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Construct Validity of the Four Square Step Test in Multiple Sclerosis

  • Alon Kalron
    Correspondence
    Corresponding author Alon Kalron, PhD, Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, 60 HaBanim St, Tel-Aviv, Israel 46379.
    Affiliations
    Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
    Search for articles by this author
  • Uri Givon
    Affiliations
    Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel

    Department of Pediatric Orthopedics, Sheba Medical Center, Tel Hashomer, Tel-Aviv, Israel

    Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
    Search for articles by this author

      Abstract

      Objective

      To expand the construct validity of the Four Square Step Test (FSST) in people with multiple sclerosis (PWMS).

      Design

      Cross-sectional study.

      Setting

      Multiple sclerosis center.

      Participants

      PWMS (N=218; 133 women, 85 men; mean age, 43.2±13.5y; mean disease duration, 7.5±7.7y since diagnosis) were enrolled in the study. The Expanded Disability Status Scale score was 3.1±1.3, indicating minimal to moderate neurologic disability.

      Interventions

      Not applicable.

      Main Outcome Measures

      The FSST, posturography measures, 2-minute walk test, timed Up & Go test, timed 25-foot walk, fall status, Falls Efficacy Scale International, Modified Fatigue Impact Scale, instrumented cognitive assessment, and 12-item Multiple Sclerosis Walking Scale.

      Results

      The FSST score of the total sample was 11.0±4.9. Significant differences were observed between the very mild, mild, and moderate disability groups: 8.8±3.4, 11.1±4.9, and 14.1±5.3, respectively. In terms of fall status, the fallers demonstrated a significant slower FSST score than the nonfallers (12.5±5.7 vs 9.0±2.6, respectively). Modest significant correlation scores were found between the FSST and the timed Up & Go test and 2-minute walk test (Pearson ρ=.652 and ρ=−.575, respectively). In terms of posturography, all measures were significantly associated with the FSST scores. A significant positive relation was observed with the visual spatial cognitive domain (Pearson ρ=−.207).

      Conclusions

      The current study supports and broadens the construct validity of the FSST in PWMS.

      Keywords

      List of abbreviations:

      COP (center of pressure), EDSS (Expanded Disability Status Scale), FSST (Four Square Step Test), MS (multiple sclerosis), MSWS-12 (12-item Multiple Sclerosis Walking Scale), PWMS (people with multiple sclerosis)
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      References

