest discrepancy was during the tandem firm stance. Conclusion: The 2 methods of BESS scoring are different with wide limits of agreement. The benefits and risks of each approach to error scoring should be considered when selecting the most appropriate metric for clinical use or research studies.