Reliability of center of pressure measures of postural stability in healthy older adults: Effects of postural task difficulty and cognitive load

Postural instability is a major risk factor of falling in the elderly. It is well documented that postural control may decline while performing a concurrent cognitive task and this effect increases with age. Despite the extensive use of dual tasking in balance assessment protocols, a lack of sufficient reliability information is evident. This study determines the reliability of the postural stability measures in older adults, assessed under single and dual-task conditions and different levels of postural difficulty. Sixteen older adults completed quiet stance postural measurements at three levels of difficulty (rigid surface-eyes open, rigid surface-eyes closed, and foam surface-eyes closed), with or without performing a concurrent backward counting task, in two sessions 1 week apart. Force plate data was used to calculate center of pressure (COP) parameters including mean velocity, phase plane portrait, area (95% confidence ellipse), standard deviation (SD) of amplitude, and SD of velocity. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), coefficient of variation (CV), and minimal metrically detectable change (MMDC) were calculated for each COP measure in all test conditions. Mean velocity, total phase plane, phase plane in ML direction, and SD of velocity in ML direction were the most reliable COP measures across all test conditions. ICC values were consistently higher in ML direction compared with AP direction. In general, velocity-related COP measures in ML direction showed to be highly reliable. Further research may explore the predictive and evaluative value of these COP parameters. (C) 2011 Elsevier B.V. All rights reserved.