Assessing An Undirected Limits Of Stability Protocol For Reliability In Individuals With Type 2 Diabetes

BACKGROUND: Limits of Stability (LoS) tests dynamic balance; maintaining stability while shifting weight within one's base of support. This assessment is particularly relevant for individuals with type 2 diabetes (T2D), who face balance impairments due to complications such as neuropathy, retinopathy, and vestibulopathy. The BTrackS LoS test employs an undirected approach, where participants explore their stability limits freely. This protocol was validated with healthy young adults aged 20-30 (Haworth et. al, 2020). However, individuals with T2D may exhibit different postural control due to sensory impairments, highlighting the need to understand this protocol's performance among this population. PURPOSE: This study aims to examine the applicability of an undirected LoS protocol in a T2D population, exploring whether consistent results and movement strategies are observed across multiple trials. METHODS: 72 participants with T2D completed two trials using an undirected LoS protocol. The total area explored by participants (cm2) was measured for each trial. Additionally, laterality assessed bias in the time spent on the right and left side of the platform. To evaluate both absolute agreement and consistency across trials, Intraclass Correlation Coefficient (ICC) (2,k model) analyses were conducted to determine reliability. RESULTS: The area of exploration demonstrated high reliability, with an ICC for absolute agreement of 0.900 and a consistency ICC of 0.914 (T1 M = 315 ± 120, T2 M = 287 ± 113 P < .001). Laterality bias showed good reliability, with an absolute agreement ICC of 0.722 and a consistency ICC of 0.727 (T1 M = -2.2 ± 12.7, T2 M = 0.1 ± 12.5 P < .001). CONCLUSION: The present study demonstrates the reliability of an undirected LOS protocol for assessing dynamic postural stability in individuals with T2D, while recognizing that variations in movement strategies should be taken into account when interpreting results. The findings suggest that a single-trial approach effectively captures limits of stability and postural sway, offering significant advantages in clinical settings by reducing the need for repeated testing. This is particularly beneficial for individuals with chronic conditions like T2D, who may be more prone to fatigue. Supported by: No Grant Funding was received for this project.