Simplifying the star excursion balance test: Analyses of subjects with and without chronic ankle instability

Study Design: Case control study. Objectives: The objectives of this study are: (1) to perform factor analyses on data from the 8 components of the star excursion balance test (SEBT) in subjects with and without chronic ankle instability (CAI) in an effort to reduce the number of components of the SEBT, (2) to assess the relationships between performance of the different reach directions using correlation analyses, and (3) to determine which components of the SEBT are most affected by CAI. Background: The SEBT is a series of 8 lower-extremity-reaching tasks purported to be useful ill identifying lower extremity functional deficits. Methods and Measures: Forty-eight young adults with unilateral CAI (22 males, 26 females; mean +/- SD age, 20.9 +/- 3.2 years; mean +/- SD height, 173.6 +/- 11.1 cm; mean +/- SD mass, 80.1 +/- 22.1 kg) and 39 controls (23 males, 16 females; mean SD age, 20.7 +/- 2.4 years; mean +/- SD height, 174.1 +/- 12.9 cm; mean +/- SD mass, 75.1 +/- 18.6 kg) performed 3 trials of the 8 tasks with each of their limbs. Separate exploratory factor analyses were performed on data for involved limbs of the CAI group, uninvolved limbs of the CAI and control groups, and both limbs of the CAI and control groups. Pearson product moment correlations were calculated to identify the relationships between the different reach directions. A series of eight 2 x 2 analyses of variance were calculated to determine the influence of group (CAI, control) and side (involved, uninvolved) on performance of the 8 tasks. Results: For all 3 factor analyses, only 1 factor in each analysis produced an eigenvalue greater than 1 and the posteromedial reach score was the most strongly correlated task with the computed factor (alpha >.90), although all 8 tasks produced alpha scores greater than .67. Bivariate correlations between specific reach directions ranged from .40 to .91. Subjects with CAI reached significantly less on the anteromedial, medial, and posteromedial directions when balancing on their involved limbs compared to their uninvolved limbs and the side-matched limbs of controls. Conclusions: The posteromedial component of the SEBT is highly representative of the performance of all 8 components of the test in limbs with and without CAI. There is considerable redundancy in the 8 tasks. The anteromedial, medial, and posteromedial reach tasks may be used clinically to test for functional deficits related to CAI in lieu of testing all 8 tasks. There is a need for a hypothesis-driven study to confirm the results of this exploratory study.