title: The four square step test in children with Down syndrome: Reliability and concurrent validity.
abstract: OBJECTIVE
  To estimate test-retest reliability, inter-rater reliability and validation of a method for measuring balance by stepping over four squares, four square step test (FSST) in children with Down syndrome (DS).
  
  
  METHODS
  A sample of 13 children with DS was recruited for the cross-sectional study. They were asked to perform FSST and the time taken was noted. For estimating test-retest reliability, FSST was done by principal investigator twice and Inter-rater reliability was assessed by principal investigator and second investigator with an interval of 7 days. FRT was used as the criterion dynamic balance measure to validate FSST. The data was tabulated and analysed statistically.
  
  
  RESULTS
  The test-retest reliability and inter-rater reliability of FSST are ICC(1,1) = 0.70 (0.64-0.90) and ICC(2,1) = 0.78 (0.62-0.91) respectively. The Bland-Altman limits of agreement were also satisfied. Concurrent validity between FRT and FSST with Spearman's ρ = -0.58 (-0.86 to -0.13).
  
  
  CONCLUSIONS
  FSST has moderate to good concurrent validity and good reliability among the children with Down syndrome.
authors.affiliation: Department of Pediatric Physiotherapy, Alva's College of Physiotherapy, Moodabidri, Karnataka, India.
authors.forename: Ajai
authors.initials: A
authors.lastname: Verma
authors.affiliation: Department of Pediatric Physiotherapy, Maharishi Markandeswar Institute of Physiotherapy and Rehabilitation (MMIPR), Maharishi Markandeswar University, Mullana, Haryana, India.
authors.forename: Asir John
authors.initials: AJ
authors.lastname: Samuel
authors.affiliation: Department of Pediatric Physiotherapy, Maharishi Markandeswar Institute of Physiotherapy and Rehabilitation (MMIPR), Maharishi Markandeswar University, Mullana, Haryana, India.
authors.forename: Vencita Priyanka
authors.initials: VP
authors.lastname: Aranha
keywords: Down syndrome; dynamic balance; functional reach test; inter-rater reliability; test-retest reliability; validity