Star Excursion Balance Test

The Star Excursion Balance Test (SEBT) is a dynamic test that requires strength, flexibility, and proprioception. It is a measure of dynamic balance that provides a significant challenge to athletes and physically active individuals.

The test can be used to assess physical performance, but can also be used to screen deficits in dynamic postural control due to musculoskeletal injuries (e.g. chronic ankle instability), to identify athletes at greater risk for lower extremity injury, as well as during the rehabilitation of orthopedic injuries in healthy active adults (1)

Research has suggested to use this test as a screening tool for sport participation as well as a post-rehabilitation test to ensure dynamic functional symmetry. 

Figure (physiopedia)

How to perform The SEBT:

Conducting the Test (science for sport)

  • The athlete should be wearing lightweight clothing and remove their footwear. After doing so, they are the required to stand in the centre of the star, and await further instruction.
  • When using the right foot as the reaching foot, and the left leg to balance, the athlete should complete the circuit in a clockwise fashion. When balancing on the right leg, the athlete should perform the circuit in an anti-clockwise fashion.
  • With their hands firmly placed on their hips, the athlete should then be instructed to reach with one foot as far as possible and lightly touch the line before returning back to the starting upright position.
  • With a pencil, the test administrator should mark the spot at which the athlete touched the line with their toe. This can then be measured from the centre spot after the test to calculate the reach distance of each reach direction. Reach distances should be recorded to the nearest 0.5cm (22).
  • They should then repeat this with the same foot for all reach directions before changing foot.
  • After they have completed a full circuit (every reach direction) with each foot, they should then repeat this process for a total of three times per leg. For example, they should have three anterior reach performances for both their right and left leg.
  • Once the athlete has performed 3 successful reaches with each foot in all directions, they are then permitted to step away from the testing area.
  • The test administrator should have recorded the reach distance of each successful attempt, with a pencil, in order to calculate the athlete’s SEBT score after the test.

Scoring System

With the test complete and all performances measured and recorded, the test administrator can then calculate the athlete’s SEBT performance scores using the following simple equations:

  • Average distance in each direction (cm) = Reach 1 + Reach 2 + Reach 3 / 3
  • Relative (normalised) distance in each direction (%) = Average distance in each direction / leg length * 100

These calculations should be performed for both the right and left leg in each direction, providing you with a total of 16 scores per athlete.

 Normative data

Figure ( Miller, T., 2012).

  • According to Hertel, Miller, and Deneger (2000), the reliability of the SEBT ranges between r = 0.85-0.96
  • According to Plisky et al (2006), the reliability of this test ranges between 0.82-0.87 and scores 0.99 for the measurement of limb length
  • Chaiwanichsiri et al (2005) concluded that the Star Excursion Balance training was more effective than a conventional therapy program in improving functional stability of a sprained ankle
  • Plisky et al (2009) concluded that the intra-rater reliability of the SEBT as being moderate to good (ICC 0.67- 0.97) and inter-rater reliability as being poor to good (0.35-0.93) [2]

Supporting Articles/text

Advanced fitness assessment and exercise prescription. Heyward V. Human kinetics, 6th edition: 303 (5)

Miller, T. (2012). National Strength and Conditioning Association. Test and Assessment. Human Kinetics. Champagne, IL.

Bressel E, Yonker JC, Kras J, Heath EM. Comparison of Static and Dynamic Balance in Female Collegiate Soccer, Basketball, and Gymnastics Athletes. Journal of Athletic Training 2007;42(1):42–46.

Chaiwanichsiri D., Lorprayoon E., Noomanoch L. (2005). Star Excursion Balance Training : Effects on Ankle Functional Stability after Ankle Sprain. Journal of Medical Association Thailand 88(4): 90-94 (1B)

Plisky P., Rauh M., Kaminski T., Underwood F (2006) Star Excursion Balance Test as a Predictor of Lower Extremity Injury in High School Basketball Players. Journal of Orthopaedic and Sports Physical Therapy. 36 (12) (1B)

Plisky P et al. (2009). The Reliability of an Instrumented Device for Measuring Components of the Star Excursion Balance Test.  American Journal of Sports Physical Therapy. 4(2): 92–99. (2B)

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Star Excursion Balance Test (SEBT)

The Star Excursion Balance Test (SEBT) is a test of dynamic balance, using in a single-leg stance that requires strength, flexibility, core control and proprioception. The test requires participants to balance on one leg and reach as far as possible in eight different directions. The similar Y-Balance Test was derived from this test.

purpose : To assess active balance and core control

equipment required: A flat, smooth, non-slip surface, measuring tape, marking tape. To prepare for the test, four 120cm lengths of marking tape are placed on to the floor, intersecting in the middle, and with the lines placed at 45-degree angles.

pre-test: Explain the test procedures to the subject. Perform screening of health risks and obtain informed consent. Prepare forms and record basic information such as age, height, body weight, gender, test conditions. Perform an appropriate warm-up. See more details of pre-test procedures .

procedure: The subject should be wearing lightweight and non-restrictive clothing and no footwear. The subject stands on one foot in the center of the star with their hands on their hips. They then reach with one foot as far as possible in one direction and lightly touch the line before returning back to the starting position. The support foot must stay flat on the ground. This is repeated for a full circuit, touching the line in every reach direction. The assessor should mark the spot on the line where the subject was able to reach. The test should be repeated three times for each foot. The trial is invalid if the subject cannot return to the starting position, the foot makes too heavy of a touch, or if the subject loses balance. see video .

Star Excursion Balance Test (SEBT)

Scoring : After the test all the reached distances are recorded to the nearest 0.5cm. Calculate Average distance in each direction (average of the three measurements) and Relative (normalised) distance in each direction (%) (average distance in each direction / leg length * 100). These calculations should be performed for both the right and left leg in each direction, providing a total of 16 scores per athlete.

Comments: this test has been used as an indicator of lower limb injury risk in a variety of populations

advantages: this is a simple test to perform with simple and inexpensive equipment.

disadvantages: the test can be time-consuming if it needs to be performed on a large group of individuals.

The Test in Action

  • See a video description of the star excursion balance test

Similar Tests

  • A similar test, the y-balance test

Related Pages

  • See a video about the Y Balance test
  • About balance testing
  • Other balance tests

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Star Excursion Balance Test

The Star Excursion Balance Test (SEBT) is a simple, but time intensive, test used to measure dynamic balance/dynamic postural control.

Owen Walker

By Owen Walker Last updated: February 29th, 2024 8 min read

Contents of Article

What is the Star Excursion Balance Test?

Why is balance important in sports, how do you conduct the star excursion balance test, what is the star excursion balance test scoring system, is the star excursion balance test valid and reliable, further reading.

  • About the Author

The Star Excursion Balance Test was developed to be a reliable measure of dynamic stability. Since then, it has proven to be a sensitive indicator of lower limb injury risk in a variety of populations. To add to this, the Star Excursion Balance Test has been shown to have high levels of intra-rater test-retest reliability , though no validity coefficients have been studied.

The Star Excursion Balance Test (SEBT) is a relatively simple, but somewhat time-intensive, test used to measure dynamic balance, otherwise known as dynamic postural control (1). It measures dynamic balance by challenging athletes to balance on one leg and reach as far as possible in eight different directions (2). Though the SEBT is very similar to the Y Balance Test TM , it is important to understand that these are in fact different, with the Y Balance Test TM being a newer and condensed version of the SEBT.

Performance on the SEBT has been shown to differentiate between individuals with lower limb conditions such as chronic ankle instability (3-10), patellofemoral pain (11), and anterior cruciate ligament reconstruction (12). To add to this, the SEBT is even capable of assessing improvements in dynamic balance following training interventions (13, 14).

Perhaps the SEBT’s greatest talent is its ability to identify athletes with a higher risk of lower limb injury. For example, an anterior reach asymmetry of greater than 4cm during the SEBT has been suggested to predict which individuals are at higher risk of lower limb injury (15). However, other researchers have found that only female athletes with a composite score of less than 94 % of limb length were at greater risk of injury (15). More recent research in collegiate American football players has shown that athletes with a composite score of less than 90 % are 3.5 times more likely to sustain an injury (16).

All of this information suggests that each sport and population (e.g. gender) appear to have their own injury risk cut-off point (15, 16).

Balance, otherwise known as ‘postural control’, can be defined statically as the ability to maintain a base of support with minimal movement, and dynamically as the ability to perform a task while maintaining a stable position (17, 18). In a chaotic sporting environment, the ability to maintain a stable position is vital not only for successful application of the skill but to also reduce the likelihood of injury (15, 16, 19).

As dynamic balance is an integral part of performance, and poor balance is related to a higher risk of injury (20, 21, 15), then it may be of great interest to test and monitor an athlete’s dynamic stability.

