Validity of the four‐square step test in persons with haemophilia

Abstract Background Persistent postural-perceptual dizziness (PPPD) is a condition characterized by chronic subjective dizziness and exacerbated by visual stimuli or upright movement. Typical balance tests do not replicate the environments known to increase symptoms in people with PPPD—crowded places with moving objects. Using a virtual reality system, we quantified dynamic balance in people with PPPD and healthy controls in diverse visual conditions. Methods Twenty-two individuals with PPPD and 29 controls performed a square-shaped fast walking task (Four-Square Step Test Virtual Reality—FSST-VR) using a head-mounted-display (HTC Vive) under 3 visual conditions (empty train platform; people moving; people and trains moving). Head kinematics was used to measure task duration, movement smoothness and anterior–posterior (AP) and medio-lateral (ML) ranges of movement (ROM). Heart rate (HR) was monitored using a chest-band. Participants also completed a functional mobility test (Timed-Up-and-Go; TUG) and questionnaires measuring anxiety (State-Trait Anxiety Inventory; STAI), balance confidence (Activities-Specific Balance Confidence; ABC), perceived disability (Dizziness Handicap Inventory) and simulator sickness (Simulator Sickness Questionnaire). Main effects of visual load and group and associations between performance, functional and self-reported outcomes were examined. Results State anxiety and simulator sickness did not increase following testing. AP-ROM and HR increased with high visual load in both groups (p < 0.05). There were no significant between-group differences in head kinematics. In the high visual load conditions, high trait anxiety and longer TUG duration were moderately associated with reduced AP and ML-ROM in the PPPD group and low ABC and high perceived disability were associated with reduced AP-ROM (|r| = 0.47 to 0.53; p < 0.05). In contrast, in controls high STAI-trait, low ABC and longer TUG duration were associated with increased AP-ROM (|r| = 0.38 to 0.46; p < 0.05) and longer TUG duration was associated with increased ML-ROM (r = 0.53, p < 0.01). Conclusions FSST-VR may shed light on movement strategies in PPPD beyond task duration. While no main effect of group was observed, the distinct associations with self-reported and functional outcomes, identified using spatial head kinematics, suggest that some people with PPPD reduce head degrees of freedom when performing a dynamic balance task. This supports a potential link between spatial perception and PPPD symptomatology.

Download Full-text

Compléter l’interprétation des tests cliniques usuels par analyse métrologique : performance et stratégie au Four Square Step Test chez l’amputé transfémoral

Neurophysiologie Clinique ◽

10.1016/j.neucli.2018.10.046 ◽

2018 ◽

Vol 48 (6) ◽

pp. 328-329

Author(s):

Arnaud Gouelle ◽

Michael Jason Highsmith

Keyword(s):

Step Test ◽

Four Square

Download Full-text

FEASIBILITY OF FOUR SQUARE STEP TEST IN HIP FRACTURE PATIENTS

Innovation in Aging ◽

10.1093/geroni/igy023.1918 ◽

2018 ◽

Vol 2 (suppl_1) ◽

pp. 518-518

Author(s):

H Mutchie ◽

D Orwig ◽

B Beamer ◽

V Conroy ◽

J Guralnik ◽

...

Keyword(s):

Hip Fracture ◽

Step Test ◽

Four Square

Download Full-text

The Effect of Pilates Training on the Balance of Elderly

Reabilitacijos mokslai slauga kineziterapija ergoterapija ◽

10.33607/rmske.v1i16.745 ◽

2019 ◽

Vol 1 (16) ◽

Author(s):

Kristina Zaičenkovienė ◽

Renata Rakovaitė

Keyword(s):

