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. 2024 Dec 18:18:1498107.
doi: 10.3389/fnhum.2024.1498107. eCollection 2024.

Normative data for instrumented posturography: a systematic review and meta-analysis

Angela Julienne  1 , Evi Verbecque  2 , Stéphane Besnard  1
Affiliations

Normative data for instrumented posturography: a systematic review and meta-analysis

Angela Julienne et al. Front Hum Neurosci. .

Abstract

Postural control is a multisensory adaptive system performing predictive (anticipatory) and/or reactive (compensatory) actions, with varying degrees of accuracy, to maintain balance in a changing environmental context. Common instrumentation to evaluate balance includes static and dynamic force platforms; added sway-referenced perturbations on the dynamic platform constitute its main advantage. Clinical applications notwithstanding, normative data are needed for interpretation in clinical settings. Posturography norms are used to compare a reference group (healthy individuals) and a specific patient population. This work, to the best of our knowledge, represents the first attempt to synthesize the literature on normative data for computerized posturography using a combined mixed method. The search strategy resulted in the retrieval of 1,244 articles from PubMed, Web of Science, and Science Direct. After deduplication, 689 articles were screened based on title and abstract. One hundred and seven articles met the criteria after the first screening. In-depth, full-text screening resulted in the inclusion of 44 studies for the systematic review and 17 studies for the meta-analyses. The main findings of the systematic review are (1) extensive heterogeneity was found in methodological characteristics, (2) there was insufficient risk of bias mitigation, (3) the majority of tasks evaluated less than four components of the systems framework for postural control (SFPC), and (4) studies mostly used distance domain sway parameters and did not report the influence of other variables on postural sway. Based on the multilevel meta-analyses, females appeared to outperform males in eyes closed (EC) conditions significantly. Based on the network meta-analyses, we found that younger children swayed more than those aged between 8 and 14 years both in eyes open (EO) conditions and EC conditions significantly. The results also revealed a significant difference in sway between individuals of age range between 50 and 79 years old and younger individuals, with more instability observed in older participants both in EO conditions and in EC conditions. Thus, future studies need to ensure that enough information about participants is provided. Standardization of experimental conditions and sway parameters harmonization are still needed to ensure high-quality assessment (QA). Finally, evidence-based postural impairment management requires both age- and sex-related normative data. Systematic review registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023378144, identifier PROSPERO 2023 CRD42023378144.

Keywords: Posturography test; meta-analysis; normative data; postural control; systematic review.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart for the systematic review and meta-analysis.
Figure 2
Figure 2
Assessment of study quality (QA) and risk of bias. The risk of bias, using QUADAS’s tool, for each study, is included in the systematic review. Answers were scored “Yes” or “No,” and missing or ambiguous details were scored as “Unclear.” Unreported details were scored as an ‘unclear’ risk of bias.
Figure 3
Figure 3
Methodological characteristics for tasks and sway parameters. (A) Tasks reported in n ≥ 3 number of studies based on the Systems Framework of Postural Control components evaluated in each task. (B) Sway parameters used in n ≥ 3 number of studies and grouped by domain.
Figure 4
Figure 4
Forest plot visualizing the overall effect in EO, calculated using robust variance estimation (RVE). SMD, standardized mean difference between females and males, CI, confidence interval.
Figure 5
Figure 5
(A–D) Forest plot visualizing the overall effect in EC, calculated using robust variance estimation (RVE). SMD, standardized mean difference between females and males; CI, confidence interval.
Figure 6
Figure 6
Forest plot showing the SUCRA ranking and effect estimates for EO (left) and EC (right) conditions. (A,B) The age group 20–29 years was used as a reference for the first subnetwork analysis. (C,D) The age group 14 years was used as a reference for the second subnetwork analysis. SMD, standardized mean difference; CI, confidence intervals.
Figure 7
Figure 7
Network plots for EO condition (left) and EC condition (right) of the (A,B) first and (C,D) the second subnetworks. The width of the lines represents the number of studies comparing each pair of groups. The size of the circle represents the sample size in each arm.
Figure 8
Figure 8
Net league tables for the EO and EC conditions of first subnetwork (upper) and second subnetwork (lower). Relative effect estimates for the contrasts between the different intervention and control arms for the EO condition (lower triangle) and the EC condition (upper triangle). Statistically significant effects are shown in bold letters and highlighted in white cells. SMD, standardized mean difference; CI, confidence intervals.
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