It is important to understand that whenever fitness testing is performed, it must be done so in a consistent environment (e.g. facility) so it is protected from varying weather types, and with a dependable surface that is not affected by wet or slippery conditions. If the environment is not consistent, the reliability of repeated tests at later dates can be substantially hindered and result in worthless data.

Required Equipment Before the start of the test, it is important to ensure you have the following items:

  • Reliable and consistent testing facility (minimum 2×2 metres (m)).
  • Test administrator(s)
  • Sticky tape (minimum 8m)
  • Measuring tape
  • Performance recording sheet

Test Configuration Video 1 displays the test configuration for the SEBT. This setup must be adhered to if accurate and reliable data is desired. The test administrator should stick four 120 cm lengths of sticky tape onto the floor, intersecting in the middle, and with the lines placed at 45°   angles (2).

Participants should thoroughly warm up prior to the commencement of the test. Warm-ups should correspond to the biomechanical and physiological nature of the test. In addition, sufficient recovery (e.g. 3-5 minutes) should be administered following the warm-up and prior to the commencement of the test.

Conducting the test

  • The athlete should be wearing lightweight clothing and remove their footwear. After doing so, they are then required to stand in the centre of the star and await further instruction.
  • When using the right foot as the reaching foot, and the left leg to balance, the athlete should complete the circuit in a clockwise fashion. When balancing on the right leg, the athlete should perform the circuit in an anti-clockwise fashion.
  • With their hands firmly placed on their hips, the athlete should then be instructed to reach with one foot as far as possible and lightly touch the line before returning back to the starting upright position.
  • With a pencil, the test administrator should mark the spot at which the athlete touched the line with their toe. This can then be measured from the centre spot after the test to calculate the reach distance of each reach direction. Reach distances should be recorded to the nearest 0.5cm (22).
  • They should then repeat this with the same foot for all reach directions before changing foot.
  • After they have completed a full circuit (every reach direction) with each foot, they should then repeat this process for a total of three times per leg. For example, they should have three anterior reach performances for both their right and left leg.
  • Once the athlete has performed three successful reaches with each foot in all directions, they are then permitted to step away from the testing area.
  • The test administrator should have recorded the reach distance of each successful attempt, with a pencil, in order to calculate the athlete’s SEBT score after the test.

NOTE: Failed attempts include the following:

  • The athlete cannot touch their foot down on the floor before returning back to the starting position. Any loss of balance will result in a failed attempt.
  • The athlete cannot hold onto any implement to aid their balance.
  • The athlete must keep their hands on their hips at all times throughout the test.
  • The athlete must lightly touch their toe on the reach line whilst staying in full control of their body. Any loss of balance resulting in a heavy toe/foot contact with the floor should be regarded as a failed attempt.

With the test complete and all performances measured and recorded, the test administrator can then calculate the athlete’s SEBT performance scores using the following simple equations (17):

  • Average distance in each direction (cm) = Reach 1 + Reach 2 + Reach 3 / 3
  • Relative (normalised) distance in each direction (%) = Average distance in each direction / leg length * 100

These calculations should be performed for both the right and left leg in each direction, providing you with a total of 16 scores per athlete.

Though no validity coefficients are available for the SEBT, authors (23) have provided evidence that the SEBT is sensitive for screening various musculoskeletal injuries (17). Furthermore, high intratester reliability has been found for the SEBT (intraclass correlation coefficients = 0.78 – 0.96) (24).

We suggest you now check out this article on The Landing Error Scoring System (LESS).

All information provided in this article is for informational and educational purposes only. We do not accept any responsibility for the administration or provision of any testing conducted, whether that results in any positive or negative consequences. As an example, we do not take any responsibility for any injury or illness caused during any test administration. All information is provided on an as-is basis.

  • Nelson, Brian D., “Using the Star Excursion Balance test as a predictor of lower extremity injury among high school basketball athletes” (2012).Theses and Dissertations. Paper 389. [Link]
  • Gribble PA, Kelly SE, Refshauge KM, Hiller CE. Interrater Reliability of the Star Excursion Balance Test. Journal of Athletic Training 2013;48(5):621–626. [PubMed]
  • Akbari M, Karimi H, Farahini H, Faghihzadeh S. Balance problems after unilateral lateral ankle sprains. J Rehabil Res Dev. 2006;43(7): 819–824. [PubMed]
  • Gribble PA, Hertel J, Denegar CR. Chronic ankle instability and fatigue create proximal joint alterations during performance of the Star Excursion Balance Test. Int J Sports Med. 2007;28(3):236–242. [PubMed]
  • Gribble PA, Hertel J, Denegar CR, Buckley WE. The effects of fatigue and chronic ankle instability on dynamic postural control. J Athl Train. 2004;39(4):321–329. [PubMed]
  • Hale SA, Hertel J, Olmsted-Kramer LC. The effect of a 4-week comprehensive rehabilitation program on postural control and lower extremity function in individuals with chronic ankle instability. J Orthop Sport Phys Ther. 2007;37(6):303–311. [PubMed]
  • Hertel J, Braham RA, Hale SA, Olmsted-Kramer LC. Simplifying the Star Excursion Balance Test: analyses of subjects with and without chronic ankle instability. J Orthop Sport Phys Ther. 2006;36(3):131– 137. [PubMed]
  • Martinez-Ramirez A, Lecumberri P, Gomez M, Izquierdo M. Wavelet analysis based on time-frequency information discriminate chronic ankle instability. Clin Biomech (Bristol, Avon). 2010;25(3): 256–264. [PubMed]
  • Nakagawa L, Hoffman M. Performance in static, dynamic, and clinical tests of postural control in individuals with recurrent ankle sprains. J Sport Rehabil. 2004;13(3):255–268. [Link]
  • Olmsted LC, Carcia CR, Hertel J, Shultz SJ. Efficacy of the Star Excursion Balance Tests in detecting reach deficits in subjects with chronic ankle instability. J Athl Train. 2002;37(4):501–506. [PubMed]
  • Aminaka N, Gribble PA. Patellar taping, patellofemoral pain syndrome, lower extremity kinematics, and dynamic postural control. J Athl Train. 2008;43(1):21–28. [PubMed]
  • Herrington L, Hatcher J, Hatcher A, McNicholas M. A comparison of Star Excursion Balance Test reach distances between ACL deficient patients and asymptomatic controls. Knee. 2009;16(2):149–152. [PubMed]
  • McKeon PO, Ingersoll CD, Kerrigan DC, Saliba E, Bennett BC, Hertel J. Balance training improves function and postural control in those with chronic ankle instability. Med Sci Sports Exerc. 2008; 40(10):1810–1819. [PubMed]
  • McLeod TC, Armstrong T, Miller M, Sauers JL. Balance improvements in female high school basketball players after a 6- week neuromuscular-training program. J Sport Rehabil. 2009;18(4): 465–481. [PubMed]
  • Plisky PJ, Rauh MJ, Kaminski TW, Underwood FB. Star Excursion Balance Test as a predictor of lower extremity injury in high school basketball players. J Orthop Sports Phys Ther. 2006;36(12):911–919. [PubMed]
  • Butler RJ, Lehr ME, Fink ML, Kiesel KB, Plisky PJ. Dynamic balance performance and noncontact lower extremity injury in college football players: an initial study. Sports Health. 2013;5(5): 417–422. [PubMed]
  • Bressel E, Yonker JC, Kras J, Heath EM. Comparison of Static and Dynamic Balance in Female Collegiate Soccer, Basketball, and Gymnastics Athletes. Journal of Athletic Training 2007;42(1):42–46. [PubMed]
  • Winter DA, Patla AE, Frank JS. Assessment of balance control in humans. Med Prog Technol. 1990;16:31–51. [PubMed]
  • Zazulak B, Cholewicki J, and Reeves NP. Neuromuscular control of trunk stability: Clinical implications for sports injury prevention. J Am Acad Orthop Surg 16: 497–505, 2008. [PubMed]
  • de Noronha M, Franca LC, Haupenthal A, Nunes GS. Intrinsic predictive factors for ankle sprain in active university students: a prospective study [published online January 20, 2012]. Scan J Med Sci Sports. doi:10.1111/j.1600-0838.2011.01434. [PubMed]
  • McGuine T. Sports injuries in high school athletes: a review of injury-risk and injury-prevention research. Clin J Sports Med. 2006;16:488-499. [PubMed]
  • Shaffer SW, Teyhen DS, Lorenson CL, Warren RL, Koreerat CM, Straseske CA, Childs JD. Y-Balance Test: a reliability study involving multiple raters. Mil Med. 2013;178(11):1264-70. [PubMed]
  • Olmstead L, Carcia C, Hertel J, Shultz S. Efficacy of star excursion balance test in detecting reach deficits in subjects with chronic ankle instability. Journal of Athletic Training. 2002;37(4):501-507. [PubMed]
  • Hertel J, Miller S, Denegar C. Intratester and intertester reliability during the star excursion balance test. Journal of Sport Rehabilitation. 2000;9(1):104-116. [Link]

modified star excursion balance test scoring

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  • v.14(5); 2019 Sep

THE RELIABILITY OF THE STAR EXCURSION BALANCE TEST AND LOWER QUARTER Y-BALANCE TEST IN HEALTHY ADULTS: A SYSTEMATIC REVIEW

Cameron j. powden.

