Incongruence Between Self-report and Performance-based Measure of Balance in Community-dwelling Adults

BACKGROUND: Most population-based studies and clinical fall-risk screenings depend on self-reported balance information. This study investigated the congruency between self-reported balance information and performance-based balance measure (Romberg Test of Standing Balance on Firm and Compliant Support Surfaces, RTSBFCSS). It also explored predictors of congruency between these balance measures. METHODS: Design: Secondary analysis of cross-sectional National Health and Nutrition Examination Survey cycles 2001-2004 (latest data cycles with variables of interest). Participants: Nationally representative sample of 4 939 adults (≥ 40 years). Procedures: The proportion of individuals who underestimated (self-reported no balance problem but failed RTSBFCSS) or overestimated (self-reported having a balance problem but passed RTSBFCSS) their balance problem was calculated. Predictors of congruency among balance measures were explored using multivariable regression. RESULTS: The study included 4 939 adults (mean-age 56.0 years [0.3 SE], 51.2% females). Of all participants, 36.9% had evidence of balance problems on RTSBFCSS. About 70% of those with performance-based balance deficits reported no balance problems on the self-reported question. About 35.8% (95% confidence intervals, CI: 33.7%-38.1%) were incongruent among balance measures. Specifically, 25.8% (95% CI: 23.9%-27.8%) underestimated their balance issues, and 10.1% (95% CI: 8.8%-11.5%) overestimated their balance problems. Males had 4% reduction in odds of congruency among balance measures with every 1-year increase in age compared to 3% reduction in the same for females (adjusted odds ratio = 0.96; 95% CI: 0.95-0.96; p value < .001 males; adjusted odds ratio = 0.97; 95% CI: 0.96-0.98; p value < .001 females). CONCLUSIONS: About 7 in 10 adults with performance-based balance deficits were unaware of their condition. Sole reliance on self-reported information for balance screening may be inadequate. Results can help identify populations more likely to have discrepancies between balance measures.