title: A clinical test of stepping and change of direction to identify multiple falling older adults.
abstract: OBJECTIVE
  To establish the reliability and validity of a new clinical test of dynamic standing balance, the Four Square Step Test (FSST), to evaluate its sensitivity, specificity, and predictive value in identifying subjects who fall, and to compare it with 3 established balance and mobility tests.
  
  
  METHODS
  A 3-group comparison performed by using 3 validated tests and 1 new test.
  
  
  METHODS
  A rehabilitation center and university medical school in Australia.
  
  
  METHODS
  Eighty-one community-dwelling adults over the age of 65 years. Subjects were age- and gender-matched to form 3 groups: multiple fallers, nonmultiple fallers, and healthy comparisons.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Time to complete the FSST and Timed Up and Go test and the number of steps to complete the Step Test and Functional Reach Test distance.
  
  
  RESULTS
  High reliability was found for interrater (n=30, intraclass correlation coefficient [ICC]=.99) and retest reliability (n=20, ICC=.98). Evidence for validity was found through correlation with other existing balance tests. Validity was supported, with the FSST showing significantly better performance scores (P<.01) for each of the healthier and less impaired groups. The FSST also revealed a sensitivity of 85%, a specificity of 88% to 100%, and a positive predictive value of 86%.
  
  
  CONCLUSIONS
  As a clinical test, the FSST is reliable, valid, easy to score, quick to administer, requires little space, and needs no special equipment. It is unique in that it involves stepping over low objects (2.5cm) and movement in 4 directions. The FSST had higher combined sensitivity and specificity for identifying differences between groups in the selected sample population of older adults than the 3 tests with which it was compared.
authors.affiliation: Royal Talbot Rehabilitation Centre, Physiotherapy Department, RMIT University, Faculty of Life Sciences, School of Medical Sciences, Melbourne, Australia. wayne.dite@armc.org.au
authors.forename: Wayne
authors.initials: W
authors.lastname: Dite
authors.forename: Viviene A
authors.initials: VA
authors.lastname: Temple
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000203:Activities of Daily Living; D000368:Aged / Q000502:physiology*; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002183:Canes; D016022:Case-Control Studies; D015897:Comorbidity; D005080:Exercise Test / Q000379:methods* / Q000592:standards; D005260:Female; D005684:Gait; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D004856:Postural Balance; D012307:Risk Factors; D012678:Sensation Disorders / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D012680:Sensitivity and Specificity; D013997:Time Factors; D016138:Walking / Q000502:physiology