OBJECTIVE: To determine whether a dance mat test of choice stepping reaction time (CSRT) is reliable and can detect differences in fall risk in older adults. DESIGN: Randomized order, crossover comparison. SETTING: Balance laboratory, medical research institute, and retirement village. PARTICIPANTS: Older (mean age 78.87 +/- 5.90y; range 65 to 90y) independent-living people (n = 47) able to walk in place without assistance. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Reaction (RT), movement, and response times of dance pad-based stepping tests, Physiological Profile Assessment (PPA) score, Digit Symbol Substitution Test (DSST) score, time to complete the Trail Making Test (TMT) A+B, Fall Efficacy Scale International (FES-I) score, Activities-specific Balance Confidence (ABC) Scale score, and Incidental and Planned Exercise Questionnaire (IPEQ) incidental IPEQ activity subscore. RESULTS: Test-retest reliability of the dance mat CSRT response time was high (intraclass correlation coefficient model 3, k = 0.90; 95% confidence interval (CI) 0.82 to 0.94; p < 0.001) and correlated highly with the existing laboratory-based measure (r = 0.86; 95% CI 0.75 to 0.92; p < 0.001). Concurrent validity was shown by significant correlations between response time and measures of fall risk (PPA: r = 0.42; 95% CI 0.15 to 0.63; p < 0.01; TMT A: r = 0.61; 95% CI 0.39 to 0.77; TMT B: r = 0.55; 95% CI 0.31 to 0.72; DSST: r = -0.53; 95% CI -0.71 to -0.28; p < 0.001; FES-I: Spearman rho = 0.50; 95% CI 0.25 to 0.69; ABC Scale: Spearman rho = -0.58; 95% CI -0.74 to -0.35; p < 0.01). Participants with moderate/high fall-risk scores (PPA score > 1) had significantly slower response times than people with low/mild fall-risk scores (PPA score < 1) at 1,146 +/- 182 and 1,010 +/- 132ms, respectively (p = 0.005), and multiple fallers and single/nonfallers showed significant differences in RT (883 +/- 137 versus 770 +/- 100ms; p = 0.009) and response time (1,180 +/- 195 versus 1,031 +/- 145ms; p = 0.017). CONCLUSIONS: The new dance mat device is a valid and reliable tool for assessing stepping ability and fall risk in older community-dwelling people. Because it is highly portable, it can be used in clinic settings and the homes of older people as both an assessment and training device.

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