        • Trapp B.D.
        • Nave K.
        Multiple sclerosis: an immune or neurodegenerative disorder?.
        Annu Rev Neurosci. 2008; 31: 247-269
        • Mayr W.T.
        • Pittock S.J.
        • McClelland R.L.
        • Jorgensen N.W.
        • Noseworthy J.H.
        • Rodriguez M.
        Incidence and prevalence of multiple sclerosis in Olmstead County, Minnesota, 1985-2000.
        Neurology. 2003; 61: 1373-1377
        • Wallin M.T.
        • Page W.F.
        • Kurtzke J.F.
        Epidemiology of multiple sclerosis in US veterans. VIII. Long term survival after onset of multiple sclerosis.
        Brain. 2000; 123: 1677-1687
        • Hauser S.L.
        • Oksenberg J.R.
        The neurobiology of multiple sclerosis: genes, inflammation, and neurodegeneration.
        Neuron. 2006; 52: 61-76
        • Kalron A.
        • Achiron A.
        • Dvir Z.
        Effect of a cognitive task on postural control in patients with a clinically isolated syndrome suggestive of multiple sclerosis.
        Eur J Phys Rehabil Med. 2011; 47: 579-586
        • Matsuda P.N.
        • Shumway-Cook A.
        • Ciol M.A.
        • Bombardier C.H.
        • Kartin D.A.
        Understanding falls in multiple sclerosis: association of mobility status, concerns about falling, and accumulated impairments.
        Phys Ther. 2012; 92: 407-415
        • Bethoux F.
        • Bennett S.
        Evaluating walking in patients with multiple sclerosis: which assessment tools are useful in clinical practice?.
        Int J MS Care. 2011; 13: 4-14
        • Dite W.
        • Temple V.A.
        A clinical test of stepping and change in direction to identify multiple falling older adults.
        Arch Phys Med Rehabil. 2012; 83: 1566-1571
        • Goh E.Y.
        • Chua S.Y.
        • Hong S.J.
        • Ng S.S.
        Reliability and concurrent validity of four square step test in subjects with chronic stroke: a pilot study.
        Arch Phys Med Rehabil. 2013; 94: 1306-1311
        • McKee K.E.
        • Hackney M.E.
        The four square step test in individuals with Parkinson's disease: association with executive function and comparison with older adults.
        Neurorehabilitation. 2014; 35: 279-289
        • Whitney S.L.
        • Marchetti G.F.
        • Morris L.O.
        • Sparto P.J.
        The reliability and validity of the four square step test for people with balance deficits secondary to a vestibular disorder.
        Arch Phys Med Rehabil. 2007; 88: 99-104
        • Wagner J.M.
        • Norris R.A.
        • Van Dillen L.R.
        • Thomas F.P.
        • Naismith R.T.
        Four square step test in ambulant persons with multiple sclerosis: validity, reliability, and responsiveness.
        Int J Rehabil Res. 2013; 36: 253-259
        • Nilsagard Y.
        • Lundholm C.
        • Denison E.
        • Gunnarsson L.G.
        Predicting accidental falls in people with multiple sclerosis - a longitudinal study.
        Clin Rehabil. 2009; 23: 259-269
        • Prosperini L.
        • Pozzilli C.
        The clinical relevance of force platform measures in multiple sclerosis: a review.
        Mult Scler Int. 2013; 2013: 756564
        • Polman C.H.
        • Reingold S.C.
        • Banwell B.
        • et al.
        Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria.
        Ann Neurol. 2001; 69: 292-302
        • Kurtzke J.F.
        Rating neurologic impairment in multiple sclerosis: an Expanded Disability Status Scale (EDSS).
        Neurology. 1983; 33: 1444-1452
        • Prosperini L.
        • Fortuna D.
        • Gianni C.
        • Leonardi L.
        • Pozzilli C.
        The diagnostic accuracy of static posturography in predicting accidental falls in people with multiple sclerosis.
        Mult Scler. 2012; 27: 45-52
        • Butland R.J.
        • Pang J.
        • Gross E.R.
        • Woodcock A.A.
        • Geddes D.M.
        Two-, six-, and 12-minute walking tests in respiratory disease.
        Br Med J (Clin Res Ed). 1982; 284: 1607-1608
        • Baert I.
        • Freeman J.
        • Smedal T.
        • et al.
        Responsiveness and clinically meaningful improvement, according to disability level, of walking measures after rehabilitation in multiple sclerosis: a European multi-center study.
        Neurorehabil Neural Repair. 2014; 28: 621-631
        • Sebastião E.
        • Sandroff B.M.
        • Learmonth Y.C.
        • Motl R.W.
        Validity of the timed up and go test as a measure of functional mobility in persons with multiple sclerosis.
        Arch Phys Med Rehabil. 2016; 97: 1072-1077
        • Fisher J.
        • Rudick G.
        • Cutter S.
        • Reingold S.
        The Multiple Sclerosis Functional Composite Measure (MSFC): an integrated approach to MS clinical outcome assessment.
        Mult Scler. 1999; 5: 244-250
        • McGuigan C.
        • Hutchinson M.
        Confirming the validity and responsiveness of the Multiple Sclerosis Walking Scale-12 (MSWS-12).
        Neurology. 2004; 62: 2103-2105
        • Learmonth Y.C.
        • Dlugonski D.
        • Pilutti L.A.
        • Sandroff B.
        • Klaren R.
        • Motl R.W.
        Psychometric properties of the Fatigue Severity Scale and the Modified Fatigue Impact Scale.
        J Neurol Sci. 2013; 331: 102-107
        • van Vliet R.
        • Hoang P.
        • Lord S.
        • Gandevia S.
        • Delbaere K.
        The Falls Efficacy Scale International: a cross-sectional validation in people with multiple sclerosis.
        Arch Phys Med Rehabil. 2013; 94: 883-889
        • Schweiger A.
        • Doniger G.M.
        • Dwolatzky T.
        • Jaffe D.
        • Simon E.S.
        Reliability of a novel computerized neuropsychological battery for mild cognitive impairment.
        Acta Neuropsychologica. 2003; 1: 407-413
        • Achiron A.
        • Doniger G.M.
        • Harel Y.
        • Appelboim-Gavish N.
        • Lavie M.
        • Simon E.S.
        Prolonged response times characterize cognitive performance in multiple sclerosis.
        Eur J Neurol. 2007; 14: 1102-1108
        • Finlayson M.L.
        • Peterson E.W.
        • Cho C.C.
        Risk factors for falling among people aged 45 to 90 years with multiple sclerosis.
        Arch Phys Med Rehabil. 2006; 87: 1274-1279
        • Weber J.C.
        • Lamb D.R.
        Statistics and research in physical education.
        CV Mosby, St Louis1970
        • Nagamatsu L.S.
        • Munkacsy M.
        • Liu-Ambrose T.
        • Handy T.C.
        Altered visual-spatial attention to task-irrelevant information is associated with risk falls risk in older adults.
        Neuropsychologia. 2013; 51: 3025-3032
        • Wadja D.A.
        • Motl R.W.
        • Sosnoff J.J.
        Dual task cost of walking is related to fall risk in persons with multiple sclerosis.
        J Neurol Sci. 2013; 335: 160-163
        • Allali G.
        • Laidat M.
        • Assal F.
        • et al.
        Adapted timed up and go: a rapid clinical measure to assess gait and cognition in multiple sclerosis.
        Eur J. 2012; 67: 116-120