Journal of Physical Therapy Science
Online ISSN : 2187-5626
Print ISSN : 0915-5287
ISSN-L : 0915-5287
Original Article
Inter-rater reliability of the instrumented lean-and-release (iLEAN) test for manual assessment of reactive balance: a pilot study in simulated older adults
Tatsuya Hirase, Asahi Nishimura, Yuika Kato, Nanako Ishizaka, Naoya Hasegawa, Stephen R. Lord, Yoshiro Okubo
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JOURNAL OPEN ACCESS

2026 Volume 38 Issue 3 Pages 96-101

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Abstract

[Purpose] Quantitative assessment of reactive balance often requires large, costly equipment, limiting its use in clinical practice. This study investigated the inter-rater reliability of the instrumented lean-and-release (iLEAN) test, a manual reactive balance assessment designed to provide a practical alternative for physiotherapists. [Participants and Methods] Sixteen healthy young women completed the iLEAN test in standing, where reactive balance control was assessed in forward, left, right, and backward directions. During tests, an assessor applied the iLEAN device against the shoulder and released support once the participant reached a target lean load, which was progressively increased until balance could not be regained with a single step. Inter-rater reliability was analyzed using intraclass correlation coefficients (ICC, model 2,1) and Bland–Altman plots. [Results] The ICCs (95% confidence intervals) for the iLEAN scores were 0.60 (0.17–0.84) for forward, 0.75 (0.34–0.92) for left, 0.80 (0.45–0.94) for right, and 0.83 (0.58–0.94) for backward. Bland–Altman analysis revealed no systematic bias between raters across all directions. [Conclusion] This study provides preliminary evidence that the iLEAN test has acceptable inter-rater reliability for assessing reactive balance, with the backward condition demonstrating the highest reliability and sensitivity to change.

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© 2026 by the Society of Physical Therapy Science. Published by IPEC Inc.

This article is licensed under a Creative Commons [Attribution-NonCommercial-NoDerivatives 4.0 International] license.
https://creativecommons.org/licenses/by-nc-nd/4.0/
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