Interpreting the Need for Initial Support to Perform Tandem Stance Tests of Balance
Identifieur interne : 002375 ( Main/Merge ); précédent : 002374; suivant : 002376Interpreting the Need for Initial Support to Perform Tandem Stance Tests of Balance
Auteurs : Elizabeth S. Hile [États-Unis] ; Jennifer S. Brach [États-Unis] ; Subashan Perera [États-Unis] ; David M. Wert [États-Unis] ; Jessie M. Vanswearingen [États-Unis] ; Stephanie A. Studenski [États-Unis]Source :
- Physical Therapy [ 0031-9023 ] ; 2012.
Abstract
Geriatric rehabilitation reimbursement increasingly requires documented deficits on standardized measures. Tandem stance performance can characterize balance, but protocols are not standardized.
The purpose of this study was to explore the impact of: (1) initial support to stabilize in position and (2) maximum hold time on tandem stance tests of balance in older adults.
A cross-sectional secondary analysis of observational cohort data was conducted.
One hundred seventeen community-dwelling older adults (71% female, 12% black) were assigned to 1 of 3 groups based on the need for initial support to perform tandem stance: (1) unable even with support, (2) able only with support, and (3) able without support. The able without support group was further stratified on hold time in seconds: (1) <10 (low), (2) 10 to 29, (medium), and (3) 30 (high). Groups were compared on primary outcomes (gait speed, Timed “Up & Go” Test performance, and balance confidence) using analysis of variance.
Twelve participants were unable to perform tandem stance, 14 performed tandem stance only with support, and 91 performed tandem stance without support. Compared with the able without support group, the able with support group had statistically or clinically worse performance and balance confidence. No significant differences were found between the able with support group and the unable even with support group on these same measures. Extending the hold time to 30 seconds in a protocol without initial support eliminated ceiling effects for 16% of the study sample.
Small comparison groups, use of a secondary analysis, and lack of generalizability of results were limitations of the study.
Requiring initial support to stabilize in tandem stance appears to reflect meaningful deficits in balance-related mobility measures, so failing to consider support may inflate balance estimates and confound hold time comparisons. Additionally, 10-second maximum hold times limit discrimination of balance in adults with a higher level of function. For community-dwelling older adults, we recommend timing for at least 30 seconds and documenting initial support for consideration when interpreting performance.
Url:
DOI: 10.2522/ptj.20110283
PubMed: 22745198
PubMed Central: 3461133
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Tests of Balance</title><author><name sortKey="Hile, Elizabeth S" sort="Hile, Elizabeth S" uniqKey="Hile E" first="Elizabeth S." last="Hile">Elizabeth S. Hile</name><affiliation wicri:level="2"><nlm:aff id="aff1">E.S. Hile, PT, PhD, NCS, Department of Physical Therapy, University of Pittsburgh, 6035 Forbes Tower, Pittsburgh, PA 15260 (USA).</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName><wicri:cityArea>E.S. Hile, PT, PhD, NCS, Department of Physical Therapy, University of Pittsburgh, 6035 Forbes Tower, Pittsburgh</wicri:cityArea></affiliation></author><author><name sortKey="Brach, Jennifer S" sort="Brach, Jennifer S" uniqKey="Brach J" first="Jennifer S." last="Brach">Jennifer S. Brach</name><affiliation wicri:level="4"><nlm:aff id="aff2">J.S. Brach, PT, PhD, Department of Physical Therapy, University of Pittsburgh.</nlm:aff><country>États-Unis</country><placeName><settlement type="city">Pittsburgh</settlement><region type="state">Pennsylvanie</region></placeName><orgName type="university">Université de Pittsburgh</orgName></affiliation></author><author><name sortKey="Perera, Subashan" sort="Perera, Subashan" uniqKey="Perera S" first="Subashan" last="Perera">Subashan Perera</name><affiliation wicri:level="4"><nlm:aff id="aff3">S. Perera, PhD, Division of Geriatric Medicine, University of Pittsburgh.