title: The reliability and validity of the Four Square Step Test for people with balance deficits secondary to a vestibular disorder.
abstract: OBJECTIVE
  To determine the reliability and validity of the Four Square Step Test (FSST) for use in people with balance deficits secondary to vestibular disorders, who frequently report falling and have difficulty with changes of direction.
  
  
  METHODS
  Cross-sectional descriptive study.
  
  
  METHODS
  Outpatient clinic.
  
  
  METHODS
  Thirty-two people with balance deficits secondary to vestibular disorders (mean age, 63.7+/-17.8y) who were currently enrolled in a vestibular physical therapy program agreed to participate.
  
  
  METHODS
  Participants performed the FSST, the Timed Up & Go (TUG) test, an 11-m walk test during which walking speed was recorded, and the Dynamic Gait Index (DGI) and completed the Dizziness Handicap Inventory (DHI) and the Activities-Specific Balance Confidence (ABC) Scale.
  
  
  METHODS
  The main outcome measures were the FSST time, TUG results, DGI score, gait velocity, and DHI and ABC scores. Number of fall risk factors, as determined by published scores for people at risk for falling on the TUG test and gait speed, and number of falls were compared with FSST scores.
  
  
  RESULTS
  The FSST has good reliability (intraclass correlation coefficient, model 3,1: .93; 95% confidence interval, .86-.96) and had good correlations with the other gait measures (correlation coefficients for the TUG, .69; gait speed, .65; DGI, -.51) and poor correlations with the DHI and the ABC (DHI, -.13; ABC, -.12). Multivariate linear regression showed that 51.5% of FSST performance was explained by TUG score and gait speed. The mean FSST time differed significantly between groups with 0 (n=12), 1 (n=12), or 2 to 3 (n=8) risk factors for falls (analysis of variance, F=10.02; P<.01). A cutoff score of greater than 12 seconds on the FSST was associated with a sensitivity of 80% and specificity of 92% for the identification of subjects with 1 or more risk factors for falls.
  
  
  CONCLUSIONS
  The FSST is a reliable and valid tool for measuring the ability to perform multidirectional movements in people with balance deficits secondary to vestibular disorders.
authors.affiliation: Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, PA, USA. whitney@pitt.edu
authors.forename: Susan L
authors.initials: SL
authors.lastname: Whitney
authors.forename: Gregory F
authors.initials: GF
authors.lastname: Marchetti
authors.forename: Laura O
authors.initials: LO
authors.lastname: Morris
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Sparto
mesh_terms: D000058:Accidental Falls; D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D016002:Discriminant Analysis; D005080:Exercise Test / Q000379:methods* / Q000592:standards; D005684:Gait; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D016014:Linear Models; D015999:Multivariate Analysis; D004856:Postural Balance; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D015983:Selection Bias; D012678:Sensation Disorders / Q000145:classification / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D015837:Vestibular Diseases / Q000150:complications*; D016138:Walking