Reliability and validity of the Four Square Step Test in patients with hip osteoarthritis before and after total hip replacement. Issue 2 (June 2019)

• Record Type: Journal Article
• Authors: Batting, M.; Barker, K.L.
• Is Part Of: Physiotherapy. Volume 105:Issue 2(2019)
• Page Start: 244
• Page End: 253
• Publication Date: 2019-06
• Subjects: Outcome assessments -- Gait -- Balance -- Osteoarthritis -- Total hip replacement -- Reproducibility of results; Physical therapy -- Periodicals; Therapeutics, Physiological -- Periodicals; 615.8205
• DOI: 10.1016/j.physio.2018.07.014
• Languages: English
• ISSNs: 0031-9406

Abstract

Abstract: Objective: To determine the validity and inter- and intra-rater reliability of the Four Square Step Test (FSST) in assessing gait performance, balance and physical function for patients with hip osteoarthritis before and after total hip replacement (THR). Design: Observational, repeated measures. Setting: A specialist orthopaedic hospital. Participants: Fifty-eight participants with moderate to severe hip osteoarthritis scheduled to receive primary hip replacement within 4 months from recruitment. Main outcome measure: Time to complete the FSST, time and steps to complete the Figure of 8 Walk Test (F8W) and Berg Balance Scale score (BBS). Results: The Bland and Altman limits of agreement for intra-rater measurements of the FSST were −3.2 s to 3.5 seconds before THR and −1.5 to 2.0 seconds after THR. Limits of agreement for two different raters were −2.2 to 3.4 seconds, all with small mean differences indicating little bias between raters or replications. Concurrent validity was assessed, and the FSST correlated highly with the F8W ( r = 0.7, P < 0.001) and moderately with the BBS ( r = 0.6, P < 0.001). Only one participant was rated as being at moderate risk of falls on the BBS, with the other participants scoring low; only one participant failed to complete the F8W. This is in contrast to the FSST, which 21 people failed to complete pre-operatively. Conclusions: The FSST is a valid and reliable measure of multi-directional stepping speed and balance, giving a more informative measure of gait performance than the F8W and BBS, and is feasible for use in a clinical population of patients both before and after THR.