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A clinical test of stepping and change of direction to identify multiple falling older adults☆,☆☆

https://doi.org/10.1053/apmr.2002.35469Get rights and content

Abstract

Dite W, Temple VA. A clinical test of stepping and change of direction to identify multiple falling older adults. Arch Phys Med Rehabil 2002;83:1566-71. Objectives: 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. Design: A 3-group comparison performed by using 3 validated tests and 1 new test. Setting: A rehabilitation center and university medical school in Australia. Participants: 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. Interventions: Not applicable. Main Outcome Measures: 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%. Conclusion: 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. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Section snippets

Participants

Eighty-one community-dwelling adults over the age of 65 years were tested. Fifty-four subjects were outpatients attending Community Rehabilitation Programs (CRP) at Bundoora Extended Care Centre, Austin & Repatriation Medical Centre or Royal Talbot Rehabilitation Centre (RTRC). Subjects were categorized either as multiple fallers (n=27; mean age ± standard deviation, 74.00±5.68y) who had 2 or more falls in the last 6 months or as nonmultiple fallers (n=27; mean age, 73.78±6.09y) who had fewer

Test order results

To account for a possible practice or learning effect between balance tests or a fatigue effect as the result of testing, subjects were randomly assigned into 1 of 4 test order groups. The Kruskal-Wallis 1-way ANOVA by ranks found no significant differences between test order groups on any of the balance and mobility measurements (FSST: X32=2.09, P=.55; TUG: X32=4.84, P=.18; Step Test: X32=.89, P=.59; FRT: X32=2.75, P=.43).

FSST reliability and group performance on balance and mobility measures

Excellent reliability for the FSST was found for interrater (n=30,

Discussion

The FSST was found to have excellent interrater and retest reliability. Evidence for validity of the FSST was found through its strong correlations with the TUG and Step Test. The lower correlations found between the FSST and FRT were expected because the FRT measured a different aspect of balance than the tests that involved stepping. The FRT was the only measure used in this study that did not involve movement of the feet. The FSST identified significant differences between the 3 groups

Conclusion

The objective of the study was to establish the reliability and validity of a new clinical test of dynamic standing balance, the FSST, and to evaluate its sensitivity, specificity, and predictive value in identifying subjects who fall. The FSST was both sensitive and specific and had higher combined sensitivity and specificity than the 3 tests with which it was compared for identifying differences between groups in the selected sample population of older adults. The FSST also had excellent

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    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

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    Reprint requests to Wayne Dite, 3 Kett St, Lower Plenty, 3093 Victoria, Australia, e-mail: [email protected].

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    Copyright © 2002 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.