Blog | | Bastiaan Meijer

Why Balance Matters: From Daily Functioning to Fall Prevention

Balance is something most people take for granted until it starts to decline. From standing up out of a chair to walking outdoors or turning quickly, balance is an essential prerequisite for independent functioning. Research shows that balance can begin to deteriorate as early as age 30, with this decline accelerating after age 60. This increases the risk of falls, injury, and loss of independence.

In the Netherlands alone, falls among older adults lead to approximately €1 billion in direct medical costs each year. Every four minutes, a person aged 65 or older is admitted to the emergency department following a fall. These figures underscore the need for objective balance assessment and targeted training to be core components of preventive and rehabilitative care.

What Is Balance and Why Measuring It Is Complex

Balance is the result of a finely coordinated interaction between three systems:

  • The visual system – what we see
  • The vestibular system – movement and head position
  • The proprioceptive system – information from muscles and joints

This sensory input is processed by the central nervous system and translated into motor responses that keep us upright. When one or more of these systems function less effectively – as is often the case with aging, musculoskeletal complaints, or neurological conditions – postural stability decreases.

Traditional clinical balance tests are valuable, but they are often subjective and have limited sensitivity. This is where objective, sensor-based measurement provides clear added value.

The DAVID Balance Module: Objective Insight into Postural Control

The DAVID Balance Module is a medically certified measurement system that objectively maps postural stability using sensor technology. The main outcome measures include:

  • Postural sway distance (primary outcome measure)
  • Postural sway speed
  • Postural sway area
  • Percentile scores compared to a reference population

By using different test conditions – such as feet together, tandem stance, or single-leg stance, on both firm and soft surfaces – balance demand is systematically increased. This enables observation of how a person responds to increasing complexity and altered sensory conditions.

Study Background: Real-World Data from Clinical Practice

To evaluate the performance of the DAVID Balance Module, an observational, retrospective analysis was conducted using real-world data from two primary care settings:

  • Leef Center Heerhugowaard (municipality of Dijk en Waard)
  • Fysiotherapie Elisabeth (municipality of Alkmaar)
Study Characteristics:
  • N = 78 participants
  • Age ≥ 65 years
  • At least one valid balance measurement
  • For longitudinal analyses: at least two measurements per participant

The primary objective was not to demonstrate training effects, but to assess whether the system functions as a valid, discriminative, and responsive measurement instrument in daily clinical practice.

Key Results: What Do the Data Show?

Clear Differentiation Between Balance Conditions

Postural sway increased systematically in more challenging positions (from normal stance to single-leg stance). Statistical analysis showed highly significant differences (p < 0.001) between test conditions. This confirms that the measurement system behaves as expected biomechanically and clinically, supporting its construct validity.

Sensitivity to Sensory Changes

Among participants tested on both firm and soft surfaces, sway distance was significantly greater on the soft surface (p ≈ 0.046; small to moderate effect). This demonstrates that the system reliably detects subtle changes in sensory input crucial for fall risk assessment.

Responsiveness Over Time

Among participants with repeated measurements (T0–T1), a significant difference over time was observed (p ≈ 0.024). Although the direction of change varied per individual and no standardized intervention was recorded, this finding shows that the instrument is sensitive to individual changes – an essential feature for monitoring and evaluation.

No Evidence of Systematic Measurement Bias

Exploratory analyses showed no significant differences between men and women and only a weak, non-significant association with age. This suggests that the measurements are robust and broadly applicable within the older population.

From Measurement to Targeted Care

The true value of balance measurement lies in the follow-up. Within an integrated care pathway, the DAVID Balance Module can be combined with:

  • Digital questionnaires (via EVE software)
  • Additional clinical outcome measures
  • Evidence-based interventions such as Otago and InBalans
  • Structured retesting and outcome reporting

This creates a logical pathway from screening → targeted training → objective evaluation, supported by data.

Conclusion: Balance Data as a Driver for Prevention

The combined results from two primary care settings demonstrate that the DAVID Balance Module is a valid, discriminative, and responsive instrument for objective balance assessment in older adults. The system reliably distinguishes among balance conditions, detects temporal changes, and supports data-driven decision-making for fall prevention.

In short, balance is too important to assess by intuition alone. With objective measurement, prevention becomes proactive, and independence can be maintained for longer.