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Published in: Current Geriatrics Reports 1/2021

01-03-2021 | Physical Therapy and Rehabilitation (O Addison, Section Editor)

The Four Square Step Test and its Use Clinically in Different Populations

Authors: Megan A. Connelly Ortega, Louise A. Zimmermann, Stormy G. Zyzyk

Published in: Current Geriatrics Reports | Issue 1/2021

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Abstract

Purpose of Review

This review will summarize and appraise the most recent literature that has been published on the Four Square Step Test (FSST) so that clinicians can make informed decisions about its appropriate use with patients.

Recent Findings

The FSST is a valid and reliable measure of dynamic balance that has been successfully utilized across age cohorts and in multiple patient populations including those with neurologic diagnoses, musculoskeletal pathologies, and lower limb amputations. Performance on the FSST correlates with the functioning of multiple body structures, processes, and systems and it may be useful in predicting the care needs of older adults. The FSST does have some limitations; however, and in order to address these limitations, alternative administrations have been developed. The initial literature on these variations shows promise in their ability to build on the clinical utility of the traditional FSST.

Summary

The FSST is quick, easy, and inexpensive to administer. It has robust psychometric properties, and there is a rapidly growing body of literature on its use in diverse circumstances. When using the FSST with specific populations, clinicians should refer to the available literature to determine the appropriateness of the test, how to interpret scores, and the potential utility of alternative administration methods. Future research should continue to explore the utility of these alternative administrations, as well as the use of the FSST in combination with other balance and mobility measures, and the relationship between FSST score and various body structures, functions, and systems.
Literature
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go back to reference •• Gouelle A, Highsmith MJ. Instrumented four square step test in adults with transfemoral amputation: test-retest reliability and discriminant validity between two types of microprocessor knees. Sensors. 20(17):4782. https://doi.org/10.3390/s20174782This cross-sectional study of community-dwelling adults with transfemoral amputation examined differences in performance on the Instrumented Four Square Step Test with the use of two different microprocessor prosthetic knee joints. Moderate to excellent test-retest reliability was found for the various constructs assessed. Findings suggest that this test detects subtle but potentially functionally important differences that the traditional FSST would miss. •• Gouelle A, Highsmith MJ. Instrumented four square step test in adults with transfemoral amputation: test-retest reliability and discriminant validity between two types of microprocessor knees. Sensors. 20(17):4782. https://​doi.​org/​10.​3390/​s20174782This cross-sectional study of community-dwelling adults with transfemoral amputation examined differences in performance on the Instrumented Four Square Step Test with the use of two different microprocessor prosthetic knee joints. Moderate to excellent test-retest reliability was found for the various constructs assessed. Findings suggest that this test detects subtle but potentially functionally important differences that the traditional FSST would miss.
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go back to reference •• Mathurapongsakul P, Siriphorn A. Four square step test with foam is more accurate than those without foam for discriminating between older adults with and without fall history. J Aging Phys Act. 2018;26(4):624–8. https://doi.org/10.1123/japa.2017-0363This cross-sectional study describes the performance of the FSST on foam in older adults with and without a history of falls compared to healthy young adults. Findings suggest that performance varies with age and the FSST + Foam may be more sensitive than the traditional FSST for detecting fall risk.CrossRefPubMed •• Mathurapongsakul P, Siriphorn A. Four square step test with foam is more accurate than those without foam for discriminating between older adults with and without fall history. J Aging Phys Act. 2018;26(4):624–8. https://​doi.​org/​10.​1123/​japa.​2017-0363This cross-sectional study describes the performance of the FSST on foam in older adults with and without a history of falls compared to healthy young adults. Findings suggest that performance varies with age and the FSST + Foam may be more sensitive than the traditional FSST for detecting fall risk.CrossRefPubMed
Metadata
Title
The Four Square Step Test and its Use Clinically in Different Populations
Authors
Megan A. Connelly Ortega
Louise A. Zimmermann
Stormy G. Zyzyk
Publication date
01-03-2021
Publisher
Springer US
Published in
Current Geriatrics Reports / Issue 1/2021
Electronic ISSN: 2196-7865
DOI
https://doi.org/10.1007/s13670-020-00348-0

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