1 Department of Athletic Training, University of Indianapolis, Indianapolis, IN, USA

Teralyn K. Dodds

2 Department of Applied Medicine and Rehabilitation, Indiana State University, Terra Haute, IN, USA

Emily H. Gabriel

3 Department of Athletic Training, Mercer University, Macon, GA, USA

Dynamic balance is often an important criterion used during lower extremity musculoskeletal injury prediction, prevention, and rehabilitation processes. Methods to assess lower extremity dynamic balance include the Star Excursion Balance Test (SEBT) and Lower Quarter Y-Balance Test (YBT). Due to the importance of dynamic balance it is imperative to establish reliable quantification techniques.

To conduct a systematic review to assess the reliability and responsiveness of the SEBT/YBT.

Study Design

Systematic Review.

Electronic databases (PubMed, MEDLINE, CINAHL, and SPORTDiscus) were searched from inception to August 2018. Included studies examined the intra- and inter-rater reliability of the SEBT/YBT in healthy adults. Two investigators independently assessed methodological quality, level of evidence and strength of recommendation with the Qualtiy Appraisal of Reliability Studies (QAREL) scale. Relative intra and inter-rater reliability was examined through intraclass correlation coefficients (ICC) and responsiveness was evaluated through minimal detectable change (MDC). Data was analyzed based on reach direction (Anterior, Posteromedial, and Posterolateral) and normalization (normalized and non-normalized). Additionally, data were then synthesized using the strength of recommendation taxonomy to provide a grade of recommendation.

A total of nine studies were included in this review. Six studies examined the inter-rater reliability and seven assessed intra-rater reliability. The included studies had a median QAREL score of 66.89% (range = 55.56% to 75.00%) and 59.03% (range = 33.33 to 66.67%) for inter and intra-rater reliability respectively. Median ICC values for inter-rater reliability were 0.88 (Range = 0.83 – 0.96), 0.87 (range = 0.80 – 1.00), and 0.88 (range = 0.73 – 1.00) for the anterior, posteromedial, and posterolateral directions respectively. Median ICC values for intra-rater reliability were 0.88 (Range = 0.84 – 0.93), 0.88 (Range = 0.85 – 0.94), and 0.90 (Range = 0.68 – 0.94) for the anterior, posteromedial, and posterolateral directions, respectively.

Conclusions

There is grade A evidence to support that the SEBT/YBT have excellent inter and intra-rater reliability when used in healthy adults. Furthermore, minimal detectable change values have been provided that can be used in practice to aid clinical decision making. Future research is needed to assess the reliability, responsiveness, and validity of the SEBT/YBT in pathologic populations.

Level of Evidence

Introduction.

It is estimated that approximately three to five million sport related injuries occur each year and primarily occur within the lower extremity. 1 , 2 These injuries result in significant time loss, medical costs, and often long term consequences such as an increased risk of osteoarthritis when joint trauma has occurred. 3 Due to the prevalence and burden of lower extremity injuries, it is imperative to develop screening tools to identify those at risk of injury and implement proper preventative interventions. Effective injury screening tools and subsequent preventative strategies can ultimately reduce the incidence of injuries, time loss from participation, and healthcare costs associated with the short and long-term treatment of these injuries. 4 , 5 Dynamic balance is thought to be essential for those participating in physical activity. 6 , 7 Therefore, deficits in balance have been widely investigated as a predictor of lower extremity injury. 6-8 Furthermore, dynamic balance is regularly used during the rehabilitation process to track progress and make return to play decisions. 8 , 9 The established clinical importance of dynamic balance for injury prediction, prevention, and decision making necessitates the establishment of reliable measurement tools.

The Star Excursion Balance Test (SEBT) and lower quarter Y-Balance Test (YBT) are two of the most prominent tools in the literature to measure dynamic balance of the lower extremity. 10 The SEBT began as a star comprised of four lines, all crossing at the same center point. 11 To complete the test, an individual stands at the center of the star then reaches with the contralateral leg as far as possible along one of the eight reach directions, while maintaining single leg squat stance. 11 The distance reached is measured in centimeters and typically normalized to the participant's height or leg length to quantify dynamic balance; however it can also be completed without leg length normalization. 11 In its current form, the SEBT has been reduced to three directions due to redundancy ( Figure 1 ). 12 Additionally, an instrumented version, the YBT, was created with the intention to improve the reliability and uniformity of administration of the test. 13 Similar to the SEBT, the YBT consists of three reach directions (anterior, posteromedial, posterolateral) which require participants to move in similar patterns ( Figure 1 ). Although the movements necessary for both tests are similar, research has indicated the anterior reach distances have been different when comparing the two tests. 13 Therefore, the two instruments may not be directly comparable. Clinicians and researchers commonly use the SEBT and YBT to assess dynamic balance, track changes in performance after the introduction of an injury prevention or rehabilitation program, and to identify those that may be at a heightened risk of injury. 8 , 14 , 15

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Object name is ijspt-14-683-F001.jpg

Star-Excursion Balance Test and Y-Balance Test Examples, A) Setup, B) Anterior Reach (ANT), C) Posterolateral Reach (PL), D) Posteromedial Reach (PM) .

With the SEBT and YBT commonly being used to assess dynamic balance, ensuring consistency is essential for clinical decision-making. Currently, there have been a variety of SEBT and YBT methodologies evaluated in the literature to assess the reliability of these tests. 16-22 Although there are several reliability studies, it is challenging to draw conclusions from the literature because of the varied assessment techniques and lack of evidence consolidation. Therefore, the purpose of this systematic review was to collect, critically appraise, and synthesize the published evidence describing the inter-rater and intra-rater reliability of the SEBT and YBT to measure dynamic balance in healthy adults.

Search Strategy

The PRISMA guidelines were followed to conduct a systematic search of the literature to identify studies assessing intra-rater and/or inter-rater reliability of the SEBT and YBT as well as report those findings. 23 Electronic databases were searched using combinations of key words related to the SEBT and/or YBT and reliability ( Table 1 ). Boolean operators “OR” and “AND” were employed to combine search terms.

Search Strategy, Keywords, and Search Terms Used .

The Boolean phrase and systematic search was derived and completed by investigators (CJP, TKD). The databases PubMed and EBSCO Host (CINHAL, MEDLINE, SportDiscus) were searched from inception through August 2018. Furthermore, the search was limited to full-text manuscripts written in English, which used human participants.

Eligibility Criteria

Investigators (CJP, TKD) reviewed identified studies against eligibility criteria. Studies were screened for eligibility based on the criteria below. Initially, potential eligibility was determined by titles and abstracts. In cases in which eligibility was uncertain, the full text of the manuscript was reviewed for inclusion.

Inclusion Criteria

The following inclusion criteria were used to select and screen studies for inclusion:

  • Study purpose: Studies were included if the primary aim was to evaluate the intra-rater and or inter-rater reliability of the SEBT and or YBT.
  • Type of participants: Studies on adult (≥18 years of age) human participants were included. No restrictions were made in regards to health status of the participants.
  • Type of outcome measures: SEBT and or YBT. Composite scores in the directions of Anterior (Ant), Posteromedial (PM), and Posterolateral (PL) were included for the review.
  • Only peer reviewed, full text studies were included for the review.

Exclusion Criteria

The following exclusion criteria were used to screen studies for inclusion:

  • Studies that did not evaluate reliability using intraclass correlation coefficients (ICCs) or provide the data needed to calculate this statistic.
  • Studies which included participants that were under the age of eighteen.
  • Studies not published in English.
  • Studies that did not use the SEBT or YBT to assess dynamic balance in the lower extremity

Data Extraction

Two reviewers (CJP, TKD) extracted data during the primary review. The extracted data included: study design, aims, population demographics, clinician demographics, methodology of the SEBT and YBT, reliability outcomes, statistical evaluations, and limitations. Discussion and the use of another independent reviewer (EHG) was used to resolve any discrepancies in interpretation if needed.

Assessing Quality of Studies

The methodological quality of the included studies was assessed using the Quality Appraisal of Reliability Studies (QAREL) scale. The QAREL is specifically designed for reliability studies and evaluates statistical methods as well as internal and external validity. 24 , 25 The QAREL consists of an 11-item checklist, all 11 items are weighted equally and scored using Yes, No, Unclear, or N/A in accordance with scoring guidelines. 24 , 25 Included studies were considered to be of high quality if ≥60% of the checklist items were assigned as Yes . 24,25 Initially, two reviewers (CJP, TKD) scored the selected studies independently. Reviewers then met to develop a consensus for each study. Any disagreements that could not be brought to consensus through discussions were resolved using a third reviewer (EHG). Percent agreement was calculated to determine the initial agreement between the reviewers for each QAREL item.

