The Four Square Step Test is a feasible and valid clinical test of dynamic standing balance for use in ambulant people poststroke.

ABSTRACT

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. DESIGN: Prospective observational cohort study over a 4-week duration. SETTING: Rehabilitation hospital. PARTICIPANTS: People with stroke (N=37) who could walk at least 50m with minimal assistance were recruited consecutively when attending physical therapy during rehabilitation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: 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.