Objective. The purpose of this study was to explore the usefulness of the Mini-BESTest compared to the Berg Balance Scale in evaluating balance in people with PD of varying severity. We evaluated (1) the distribution of patients scores to look for ceiling effects, (2) concurrent validity with severity of disease, and (3) the sensitivity/specificity of separating people with or without postural response deficits. Subjects. Ninety-seven people with PD were tested for balance deficits using the Berg, Mini-BESTest, Unified Parkinson’s Disease Rating Scale (UPDRS) III and the Hoehn & Yahr (H&Y) disease severity classification. Setting. Clinical research facility at Oregon Health & Science University. Results. The Mini-BESTest is highly correlated with the Berg ( , ), but avoids the ceiling compression effect of the Berg for mild PD (skewness ？2.30 Berg, ？0.93 Mini-BESTest). Consequently, the Mini-BESTest is more effective than the Berg for predicting UPDRS Motor score ( Mini-BESTest versus Berg), and for discriminating between those with and without postural response deficits as measured by the H&Y (ROC differential ). Conclusion. The Mini-BESTest is a promising tool for discerning balance deficits in patients with PD, most importantly those with more subtle deficits. 1. Introduction Postural instability and balance deficits are one of the most debilitating impairments associated with chronic neurological disease, such as Parkinson’s disease (PD) [1]. The most commonly used clinical test of balance severity in people with PD is the Berg Balance Scale (Berg) [2]. The Berg, originally designed for use in the frail elderly, is a 14-item test that focuses on a variety of self-initiated tasks related to everyday function such as sit-to-stand and functional reach forward. The Berg has excellent reliability and is somewhat correlated with severity of PD, as measured with the Unified Parkinson Rating Scale (UPDRS) [3, 4]. However, the Berg has limitations such as documented ceiling effects [5–7] and problems with underutilization and redundancy of categories due to the rating scale [8, 9]. These particular limitations are important considerations when evaluating patients with mild neurological deficits, who are easy to underidentify and therefore less likely to receive rehabilitation. Such documented limitations of the Berg have led many clinicians to do more than one validated balance assessment in order to identify deficits that may respond to treatment. Recently, a new and more comprehensive clinical balance test, the Balance Evaluation Systems Test (BESTest),
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