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The Four Square Step Test is a useful mobility tool for discriminating older persons with frailty syndrome
Marcos Paulo Miranda de Aquino1, Nayara Tasse de Oliveira Cirino1, Camila Astolphi Lima1
1Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil.
Purpose:
To identify the usefulness of Four Square Step Test (FSST) in discriminating balance control in non-frail, pre-frail, and frail community-dwelling older adults.
Design:
Cross-sectional study.
Methods:
Cross- sectional study conducted in specialized outpatient geriatric care settings. One hundred and fifty-six consecutive patients without severe cognitive impairment and who could walk were included. We classified participants as non-frail, pre-frail, and frail using the Fried frailty phenotype. FSST was assessed by measuring the time (seconds) participants took to step into each of the four quadrants formed by four sticks arranged on the floor (clockwise and counterclockwise as quickly as possible) without knocking the sticks.
Results:
Of all participants, 36% were non-frail, 37% pre-frail, and 27% frail. Frail and pre-frail older adults took significantly more time to execute the FSST (23.1, 95% CI 18.8-27.4; p < 0.001 and 17.9; 95% CI 14.3-21.5; p = 0.003, respectively) compared to with non-frail (11.6, 95% CI 11.0-12.3). Frail and pre-frail older adults were not significantly different (p = 0.058). Most participants who failed to perform the test were frail (n = 15; 36%), followed by pre-frail (n = 7; 12%) and non-frail (n = 2; 3.5%).
Discussion:
Our results showed that pre-frail and frail older adults had poorer performance in FSST when compared to non-frail older adults. It is important to use instruments that allow early identification, especially of pre-frail older adults, as they are still at the beginning of the frailty process when the control and reversal of adverse outcomes are promising. Failing the test could be a sign of mobility loss, particularly due to balance and cognitive problems. Clinical practitioners could use the test to compare individual's performance attending rehabilitation programs over different periods of time.
Conclusion:
FSST is a useful and safe measure of dynamic balance and discriminates frail and pre-frail from non-frail older adults. Further diagnostic accuracy studies should be conducted to determine FSST predictive capacity.
