Journal of Rehabilitation Research & Development (JRRD)

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Volume 53 Number 3, 2016
   Pages 403 — 412

Abstract — Development of the Modified Four Square Step Test and its reliability and validity in people with stroke

Margaret A. Roos, PT, PhD;1* Darcy S. Reisman, PT, PhD;2–3 Gregory E. Hicks, PT, PhD;2–3 William Rose, PhD;2 Katherine S. Rudolph, PT, PhD4

1Department of Physical Therapy, University of the Sciences in Philadelphia, Philadelphia, PA; 2Graduate Program in Biomechanics and Movement Science and 3Department of Physical Therapy, University of Delaware, Newark, DE; 4College of Health Professions, University of New England, Portland, ME

Abstract — Adults with stroke have difficulty avoiding obstacles when walking, especially when a time constraint is imposed. The Four Square Step Test (FSST) evaluates dynamic balance by requiring individuals to step over canes in multiple directions while being timed, but many people with stroke are unable to complete it. The purposes of this study were to (1) modify the FSST by replacing the canes with tape so that more persons with stroke could successfully complete the test and (2) examine the reliability and validity of the modified version. Fifty-five subjects completed the Modified FSST (mFSST) by stepping over tape in all four directions while being timed. The mFSST resulted in significantly greater numbers of subjects completing the test than the FSST (39/55 [71%] and 33/55 [60%], respectively) (p < 0.04). The test-retest, intrarater, and interrater reliability of the mFSST were excellent (intraclass correlation coefficient ranges: 0.81–0.99). Construct and concurrent validity of the mFSST were also established. The minimal detectable change was 6.73 s. The mFSST, an ideal measure of dynamic balance, can identify progress in people with stroke in varied settings and can be completed by a wide range of people with stroke with the use of minimal equipment (tape, stop watch).

Key words: accidental falls, clinical testing, dynamic balance, gait speed, obstacle avoidance, outcome measure, reliability, static balance, stroke, validity.


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This article and any supplementary material should be cited as follows:
Roos MA, Reisman DS, Hicks GE, Rose W, Rudolph KS. Development of the Modified Four Square Step Test and its reliability and validity in people with stroke. J Rehabil Res Dev. 2016;53(3):403–12.
http://dx.doi.org/10.1682/JRRD.2014.04.0112
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