Data Analysis and Synthesis

Inter and intra-rater reliability of the SEBT and YBT were assessed using separate analyses of the anterior, posteromedial, and posterolateral directions. Studies could be included in both or one analysis based on the data presented. Relative reliability was evaluated through calculated or reported Interclass Correlation Coefficients (ICC) for both the inter-rater and intra-rater analyses. The confidence interval at 95% around the ICC was included when reported. Interclass Correlation Coefficients were interpreted in this manner: poor = 0.00-0.25, fair = 0.26-0.50, moderate = 0.51-0.75, and good = 0.76-1.00 reliability. 26 Standard error of measurement (SEM), a measure of measurement dispersion around a “true” score, 26 was used to examine absolute reliability. In cases where the SEM was not reported, it was calculated using the standard deviation and the square root of one minus the ICC if the required data was reported (SEM = SD*√1-ICC). 26 Furthermore, minimal detectable change (MDC) was used to determine the amount of change needed to exceed measurement error at the 95% confidence level. In instances where the MDC was not reported or it was reported at a level of confidence other than 95%, the investigators calculated it if possible (MDC = SEM*√2*1.96). Descriptive analysis, through the use of mean, median, standard error, minimum, maximum, and z-skewness, were used to synthesize the ICC and MDC values from included studies (SPSS software, version 32.0; IBM Corporation, Armonk, NY).

Level of Evidence and Grade of Recommendation

Data were then synthesized using the strength of recommendation taxonomy (SORT). The SORT method allows for the assessment of individual study level of evidence and a grade of recommendation based on quality, quantity, and consistency of the body of literature. 27 Individual studies were categorized into Level 1, 2, and 3 evidence based on the quality of the study. 27 An A-level recommendation is determined based on good quality patient-oriented evidence. 27 A B-level recommendation is based on limited-quality patient-oriented evidence. 27 A C-level recommendation is determined based on consensus, usual practice, opinion, and disease-oriented evidence. 27

Sensitivity Analysis

The effect of quality criteria on the assumptions of level of evidence for high quality studies ( ≥ 60%) was tested by subjecting the criteria to changes of ± 10% and determining the subsequent level of evidence change. Separate sensitivity analyses were conducted for intra- and inter-rater reliability for each direction (anterior, posteromedial, and posterolateral).

Literature Search

Figure 2 displays a diagram outlining the results of the search and study review process. A total of 93 studies were retrieved from electronic and hand searches. Of those, nine studies were identified as meeting the selection criteria. Eight studies were identified through electronic search. 16-20 , 22 , 28 , 29 One study was identified through hand search. 2 Six studies examined inter-rater reliability. 16 , 19-22 , 28 Seven studies examined intra-rater reliability. 19-22 , 24 , 30 , 31

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Flow Chart of Literature Review .

General Characteristics

The study characteristics of included studies are displayed in Table 2 . All studies included participants free of lower extremity injury. Seven studies 16-18 , 21 , 22 , 28 , 29 quantified the SEBT using a tape measure and measurements in centimeters. Two studies 19 , 20 quantified the SEBT using the YBT instrumented kit and measured in centimeters.

Characteristics of Included Studies .

M = Male, F = Female, Y = Years of age, SEBT = Star Excursion Balance Test, YBT = Y- balance Test, A = Anterior, PM = Posteromedial, PL = Posterolateral, C = Collection Trials, P = Practice Trials, Non-norm = Not Normalized to Leg Length, Norm Leg = Normalized to Leg Length, ? = Unspecified practice trials

Quality Analysis of Reliability Studies Using the Quality Appraisal of Reliability Studies Tool . 24 , 25

Inter-rater Studies

Excellent inter-rater reliability was demonstrated within each investigation regardless of use of SEBT or YBT or quantification technique (normalized or non-normalized). Table 5 and ​ and6 6 illustrate the mean, median, minimum, maximum, standard error, and z-skewness of ICC and MDC values for both quantification techniques and each reach direction. Anterior reach inter-rater reliability had a median ICC of 0.88 (Range = 0.83 – 0.96). Posteromedial reach inter-rater reliability had a median ICC of 0.87 (range = 0.80 – 1.00). Posterolateral reach inter-rater reliability had a median ICC of 0.88 (range = 0.73 – 1.00).

Intra-Rater Reliability Statistics and Minimal Detectable Change.

ICC = Intraclass Correlation Coefficient, SEM = Standard Error of Measurement, MDC = Minimum Detectable Change, Non- Norm = Non- Normalized Leg Length, Nom Leg Length = Normalized Leg Length

Inter-Rater Reliability Statistics and Minimal Detectable Change .

ICC = Intraclass Correlation Coefficient, SEM = Standard Error of Measurement, MDC = Minimum Detectable Change, Non- Norm = Non Nomalized Leg Length, Norm Leg Length = Normalized Leg, NR = Not Reported

Intra-rater Studies

Excellent intra-rater reliability was demonstrated within each investigation regardless of use of SEBT or YBT or quantification technique (normalized or non-normalized). Table 4 illustrates the mean, median, minimum, maximum standard error, and z-skewness of ICC and MDC values for both quantification techniques and each reach direction. Anterior reach intra-rater reliability had an overall median ICC of 0.88 (Range = 0.84 – 0.93). Posteromedial reach intra-rater reliability had an overall median ICC of 0.88 (Range = 0.85 – 0.94). Posterolateral reach intra-rater reliability had an overall median ICC of 0.90 (Range = 0.68 – 0.94).

Pooled Intraclass Correlation Coefficients (ICC) and Minimal Detectable Change (MDC) .

Methodological Quality

The two reviewers (CJP, TKD) agreed on 109/110 (99%) items on the QAREL checklist. The one difference in QAREL score was resolved by discussion between the reviewers.

There were a total of four high quality studies 19-22 and two low quality studies. 16 , 28 Quality appraisal tool for studies of diagnostic reliability scores for the inter-rater reliability studies ranged from 55.56% to 75.00% with a median of 66.69%. The internal validity portion of the scale ranged from 0% to 50% with a median of 40%. Primarily, the included studies suffered from a lack of blinding of the raters to their own findings, others, and additional cues as well as a lack of testing order variation. The external validity portion of the scale ranged from 66.67% to 100.00% with a median of 100.00%.

There were a total of three high quality studies 18 , 19 , 21 and four low quality studies. 16 , 17 , 28 , 29 Quality appraisal tool for studies of diagnostic reliability scores for the intra-rater reliability studies ranged from 33.33% to 66.67% with a median of 59.03%. Primarily, the included studies suffered from a lack of blinding of the raters to their own findings, others, and additional cues as well as a lack of testing order variation. The internal validity portion of the scale ranged from 0% to 50% with a median of 40%. The external validity portion of the scale ranged from 66.67% to 100% with a median of 66.67%.

Inter-rater reliability

The results of this review indicate that there is Grade A evidence to support excellent inter-rater reliability of the SEBT/YBT. This recommendation is based on consistent findings from four high quality studies 19-22 and two low quality studies 16 , 28 that are all level 2 investigations.

Intra-rater reliability

The results of this review indicate that there is Grade A evidence to support excellent intra-rater reliability of the SEBT/YBT. This recommendation is based on consistent findings from three high quality studies 18 , 19 , 21 and four low quality studies 16 , 17 , 28 , 29 that are all level 2 investigations.

Changing the quality criterion for determining high or low quality studies by ±10% did not affect the recommendation for inter-rater reliability. The recommendation for intra-rater reliability would change to a B if the criterion were increased by 10% because the authors’ recommendation would be based upon the findings from one high quality study 21 and six low quality studies. 8 , 16-18 , 28 , 29 This indicates that the current available evidence is generally high quality and that the findings of this review are not likely biased by lower quality evidence.

Summary of Results

The purpose of this systematic review was to determine the inter- and intra-rater reliability of the SEBT/YBT. The results demonstrate that there is Grade A evidence indicating excellent inter- and intra-rater reliability of the SEBT/YBT. This recommendation does not change when using normalized or non-normalized quantification techniques as well as when evaluating each reach direction. The findings demonstrate that the SEBT/YBT can be used consistently between one or more clinicians as well as over time. Additionally, summated MDC scores are provided that can be used to help guide clinical decisions by enhancing the determination of when patient change has occurred that exceed the error associated with the test. Furthermore, the results of the sensitivity analysis demonstrate that primarily high level of evidence supports the reliability and usefulness of the SEBT/YBT.

