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Development of a Clinical Static and Dynamic Standing Balance Measurement Tool Appropriate for Use in Adolescents

CA Emery, BSc(PT), MSc(Epidemiology), PhD, is an Assistant Professor and Head Physiotherapist, Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, 2500 University Dr NW, Calgary, Alberta, Canada T2N 4E4 (caemery{at}ucalgary.ca)
JD Cassidy, PhD, DrMedSc, is Professor, Public Health Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada, and Senior Scientist, Division of Outcomes and Population Health, Toronto Western Research Institute, University Health Network
TP Klassen, MD, MSc, FRCPC, is Director, Alberta Research Centre for Child Health Evidence, and Professor and Chair, Department of Pediatrics, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
RJ Rosychuk, PhD, is Assistant Professor, Department of Pediatrics, Faculty of Medicine, University of Alberta
BH Rowe, MD, MSc, CCFP(EM), FCCP, is Professor and Research Director, Department of Emergency Medicine, Faculty of Medicine, University of Alberta

Address correspondence to Dr Emery

Background and Purpose. There is a need in sports medicine for a static and dynamic standing balance measure to quantify balance ability in adolescents. The purposes of this study were to determine the test-retest reliability of timed static (eyes open) and dynamic (eyes open and eyes closed) unipedal balance measurements and to examine factors associated with balance. Subjects. Adolescents (n=123) were randomly selected from 10 Calgary high schools. Methods. This study used a repeated-measures design. One rater measured unipedal standing balance, including timed eyes-closed static (ECS), eyes-open dynamic (EOD), and eyes-closed dynamic (ECD) balance at baseline and 1 week later. Dynamic balance was measured on a foam surface. Reliability was examined using both intraclass correlation coefficients (ICCs) and Bland and Altman statistical techniques. Multiple linear regressions were used to examine other potentially influencing factors. Results. Based on ICCs, test-retest reliability was adequate for ECS, EOD, and ECD balance (ICC=.69, .59, and .46, respectively). The results of Bland and Altman methods, however, suggest that caution is required in interpreting reliability based on ICCs alone. Although both ECS balance and ECD balance appear to demonstrate adequate test-retest reliability by ICC, Bland and Altman methods of agreement demonstrate sufficient reliability for ECD balance only. Thirty percent of the subjects reached the 180-second maximum on EOD balance, suggesting that this test is not appropriate for use in this population. Balance ability (ECS and ECD) was better in adolescents with no past history of lower-extremity injury. Discussion and Conclusion. Timed ECD balance is an appropriate and reliable clinical measurement for use in adolescents and is influenced by previous injury.

Key Words: Adolescent • Balance • Measurement • Proprioception • Reliability

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