{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T18:30:27Z","timestamp":1786645827021,"version":"build-2736575974"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100023674","name":"Deanship of Scientific Research, King Khalid University","doi-asserted-by":"publisher","award":["RGP. 2\/62\/47"],"award-info":[{"award-number":["RGP. 2\/62\/47"]}],"id":[{"id":"10.13039\/501100023674","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>\n                    Long COVID is increasingly associated with persistent neuromuscular and functional impairments, including deficits in balance and trunk control. This cross-sectional study examined postural stability and trunk biomechanics in adults with Long COVID, comparing them to matched healthy controls. A total of 128 participants (64 per group) underwent computerized posturography to assess sway area, sway velocity, and stability index under varying sensory conditions. Trunk range of motion and isometric muscle strength were measured, along with fatigue, pain sensitivity, and physical function, using validated patient-reported outcomes. Compared to controls, individuals with Long COVID demonstrated significantly larger sway area (eyes closed on foam: 8.12\u2009\u00b1\u20091.87 cm\n                    <jats:sup>2<\/jats:sup>\n                    vs. 6.01\u2009\u00b1\u20091.65 cm\n                    <jats:sup>2<\/jats:sup>\n                    , p\u2009&lt;\u20090.001), higher sway velocity (1.23\u2009\u00b1\u20090.34 cm\/s vs. 0.98\u2009\u00b1\u20090.29 cm\/s, p\u2009&lt;\u20090.001), and lower stability index (78.45\u2009\u00b1\u20095.67 vs. 83.21\u2009\u00b1\u20096.12, p\u2009&lt;\u20090.001). Trunk flexion and extension were reduced (p\u2009&lt;\u20090.001), as were flexor and extensor strength (p\u2009&lt;\u20090.001). Fatigue was markedly elevated (FSS: 5.72\u2009\u00b1\u20091.03 vs. 2.34\u2009\u00b1\u20090.98, p\u2009&lt;\u20090.001). Multivariate analysis identified trunk extensor strength (\u03b2\u2009=\u20090.34, p\u2009=\u20090.001), fatigue severity (\u03b2\u2009=\u2009\u20130.38, p\u2009=\u20090.002), and physical function (\u03b2\u2009=\u20090.28, p\u2009=\u20090.015) as independent predictors of postural instability. These findings underscore the need for integrated rehabilitation that addresses both trunk biomechanics and symptom burden in Long COVID.\n                  <\/jats:p>","DOI":"10.1371\/journal.pone.0354593","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T17:43:49Z","timestamp":1786643029000},"page":"e0354593","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Postural control and trunk mobility impairments in adults with long COVID: A cross-sectional study using computerized posturography and clinical biomechanical tools"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5939-5340","authenticated-orcid":true,"given":"Adel","family":"Alshahrani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravi Shankar","family":"Reddy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kumar","family":"Gular","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venkata Nagaraj","family":"Kakaraparthi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajay Prashad","family":"Gautam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"issue":"9","key":"pone.0354593.ref001","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1016\/S2213-2600(22)00126-6","article-title":"Health outcomes in people 2 years after surviving hospitalisation with COVID-19: a longitudinal cohort study","volume":"10","author":"L Huang","year":"2022","journal-title":"Lancet Respir 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encephalomyelitis\/chronic fatigue syndrome","volume":"25","author":"DL Goldenberg","year":"2025","journal-title":"Expert Rev Neurother"},{"key":"pone.0354593.ref012","unstructured":"Frizzelli A. The functional status of patients with post COVID-19: from resting and exertional assessment to therapeutic approach. 2024."},{"issue":"3","key":"pone.0354593.ref013","doi-asserted-by":"crossref","first-page":"910","DOI":"10.3390\/s26030910","article-title":"Center of Pressure Measurement Sensing System for Dynamic Biomechanical Signal Acquisition and Its Self-Calibration","volume":"26","author":"N Li","year":"2026","journal-title":"Sensors (Basel)"},{"key":"pone.0354593.ref014","doi-asserted-by":"crossref","first-page":"1497079","DOI":"10.3389\/fpubh.2025.1497079","article-title":"Chronic low back pain and postural instability: interaction effects of pain severity, age, BMI, and disability","volume":"13","author":"A Alshahrani","year":"2025","journal-title":"Front Public Health"},{"issue":"2","key":"pone.0354593.ref015","first-page":"129","article-title":"The reliability and concurrent validity of measurements used to quantify lumbar spine mobility: an analysis of an iphone\u00ae application and gravity based inclinometry","volume":"8","author":"MJ Kolber","year":"2013","journal-title":"Int J Sports Phys Ther"},{"issue":"3","key":"pone.0354593.ref016","doi-asserted-by":"crossref","first-page":"137","DOI":"10.15412\/J.PTJ.07050303","article-title":"The reliability of bubble inclinometer and tape measure in determining lumbar spine range of motion in healthy individuals and patients","volume":"5","author":"R Sadeghi","year":"2015","journal-title":"PTJ"},{"key":"pone.0354593.ref017","doi-asserted-by":"crossref","first-page":"43","DOI":"10.5114\/jhk\/172640","article-title":"Reliability of a Trunk Flexion and Extensor Muscle Strength Test with Hand-Held and Isokinetic Dynamometers in Female Athletes","volume":"92","author":"C Juan-Recio","year":"2023","journal-title":"J Hum Kinet"},{"issue":"10","key":"pone.0354593.ref018","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0140822","article-title":"Assessment of Lower Limb Muscle Strength and Power Using 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