Short communicationMinimal clinically important difference of the Four Square Step Test in people with degenerative spinal conditions
Section snippets
Background
The Four Square Step Test (FSST) is a measure of dynamic balance involving rapid step taking in multiple directions over obstacles [1]. It is valid and reliable in a number of other health conditions [2] and is shown to provide a more accurate measure of falls risk over other objective outcome measures [1]. For the FSST to become more widely used in clinical practice the clinically meaningful change to patients needs to be determined, allowing clinicians to confidently use it as a reliable
Methods
This was a secondary data analysis of a longitudinal cohort study: Walking and Balance related to sagittal Spinal Posture and Alignment (WiSPA) study. FSST and Activities-specific Balance Confidence (ABC) Scale were collected at baseline, post-physiotherapy and six months. Each participant took part in outpatient group-based physiotherapy once a week for six weeks. Inclusion criteria were men and women over 18 years who were attending group-based physiotherapy for a diagnosed degenerative
Statistical analysis
Descriptive statistics analysed baseline data. To determine improved versus not improved participants, the Standard Error of Measurement (SEM) of the ABC Scale was used (SEM = 1.197) [5]. Differences in mean change scores between improved and not improved on the FSST were assessed to calculate the MCID [6].
Results
Of the 28 participants, 19 were female and 9 had fallen on ≥1 occasion(s) in the previous year; the mean (SD) age was 73 (7.7) years and BMI was 28.34 (5.5) kg/m2. Fifteen participants had a primary diagnosis of osteoporosis and 13 of spinal stenosis.
The mean (SD) ABC Scale scores were 61% (19%) at baseline and 66% (18%) postphysiotherapy. The mean (SD) FSST scores were 19.1 seconds (9.8 seconds) at baseline and 13.9 seconds (6.3 seconds) post-physiotherapy. Table 1 shows the group split to those
Discussion
Using an anchor-based MCID method, the results show that an FSST score reduced by ≥3.6 seconds indicates a clinically important change in balance performance. This is the first study to determine the MCID of the FSST in any patient condition.
Due to the small sample size, it was decided MCID would be calculated through the mean change score between improved vs. not improved. With this relatively small sample the authors recognise that the sample demographics can have a greater impact on the MCID
Conclusions
The MCID of the FSST was shown to be 3.6 seconds for a sample of patients with degenerative spinal conditions. The results should however be interpreted with caution since there are varying techniques and outputs when calculating MCID and should not be transferred across patient groups.
Ethical approval
The WiSPA study was approved by North West – Greater Manchester Central Research Ethics Committee (ref: 19/NW/0111) and all participants gave written informed consent.
Conflict of interest
Karen Barker is an Associate Editor for Physiotherapy.
Professor Karen Barker is an associate editor of Physiotherapy, but had no involvement in the peer review or decision process for this paper.
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