Introduction: Concussion is defined as a pathophysiological process affecting the brain, caused by a head impact or blast exposure. Although the injury is usually not life-threatening, the effects may be serious. Accurate diagnosis and proper post-injury management are important steps for mitigating possible consequences. Purpose: To review the existing research about measurement properties of balance tests for screening and assessment of concussion. Methods: The literature was searched in the Pubmed database. Articles written in English and published until June 2021 were included. Results: 26 studies were included in the review. A total of 4.665 subjects were included in the studies of which 2.459 were healthy and 1.415 were diagnosed with concussion. In 18 studies they used Balance Error Scoring System (BESS), in 11 studies it's modified version (mBESS), in one BESS with a cognitive task and in another one Single Leg Stance (SLS). In five studies Tandem Gait (TG) was used and in individual studies TG with a cognitive task, Complex TG, and Modified Star Excursion Balance Test (mSEBT). Research results show that BESS and mBESS are the most appropriate tests for measuring static balance. They both are sensitive and mBESS has a slightly higher specificity. Of all the dynamic balance tests the TG test is the most suitable as it has the highest intra-rater reliability, although in healthy subjects. Tests (BESS, mBESS, TG) had the best discriminative validity if performed in the acute period (<72 hours) after concussion. Discussion and conclusion: The BESS, mBESS, and TG tests are cheaper and easier to perform than tests with high-technology devices, and have satisfactory measurement properties so that they could be appropriate for the on-field balance assessment. The most researched are two tests for static balance (BESS and mBESS), while measurement properties of dynamic balance tests need further research.
|