Inter-rater reliability using a modified Balance Error Scoring System

Lily Purdon
13 August 2021

Purdon, L. (2021). Inter-rater reliability using a modified Balance Error Scoring System. (A thesis submitted for the degree of Master of Applied Science at Otago Polytechnic.) [PDF 1.4 MB]



Falling is a common occurrence among older adults with over 1/3 of older adults falling per year. There are a range of balance tests used to indicate an older adult's risk of falling, many of which are attention invested and arguably do not apply to real-world settings. In real-world situations an individual’s primary focus cannot always be fixed on a balance task. This study used divested attention by combining the Balance Error Scoring System (BESS), an established balance test, with the controlled oral word association (COWA) test.

The primary aim of this research was to examine the inter-rater reliability of a modified BESS (mBESS) test. Secondary aims included determining if there was a relationship between the BESS and COWA scores, and whether this test was an
appropriate level of difficulty for older adults.

The mBESS test was administered to four older adults, each completing three recorded sessions involving three trials of each balance stance. These recordings were then submitted to four volunteer raters who scored the tests independently using the prescribed BESS tools provided. Inter-rater reliability was assessed using Pearson’s correlation coefficient.

The average total inter-rater reliability was 0.97, with the lowest reliability observed when scoring the one-legged stance (0.83). As expected, the variability between raters increased with the difficulty of the balance stance task. The mBESS test therefore offers excellent inter-rater reliability. Due to Covid-19 and the nationwide lockdown interfering with data collection, the secondary aims could not be addressed. 

The mBESS test has excellent inter-rater reliability (0.97) and the test could be suitable for future research regarding falls prevention to help assess falls risk with more authenticity.

Keywords: inter-rater reliability, elderly, balance, older adults, falls prevention, balance error scoring system

Lily's primary supervisor was Phil Handcock.


This thesis is publicly available under a Creative Commons licence CC BY-NC-ND 4.0.

Creative Commons License