Interpreting the need for initial support to perform tandem stance tests of balance

Abstract

Background: Geriatric rehabilitation reimbursement increasingly requires documented deficits on standardized measures. Tandem stance performance can characterize balance, but protocols are not standardized. Objective 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. Design A cross-sectional secondary analysis of observational cohort data was conducted.

Methods: 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.

Results: 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. Limitations Small comparison groups, use of a secondary analysis, and lack of generalizability of results were limitations of the study.

Conclusions: 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.

Figure.

Descriptive results for tandem stance performance with participants categorized based on ability to perform tandem stance with or without initial support to stabilize in position. All percentages indicate the percentage of the total sample (n=117). 10TSTS=10-second tandem stance test with support, 30TST=30-second tandem stance test without support. Unable even with support=unable to hold tandem stance for 1 second, even if supported until stable in position; unable to perform either the 10TSTS protocol or the 30TST protocol. Able only with support=holds tandem stance only if supported until stable in the position; able to perform the 10TSTS, but not the 30TST protocol. Able without support=holds tandem stance after stabilizing in position without initial support; able to perform both the 10TSTS and 30TST protocols. Support=light physical assistance provided at one arm while moving feet into tandem stance position and attempting to stabilize.