Methodological Considerations

Included studies assessed the reliability of the SEBT/YBT in healthy populations. Primarily, healthy adults with a mean age range from 19 to 31 years old were included. The activity level of the participants included in this review varied. The majority of the participants in this review were general population or recreationally active. One study's participants 19 consisted of recreational collegiate soccer players while another study's participants 20 were individuals actively participating in military training. However, regardless of these variations there were consistent reliability measures demonstrated by the included studies. Based on the characteristic that all participants were healthy, it is unclear how lower extremity pathology may affect SEBT/YBT reliability. Additionally, there is limited evaluation of the SEBT/YBT outside of a physically active collegiate population. Therefore, further evaluations are needed to determine the reliability and utility of the SEBT/YBT in a wide range of populations.

Instrumentation techniques used to conduct the SEBT/YBT varied slightly between studies. The most common quantification technique used a tape measure attached to the floor. 16-18 , 21 , 22 , 28-30 The other method used quantified the SEBT/YBT using the Y-Balance instrumented kit. 19 , 20 Other methodological variations that were noted between the studies included normalization of reaching limb, number of practice and test trials, and body positioning during the SEBT/YBT. The reliability of the SEBT/YBT was found to be excellent regardless of the quantification technique that was used. Five studies 16 , 19 , 20 , 22 , 28 , 29 allowed the participants to complete between one and six practice trials before completing the trials for collection. Body positioning of the participants while completing the SEBT/YBT varied between the studies. Six studies 16-18 , 21 , 22 , 30 required that the participants’ hands must remain on hips while reaches were completed. Two studies 18 , 30 required the heel of the stance leg to remain flat on the ground while the reaches were completed. Additionally, the positioning of the foot on the tape measure/block during testing varied between studies. The foot was most commonly placed behind or in front of the intersection of the reach directions 16 , 18-20 , 28 or so the foot was bisected by the reach directions. 17 , 21 , 22 , 30 When conducting the SEBT/YBT clinicians should allow for four practice trials. Studies in which at least four practice trials were permitted, saw more consistent results in fewer collected trials. 16 , 19 , 20 , 22 Although there were several methodological differences between the studies in terms of quantification technique, normalization, practice trials, and body position, these differences did not appear to affect the reliability of the SEBT/YBT. It is important to note though that if a clinician is using the non-normalized method, results can only be compared within the same patient and not across patients. Thus, it is important for a clinician to be consistent in the methodology used in their practice.

Practical Implications

The results of this review indicate that quantification technique, normalization, practice trials, and body positioning do not appear to affect intra or inter-rater reliability. The results indicate that clinicians can perform the SEBT/YBT using their preferred technique with a high degree of consistency between clinicians and over time. However, clinicians should use the same methodology when attempting to compare scores as the use of different measurement techniques may produce different raw values. Furthermore, normalization to leg length should occur to allow for comparison across patients. In summary, the results indicate that the SEBT/YBT is a reliable tool that can provide comparable results between multiple raters during pre-participation injury screening as well as throughout the rehabilitation process.

The following summary MDCs should be used in clinical practice to determine patient change that exceeds the error associated with the SEBT/YBT. When evaluating changes in normalized reach distances over time MDCs of 5.87%, 7.84%, and 7.55% should be used for anterior, posteromedial, and posterolateral reach directions, respectively. When evaluating changes in non-normalized reach distances MDCs of 6.37cm, 7.12cm, and 8.76cm should be used for anterior, posteromedial, and posterolateral reach directions, respectively. For example, if a patient's anterior reach increases or decreases 5.87% or more for a normalized reach, the change can be considered true change and potentially clinically meaningful change. The same is true for an increase or decrease in anterior reach of greater than 6.37cm for a non-normalized reach, the change can be considered true change and potentially clinically meaningful change. The ability to determine change that exceeds dynamic balance measurement error can assist a clinician in making prevention, rehabilitation, and return to play decisions. However, it is important to note that the included MDCs are based on healthy participants and that these values may not translate to pathologic populations.

Limitations of Review

This systematic review is not without limitations. Following the inclusion criteria, only healthy adult participants were included in the review. Due to this, five studies 30-34 were excluded due to the participant group including individuals under the age of 18 years. This review did not include any studies in which the participant group was pathologic or injured due to limitations in the literature. By excluding these studies the authors may have unintentionally limited the scope of the reliability of the SEBT/YBT. Future research should investigate the reliability of the SEBT/YBT within participants with pathologic conditions or injuires. Lastly, this investigation was only able to assess ICCs and MDCs of the SEBT/YBT. Important clinical statistics such as minimally clinically important difference should be investigated in future studies.

The results of this systematic review demonstrate that there is Grade A evidence to support excellent inter- and intra-rater reliability of the SEBT/YBT. These results infer that the SEBT/YBT should be used clinically to assess dynamic balance and provide consistent and repeatable results between one or more clinicians. Due to all of the included studies assessing dynamic balance in healthy populations, future research should determine the reliability of the SEBT/YBT in a pathologic population.

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SCORING PERFORMANCE VARIATIONS BETWEEN THE Y-BALANCE TEST, A MODIFIED Y-BALANCE TEST, AND THE MODIFIED STAR EXCURSION BALANCE TEST.

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  • Frazier A 2

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International Journal of Sports Physical Therapy , 01 Feb 2020 , 15(1): 34-41 PMID: 32089956  PMCID: PMC7015020

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Abstract 

Study design, levels of evidence, free full text , scoring performance variations between the y-balance test, a modified y-balance test, and the modified star excursion balance test, kristen jagger.

1 Regis University, School of Physical Therapy, Denver, CO, USA

Amanda Frazier

2 Radford University, Department of Physical Therapy, Roanoke, VA, USA

Adrian Aron

Brent harper.

3 Chapman University, Department of Physical Therapy, Irvine, CA, USA

The Modified Star Excursion Balance Test (MSEBT) and the Y-Balance Test- Lower Quarter (YBT-LQ) are utilized to assess dynamic postural stability. These assessments cannot be used interchangeably secondary to kinematic variations and performance differences. A Modified Y-Balance Test-Lower Quarter (MYBT-LQ) was developed to determine if a modification allows performance scores to be directly compared to the MSEBT.

The purpose of this research was to determine if reach distances were similar for young, healthy individuals between three different balance tests: the YBT-LQ, the MYBT-LQ, and the MSEBT.

Study Design

Repeated measures, descriptive cohort study

Twenty-eight participants (17 males, 11 females) were recruited from a convenience sample of young, healthy adults. Participants completed all testing within a single session and performed three trials in each direction, on each leg, for all balance tests. Scoring performance was calculated for each balance test using the average normalized reach distance in the anterior, posterolateral, and posteromedial directions. A one-way ANOVA was used to compare between-subject posteromedial and posterolateral scores, while anterior scores were analyzed using a Kruskal Wallis test. The intraclass correlation coefficient (ICC) was used to determine within-subject participant performance reliability.

Analyses indicated significant differences in the posterolateral and posteromedial reach directions between the YBT-LQ and MSEBT and between the MYBT-LQ and MSEBT, while no significant difference was found between the YBT-LQ and MYBT-LQ in any direction. No anterior reach differences were noted between any of the tests. Within-subject ICCs showed a very strong level of agreement between right and left anterior and right posteromedial reaches between all three tests, while only the YBT-LQ and MYBT-LQ demonstrated very strong agreement in all directions.

Reach performance on the MSEBT differed from the performance on the YBT-LQ and MYBT-LQ in the anterior, posteromedial and posterolateral directions in this population. These findings further support the difference in motor control strategies used during these tests.

Levels of Evidence

  • INTRODUCTION

The neuromuscular system plays an integral role in postural control during dynamic balance activities to limit the occurrence of loss of balance. 1 When there is a lack of coordination between the sensory and motor aspects of the neuromusculoskeletal system, balance is hindered, and postural instability may occur. Postural instability could lead to falls or uncoordinated and uncontrolled body movements that could ultimately produce injuries. 2 Previous research has shown that impairments within the neuromuscular system result in an increased risk for injury in young, active individuals, therefore warranting dynamic balance screening. 3 The Modified Star Excursion Balance Test (MSEBT) and the Y-Balance Test of the Lower Quarter (YBT-LQ) are reliable measures in the assessment of postural control within this population. 4 Gorman et al. 5 concluded that the YBT-LQ is a reliable derivation of the MSEBT, yet this could potentially lead clinicians to infer that these tests can be used interchangeably and that data collected during each test could be compared equally. Fullam et al. 6 identified kinematic variations and differences in performance scores on these tests, which has confirmed that they cannot be used interchangeably in the assessment of dynamic balance. 6 Specifically, authors of previous research have described significant differences have been identified in anterior reach distances comparing the SEBT and YBT-LQ. 6 , 7 The present study introduced and evaluated an alteration to the YBT-LQ that included a modification intended to counteract the physical alignment differences between the YBT-LQ and MSEBT.