</nlm:aff><country>États-Unis</country><placeName><settlement type="city">Pittsburgh</settlement><region type="state">Pennsylvanie</region></placeName><orgName type="university">Université de Pittsburgh</orgName></affiliation></author><author><name sortKey="Wert, David M" sort="Wert, David M" uniqKey="Wert D" first="David M." last="Wert">David M. Wert</name><affiliation wicri:level="4"><nlm:aff id="aff4">D.M. Wert, PT, PhD, Department of Physical Therapy, University of Pittsburgh.</nlm:aff><country>États-Unis</country><placeName><settlement type="city">Pittsburgh</settlement><region type="state">Pennsylvanie</region></placeName><orgName type="university">Université de Pittsburgh</orgName></affiliation></author><author><name sortKey="Vanswearingen, Jessie M" sort="Vanswearingen, Jessie M" uniqKey="Vanswearingen J" first="Jessie M." last="Vanswearingen">Jessie M. Vanswearingen</name><affiliation wicri:level="4"><nlm:aff id="aff5">J.M. VanSwearingen, PT, PhD, FAPTA, Department of Physical Therapy, University of Pittsburgh.</nlm:aff><country>États-Unis</country><placeName><settlement type="city">Pittsburgh</settlement><region type="state">Pennsylvanie</region></placeName><orgName type="university">Université de Pittsburgh</orgName></affiliation></author><author><name sortKey="Studenski, Stephanie A" sort="Studenski, Stephanie A" uniqKey="Studenski S" first="Stephanie A." last="Studenski">Stephanie A. Studenski</name><affiliation wicri:level="4"><nlm:aff id="aff6">S.A. Studenski, MD, MPH, Division of Geriatric Medicine, University of Pittsburgh.</nlm:aff><country>États-Unis</country><placeName><settlement type="city">Pittsburgh</settlement><region type="state">Pennsylvanie</region></placeName><orgName type="university">Université de Pittsburgh</orgName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">22745198</idno><idno type="pmc">3461133</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3461133</idno><idno type="RBID">PMC:3461133</idno><idno type="doi">10.2522/ptj.20110283</idno><date when="2012">2012</date><idno type="wicri:Area/Pmc/Corpus">001520</idno><idno type="wicri:Area/Pmc/Curation">001520</idno><idno type="wicri:Area/Pmc/Checkpoint">001699</idno><idno type="wicri:Area/Ncbi/Merge">002105</idno><idno type="wicri:Area/Ncbi/Curation">002105</idno><idno type="wicri:Area/Ncbi/Checkpoint">002105</idno><idno type="wicri:doubleKey">0031-9023:2012:Hile E:interpreting:the:need</idno><idno type="wicri:Area/Main/Merge">002375</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Interpreting the Need for Initial Support to Perform Tandem Stance
Tests of Balance</title><author><name sortKey="Hile, Elizabeth S" sort="Hile, Elizabeth S" uniqKey="Hile E" first="Elizabeth S." last="Hile">Elizabeth S. Hile</name><affiliation wicri:level="2"><nlm:aff id="aff1">E.S. Hile, PT, PhD, NCS, Department of Physical Therapy, University of Pittsburgh, 6035 Forbes Tower, Pittsburgh, PA 15260 (USA).</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName><wicri:cityArea>E.S. Hile, PT, PhD, NCS, Department of Physical Therapy, University of Pittsburgh, 6035 Forbes Tower, Pittsburgh</wicri:cityArea></affiliation></author><author><name sortKey="Brach, Jennifer S" sort="Brach, Jennifer S" uniqKey="Brach J" first="Jennifer S." last="Brach">Jennifer S. Brach</name><affiliation wicri:level="4"><nlm:aff id="aff2">J.S. Brach, PT, PhD, Department of Physical Therapy, University of Pittsburgh.</nlm:aff><country>États-Unis</country><placeName><settlement type="city">Pittsburgh</settlement><region type="state">Pennsylvanie</region></placeName><orgName type="university">Université de Pittsburgh</orgName></affiliation></author><author><name sortKey="Perera, Subashan" sort="Perera, Subashan" uniqKey="Perera S" first="Subashan" last="Perera">Subashan Perera</name><affiliation wicri:level="4"><nlm:aff id="aff3">S. Perera, PhD, Division of Geriatric Medicine, University of Pittsburgh.</nlm:aff><country>États-Unis</country><placeName><settlement type="city">Pittsburgh</settlement><region type="state">Pennsylvanie</region></placeName><orgName type="university">Université de Pittsburgh</orgName></affiliation></author><author><name sortKey="Wert, David M" sort="Wert, David M" uniqKey="Wert D" first="David M." last="Wert">David M. Wert</name><affiliation wicri:level="4"><nlm:aff id="aff4">D.M. Wert, PT, PhD, Department of Physical Therapy, University of Pittsburgh.