Objectives To explore whether the mean lumbar acceleration is a feasible tool for determining minimum eligibility criteria to compete in cerebral palsy football, differentiating between new sports classes, and to assess the effect of foot contacts on balance evaluation and class distinction. Design Cross-sectional study. Methods A total of 146 male cerebral palsy footballers classified into FT1 (n=34), FT2 (n=87), and FT3 (n=25), alongside 12 non-impaired athletes as a control group, participated. Two trials of one-leg standing, performed with the more and less affected legs, were measured using a smartphone-based accelerometer. Results Reliability was moderate-to-excellent (ICC3,1>0.70; SEM<20%). Significant differences were observed between legs for footballers with cerebral palsy but not for the control group. Mean lumbar acceleration and the number of foot contacts showed significant differences between footballers with cerebral palsy and controls, with pairwise comparisons revealing distinctions between classes. Receiver operating characteristic curves demonstrated high sensitivity and specificity for distinguishing the control group from FT3 using the most affected leg (1.00 [excellent]), with a cutoff score of 0.115 m/s2 achieving very high sensitivity and specificity. Conclusions Mean lumbar acceleration appears to be a suitable metric for assessing minimum impairment criteria for eligibility in para-sports for ambulant athletes with cerebral palsy. However, foot contacts during one-leg standing tests may mask true balance performance in individuals with more severe impairments, which could affect class distinction. Practical implications • The use of the accelerometer embedded in smartphone devices is a practical tool to assess one-leg balance in para-athletes with cerebral palsy. • Assessing balance of para-athletes with different levels of impairment is done with moderate-to-excellent reliability because of balance losses by those with more severe impairment. • A cut-off score is set to distinguish impaired balance of the more affected leg in those para-athletes with the minimum impairment criteria, so it is applicable for set objective eligibility criteria in para-sports involving para-athletes with (mild) cerebral palsy.
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