The Star Excursion Balance Test (SEBT) utilizes an eight point star-shaped pattern, upon which an individual stands in the middle, balanced on one foot, while reaching as far as possible in each of the eight directions with the opposite leg. 8 The SEBT has been shown to be an effective assessment of dynamic postural control and is reliable at identifying risk for injury in individuals with chronic ankle instability, but limitations have also been discussed through extensive research. 9 - 11 Plisky and colleagues 8 determined that a difference in anterior reach distance of greater than four centimeters between each limb was associated with a higher risk of injury in high school basketball players. Robinson and Gribble 10 hypothesized that the eight reach directions within the SEBT were redundant in both healthy populations and in those with chronic ankle instability. 10 Reducing the number of reach directions tested, referred to as the Modified SEBT (MSEBT), has been a common suggestion for improving the administration and time efficiency of the SEBT, though the directions most appropriate to test for measurements continues to be debatable. 3 , 10 , 12 , 13 The directions that have been utilized for the MSEBT in other studies consist of anterior, posteromedial, and posterolateral directions. 6

The YBT-LQ was developed based on the MSEBT protocol, but instead of reaching and touching a taped line, the individual stands on a stance plate and slides a reach indicator along a static frame while maintaining balance on the opposite lower extremity ( Figure 1 ). 5 The YBT-LQ was developed to address some of the limitations of the SEBT to provide a more consistent dynamic balance assessment tool. 13 The YBT-LQ assesses dynamic limits of stability during single limb stance while the opposite leg reaches in the same three directions as the MSEBT: anterior, posteromedial, and posterolateral. 3 It can also be utilized to assess risk of injury from functional asymmetries associated with young, athletic populations. 13 , 14 As with the SEBT, the YBT-LQ reach distances are normalized to leg length. 5 The YBT-LQ has also been proposed to provide a better assessment of movement quality as compared to the SEBT, by allowing more focused attention to observing the subject and their technique during performance of the test, rather than primarily on marking the reach distance. 13

modified star excursion balance test scoring

Y-Balance Test anterior reach direction .

Because the YBT-LQ was developed from the MSEBT, it was hypothesized that the results would be equivalent or very similar between the two dynamic balance assessments. 7 However, Fullam et al. 6 and Coughlan et al. 7 have shown differences between the MSEBT and YBT-LQ in the composite anterior reach score as well as the sagittal plane hip and knee angular displacements, while no significant differences were noted in the posteromedial and posterolateral directions. 6 , 7 Differences in the anterior reach direction impacts the overall composite score of the evaluation, which affects the interpretation of test results. 6 It was suggested that these discrepancies resulted from variations in dynamic neuromuscular demands and/or the use of different postural control strategies during the task of reaching in each direction. 6 , 7 Differences among the reach directions between the YBT-LQ and the MSEBT are clinically relevant because patients with neuromuscular control deficits, such as those with chronic ankle instability, will likely perform differently on one test versus the other. 6

During performance of the YBT-LQ, participants push a reach indicator slightly lateral to midline and inferior to the floor level of the stance foot, which varies from the midline and floor-level reach performed during the MSEBT. A modification to the reach indicator of the YBT-LQ was introduced by the current researchers in order to better match an individual's physical position and alignment during performance of the MSEBT and the YBT-LQ ( Figure 2 ). This modification allowed the reach indicator to be pushed from a central location, at stance foot level, similar to the physical parameters of the MSEBT. This modification of the YBT-LQ, the Modified YBT-LQ (MYBT-LQ), was intended to counteract the physical differences between testing parameters so that any additional discrepancies in performance could be attributed to other factors. As the MSEBT and YBT-LQ cannot be used interchangeably at this time, secondary to performance differences and kinematic variations, further research assessing the kinematics and postural strategies required to perform these tests have been deemed necessary. 6 The purpose of this research was to determine if reach distances were similar for young, healthy individuals between three different balance tests: the YBT-LQ, the MYBT-LQ, and the MSEBT.

modified star excursion balance test scoring

Y-Balance Test reach indicator (A) and Modified Y-Balance Test reach indicator (B) .

Participants completed a total of three different balance tests during a single testing session, including the YBT-LQ (Functional Movement Systems™, Danville, VA), the MSEBT, and the MYBT-LQ. Performances were normalized using leg length, and maximal reach distances for anterior, posterolateral, and posteromedial directions. Prior to testing, each participant received an orientation to the balance assessments, and bilateral lower extremity leg lengths were measured. Leg length data were collected by the same researcher for all participants for consistency of measurements. The order of the three balance tests was randomized to account for the impact of fatigue and learning effect. Each test was demonstrated and scored by the same researcher who was certified to administer the Y-Balance Test through Functional Movement Systems™ (Danville, VA). Prior researchers have demonstrated good to excellent intra-rater reliability (0.85-0.91), 13 and good 3 to excellent 13 interrater reliability (0.80-0.85 and 0.99-1.0, respectively) when the YBT-LQ was performed by trained examiners. Participants were allotted three practice trials per lower extremity and direction prior to testing. A two-minute rest period was required after completion of all practice trials prior to initiation of testing.

In contrast to the YBT-LQ, during the MYBT-LQ participants pushed the reach indicator by using an additional fabricated tab that was centered on the superior surface of the reach indicator and flush with the trailing edge ( Figure 2 ). The fabricated tab was attached to the top of the Y Balance reach indicator such that the reach foot was centered over the reach indicator and was not effectively reaching below the stance surface or lateral to midline, which is physically more similar to the MSEBT.

modified star excursion balance test scoring

Modified Star Excursion Balance Test as performed atop the Y-Balance Test frame .

Statistical Methods

Prior to conducting this study, an a priori power analysis was conducted to determine the necessary sample size using G*Power 3.1 (© 2010-2019 Heinrich Heine Universität Düsseldorf). Calculations based on a similar study conducted by Fullam and colleagues 6 indicated that a sample size of 27 was necessary to achieve 80% power. A between- and within-subjects analysis was performed comparing the differences between the normalized reach distances on the YBT-LQ, MSEBT, and MYBT-LQ. Posterolateral and posteromedial reach distances for the YBT-LQ, MYBT-LQ, and MSEBT were analyzed utilizing a one-way ANOVA and Tukey's HSD post hoc tests, while anterior reach distances were analyzed using a Kruskal Wallis test due to non-normality. Intraclass correlation coefficients (ICCs), using a consistency definition and a two-way mixed model, were analyzed to determine the reliability of individual participant performance among the three tests. All participants served as their own controls. Statistical analysis was completed using IBM SPSS Statistics for Windows, Version 24.0. (Armonk, NY: IBM Corp) with an alpha value of 0.05 utilized to determine any statistically significant different results were found among the variables.

The normalized reach distances of the YBT-LQ, MYBT-LQ, and MSEBT were analyzed for the 28 participants. A significant main effect was found between subjects for the average reach distances for the posterolateral [right: F (2) = 4.816, p = 0.011, left: F (2) = 5.455, p = 0.006] and posteromedial [right: F (2) = 3.425 , p = 0.037, left: F (2) = 3.121, p = 0.049] reach directions between the three tests. The average anterior reach distances were not found to be significantly different [right: X ( 2 ) 2 = 0.779, p = 0.677, left: X ( 2 ) 2 = 1.869, p = 0.393] between any of the three tests ( Figure 4 ). Tukey's HSD post-hoc analyses indicated significant differences in the right posteromedial reach direction between the MYBT-LQ and MSEBT ( Figure 5 and Table 1 ), and significant differences in bilateral posterolateral reach directions between the YBT-LQ and MSEBT and between the MYBT-LQ and MSEBT ( Figure 6 and Table 1 ). There was no significant difference between the YBT-LQ and MYBT-LQ in any reach direction (p = 0.23), no significant difference between any of the three tests in the left posteromedial reach direction (p = 0.51), and no significant difference between the YBT-LQ and MSEBT in the right posteromedial reach direction (p = 0.14) ( Table 1 ).

modified star excursion balance test scoring

Normalized scores for all anterior reach directions. YBT-LQ = Y-Balance Test Lower Quarter; MYBT-LQ = Modified Y-Balance Test Lower Quarter; MSEBT = Modified Star Excursion Balance Test .

modified star excursion balance test scoring

Normalized scores for all posteromedial reach directions. YBT-LQ = Y-Balance Test Lower Quarter; MYBT-LQ = Modified Y-Balance Test Lower Quarter; MSEBT = Modified Star Excursion Balance Test .

modified star excursion balance test scoring

Normalized scores for all posterolateral reach directions. YBT-LQ = Y-Balance Test Lower Quarter; MYBT-LQ = Modified Y-Balance Test Lower Quarter; MSEBT = Modified Star Excursion Balance Test .

Tukey's HSD Post Hoc Results.

YBT-LQ = Y-Balance Test Lower Quarter; MYBT-LQ = Modified Y-Balance Test Lower Quarter; MSEBT = Modified Star Excursion Balance Test

Intraclass correlation coefficients comparing YBT-LQ and MYBT-LQ demonstrated very strong agreement for all reach directions, and all three tests demonstrated very strong agreement in the anterior reach direction ( Table 2 ). Reaches in the right posteromedial direction showed very strong agreement for MYBT-LQ and MSEBT and for YBT-LQ and MSEBT, while there was less strong agreement among the remaining tests and reach directions ( Table 2 ).

