The Convergent Validity of the SWAY Balance Application to Assess Postural Stability in Military Cadets Recovering from Concussion.
Max K Dummar, Michael S Crowell, Will Pitt and 5 others
PMID 38313668WHAT IT FOUND
The SWAY app failed to detect balance differences in military cadets with recent concussions compared to healthy controls.
It also showed no correlation with the gold-standard NeuroCom test. Clinicians should not rely on SWAY scores to assess post-concussion balance deficits or guide return-to-activity decisions.
Key findings
01The SWAY modified Balance Error Scoring System (mBESS) showed no significant difference in balance scores between concussed participants and healthy controls, nor any change over time.
02SWAY mBESS scores did not correlate with the NeuroCom Sensory Organization Test (SOT), a validated balance measure, in either the concussed or control groups.
03The NeuroCom SOT successfully distinguished concussed participants from controls at initial and one-week assessments, unlike the SWAY app.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The sample was small (n=40) and consisted of young, active military cadets, which may not generalize to older adults, civilians, or athletes with different concussion profiles. The study did not include a familiarization trial for the SWAY app due to ethical concerns about repeated testing in concussed patients, which may have affected performance. One participant in the concussed group did not complete the final data collection, and their last available values were carried forward. The concussed group had a significantly higher history of prior concussions than the control group, which may have influenced baseline balance strategies. Psychosocial factors influencing performance, such as the desire to return to activity, were not controlled for and may have skewed results.
Declared interests
The authors declare no conflicts of interest. The study was funded by the Telemedicine and Advanced Technology Research Center (TATRC) at the U.S. Army Medical Research and Development Command.
The easy way to misread this
Do not assume the SWAY app is valid because it is widely used for baseline testing. This study found it could not detect balance deficits in concussed cadets and did not correlate with the NeuroCom SOT. Using it to guide return-to-activity decisions may miss genuine balance impairments.