Normalized stability time analysis within the boundaries between adults with and without fear of falling

Abstract

Background: The unilateral stance test, measured by the center of pressure (COP), has been widely used to identify balance deficits. However, there is a critical gap in understanding the specific COP thresholds on postural stability in adults with a fear of falling (FOF). Aims: To investigate the normalized stability time, which was defined as the ratio of time spent within stability boundaries to the total test duration, under different visual conditions and specific thresholds between adults with and without FOF. Methods: Twenty-one older adults with FOF and 22 control subjects completed the unilateral limb standing test in eyes-open and eyes-closed conditions. Normalized stability times were computed based on five pre-determined COP sway range thresholds: 10 mm, 15 mm, 20 mm, 25 mm, and 30 mm. Results: Receiver operating characteristic analysis determined the diagnostic accuracy of FOF. There were significant differences in the effects of both visual conditions (F = 46.88, p = 0.001) and threshold settings (F = 119.38, p = 0.001) on stability time between groups. The FOF group significantly reduced normalized stability time at the 10 mm COP threshold under eyes-closed conditions (t = – 1.95, p = 0.03). Discussion: The findings highlight the heightened sensitivity of the 10 mm COP threshold in identifying group variances in postural stability when eyes are closed. Moreover, the FOF group displayed a marked reduction in stability duration based on visual scenarios and normalized thresholds. Conclusion: The study highlights the need to account for both COP boundaries and visual conditions in adults with FOF. When assessing postural control during unilateral stances, clinicians must also give attention to non-visual cues.