Intraclass Correlation Coefficients by Lower Extremity and Reach Direction.

The primary aim of the present study was to determine if there were differences between reach distances during performance of the YBT-LQ, the newly developed MYBT-LQ, and the MSEBT. Analyses revealed that participants performed more similarly on the YBT-LQ and MYBT-LQ, and less similarly on the MSEBT, indicating that the modification to the YBT-LQ did not significantly alter performance outcomes of the YBT-LQ. It has previously been proposed that differences occurred between performance in the YBT-LQ and SEBT due to variations in the position of the reach foot; the SEBT is performed by reaching directly in line and at floor level, while the YBT-LQ is performed by reaching slightly lateral to the position of the stance foot and at a level slightly below that of the stance foot. 7 The MYBT-LQ was specifically developed for the present study to evaluate these differences inferred by Coughlan and colleagues 7 . The YBT-LQ and MYBT-LQ showed very strong agreement in overall reach distance performance, which suggests that differences shown in previous research between the YBT-LQ and MSEBT should not be attributed to the foot position relative to the reach indicator or stance foot.

Variations in performance between the MSEBT and YBT-LQ have also been attributed to varying feedback and feedforward mechanisms of postural control. 7 In the YBT-LQ, it is proposed that a continuous feedback loop is present due to the proprioceptive input to the reach foot as it pushes the reach indicator during testing. This feedback loop is thought to assist participants in determining how far they have reached and when they are nearing the limits of their stability. In contrast, the MSEBT utilizes a feedforward mechanism of postural control as participants reach to their limits of stability prior to making contact with the support surface; this means that participants must rely heavily on anticipatory actions before they receive sensory input from the ground. 7 The present study appears to further support a difference in postural control mechanisms between these tests. The MYBT-LQ altered the physical alignment to more closely approximate the MSEBT, yet the reach distance outcomes remained similar to those of the YBT-LQ. Reaching out while utilizing proprioceptive feedback from the reach indicator may have provided an advantage during the YBT-LQ and MYBT-LQ that allowed for greater reach distances in the posteromedial and posterolateral directions. In the present study, participants displayed more difficulty locating the YBT frame while performing the MSEBT atop it, compared to the YBT-LQ and MYBT-LQ. This could be due to the role of the proprioceptive systems and a continuous feedback loop that is present during the YBT-LQ and MYBT-LQ.

Contrary to the findings of Coughlin and colleagues, 7 no statistically significant differences were noted between the three tests in the anterior direction. In order to perform these balance assessments, participants utilize three different sensory systems (visual, vestibular, and proprioceptive) to maintain postural control. 7 It is likely that participants performed similarly on the three tests in the anterior direction due to the increased visual input and awareness of their body position during completion of the anterior reach. In the posteromedial and posterolateral directions, the participants could not see the labeled frame, were unaware of their reach distances during the performance of each trial, and had to seek the rail positions during the MSEBT. Participants likely relied more heavily on vestibular and proprioceptive input to perform the posteromedial and posterolateral reaches which may have led to more variation between the overall group's performances in these directions. 7 In contrast, participants’ performance of the anterior direction likely utilized all three sensory systems, yielding a more uniform reach distance in this direction. Additionally, unlike participants in the Coughlan 7 study, the participants in the present study were not members of organized collegiate sports teams at the time of testing. This may have resulted in a group of participants who did not have the proprioceptive abilities typically demonstrated by collegiate athletes. These participants, however, may be more representative of average healthy active young adults, making the findings applicable to a larger subset of the population.

Clinical Relevance

The outcomes of this study support prior findings indicating that performance scores on the YBT-LQ and MSEBT are not equivalent and thus, the assessments should not be used interchangeably. A modification designed to align the physical parameters of the two tests (MYBT-LQ) did not result in significant differences in reach distances when compared to the MSEBT, and therefore is not suggested for future use of the YBT-LQ. Choosing between the MSEBT and the YBT-LQ should continue to be at the discretion of the sports or rehabilitation professional and should best match the needs of the professional and their athlete/patient, since both tests are reliable and have demonstrated injury prediction capabilities. Given that the primary difference between the two tests is the pattern associated with the reach, sports and rehabilitation professionals should select the test that best aligns with the individual's sports, recreation, or job duties. Those who are able to utilize environmental inputs during their movements may benefit from testing using the YBT, while those who are required to target in open space should choose the MSEBT.

A potential limitation in the present study is the method of testing during the MSEBT. Standing atop the YBT frame allowed for consistent positioning and measurement of reach distances, but it did not address the altered visual perception that may result from standing on a raised surface.

Results of the present study show strong correlations between performance on the YBT-LQ and the MYBT-LQ, suggesting that feedback from the reach indicator may be responsible for variations noted when comparing performance to the MSEBT. These findings also indicate that there is no need to modify the YBT-LQ reach indicator to more closely replicate the physical parameters of the MSEBT, as the reach distance outcomes do not differ significantly. Results of this study also indicate that healthy active young adults demonstrate performance variations in the posterolateral and posteromedial reach directions when performing the YBT-LQ, MYBT-LQ, and MSEBT, while anterior reach directions do not differ. Future research that investigates the effect of standing on a raised versus level surface during completion of the MSEBT (i.e., on the YBT frame) would be beneficial in helping determine the cause of variable findings on these balance tests.

Citations & impact 

Impact metrics, article citations, investigating the combined effects of fascial distortion model manual therapy and balance-strength training in individuals with chronic ankle instability..

Mohammadi A , Sakhtemani SE , Trimmel L , Petricsevics K , Makai A , Zsenak I , Melczer C , Tardi PS

Sports (Basel) , 12(1):33, 18 Jan 2024

Cited by: 0 articles | PMID: 38251307 | PMCID: PMC10820242

Exploring the Y-Balance-Test scores and inter-limb asymmetry in soccer players: differences between competitive level and field positions.

González-Fernández FT , Martínez-Aranda LM , Falces-Prieto M , Nobari H , Clemente FM

BMC Sports Sci Med Rehabil , 14(1):45, 23 Mar 2022

Cited by: 6 articles | PMID: 35321733 | PMCID: PMC8944159

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Europe PMC is part of the ELIXIR infrastructure

REPRODUCIBILITY OF THE MODIFIED STAR EXCURSION BALANCE TEST COMPOSITE AND SPECIFIC REACH DIRECTION SCORES

Affiliation.

  • 1 Physical Therapy Science, Program in Clinical Health Sciences, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
  • PMID: 27274422
  • PMCID: PMC4886804

Background: The mSEBT is a screening tool used to evaluate dynamic balance. Most research investigating measurement properties focused on intrarater reliability and was done in small samples. To know whether the mSEBT is useful to discriminate dynamic balance between persons and to evaluate changes in dynamic balance, more research into intra- and interrater reliability and smallest detectable change (synonymous with minimal detectable change) is needed.

Purpose: To estimate intra- and interrater reliability and smallest detectable change of the mSEBT in adults at risk for ankle sprain.

Study design: Cross-sectional, test-retest design.

Methods: Fifty-five healthy young adults participating in sports at risk for ankle sprain participated (mean ± SD age, 24.0 ± 2.9 years). Each participant performed three test sessions within one hour and was rated by two physical therapists (session 1, rater 1; session 2, rater 2; session 3, rater 1). Participants and raters were blinded for previous measurements. Normalized composite and reach direction scores for the right and left leg were collected. Analysis of variance was used to calculate intraclass correlation coefficient values for intra- and interrater reliability. Smallest detectable change values were calculated based on the standard error of measurement.

Results: Intra- and interrater reliability for both legs was good to excellent (intraclass correlation coefficient ranging from 0.87 to 0.94). The intrarater smallest detectable change for the composite score of the right leg was 7.2% and for the left 6.2%. The interrater smallest detectable change for the composite score of the right leg was 6.9% and for the left 5.0%.

Conclusion: The mSEBT is a reliable measurement instrument to discriminate dynamic balance between persons. Most smallest detectable change values of the mSEBT appear to be large. More research is needed to investigate if the mSEBT is usable for evaluative purposes.

Level of evidence: Level 2.

Keywords: Ankle; Dynamic Balance; Reliability; mSEBT; smallest detectable change.

