Elsevier

Gait & Posture

Volume 27, Issue 4, May 2008, Pages 676-682
Gait & Posture

Task-specific measures of balance efficacy, anxiety, and stability and their relationship to clinical balance performance

https://doi.org/10.1016/j.gaitpost.2007.09.002Get rights and content

Abstract

The main objective of this research was to investigate the effects of postural threat on performance of three clinical balance tests. Thirty-one healthy young adults performed quiet stance, maximal reach, and one-leg stance tasks at two levels of postural threat, which was modified through the use of a hydraulic lift. Increased postural threat significantly affected postural control measures for both simple and dynamic balance tests. Physiological and state anxiety increased as a result of increased postural threat whereas ratings of perceived stability and balance efficacy were reduced as a function of increased postural threat. Efforts to diagnose balance disorders based on balance performance may be confounded by the influence of psychological factors.

Introduction

Despite the prevalence of fear of falling, coupled with low balance confidence in older adults [1] and patient populations [2], [3], [4], there has been little focus on the impact of such psychological factors on postural control. The majority of research examining the effects of fear and anxiety on balance behavior has been restricted to posturographic measures [5], [6], [7], [8], [9], [10], which are not commonly used in clinical settings, in addition to being poorly correlated with patient performance during clinical balance assessments [11], [12]. Therefore, it is of value to examine how psychological measures affect performance on tests used in clinical balance assessments; in particular, functional reach and one-leg stance tests, which have shown strong intrarater and interrater reliability [13], [14], [15] and potential for predicting falls in elderly patients [16], [17].

Fear of falling has commonly been assessed using scales such as the Activities-Specific Balance Confidence scale (ABC) [18]. However, there is evidence that psychological measures relating to gait and balance are task-specific [19], and that self-efficacy and anxiety are separate constructs [20], suggesting that independent evaluation tools for confidence, anxiety, and stability are necessary. Task-specific tools that probe self-efficacy and perceived anxiety have been developed, which are sensitive to changes in postural threat and related to concomitant changes in postural control [6]. However, the reliability of these task-specific measures remains unknown.

In this study, a height-induced postural threat was used to gain insight into the relationship between balance and psychological factors. The use of healthy young adults as participants was the result of minimizing potential confounds related to the aging process. The study's objectives were three-fold: (1) to determine the effects of postural threat on balance control during quiet stance, functional reach, and one-leg stance tasks; (2) to explore the predictive validity of task-specific questionnaires; and (3) to determine the reliability of these questionnaires over three repeated sessions.

Section snippets

Subjects

The subjects were: 31 healthy young adults, composed of 18 females (mean ± S.D.: age = 19.94 ± 1.51 years, height = 1.66 ± 0.07 m, mass = 62.06 ± 8.65 kg) and 13 males (mean ± S.D.: age 20.23 ± 1.64 years, height = 1.78 ± 0.08 m, mass = 76.12 ± 12.39 kg) all of whom were volunteer participants. All participants were required to provide written, informed consent in relation to experimental procedures approved by the University of Waterloo's Office of Human Research (OHR# 8509).

Procedure

Participants stood on a portable force platform

Postural changes

MANOVAs for postural measures during the quiet stance revealed a significant main effect of postural threat (Wilks’ = 0.56, F(6,25) = 3.28, p = 0.02). Univariate ANOVAs revealed significant effects for COP measures of AP-RMS, AP-MPF, and AP-MP: F(1,30) = 13.66, p = 0.001; F(1,30) = 6.03, p = 0.02; and F(1,30) = 5.86, p = 0.02, respectively. As shown in Fig. 1A, the AP-MPF was significantly increased (18.26%) in the high compared to the low threat, while the AP-RMS and AP-MP were both significantly reduced

Discussion

Increased frequency and decreased amplitude of COP displacement were observed during quiet standing in conditions of “high” compared to “low” postural threat, which replicates previous findings [5], [6], [8], [9], [10]. We have provided new empirical evidence that postural threat also affects measures of clinical balance performance such as one-leg stance and functional reach.

Diminished performance on one-leg stance and functional reach tests has been observed in healthy older adults and

Conclusions

Postural threat can modify not only physical measures of postural control but also psychological measures of perceived efficacy, anxiety, and stability during both quiet standing and more dynamic balance tasks. It is thus recommended that evaluation of psychological factors be incorporated into assessment and rehabilitation programs.

Conflict of interest statement

There are no known conflicts of interest.

Acknowledgements

Supported by the Natural Sciences and Engineering Research Council of Canada.

The authors would like to acknowledge the editorial input of Julie Falkner and Ryan J. Vetter of The Vetter Group.

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