</nlm:aff><country>États-Unis</country><placeName><settlement type="city">Pittsburgh</settlement><region type="state">Pennsylvanie</region></placeName><orgName type="university">Université de Pittsburgh</orgName></affiliation></author><author><name sortKey="Vanswearingen, Jessie M" sort="Vanswearingen, Jessie M" uniqKey="Vanswearingen J" first="Jessie M." last="Vanswearingen">Jessie M. Vanswearingen</name><affiliation wicri:level="4"><nlm:aff id="aff5">J.M. VanSwearingen, PT, PhD, FAPTA, Department of Physical Therapy, University of Pittsburgh.</nlm:aff><country>États-Unis</country><placeName><settlement type="city">Pittsburgh</settlement><region type="state">Pennsylvanie</region></placeName><orgName type="university">Université de Pittsburgh</orgName></affiliation></author><author><name sortKey="Studenski, Stephanie A" sort="Studenski, Stephanie A" uniqKey="Studenski S" first="Stephanie A." last="Studenski">Stephanie A. Studenski</name><affiliation wicri:level="4"><nlm:aff id="aff6">S.A. Studenski, MD, MPH, Division of Geriatric Medicine, University of Pittsburgh.</nlm:aff><country>États-Unis</country><placeName><settlement type="city">Pittsburgh</settlement><region type="state">Pennsylvanie</region></placeName><orgName type="university">Université de Pittsburgh</orgName></affiliation></author></analytic><series><title level="j">Physical Therapy</title><idno type="ISSN">0031-9023</idno><idno type="eISSN">1538-6724</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Geriatric rehabilitation reimbursement increasingly requires documented
deficits on standardized measures. Tandem stance performance can
characterize balance, but protocols are not standardized.</p></sec><sec><title>Objective</title><p>The purpose of this study was to explore the impact of: (1) initial support
to stabilize in position and (2) maximum hold time on tandem stance tests of
balance in older adults.</p></sec><sec><title>Design</title><p>A cross-sectional secondary analysis of observational cohort data was
conducted.</p></sec><sec><title>Methods</title><p>One hundred seventeen community-dwelling older adults (71% female,
12% black) were assigned to 1 of 3 groups based on the need for
initial support to perform tandem stance: (1) unable even with support, (2)
able only with support, and (3) able without support. The able without
support group was further stratified on hold time in seconds: (1) <10
(low), (2) 10 to 29, (medium), and (3) 30 (high). Groups were compared on
primary outcomes (gait speed, Timed “Up & Go” Test
performance, and balance confidence) using analysis of variance.</p></sec><sec><title>Results</title><p>Twelve participants were unable to perform tandem stance, 14 performed tandem
stance only with support, and 91 performed tandem stance without support.
Compared with the able without support group, the able with support group
had statistically or clinically worse performance and balance confidence. No
significant differences were found between the able with support group and
the unable even with support group on these same measures. Extending the
hold time to 30 seconds in a protocol without initial support eliminated
ceiling effects for 16% of the study sample.</p></sec><sec><title>Limitations</title><p>Small comparison groups, use of a secondary analysis, and lack of
generalizability of results were limitations of the study.</p></sec><sec><title>Conclusions</title><p>Requiring initial support to stabilize in tandem stance appears to reflect
meaningful deficits in balance-related mobility measures, so failing to
consider support may inflate balance estimates and confound hold time
comparisons. Additionally, 10-second maximum hold times limit discrimination
of balance in adults with a higher level of function. For community-dwelling
older adults, we recommend timing for at least 30 seconds and documenting
initial support for consideration when interpreting performance.</p></sec></div></front></TEI></record>Pour manipuler ce document sous Unix (Dilib)
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