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Updated: May 14, 2026
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Dynamic Digital Biomarkers of Motor and Cognitive Function in Parkinson's Disease
Published on: July 24, 2019
Four square step test performance in people with Parkinson disease
Ryan P Duncan1, Gammon M Earhart
1Washington University in St. Louis School of Medicine, St. Louis, Missouri 63108, USA.
Journal of Neurologic Physical Therapy : JNPT
|February 1, 2013
Summary
The Four Square Step Test (4SST) reliably measures changes in Parkinson disease (PD) patients on and off medication. While not superior to other tests for fall prediction, it offers valuable insights into PD progression.
Area of Science:
- Neurology
- Movement Disorders
- Rehabilitation Science
Background:
- The Four Square Step Test (4SST) is a simple test assessing multidirectional stepping.
- It may predict falls in individuals with Parkinson disease (PD).
Purpose of the Study:
- To assess the reliability of the 4SST.
- To evaluate its ability to differentiate between PD patients who freeze and those who do not.
- To determine its effectiveness in distinguishing fallers from non-fallers and identify factors influencing 4SST performance.
Main Methods:
- Fifty-three individuals with idiopathic PD underwent the 4SST and other balance, walking, and disease severity assessments.
- Data were collected while patients were on anti-PD medication.
Main Results:
- The 4SST demonstrated high interrater (ICC=0.99) and test-retest (ICC=0.78) reliability.
- A significant difference in 4SST performance was observed between on- and off-medication states (P=0.03).
- The Mini-Balance Evaluation Systems Test (Mini-BESTest), Five Time Sit to Stand, and Nine Hole Peg Test explained 56% of the variance in 4SST performance.
Conclusions:
- The 4SST is a reliable and quick tool for assessing medication effects in PD.
- It shows potential for tracking disease progression.
- However, it is less effective than other measures like the Mini-BESTest for distinguishing fallers from non-fallers in PD.
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