Dynamic Balance ◽

Step Test ◽

Control Group ◽

Static Balance ◽

Study Group ◽

Timed Up And Go ◽

Physically Active ◽

Before And After ◽

Four Square ◽

And Control

Research background. Falling is one of the most important problems in the elderly’s mobility disorder, which is most often affected by the loss of balance. It is known that Pilates exercises could help to increase the deep muscle strength, improve posture and proprioception, which affects the improvement of the balance. Objective – to evaluate the effects of Pilates exercises on the elderly’s static and dynamic balance. Methodology. The study population consisted of 20 volunteers, men and women, who were divided into Pilates exercises (n = 10, age 65.1 ± 2.6) and control (n = 10, age 68.6 ± 4.9) groups. The study group participated in Pilates classes 2 times per week for six weeks (session duration 60 minutes). The control group did not participate in any physical activity, but they were physically active as usually in their daily life. The main outcome measures were assessed before and after the intervention. The static balance was assessed by measuring posturographic parameters using the force platform, dynamic balance was measured with the Timed up and Go Test (TUG) and the Four Square Step Test (FSST). Results. The results showed signifcant improvement in static balance of the experimental group after the Pilates exercises during standing tests when the feet were apart, eyes opened and closed and when the feet together with eyes opened, and when the foot was in front of the other foot. The results of the control group did not differ during both tests. The results of both groups did not differ in the static balance tests before and after the study, but after the Pilates exercises, the results of the Pilates group signifcantly differed from the control group test results when the feet were in shoulder line with open eyes. The results of the dynamic balance after Pilates exercises signifcantly improved in both tests in the study group. Before the study, there were not statistically signifcant differences in the dynamic balance results between the groups. Conclusions. Six-week Pilates exercises had a positive effect on the elderly’s static and dynamic balance.Keywords: Pilates training, static balance, dynamic balance.

Download Full-text

Measuring everyday mobility in patients before and after knee replacement: the validity and reliability of the Four Square Step test

Physiotherapy ◽

10.1016/j.physio.2018.11.047 ◽

2019 ◽

Vol 105 ◽

pp. e78-e79

Author(s):

K. Barker ◽

M. Batting ◽

J. Nederend

Keyword(s):

Knee Replacement ◽

Step Test ◽

Validity And Reliability ◽

Before And After ◽

Four Square

Download Full-text

Interrater and Intrarater Reliability of Common Clinical Standing Balance Tests for People With Hip Osteoarthritis

Physical Therapy ◽

10.2522/ptj.20130266 ◽

2014 ◽

Vol 94 (5) ◽

pp. 696-704 ◽

Cited By ~ 16

Author(s):

Yik Ming Choi ◽

Fiona Dobson ◽

Joel Martin ◽

Kim L. Bennell ◽

Rana S. Hinman

Keyword(s):

Measurement Error ◽

Hip Osteoarthritis ◽

Standing Balance ◽

Step Test ◽

Minimal Detectable Change ◽

Functional Reach ◽

Balance Tests ◽

Functional Reach Test ◽

Single Leg Stance ◽

Four Square

Background Hip osteoarthritis (OA) is a common musculoskeletal condition affecting older individuals. Clinical balance tests are frequently used to assess standing balance in these people. There is insufficient information regarding the reliability of these tests. Objective The aim of this study was to estimate reliability and measurement error of 4 common clinical standing balance tests in people with hip OA. Design A prospective study was conducted with repeated measures between 2 independent raters within 1 session and within 1 rater over a 1-week interval. Methods Thirty people with hip OA were evaluated. Reliability was estimated for the Four-Square Step Test, Step Test, Functional Reach Test, and Timed Single-Leg Stance Test using intraclass correlation coefficients (ICC [2,1]). Measurement error was expressed as standard error of measurement and minimal detectable change. Results The Four-Square Step Test, Step Test, and Timed Single-Leg Stance Test were sufficiently reliable between raters (ICC=.85–.94, lower 1-sided 95% confidence interval [95% CI]=.71–.89), whereas the Step Test (standing on study limb) and Timed Single-Leg Stance Test (standing on nonstudy limb) were sufficiently reliable within a rater over a 1-week interval (ICC=.91, lower 1-sided 95% CI=.80–.83). The Step Test (standing on study limb) and Timed Single-Leg Stance Test (standing on nonstudy limb) achieved optimal levels of reliability (ICC >.90, lower 1-sided 95% CI >.70), with acceptable measurement error (<10%) for clinical outcome measures. The Functional Reach Test was not sufficiently reliable. A ceiling effect was detected for the Timed Single-Leg Stance Test. Limitations Reliability was assessed only between 2 raters during a single session and within 1 rater over a 1-week interval, which limits generalizability. Conclusions The Step Test (standing on study limb) is recommended as a highly reliable test with acceptable measurement error for assessing standing balance in people with hip OA.

Download Full-text