Original research| Volume 96, ISSUE 12, P2194-2200, December 2015

Reliability and Construct Validity of Limits of Stability Test in Adolescents Using a Portable Forceplate System

Published:August 29, 2015DOI:



      To examine the reliability, convergent, and discriminant validity of the limits of stability (LOS) test to assess dynamic postural stability in adolescents using a portable forceplate system.


      Cross-sectional reliability observational study.


      School setting.


      Adolescents (N=36) completed all measures during the first session. To examine the reliability of the LOS test, a subset of 15 participants repeated the LOS test after 1 week.


      Not applicable.

      Main Outcome Measures

      Outcome measurements included the LOS test, Balance Error Scoring System, Instrumented Balance Error Scoring System, and Modified Clinical Test for Sensory Interaction on Balance.


      A significant relation was observed among LOS composite scores (r=.36–.87, P<.05). However, no relation was observed between LOS and static balance outcome measurements. The reliability of the LOS composite scores ranged from moderate to good (intraclass correlation coefficient model 2,1=.73–.96).


      The results suggest that the LOS composite scores provide unique information about dynamic postural stability, and the LOS test completed at 100% of the theoretical limit appeared to be a reliable test of dynamic postural stability in adolescents. Clinicians should use dynamic balance measurement as part of their balance assessment and should not use static balance testing (eg, Balance Error Scoring System) to make inferences about dynamic balance, especially when balance assessment is used to determine rehabilitation outcomes, or when making return to play decisions after injury.


      List of abbreviations:

