Assessed and distressed: white-coat effects on clinical balance performance

While balance in young and older adults is known to change with the threat of standing on elevated surfaces, the potential for social anxiety to influence emotional states and balance performance during a clinical assessment is currently unknown.

Nineteen young and 19 older healthy female adults volunteered for the study. The effects of age and clinical assessment on balance performance were examined using a 2×2 between- and within-subjects factorial design. Balance performance measures were derived from forceplate recordings of three different postural tasks. Psychological measures included fear of negative evaluation, state anxiety, and fear related to the completed balance tasks.

There was a significant increase in state anxiety and fear when participants performed balance tasks while being assessed by an evaluator. Compared to the control condition, both age groups leaned significantly further forward during the functional reach task when being assessed. While being assessed, older adults had significantly larger amplitudes and frequencies of center of pressure (COP) displacement during two-legged stance with eyes closed (EC) and significantly less stance time during one-legged standing compared to the control condition. In contrast, balance performance in young adults during one-legged or two-legged stance tasks was unchanged by clinical assessment.

Social anxiety associated with the clinical assessment of balance can have a negative influence on both emotional states and balance control. As a result, clinicians need to recognize and account or control for potential social anxiety effects on clinical balance performance in young and older adults in particular.