The Four Square Step Test is a feasible and valid clinical test of dynamic standing balance for use in ambulant people poststroke.
OBJECTIVE
To examine if the Four Square Step Test (FSST), a previously reported clinical test of dynamic standing balance, which involves stepping over obstacles and turning, was a feasible and valid test, and sensitive to change during stroke rehabilitation.


METHODS
Prospective observational cohort study over a 4-week duration.


METHODS
Rehabilitation hospital.


METHODS
People with stroke (N=37) who could walk at least 50m with minimal assistance were recruited consecutively when attending physical therapy during rehabilitation.


METHODS
Not applicable.


METHODS
Dynamic standing balance was examined at 2 weekly intervals using 2 clinical tests: the FSST and the Step Test. Falls events were monitored using a falls diary and by an audit of medical histories.


RESULTS
Strong agreement was observed between performance scores for the FSST and Step Test obtained within the same testing session (intraclass correlation coefficient(3,k), .94-.99). A moderate to strong inverse relationship (Spearman rho=-.73 to -.86) was observed between the FSST and Step Test scores at each assessment. Scores from both tests revealed significant improvements in dynamic balance across the 4-week period (P<.001-.010). Five of the participants reported falls during the study. These 5 people had low scores for both clinical tests and difficulty clearing their foot when stepping over objects in the FSST.


CONCLUSIONS
The FSST is a feasible and valid test of dynamic standing balance that is sensitive to change during stroke rehabilitation.
Blennerhassett
Jannette M
JM
Physiotherapy Department, Austin Health: Royal Talbot Rehabilitation Centre, Kew, Victoria, Australia. Jannette.Blennerhassett@austin.org.au
Jayalath
Victoria M
VM
D000058:Accidental Falls / Q000517:prevention & control*; D000328:Adult; D000368:Aged; D004185:Disability Evaluation; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D004856:Postural Balance; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D014739:Victoria; D016138:Walking