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. 2022 Nov 2:4:999250.
doi: 10.3389/fdgth.2022.999250. eCollection 2022.

Test-Retest reliability and preliminary reliable change estimates for Sway Balance tests administered remotely in community-dwelling adults

Jaclyn B Caccese  1 , Elizabeth Teel  2 , Ryan Van Patten  3   4 , Mélissa A Muzeau  5   6 , Grant L Iverson  7   8   9   10   11 , Heidi A VanRavenhorst-Bell  6   12
Affiliations

Test-Retest reliability and preliminary reliable change estimates for Sway Balance tests administered remotely in community-dwelling adults

Jaclyn B Caccese et al. Front Digit Health. .

Abstract

Objective: Impaired balance and postural stability can occur with advanced age, following traumatic brain injury, in association with neurological disorders and diseases, and as the result of acute or chronic orthopedic problems. The remote assessment of balance and postural stability could be of value in clinical practice and research. We examined the test-retest reliability and reliable change estimates for Sway Balance Mobile Application tests (Sway Medical, Tulsa OK, USA) administered remotely from the participant's home.

Method: Primarily young, healthy community-dwelling adults completed Sway Balance Mobile Application tests remotely on their personal mobile devices once per week for three consecutive weeks while being supervised with a video-based virtual connection. Sway Balance tests include five stances (i.e., feet together, tandem right foot forward, tandem left foot forward, single leg right foot, single leg left foot), which are averaged to compute a Sway Balance composite score from 0 to 100, with higher scores indicating better postural stability. We examined test-retest reliability (measured with intraclass correlation coefficients, ICCs) and preliminary reliable change estimates for 70%, 80%, and 90% confidence intervals.

Results: Participants included 55 healthy adults (ages = 26.7 ± 9.9 years, interquartile range = 20-30, range = 18-58; 38 [69%] women). Test-retest reliability for the Sway Balance composite score across three weeks was.88. Test-retest reliability for individual stances ranged from 62 to 83 (all ps < 0.001). At the 80% confidence interval, preliminary reliable changes estimates were 9 points for the Sway Balance composite score.

Conclusions: For a remote administration, test-retest reliability was moderate-to-good for all Sway Balance stances, as well as for the Sway Balance composite score. Reliable change estimates may allow clinicians to determine whether an improvement or decline in performance is greater than the expected improvement or decline due to measurement error in young adults.

Keywords: balance; balance error scoring system (BESS); concussion; postural stability; psychometrics (MeSH).

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Conflict of interest statement

Author MM was employed by the company Sporttesting. Grant Iverson, Ph.D. serves as a scientific advisor for Sway Medical, Inc. Operations, the company that created and distributes the tests used in this study. He acknowledges unrestricted philanthropic support from ImPACT Applications, Inc., the Mooney-Reed Charitable Foundation, Boston Bolts, Heinz Family Foundation, National Rugby League, and the Schoen Adams Research Institute at Spaulding Rehabilitation. He has received research funding from several test publishing companies, including ImPACT Applications, Inc., CNS Vital Signs, and Psychological Assessment Resources (PAR, Inc.), the National Football League (NFL), and the NFL Players Association. He serves as a scientific advisor for Highmark, Inc. and NanoDx™ (formerly BioDirection, Inc.). No other authors have financial conflicts of interest to disclose.

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