THE STAR EXCURSION BALANCE TEST IS A RELIABLE AND VALID OUTCOME MEASURE FOR PATIENTS WITH KNEE OSTEOARTHRITIS

Review written by Dr Mariana Wingood info

BACKGROUND & OBJECTIVE

Active movement needs muscle coordination and joint stability, both of which require neuromuscular control. In individuals with knee osteoarthritis (OA), neuromuscular control is often impaired. This impairment is associated with increased risk of falling and/or injury, highlighting the importance of assessing and addressing neuromuscular impairments. In healthy adults or individuals with history of anterior cruciate ligament injury/ankle instability, neuromuscular control is assessed with the star excursion balance test (SEBT).

The SEBT is a dynamic test that requires an individual to stand on one leg while performing a maximal reach in eight directions with the opposite limb. To guide the participant, each direction is taped on the ground at 45 degrees to each other. See Figure 1 for a visual representation of the SEBT tape set up.

Since this method has not been validated in individuals with knee OA, the purpose of this study was to assess the test-retest reliability, concurrent validity and longitudinal validity of the SEBT in patients with knee OA. The authors hypothesized that the SEBT is a suitable outcome measure of neuromuscular control in patients with knee OA.

Figure 1: SEBT Image

METHODS

Subjects: Diagnosed with knee OA - knee pain and > 3 of the following clinical findings: 50+ years old, morning stiffness < 30 minutes, crepitus, bony tenderness on the joint, bony enlargement, and lack of palpable warmth. Intervention/Home Exercise Program:

  • Performed by all participants
  • 3x/week for 12 weeks
  • Focus on neuromuscular control
  • Program components:
    • Range of motion and stretching
    • Knee and hip strengthening exercises: step ups, forward lunges, chair stands, clam shells, etc
    • Two-legged and single limb standing balance

Outcomes:

  • Motion capture software
  • SEBT – recorded in cm and normalized to leg length (LL)
  • 40m fast-paced gait speed
  • Patient-reported outcome: Knee Injury and Osteoarthritis Outcome Score (KOOS) and numeric rating scale of pain

RESULTS

The interclass correlation coefficient was 0.94 (95% CI 0.91,0.96), indicating excellent test-retest reliability. The standard error of measurement was +/- 2.68cm and +/- 3.08% LL. The observer’s measurement of reach for both stance legs were highly correlated in all directions

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