Poster Presentation 51st International Society for the Study of the Lumbar Spine Annual Meeting 2025

Short duration quiet standing balance testing is reliable in adult spinal deformity patients: an analysis of minimal detectible change and test-retest reliability. (#184)

Paul A. Oakley 1 , Micheal L. Underhill 2 , Pascal Y Breton 3 , Thomas J Woodham 4 , Miles O Fortner 4 , William H Gage 1 , George Mochizuki 1
  1. York University, Toronto, Ontario, Canada
  2. Private Practice, Beaverton, Oregon, USA
  3. Private Practice, Winnipeg, Ontario, Canada
  4. Private Practice, Gillette, Wyoming, USA

INTRODUCTION

 

There is an effort to incorporate more functional assessment methods in the examination of adult spinal deformity (ASD) patients. Use of force plate derived center-of-pressure (COP) testing is the gold standard for testing standing balance. The modified clinical test of sensory integration and balance (mCTSIB) systematically challenges the different sensory systems and can be useful to isolate the systems contributing to balance control however, its reliability in practice has not been tested. The purpose of this study was to probe the test-retest reliability and clinical feasibility of using short, 20-second, single trials of the mCTSIB on ASD patients.

 

METHODS

 

ASD patients (C7-S1 SVA > 5cm, T4-T12 thoracic kyphosis >60°, and/or scoliosis > 20°) were recruited from 3 spine clinics. Inclusion criteria were: chronic spine pain, ability to stand freely for 30 seconds, speak and read English, and no narcotics/alcohol within the last 24 hours. Exclusion criteria were: conditions that would affect balance and to not have received any manual treatment for their current musculoskeletal disorder within the last 4 weeks. Balance testing included the mCTSIB test which consisted of 4 trials of varying conditions: eyes open-firm surface (standard), eyes closed-firm (proprioception), eyes open-foam surface (visual) and eyes closed-foam (vestibular). Patients stood with feet hip-width apart, on a portable force plate in stocking/bare feet, holding the hands on the hips. Four single, 30-second trials consistent with the mCTSIB were performed two times. Only the last 20 seconds of data was used. The COP total path length (TPL) intraclass correlation coefficients (ICCs) for the 4 trials and the sum (composite) were calculated as well as the standard error of measurement (SEM) and minimal detectable change (MDC95).

 

RESULTS

 

Sixteen ASD patients with an average age of 51.4 ± 20.0 years, BMI of 26.8 ± 4.9 kg/m2, pain intensity of 4.4/10, Oswestry disability rating of 30 ±13%, and back pain duration of 17.4 ± 20 years were recruited for participation. The ICCs for the COP TPL were 0.52, 0.83, 0.90, 0.84 and 0.92 for the standard, proprioception, visual, vestibular and composite scores, respectively. The SEM for the TPL was 3.8, 4.7, 3.5, 12.2 and 13.5 cm, and the MDC95 for the TPL was 10.6, 13.0, 9.8, 33.8 and 37.4 cm, for the standard, proprioception, visual, vestibular and composite scores, respectively.

 

DISCUSSION

 

Other than the standard condition (eyes open-firm surface), the COP TPL was determined to have good-to-excellent reliability (0.83-0.92); thus, the results demonstrate that short, 20-second and single trials of COP data capture are reliable in ASD patients. The standard condition is likely less reliable due to potential flexibility of balance control strategies when the difficulty of the balance task is low. The remaining conditions of the mCTSIB are more clinically useful and are shown to be reliable. Thus, force plate derived COP balance testing may represent a useful functional measure to assess ASD patients in clinical practice.