Although we took extra precautions
to ensure consistency of scoring
among testers in the present study,
the training DVD that is available
from the BESTest website29 is a
comprehensive training tool that
should be used by clinicians before
adopting this test as an outcome
measure. Repeated administration of
the BESTest highlighted an issue that
clinicians should be aware of when
interpreting scores for stability in
gait. The scores in this section were
the lowest among all of the sections
for most of our age groups; we
hypothesize that this finding may
have been due to difficulties with the
last item, the dual-task TUG. Participants
in all age groups struggled
with counting backward by 3 even
before the secondary physical task
was added, suggesting that this particular
cognitive dual-task item may
have been too difficult to distinguish
among people with different levels
of deficits. This observation is supported
by the study of Padgett et al,22
who found that the dual-task TUG
item was the least representative
item in the entire BESTest. Simplifying
the cognitive task to counting
backward by 2 or using a manual
dual-task TUG35 may be better alternatives
to the current cognitive dualtask
TUG, which can be influenced
by practice and familiarity with
numbers.