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Reliability and validity of the Four Square Step Test in children with cerebral palsy and Down syndrome
Aila Nica J Bandong1, Gilbert O Madriaga2, Edward James R Gorgon1
1Department of Physical Therapy, College of Allied Medical Professions, University of the Philippines Manila, Pedro Gil Street, Malate, 1004 Manila, Philippines.
Insights
The Four Square Step Test (FSST) is reliable and valid for assessing stepping in children with cerebral palsy (CP) and Down syndrome (DS). This test aids in planning therapy for balance and daily life skills.
Area of Science:
- Pediatric Physical Therapy
- Clinical Measurement
- Neuromotor Development
Background:
- Stepping in different directions is a crucial balance skill for children with cerebral palsy (CP) and Down syndrome (DS).
- Standardized clinical tests are needed to assess this skill for effective therapy planning.
- Limited data exists on the measurement properties of such tests in these pediatric populations.
Purpose of the Study:
- To determine the relative and absolute reliability of the Four Square Step Test (FSST) in children with CP and DS.
- To calculate the minimal detectable difference (MDD) for the FSST in this population.
- To assess the concurrent validity of the FSST with the Timed Up-&-Go (TUG) test.
Main Methods:
- Observational methodological study involving 30 children (16 with CP, 14 with DS) aged 5-12 years.
- Repeat testing of the FSST by 3 raters with a 2-week interval.
- Concurrent administration of the Timed Up-&-Go (TUG) test during the second FSST session.
Main Results:
- The FSST demonstrated excellent interrater reliability (ICC=.79).
- Test-retest reliability varied from moderate to excellent across raters (.54–.89).
- A high positive correlation was found between FSST and TUG scores (r=.74), indicating good concurrent validity. MDD was calculated at 5.29s.
Conclusions:
- The FSST is a reliable and valid clinical measure for assessing stepping ability in children with CP and DS.
- Findings support the use of the FSST for evaluating balance and informing therapeutic interventions in these pediatric groups.
- The calculated MDD provides a threshold for detecting meaningful changes in performance over time.
Abstract:
Little is known about the measurement properties of clinical tests of stepping in different directions for children with cerebral palsy (CP) and Down syndrome (DS). The ability to step in various directions is an important balance skill for daily life. Standardized testing of this skill can yield important information for therapy planning. This observational methodological study was aimed at defining the relative and absolute reliability, minimal detectable difference, and concurrent validity with the Timed Up-&-Go (TUG) of the Four Square Step Test (FSST) for children with CP and DS. Thirty children, 16 with CP and 14 with DS, underwent repeat testing 2 weeks apart on the FSST by 3 raters. TUG was administered on the second test occasion. Intraclass correlation coefficients (ICC [1,1] and [3,1]) with 95% confidence intervals, standard error of measurement (SEM), minimal detectable difference (MDD) and the Spearman rank correlation coefficient were computed. The FSST demonstrated excellent interrater reliability (ICC=.79; 95% CI: .66, .89) and high positive correlation with the TUG (r=.74). Test-retest reliability estimates varied from moderate to excellent among the 3 raters (.54, .78 and .89 for raters 1, 2 and 3, respectively). SEM and MDD were calculated at 1.91s and 5.29s, respectively. Scores on the FSST of children with CP and DS between 5 and 12 years of age are reliable and valid.
