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)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Multiple sclerosis: an immune or neurodegenerative disorder?.Annu Rev Neurosci. 2008; 31: 247-269
- Incidence and prevalence of multiple sclerosis in Olmstead County, Minnesota, 1985-2000.Neurology. 2003; 61: 1373-1377
- Epidemiology of multiple sclerosis in US veterans. VIII. Long term survival after onset of multiple sclerosis.Brain. 2000; 123: 1677-1687
- The neurobiology of multiple sclerosis: genes, inflammation, and neurodegeneration.Neuron. 2006; 52: 61-76
- 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
- Understanding falls in multiple sclerosis: association of mobility status, concerns about falling, and accumulated impairments.Phys Ther. 2012; 92: 407-415
- Evaluating walking in patients with multiple sclerosis: which assessment tools are useful in clinical practice?.Int J MS Care. 2011; 13: 4-14
- A clinical test of stepping and change in direction to identify multiple falling older adults.Arch Phys Med Rehabil. 2012; 83: 1566-1571
- 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
- 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
- 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
- Four square step test in ambulant persons with multiple sclerosis: validity, reliability, and responsiveness.Int J Rehabil Res. 2013; 36: 253-259
- Predicting accidental falls in people with multiple sclerosis - a longitudinal study.Clin Rehabil. 2009; 23: 259-269
- The clinical relevance of force platform measures in multiple sclerosis: a review.Mult Scler Int. 2013; 2013: 756564
- Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria.Ann Neurol. 2001; 69: 292-302
- Rating neurologic impairment in multiple sclerosis: an Expanded Disability Status Scale (EDSS).Neurology. 1983; 33: 1444-1452
- The diagnostic accuracy of static posturography in predicting accidental falls in people with multiple sclerosis.Mult Scler. 2012; 27: 45-52
- Two-, six-, and 12-minute walking tests in respiratory disease.Br Med J (Clin Res Ed). 1982; 284: 1607-1608
- 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
- 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
- The Multiple Sclerosis Functional Composite Measure (MSFC): an integrated approach to MS clinical outcome assessment.Mult Scler. 1999; 5: 244-250
- Confirming the validity and responsiveness of the Multiple Sclerosis Walking Scale-12 (MSWS-12).Neurology. 2004; 62: 2103-2105
- Psychometric properties of the Fatigue Severity Scale and the Modified Fatigue Impact Scale.J Neurol Sci. 2013; 331: 102-107
- The Falls Efficacy Scale International: a cross-sectional validation in people with multiple sclerosis.Arch Phys Med Rehabil. 2013; 94: 883-889
- Reliability of a novel computerized neuropsychological battery for mild cognitive impairment.Acta Neuropsychologica. 2003; 1: 407-413
- Prolonged response times characterize cognitive performance in multiple sclerosis.Eur J Neurol. 2007; 14: 1102-1108
- Risk factors for falling among people aged 45 to 90 years with multiple sclerosis.Arch Phys Med Rehabil. 2006; 87: 1274-1279
- Statistics and research in physical education.CV Mosby, St Louis1970
- Altered visual-spatial attention to task-irrelevant information is associated with risk falls risk in older adults.Neuropsychologia. 2013; 51: 3025-3032
- Dual task cost of walking is related to fall risk in persons with multiple sclerosis.J Neurol Sci. 2013; 335: 160-163
- Adapted timed up and go: a rapid clinical measure to assess gait and cognition in multiple sclerosis.Eur J. 2012; 67: 116-120
Article Info
Publication History
Published online: May 13, 2016
Footnotes
Disclosures: none.
Identification
Copyright
© 2016 by the American Congress of Rehabilitation Medicine