      BESS (Balance Error Scoring System), COG (center of gravity), DCL (directional control), ICC (intraclass correlation coefficient), ICC2,1 (intraclass correlation coefficient model 2,1), LOS (limits of stability), mCTSIB (Modified Clinical Test for Sensory Interaction on Balance), MDC (minimal detectable change), RT (reaction time)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Broglio S.P.
        • Puetz T.W.
        The effect of sport concussion on neurocognitive function, self-report symptoms and postural control: a meta-analysis.
        Sports Med. 2008; 38: 53-67
        • Arnold B.L.
        • De la Motte S.
        • Linens S.
        • Ross S.E.
        Ankle instability is associated with balance impairments: a meta-analysis.
        Med Sci Sports Exerc. 2009; 41: 1048-1062
        • Paterno M.V.
        • Schmitt L.C.
        • Ford K.R.
        • et al.
        Biomechanical measures during landing and postural stability predict second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport.
        Am J Sports Med. 2010; 38: 1968-1978
        • Guskiewicz K.M.
        Assessment of postural stability following sport-related concussion.
        Curr Sports Med Rep. 2003; 2: 24-30
        • Nashner L.M.
        • Mccollum G.
        The organization of human postural movements - a formal basis and experimental synthesis.
        Behav Brain Sci. 1985; 8: 135-150
        • Cohen H.
        • Blatchly C.A.
        • Gombash L.L.
        A study of the clinical test of sensory interaction and balance.
        Phys Ther. 1993; 73: 346-354
        • Riemann B.L.
        • Guskiewicz K.M.
        • Shields E.W.
        Relationship between clinical and forceplate measures of postural stability.
        J Sport Rehabil. 1999; 8: 71-82
        • Furman J.M.
        Posturography: uses and limitations.
        Bailliere Clin Neur. 1994; 3: 501-513
        • Goldie P.A.
        • Bach T.M.
        • Evans O.M.
        Force platform measures for evaluating postural control: reliability and validity.
        Arch Phys Med Rehabil. 1989; 70: 510-517
        • Alsalaheen B.A.
        • Haines J.
        • Yorke A.
        • Stockdale K.
        • P Broglio S.
        Reliability and concurrent validity of instrumented balance error scoring system using a portable force plate system.
        Phys Sportsmed. 2015; 43: 221-226
        • Clark S.
        • Rose D.J.
        Evaluation of dynamic balance among community-dwelling older adult fallers: a generalizability study of the limits of stability test.
        Arch Phys Med Rehabil. 2001; 82: 468-474
        • Wikstrom E.A.
        • Tillman M.D.
        • Smith A.N.
        • Borsa P.A.
        A new force-plate technology measure of dynamic postural stability: the dynamic postural stability index.
        J Athl Train. 2005; 40: 305-309
        • Hoffman M.A.
        • Koceja D.M.
        Dynamic balance testing with electrically evoked perturbation: a test of reliability.
        Arch Phys Med Rehabil. 1997; 78: 290-293
        • Shultz S.J.
        • Perrin D.H.
        • Adams J.M.
        • Arnold B.L.
        • Gansneder B.M.
        • Granata K.P.
        Assessment of neuromuscular response characteristics at the knee following a functional perturbation.
        J Electromyogr Kinesiol. 2000; 10: 159-170
        • Wrisley D.M.
        • Marchetti G.F.
        • Kuharsky D.K.
        • Whitney S.L.
        Reliability, internal consistency, and validity of data obtained with the functional gait assessment.
        Phys Ther. 2004; 84: 906-918
        • Cavanaugh J.T.
        • Guskiewicz K.M.
        • Stergiou N.
        A nonlinear dynamic approach for evaluating postural control: new directions for the management of sport-related cerebral concussion.
        Sports Med. 2005; 35: 935-950
        • Sell T.C.
        An examination, correlation, and comparison of static and dynamic measures of postural stability in healthy, physically active adults.
        Phys Ther Sport. 2012; 13: 80-86
        • Hrysomallis C.
        • McLaughlin P.
        • Goodman C.
        Relationship between static and dynamic balance tests among elite Australian Footballers.
        J Sci Med Sport. 2006; 9: 288-291
        • National Federation of State High School Associations
        Annual high school athletics participation survey 2012-2013.
        (Available at:) (Accessed September 14, 2015)
        • Broglio S.P.
        • Zhu W.
        • Sopiarz K.
        • Park Y.
        Generalizability theory analysis of balance error scoring system reliability in healthy young adults.
        J Athl Train. 2009; 44: 497-502
        • Bell D.R.
        • Guskiewicz K.
        • Clark M.A.
        • Padua D.A.
        Systematic review of the Balance Error Scoring System.
        Sports Health. 2011; 3: 287-295
        • Walter S.D.
        • Eliasziw M.
        • Donner A.
        Sample size and optimal designs for reliability studies.
        Stat Med. 1998; 17: 101-110
        • Portney L.
        • Watkins M.
        Foundations of clinical research: applications to practice.
        3rd ed. Prentice-Hall, Upper Saddle River2009
        • Hanline V.L.
        • Olsen B.L.
        Test-retest reliability of the stability evaluation test of the VSR™ -Sport in a pediatric sample.
        J Athl Train. 2013; 48 (S-54-S-55)
        • Geldhof E.
        • Cardon G.
        • De Bourdeaudhuij I.
        • et al.
        Static and dynamic standing balance: test-retest reliability and reference values in 9 to 10 year old children.
        Eur J Pediatr. 2006; 165: 779-786
        • Baumgartner T.
        • Jackson A.
        • Mahar M.
        • Rowe M.
        Measurement for evaluation in physical education and exercise science.
        4th ed. McGraw-Hill, Dubuque1999
        • Beckerman H.
        • Roebroeck M.E.
        • Lankhorst G.J.
        • Becher J.G.
        • Bezemer P.D.
        • Verbeek A.L.
        Smallest real difference, a link between reproducibility and responsiveness.
        Qual Life Res. 2001; 10: 571-578
        • Hertel J.
        • Olmsted-Kramer L.C.
        • Challis J.H.
        Time-to-boundary measures of postural control during single leg quiet standing.
        J Appl Biomech. 2006; 22: 67-73
        • Karlsson A.
        • Frykberg G.
        Correlations between force plate measures for assessment of balance.
        Clin Biomech. 2000; 15: 365-369
        • Hertel J.
        • Buckley W.E.
        • Denegar C.R.
        Serial testing of postural control after acute lateral ankle sprain.
        J Athl Train. 2001; 36: 363-368
        • Pickerill M.L.
        • Harter R.A.
        Validity and reliability of limits-of-stability testing: a comparison of 2 postural stability evaluation devices.
        J Athl Train. 2011; 46: 600-606
        • Hubbard T.J.
        • Kramer L.C.
        • Denegar C.R.
        • Hertel J.
        Contributing factors to chronic ankle instability.
        Foot Ankle Int. 2007; 28: 343-354
        • Davlin C.D.
        Dynamic balance in high level athletes.
        Percept Mot Skills. 2004; 98: 1171-1176
        • Balter S.G.
        • Stokroos R.J.
        • Akkermans E.
        • Kingma H.
        Habituation to galvanic vestibular stimulation for analysis of postural control abilities in gymnasts.
        Neurosci Lett. 2004; 366: 71-75
        • Hatzitaki V.
        • Zisi V.
        • Kollias I.
        • Kioumourtzoglou E.
        Perceptual-motor contributions to static and dynamic balance control in children.
        J Motor Behav. 2002; 34: 161-170
        • Horak F.B.
        • Nashner L.M.
        Central programming of postural movements - adaptation to altered support-surface configurations.
        J Neurophysiol. 1986; 55: 1369-1381
        • Massion J.
        Movement, posture and equilibrium - interaction and coordination.
        Prog Neurobiol. 1992; 38: 35-56
        • Guskiewicz K.M.
        • Perrin D.H.
        • Gansneder B.M.
        Effect of mild head injury on postural stability in athletes.
        J Athl Train. 1996; 31: 300-306
        • Guskiewicz K.M.
        • Riemann B.L.
        • Perrin D.H.
        • Nashner L.M.
        Alternative approaches to the assessment of mild head injury in athletes.
        Med Sci Sports Exerc. 1997; 29: S213-S221
        • Parker T.M.
        • Osternig L.R.
        • van Donkelaar P.
        • Chou L.S.
        Recovery of cognitive and dynamic motor function following concussion.
        Br J Sports Med. 2007; 41: 868-873
        • Quatman-Yates C.C.
        • Lee A.
        • Hugentobler J.A.
        • Kurowski B.G.
        • Myer G.D.
        • Riley M.A.
        Test-retest consistency of a postural sway assessment protocol for adolescent athletes measured with a force plate.
        Int J Sports Phys Ther. 2013; 8: 741-748
        • Hageman P.A.
        • Leibowitz J.M.
        • Blanke D.
        Age and gender effects on postural control measures.
        Arch Phys Med Rehabil. 1995; 76: 961-965
        • Brouwer B.
        • Culham E.G.
        • Liston R.A.
        • Grant T.
        Normal variability of postural measures: implications for the reliability of relative balance performance outcomes.
        Scand J Rehabil Med. 1998; 30: 131-137
        • Liston R.A.
        • Brouwer B.J.
        Reliability and validity of measures obtained from stroke patients using the Balance Master.
        Arch Phys Med Rehabil. 1996; 77: 425-430
        • Newstead A.H.
        • Hinman M.R.
        • Tomberlin J.A.
        Reliability of the Berg Balance Scale and balance master limits of stability tests for individuals with brain injury.
        J Neurol Phys Ther. 2005; 29: 18-23
        • Clark S.
        • Rose D.J.
        • Fujimoto K.
        Generalizability of the limits of stability test in the evaluation of dynamic balance among older adults.
        Arch Phys Med Rehabil. 1997; 78: 1078-1084