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. 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.