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Four square step test performance in people with Parkinson disease.
J Neurol Phys Ther. 2013 Mar; 37(1):2-8.JN

Abstract

BACKGROUND AND PURPOSE

The Four Square Step Test (4SST), a quick and simple test of multidirectional stepping, may be useful in predicting falls in people with Parkinson disease (PD). We studied the reliability of the 4SST and its ability to discriminate between freezers and nonfreezers, between fallers and nonfallers, and factors predictive of 4SST performance in people with PD.

METHODS

Fifty-three individuals with idiopathic PD completed the full protocol, including the 4SST as well as measures of balance, walking, and disease severity on anti-PD medication.

RESULTS

Interrater (intraclass correlation coefficient [ICC] = 0.99) and test-retest reliability were high (ICC = 0.78). The median 4SST performance was 9.52 seconds. There was a significant difference between 4SST time on-medication versus off (P = 0.03), while differences between fallers and nonfallers (P = 0.06) and between freezers and nonfreezers (P = 0.08) did not reach significance. All outcome measures were significantly related to 4SST time. In an exploratory, simultaneous regression analysis, 56% of the variance in 4SST performance could be accounted for by 3 measures: Mini-Balance Evaluation Systems Test (Mini-BESTest), Five Time Sit to Stand, and Nine Hole Peg Test. The 4SST cutoff score for distinguishing fallers from nonfallers was 9.68 seconds (Area under curve = 0.65, sensitivity = 0.73, specificity = 0.57). The posttest probability of an individual with a score greater than the cutoff being a faller was 31% (pretest probability = 21%).

DISCUSSION AND CONCLUSIONS

The 4SST is a reliable, quick test that can distinguish between on-and off-medication conditions in PD but is not as good as other tests (eg, Mini-BESTest) for distinguishing between fallers and nonfallers. Video Abstract available (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A31) for more insights from the authors.

Authors+Show Affiliations

Washington University in St. Louis School of Medicine, St. Louis, Missouri 63108, USA.No affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23364168

Citation

Duncan, Ryan P., and Gammon M. Earhart. "Four Square Step Test Performance in People With Parkinson Disease." Journal of Neurologic Physical Therapy : JNPT, vol. 37, no. 1, 2013, pp. 2-8.
Duncan RP, Earhart GM. Four square step test performance in people with Parkinson disease. J Neurol Phys Ther. 2013;37(1):2-8.
Duncan, R. P., & Earhart, G. M. (2013). Four square step test performance in people with Parkinson disease. Journal of Neurologic Physical Therapy : JNPT, 37(1), 2-8. https://doi.org/10.1097/NPT.0b013e31827f0d7a
Duncan RP, Earhart GM. Four Square Step Test Performance in People With Parkinson Disease. J Neurol Phys Ther. 2013;37(1):2-8. PubMed PMID: 23364168.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Four square step test performance in people with Parkinson disease. AU - Duncan,Ryan P, AU - Earhart,Gammon M, PY - 2013/2/1/entrez PY - 2013/2/1/pubmed PY - 2013/8/2/medline SP - 2 EP - 8 JF - Journal of neurologic physical therapy : JNPT JO - J Neurol Phys Ther VL - 37 IS - 1 N2 - BACKGROUND AND PURPOSE: The Four Square Step Test (4SST), a quick and simple test of multidirectional stepping, may be useful in predicting falls in people with Parkinson disease (PD). We studied the reliability of the 4SST and its ability to discriminate between freezers and nonfreezers, between fallers and nonfallers, and factors predictive of 4SST performance in people with PD. METHODS: Fifty-three individuals with idiopathic PD completed the full protocol, including the 4SST as well as measures of balance, walking, and disease severity on anti-PD medication. RESULTS: Interrater (intraclass correlation coefficient [ICC] = 0.99) and test-retest reliability were high (ICC = 0.78). The median 4SST performance was 9.52 seconds. There was a significant difference between 4SST time on-medication versus off (P = 0.03), while differences between fallers and nonfallers (P = 0.06) and between freezers and nonfreezers (P = 0.08) did not reach significance. All outcome measures were significantly related to 4SST time. In an exploratory, simultaneous regression analysis, 56% of the variance in 4SST performance could be accounted for by 3 measures: Mini-Balance Evaluation Systems Test (Mini-BESTest), Five Time Sit to Stand, and Nine Hole Peg Test. The 4SST cutoff score for distinguishing fallers from nonfallers was 9.68 seconds (Area under curve = 0.65, sensitivity = 0.73, specificity = 0.57). The posttest probability of an individual with a score greater than the cutoff being a faller was 31% (pretest probability = 21%). DISCUSSION AND CONCLUSIONS: The 4SST is a reliable, quick test that can distinguish between on-and off-medication conditions in PD but is not as good as other tests (eg, Mini-BESTest) for distinguishing between fallers and nonfallers. Video Abstract available (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A31) for more insights from the authors. SN - 1557-0584 UR - https://www.unboundmedicine.com/medline/citation/23364168/Four_square_step_test_performance_in_people_with_Parkinson_disease_ L2 - https://doi.org/10.1097/NPT.0b013e31827f0d7a DB - PRIME DP - Unbound Medicine ER -