{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T06:33:26Z","timestamp":1793428406649,"version":"4.5.0"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,12]]},"abstract":"<jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      Balance impairment is common in multiple sclerosis, but the discriminative performance of clinical balance measures for Expanded Disability Status Scale (EDSS)-defined disability remains unclear. I compared the 42-point modified Mini-Balance Evaluation Systems Test (modified Mini-BESTest) and the Single-Leg Stance Test (SLST) for EDSS greater than or equal to 4.0 in adults with relapsing\u2013remitting multiple sclerosis. This secondary, single-center, cross-sectional diagnostic accuracy analysis used prospectively collected data from 54 ambulatory participants with static or dynamic balance impairment (EDSS = 1.0\u20136.0). Both balance tests were administered during the same outpatient visit, while EDSS was assessed separately by a neurologist. Areas under the receiver operating characteristic curve (AUC) were compared using the DeLong test; associations were estimated with Firth penalized logistic regression, and the Youden-derived threshold was assessed by bootstrapping. Twenty-five participants (46%) had EDSS greater than or equal to 4.0. The modified Mini-BESTest showed an AUC of 0.95 [95% confidence interval (CI) = 0.90\u20131.00], exceeding the SLST (0.77, 0.65\u20130.90; DeLong\n                      <jats:italic toggle=\"yes\">Z<\/jats:italic>\n                      = 3.18,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.002). An exploratory threshold of less than or equal to 31\/42 yielded 92% sensitivity, 90% specificity, a positive likelihood ratio of 8.9 and a negative likelihood ratio of 0.09, and recurred in 79% of 2000 bootstrap resamples. Each additional point was associated with lower adjusted odds of EDSS greater than or equal to 4.0 (odds ratio = 0.75, 95% CI = 0.61\u20130.86). The modified Mini-BESTest showed excellent discrimination and outperformed the SLST. The less than or equal to 31\/42 threshold is exploratory, requires external validation, and must not be applied to the standard 28-point Mini-BESTest.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/mrr.0000000000000721","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T09:00:41Z","timestamp":1790067641000},"page":"286-291","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Discriminative accuracy of the 42-point modified Mini-Balance Evaluation Systems Test for identifying Expanded Disability Status Scale-defined disability in relapsing\u2013remitting multiple sclerosis: an exploratory diagnostic accuracy study"],"prefix":"10.1097","volume":"49","author":[{"given":"Tadeja","family":"Hernja Rumpf","sequence":"first","affiliation":[{"name":"Institute of Physical and Rehabilitation Medicine, University Medical Centre Maribor, Maribor, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"R1-20261031","doi-asserted-by":"crossref","first-page":"1816","DOI":"10.1177\/1352458520970841","article-title":"Rising prevalence of multiple sclerosis worldwide: insights from the Atlas of MS, third edition.","volume":"26","author":"Walton","year":"2020","journal-title":"Mult Scler"},{"key":"R2-20261031","doi-asserted-by":"crossref","first-page":"1444","DOI":"10.1212\/WNL.33.11.1444","article-title":"Rating neurologic impairment in multiple sclerosis: an Expanded Disability Status Scale (EDSS).","volume":"33","author":"Kurtzke","year":"1983","journal-title":"Neurology"},{"key":"R3-20261031","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1080\/08990220802131127","article-title":"Imbalance in multiple sclerosis: a result of slowed spinal somatosensory conduction.","volume":"25","author":"Cameron","year":"2008","journal-title":"Somatosens Mot Res"},{"key":"R4-20261031","doi-asserted-by":"crossref","first-page":"2030","DOI":"10.1016\/j.apmr.2017.11.010","article-title":"Dynamic balance is related to physiological impairments in persons with multiple sclerosis.","volume":"99","author":"Peebles","year":"2018","journal-title":"Arch Phys Med Rehabil"},{"key":"R5-20261031","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.msard.2019.01.034","article-title":"How much does balance and muscle strength impact walking in persons with multiple sclerosis? A cross-sectional study.","volume":"29","author":"Callesen","year":"2019","journal-title":"Mult Scler Relat Disord"},{"key":"R6-20261031","doi-asserted-by":"crossref","first-page":"323","DOI":"10.2340\/16501977-0537","article-title":"Using psychometric techniques to improve the Balance Evaluation Systems Test: the mini-BESTest.","volume":"42","author":"Franchignoni","year":"2010","journal-title":"J Rehabil Med"},{"key":"R7-20261031","doi-asserted-by":"crossref","first-page":"327","DOI":"10.3138\/ptc-2018-0071","article-title":"Reliability, validity, and responsiveness of the Mini-Balance Evaluation Systems Test in ambulatory individuals with multiple sclerosis.","volume":"71","author":"Potter","year":"2019","journal-title":"Physiother Can"},{"key":"R8-20261031","doi-asserted-by":"crossref","first-page":"pzab045","DOI":"10.1093\/ptj\/pzab045","article-title":"Test-retest reliability of the Mini-BESTest in people with mild to moderate multiple sclerosis.","volume":"101","author":"Wallin","year":"2021","journal-title":"Phys Ther"},{"key":"R9-20261031","first-page":"1","article-title":"Inter-rater agreement on the Slovenian translation of the modified short version of the Balance Evaluation Systems Test in patients after stroke (modified mini-BESTest) [in Slovenian].","volume":"21","author":"Rudolf","year":"2013","journal-title":"Fizioterapija"},{"key":"R10-20261031","doi-asserted-by":"crossref","first-page":"1227374","DOI":"10.3389\/fneur.2023.1227374","article-title":"The instrumented single leg stance test detects early balance impairment in people with multiple sclerosis.","volume":"14","author":"Berg-Hansen","year":"2023","journal-title":"Front Neurol"},{"key":"R11-20261031","doi-asserted-by":"crossref","first-page":"h5527","DOI":"10.1136\/bmj.h5527","article-title":"STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies.","volume":"351","author":"Bossuyt","year":"2015","journal-title":"BMJ"},{"key":"R12-20261031","first-page":"22","article-title":"Association of balance disturbances with quality of life in patients with multiple sclerosis [in Slovenian].","volume":"23","author":"Fer\u010dec","year":"2024","journal-title":"Rehabilitacija"},{"key":"R13-20261031","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1186\/1477-7525-8-55","article-title":"Disability status and quality of life in multiple sclerosis: non-linearity of the Expanded Disability Status Scale (EDSS).","volume":"8","author":"Twork","year":"2010","journal-title":"Health Qual Life Outcomes"},{"key":"R14-20261031","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1016\/j.apmr.2013.09.017","article-title":"Neuropsychological, balance, and mobility risk factors for falls in people with multiple sclerosis: a prospective cohort study.","volume":"95","author":"Hoang","year":"2014","journal-title":"Arch Phys Med Rehabil"},{"key":"R15-20261031","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1177\/1545968315597070","article-title":"Prevalence of walking-related motor fatigue in persons with multiple sclerosis: decline in walking distance induced by the 6-minute walk test.","volume":"30","author":"Leone","year":"2016","journal-title":"Neurorehabil Neural Repair"}],"container-title":["International Journal of Rehabilitation Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.1097\/MRR.0000000000000721","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T06:00:55Z","timestamp":1793426455000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1097\/MRR.0000000000000721"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,17]]},"references-count":15,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.1097\/mrr.0000000000000721","relation":{},"ISSN":["0342-5282","1473-5660"],"issn-type":[{"value":"0342-5282","type":"print"},{"value":"1473-5660","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,17]]},"assertion":[{"value":"2026-07-27","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-07","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}