Relative and absolute reliability of the new “Step-Ex” step-execution test in elderly people with and without balance problems

Purpose: To evaluate the relative and absolute test–re-test reliability of a new step-execution test, “Step-Ex”, for clinical use in elderly with and without balance problems. Method: Test–re-test design to assess intrarater reliability. Thirty-four healthy community-dwelling elderly (65–87 years), 16 with balance problems, were tested twice two weeks apart. Step-Ex consists of two portable force platforms that register vertical ground reaction forces connected to a computer for easy detection of temporal events and phases (reaction-, preparation-, stepping- and step execution phase). Standing with one foot on each platform, the subjects were given a tactile stimulus on the heel to initiate rapid steps forward. Results: Test–re-test agreement was good to very good: ICC2.6 0.83–0.87 (without balance problems) and 0.71–0.83 (with balance problems) with no apparent systematic differences between the tests. The SEM, i.e. the smallest detectable change that may indicate a real clinical improvement for a group of individuals was small, 4.6–8.6%. The smallest real difference, representing the smallest change that reveals clinical improvement for a single individual, was 13–24%. Conclusion: Step-Ex is a highly reliable instrument and can be recommended as an outcome measure evaluating the effects of balance training in elderly people with and without balance deficits. Implications for Rehabilitation Balance deficits are common in the elderly population. To evaluate the effects of treatment or changes over time it is of great importance to have reliable instruments. Step-Ex is a highly reliable instrument and can be recommended as an outcome measure evaluating the effects of treatment or changes over time in elderly people with and without balance deficits.