IMAGES

  1. ( A

    modified star excursion balance test scoring

  2. (a) Modified Star Excursion Balance Test: anterior reach on flat

    modified star excursion balance test scoring

  3. Figure 1 from Lower-Extremity Muscle Activation during the Star

    modified star excursion balance test scoring

  4. Modifi ed star excursion balance test (mSEBT) for the left stance limb

    modified star excursion balance test scoring

  5. Modified Star Excursion Balance Test

    modified star excursion balance test scoring

  6. Modified Star Excursion Balance Test. (A) Three directions. (B

    modified star excursion balance test scoring

VIDEO

  1. Balance Assessment (Stork Test & Star Excursion balance test)

  2. BALANCE TEST😱🫣 #shorts #shortscreator #shortsviral

  3. Modified Star Plank

  4. star balance excursion lateral view

  5. Balance Assessment

  6. 발목 재활 운동 4가지 방법 (발목 인대파열, 발목 재활 운동기록 1주차) / K6 리그 아마추어 축구선수 VLOG / 축구다큐멘터리 / 31살, 윙백, FC 도르마무

COMMENTS

  1. The Star Excursion Balance Test: An Update Review and Practical

    Key Points The modified Star Excursion Balance Test (mSEBT) should be used as a reliable clinical tool to assess dynamic postural control. We propose a compact version of the mSEBT for clinicians. All three directions as well as the composite score should be evaluated independently. Procedure consistency is needed (Table 1).Scores obtained from Y-Balance Test TM and mSEBT cannot be considered ...

  2. The Modified Star Excursion Balance and Y-balance Test Results Differ

    The modified Star Excursion Balance Test (mSEBT) and Y-Balance Test (YBT) are two common methods for clinical assessment of dynamic balance. Clinicians often use only one of these test methods and one outcome factor when screening for lower extremity injury risk. Dynamic balance scores are known to vary by age, sex and sport.

  3. Star Excursion Balance Test

    The Star Excursion Balance Test (SEBT) is a dynamic test that requires strength, flexibility, and proprioception. It is a measure of dynamic balance that provides a significant challenge to athletes and physically active individuals. ... According to Plisky et al (2006), the reliability of this test ranges between 0.82-0.87 and scores 0.99 for ...

  4. PDF Modified STAR Excursion Balance Test (SEBT)1

    This Clinical Guideline may need to be modified to meet the needs of a specific patient. The model should not replace clinical ... Modified STAR Excursion Balance Test (SEBT)1 Test performance description: For each limb (barefoot): - Place most distal aspect of great toe in center of "Y" ... - Female players with composite score < 94% of ...

  5. Scoring Performance Variations Between the Y-balance Test, a Modified Y

    The Modified Star Excursion Balance Test (MSEBT) and the Y-Balance Test- Lower Quarter (YBT-LQ) are utilized to assess dynamic postural stability. ... for all balance tests. Scoring performance was calculated for each balance test using the average normalized reach distance in the anterior, posterolateral, and posteromedial directions. A one ...

  6. PDF The Star Excursion Balance Test: An Update Review and Practical Guidelines

    The modified Star Excursion Balance Test (mSEBT) should be used as a reliable clinical tool to assess dynamic postural control. We propose a compact version of the mSEBT for clinicians. All three directions as well as the composite score should be evaluated independently. Procedure consistency is needed (Table 1). Scores obtained from Y-

  7. Star Excursion Balance Test

    The Star Excursion Balance Test (SEBT) is a dynamic test that requires strength, flexibility, and proprioception. It is a measure of dynamic balance that provides a significant challenge to athletes and physically active individuals. The test can be used to assess physical performance, but can also be used to screen deficits in dynamic postural ...

  8. The Star Excursion Balance Test: An Update Review and ...

    Romain Terrier. Introduction: The Star Excursion Balance Test (SEBT) is a func-tional test described 25 years ago and is commonly used in the literature to quantify the dynamic postural control of ...

  9. Using the Star Excursion Balance Test to Assess Dynamic Postural

    The Star Excursion Balance Test is a reliable measure and a valid dynamic test to predict risk of lower extremity injury, to identify dynamic balance deficits in patients with lower extremity conditions, and to be responsive to training programs in healthy participants and those with lower extremity conditions.

  10. Performance on the Modified Star Excursion Balance Test at the Time of

    The modified Star Excursion Balance Test (SEBT) is a functional screening tool to assess lower extremity dynamic stability and neuromuscular control, 9, 27, 35, 53 encompassing lower extremity strength, coordination, balance, and flexibility. 2, 8, 15 Following lower extremity injury, the modified SEBT is used to measure the extent of remaining ...

  11. Star Excursion Balance Test (SEBT) and modified SEBT (mSEBT)

    It is a simple yet challenging test to perform, and it can be time-consuming. The commonly used Y Balance Test (YBT) was derived from the SEBT to improve test procedure standardization. 28,29 Although the mSEBT and YBT tests are similar, the score of a particular reaching direction should not be used interchangeably between these 2 tests. 12,29,30

  12. Scoring Performance Variations Between the Y-balance Test, a Modified Y

    Background: The Modified Star Excursion Balance Test (MSEBT) and the Y-Balance Test- Lower Quarter (YBT-LQ) are utilized to assess dynamic postural stability. These assessments cannot be used interchangeably secondary to kinematic variations and performance differences. A Modified Y-Balance Test-Lower Quarter (MYBT-LQ) was developed to determine if a modification allows performance scores to ...

  13. Performance on the Modified Star Excursion Balance Test at the ...

    The modified Star Excursion Balance Test (SEBT) is a functional screening tool to assess lower extremity dynamic stabil - ity and neuromuscular control,9,27,35,53 encompassing lower extremity strength, coordination, balance, and flexibility.2,8,15 Following lower extremity injury, the modified SEBT is used to measure the ex -

  14. Normative performance values of modified Star Excursion Balance Test

    To establish normative performance values for the modified Star Excursion Balance Test (mSEBT) and derived Limb Symmetry Index (LSI) scores in non-injured female adolescent footballers, to and identity whether there is a relationship between the aforementioned metrics and age. Single measure study design.

  15. [PDF] The Star Excursion Balance Test: An Update Review and Practical

    An updated review of the design, implementation, and interpretation of the SEBT is provided and guidelines to standardize SEBT procedures are proposed for better comparisons across studies are proposed. The Star Excursion Balance Test (SEBT) is a reliable, responsive, and clinically relevant functional assessment of lower limbs' dynamic postural control. However, great disparity exists ...

  16. Star Excursion Balance Test

    The Star Excursion Balance Test (SEBT) is a test of dynamic balance, using in a single-leg stance that requires strength, flexibility, core control and proprioception. The test requires participants to balance on one leg and reach as far as possible in eight different directions. The similar Y-Balance Test was derived from this test. purpose ...

  17. Reproducibility of The Modified Star Excursion Balance Test Composite

    The modified Star Excursion Balance Test (mSEBT) is a screening tool, widely used by physical therapists to detect dynamic balance deficits, and to evaluate dynamic balance improvement in individuals after following a preventive training program. 7,12-15 The mSEBT measures dynamic balance, while a person maintains balance on a single leg and ...

  18. Star Excursion Balance Test

    The Star Excursion Balance Test was developed to be a reliable measure of dynamic stability. Since then, it has proven to be a sensitive indicator of lower limb injury risk in a variety of populations. To add to this, the Star Excursion Balance Test has been shown to have high levels of intra-rater test-retest reliability, though no validity ...

  19. (Pdf) the Modified Star Excursion Balance and Y-balance Test Results

    The evaluation protocol was followed according to Miranda et. al. 13 A modified Star Excursion Balance Test was used to obtain the result of the dynamic balance of the patients, the test protocol ...

  20. The Reliability of The Star Excursion Balance Test and Lower Quarter Y

    The Star Excursion Balance Test (SEBT) ... Unclear, or N/A in accordance with scoring guidelines. 24,25 Included studies were considered to be of high quality if ≥60% of the checklist items were assigned as Yes ... et al. Reproducibility of the modified star excursion balance test composite and specific reach direction scores. Int J Sports ...

  21. The Modified Star Excursion Balance and Y-balance Test Results Differ

    Background: The modified Star Excursion Balance Test (mSEBT) and Y-Balance Test (YBT) are two common methods for clinical assessment of dynamic balance. Clinicians often use only one of these test methods and one outcome factor when screening for lower extremity injury risk. Dynamic balance scores are known to vary by age, sex and sport.

  22. Scoring Performance Variations Between the Y-balance Test, a Modified Y

    INTRODUCTION. The neuromuscular system plays an integral role in postural control during dynamic balance activities to limit the occurrence of loss of balance. 1 When there is a lack of coordination between the sensory and motor aspects of the neuromusculoskeletal system, balance is hindered, and postural instability may occur.

  23. REPRODUCIBILITY OF THE MODIFIED STAR EXCURSION BALANCE TEST ...

    REPRODUCIBILITY OF THE MODIFIED STAR EXCURSION BALANCE TEST COMPOSITE AND SPECIFIC REACH DIRECTION SCORES Int J Sports Phys Ther. 2016 Jun;11(3):356-65. ... 24.0 ± 2.9 years). Each participant performed three test sessions within one hour and was rated by two physical therapists (session 1, rater 1; session 2, rater 2; session 3, rater 1). ...