The Four Square Step Test is a feasible and valid clinical test of dynamic standing balance for use in ambulant people poststroke.

OBJECTIVE To examine if the Four Square Step Test (FSST), a previously reported clinical test of dynamic standing balance, which involves stepping over obstacles and turning, was a feasible and valid test, and sensitive to change during stroke rehabilitation. DESIGN Prospective observational cohort study over a 4-week duration. SETTING Rehabilitation hospital. PARTICIPANTS People with stroke (N=37) who could walk at least 50m with minimal assistance were recruited consecutively when attending physical therapy during rehabilitation. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Dynamic standing balance was examined at 2 weekly intervals using 2 clinical tests: the FSST and the Step Test. Falls events were monitored using a falls diary and by an audit of medical histories. RESULTS Strong agreement was observed between performance scores for the FSST and Step Test obtained within the same testing session (intraclass correlation coefficient(3,k), .94-.99). A moderate to strong inverse relationship (Spearman rho=-.73 to -.86) was observed between the FSST and Step Test scores at each assessment. Scores from both tests revealed significant improvements in dynamic balance across the 4-week period (P<.001-.010). Five of the participants reported falls during the study. These 5 people had low scores for both clinical tests and difficulty clearing their foot when stepping over objects in the FSST. CONCLUSIONS The FSST is a feasible and valid test of dynamic standing balance that is sensitive to change during stroke rehabilitation.