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Related Experiment Video

Updated: May 13, 2026

The Multiple Sclerosis Performance Test (MSPT): An iPad-Based Disability Assessment Tool
11:35

The Multiple Sclerosis Performance Test (MSPT): An iPad-Based Disability Assessment Tool

Published on: June 30, 2014

Four Square Step Test in ambulant persons with multiple sclerosis: validity, reliability, and responsiveness.

Joanne M Wagner1, Rosemary A Norris, Linda R Van Dillen

  • 1Program in Physical Therapy, Department of Physical Therapy and Athletic Training, Doisy College of Health Sciences, Saint Louis University, Missouri 63104, USA. jwagne34@slu.edu

International Journal of Rehabilitation Research. Internationale Zeitschrift Fur Rehabilitationsforschung. Revue Internationale De Recherches De Readaptation
|March 21, 2013
PubMed
Summary

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The Four Square Step Test (FSST) is a valid and reliable measure for dynamic balance in individuals with multiple sclerosis (MS). However, it may not be sensitive enough to detect small, longitudinal changes in balance.

Area of Science:

  • Neurology
  • Rehabilitation Science
  • Movement Science

Background:

  • Multiple sclerosis (MS) is a progressive neurological disease affecting balance and mobility.
  • Ambulant individuals with MS often experience dynamic standing balance impairments.
  • Validated and reliable clinical measures are crucial for assessing balance in MS populations.

Purpose of the Study:

  • To determine the concurrent validity and reliability of the Four Square Step Test (FSST) in ambulant persons with multiple sclerosis (pwMS).
  • To establish the minimal detectable change (MDC) and evaluate potential floor and ceiling effects of the FSST in pwMS.
  • To assess the FSST's utility in measuring dynamic standing balance changes over time.

Main Methods:

  • Twenty-five ambulant pwMS completed the FSST on two separate occasions.

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Last Updated: May 13, 2026

The Multiple Sclerosis Performance Test (MSPT): An iPad-Based Disability Assessment Tool
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The Multiple Sclerosis Performance Test (MSPT): An iPad-Based Disability Assessment Tool

Published on: June 30, 2014

Screening People on Standing Balance with Romberg Testing and Walking Balance with Tandem Walking
06:28

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Published on: September 1, 2023

  • Concurrent validity was assessed by correlating FSST scores with the Berg Balance Scale, Dynamic Gait Index, and Activities-Specific Balance Confidence Scale.
  • Reliability was determined using intraclass correlation coefficients (ICC2,1), and MDC was calculated.

    • Main Results:

    • The FSST demonstrated strong, significant correlations with established balance measures (Berg Balance Scale: rs=-0.84; Dynamic Gait Index: rs=-0.81; ABC Scale: rs=-0.78).
    • Excellent relative reliability was observed for the FSST (ICC2,1=0.922).
    • The MDC for the FSST was 4.6 seconds, indicating that a change exceeding this value is needed to signify a true performance difference.

    Conclusions:

    • The FSST is a valid and reliable tool for assessing dynamic standing balance in ambulant pwMS.
    • A substantial change (43%) in FSST performance is required to reflect a real individual improvement.
    • The FSST's sensitivity to detect subtle longitudinal changes in dynamic balance may be limited in this population.