Original articleThe Four Square Step Test is a Feasible and Valid Clinical Test of Dynamic Standing Balance for Use in Ambulant People Poststroke
Section snippets
Participants
The participants were a consecutive sample of people with stroke who met the study criteria and who attended physical therapy at Austin Health: Royal Talbot Rehabilitation Centre, a public facility that provides therapy to inpatients and outpatients in Melbourne, Australia. All potential candidates were informed about the study and then invited to participate. No person declined to be involved in the study. To be eligible, participants needed to be able to walk at least 50m with minimal
Agreement Between Scores for Repeated Trials
Performance scores for the FSST and Step Test across the 4-week period are summarized for the available sample in table 2. There was excellent agreement between the scores obtained during the 2 repeated trials for both tests (ICC3,k=.94−.99) at each assessment point. In addition, no significant difference was found between the first and second successful trial score for either test (Z=−1.40 to −.21, P=.16−.84), indicating that a practice effect was not evident. The order in which tests were
Discussion
The FSST was found to be a feasible and valid clinical test of dynamic standing balance to use with people with stroke who are at least ambulant with minimal assistance. The FSST was also able to detect change in dynamic standing balance over a 2- or 4-week period of stroke rehabilitation. Nevertheless, the ESs calculated for change in FSST scores were found to be small. Although the FSST was challenging for some participants, physical therapists who were trained to provide physical assistance
Conclusions
The FSST appears to be a feasible and valid test to examine how people with stroke plan and organize movement to walk over small obstacles and turn within a confined space. Our findings support that clinicians who are trained to provide physical supervision are able to use the FSST during stroke rehabilitation. We recommend that the person with stroke be able to walk at least 50m with minimal assistance before the FSST is considered. The FSST could be used in conjunction with other clinical
Acknowledgments
We thank all participants for their involvement in the study; the physical therapists at Austin Health-Royal Talbot Rehabilitation Centre who recruited and tested participants; and the undergraduate physical therapy students from The University of Melbourne who assisted in data management for the study.
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