Reliability of recurrence quantification analysis measures of the center of pressure during standing in individuals with musculoskeletal disorders

Although the application of nonlinear tools including recurrence quantification analysis (RQA) has increasingly grown in the recent years especially in balance-disordered populations, there have been few studies which determine their measurement properties. Therefore, a methodological study was performed to estimate the intersession and intrasession reliability of some dynamic features provided by RQA for nonlinear analysis of center of pressure (COP) signals recorded during quiet standing in a sample of patients with musculoskeletal disorders (MSDs) including low back pain (LBP), anterior cruciate ligament (ACL) injury and functional ankle instability (FAI). The subjects completed postural measurements with three levels of difficulty (rigid surface-eyes open, rigid surface-eyes closed, and foam surface-eyes closed). Four RQA measures (% recurrence, % determinism, entropy, and trend) were extracted from the recurrence plot. Relative reliability of these measures was assessed using intraclass correlation coefficient and absolute reliability using standard error of measurement and coefficient of variation. % Determinism and entropy were the most reliable features of RQA for the both intersession and intrasession reliability measures. High level of reliability of % determinism and entropy in this preliminary investigation may show their clinical promise for discriminative and evaluative purposes of balance performance.