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RehabMeasures Instrument

Single leg stance or “One-legged stance test”

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Purpose

The SLS is used to assess static postural and balance control.

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Instrument Details

Acronym SLS or OLST

Cost

Free

Diagnosis/Conditions

  • Parkinson's Disease + Neurologic Rehabilitation

Key Descriptions

  • Performed with eyes open and arms on the hips.
  • The participant must stand unassisted on one leg and is timed in seconds from the time one foot is flexed off the floor to the time when it touches the ground or the standing leg or an arm leaves the hips.
  • Participants unable to perform the one-leg stand for at least 5 seconds are at increased risk for injurious fall.

Number of Items

1

Time to Administer

1 minutes

Required Training

No Training

Instrument Reviewers

Updated with references for the PD population by Jeffrey Hoder, PT, DPT, NCS and the PD EDGE task force of the Neurology Section of the APTA in 2013.

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

 

For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

 

Abbreviations:

 

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

 

Recommendations for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post) 

(Vestibular < 6 week post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

(Vestibular > 6 weeks post)

VEDGE

LS

 

LS

 

Recommendations Based on Parkinson Disease Hoehn and Yahr stage: 

 

I

II

III

IV

V

PD EDGE

LS/UR

LS/UR

LS/UR

NR

NR

 

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

PD EDGE

No

No

Yes

Not reported

VEDGE

Yes

Yes

No

Yes

Considerations

With regards to use for people with PD: Average time of SLS for age 80 in healthy older adults is < 10 seconds (Springer, 2007). This may not be a valid predictor of falls in individuals over age 80. Follow up studies after Jacobs (Mak, 2009, 2010) failed to identify 10 seconds as an accurate cut-off to discriminate fallers from non-fallers.

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Non-Specific Patient Population

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Normative Data

(Springer et al, 2007)

Unipedal Stance Test Time by Age Group and Gender for Eyes Open and Closed

 

Age & Gender Groups

Eyes Open Best of 3

Eyes Open Mean

Eyes Closed Best

Eyes Closed Mean

18-39

Female (n= 44)

Male (n = 54)

Total (= 98)

45.1 (0.1)

44.4 (4.1)

44.7 (3.1)

43.5 (3.8)

43.2 (6.0)

43.3 (5.1)

13.1 (12.3)

16.9 (13.9)

15.2 (13.3)

8.5 (9.1)

10.2 (9.6)

9.4 (9.4)

40-49

Female (= 47)

Male (= 51)

Total (n = 98)

42.1 (9.5) 

41.6 (10.2)

41.9 (9.9)

40.4 (10.1)

40.1 (11.5)

40.3 (10.8)

13.5 (12.4)

12.0 (13.5)

12.7 (12.9)

7.4 (6.7)

7.3 (7.4)

7.3 (7.0)

50-59

Female (= 50)

Male (n = 48)

Total (= 98)

40.9 (10.0)

41.5 (10.5)

41.2 (10.2)

36.0 (12.8)

38.1 (12.4)

37.0 (12.6)

7.9 (8.0)

8.6 (8.8)

8.3 (8.4)

5.0 (5.6)

4.5 (3.8)

4.8 (4.8)

60-69

Female (= 50)

Male (= 51)

Total ( = 101)

30.4 (16.4)

33.8 (16.0)

32.1 (16.2)

25.1 (16.5)

28.7 (16.7)

26.9 (16.6)

3.6 (2.3)

5.1 (6.8)

4.4 (5.1)

2.5 (1.5)

3.1 (2.7)

2.8 (2.2)

70-79

Female (= 45)

Male (= 50)

Total (= 95)

16.7 (15.0)

25.9 (18.1)

21.5 (17.3)

11.3 (11.2)

18.3 (15.3)

15.0 (13.9)

3.7 (6.2)

2.6 (1.7)

3.1 (4.5)

2.2 (2.1)

1.9 (0.9)

2.0 (1.6)

80-99

Female (= 22)

Male (= 37)

Total (= 59)

10.6 (13.2)

8.7 (12.6)

9.4 (12.8)

7.4 (10.7)

5.6 (8.4)

6.2 (9.3)

2.1 (1.1)

1.8 (0.9)

1.9 (1.0)

1.4 (0.6)

1.3 (0.6)

1.3 (0.6)

Total (all ages)

Female (= 258)

Male (= 291)

Total (= 549)

33.0 (16.8)

33.8 (17.1)

33.4 (16.9)

29.2 (17.4)

30.2 (17.7)

29.8 (17.5)

7.7 (9.6)

8.2 (10.8)

8.0 (10.3)

4.7 (6.0)

4.9 (6.4)

4.9 (6.2)

Parkinson's Disease

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Criterion Validity (Predictive/Concurrent)

Parkinson’s Disease

(Jacobs, 2006)

Cut-off time of 10 seconds provided the highest sensitivity and specificity for history of one or more falls (75% of those that had a h/o falls exhibited OLS time of 10 seconds or less (high sensitivity); 74% of non-fallers exhibited OLS time of > 10 seconds (high specificity). 67 subjects with PD with 65 age-matched controls (mean age of 67+ 12 years; PD 10+6 yrs) 

For the one-leg stance test, a cut-off time of 10 seconds provided the best combination of sensitivity and specificity for fall history in the PD subjects, consistent with a previous report by Smithson et al who reported that PD subjects with a history of falling, on average, exhibited one-leg stance times of under 10 seconds, and PD subjects without a history of falling, on average, exhibited one-leg stance times of about 15 seconds.

Bibliography

Jacobs, J., Horak, F., et al. (2006). "Multiple balance tests improve the assessment of postural stability in subjects with Parkinson’s disease." Journal of Neurology, Neurosurgery & Psychiatry 77(3): 322-326. 

 Mak, M. K. and Pang, M. Y. (2009). "Balance confidence and functional mobility are independently associated with falls in people with Parkinson’s disease." Journal of neurology 256(5): 742-749. 

Mak, M. K. and Pang, M. Y. (2010). "Parkinsonian single fallers versus recurrent fallers: different fall characteristics and clinical features." Journal of neurology 257(9): 1543-1551. 

Smithson, F., Morris, M. E., et al. (1998). "Performance on clinical tests of balance in Parkinson's disease." Physical therapy 78(6): 577-592. 

Springer, B. A., Marin, R., et al. (2007). "Normative values for the unipedal stance test with eyes open and closed." Journal of geriatric physical therapy 30(1): 8-15.

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