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Reliability and validity of the Six-Spot Step Test in patients with total hip arthroplasty
Elif Aygun-Polat1, Yusuf Polat2, Yunus Emre Ozbilen2
1Department of Physiotherapy and Rehabilitation, Ordu University, Ordu, Turkey.
Objectives:
To assess the validity and reliability of the Six-Spot Step Test (SSST) in total hip arthroplasty (THA) patients.
Design:
Cross-sectional cohort study.
Setting:
Outpatient clinic.
Participants:
Sixty-one patients at least six months post-primary THA.
Main Outcome Measures:
The SSST was performed twice on the same day by Rater 1, along with the Timed Up and Go (TUG), Four-Square Step Test (FSST), and Berg Balance Scale (BBS). It was repeated 5-7 days later by Raters 1 and 2. Reliability was assessed using intraclass correlation coefficients (ICC) and Bland-Altman analysis; validity with Spearman's correlation. A fall-risk cut-off was identified via receiver operating characteristic (ROC) analysis.
Results:
Participants' mean (SD) age was 64 (7) years, with an Oxford Hip Score of 37 (8). As defined by the Bland-Altman analysis, the agreement intervals, within which 95% of the differences of the second measurement, compared to the first one, fall were: within day -1.7 to 2.3 seconds (s), -2.3 to 2.0 seconds between day and -2.0 to 1.9 between raters. Reliability was excellent within-day (ICC: 0.95), between-day (ICC: 0.94), and inter-rater (ICC: 0.95). The SSST correlated strongly with the TUG (ρ = 0.70) and FSST (ρ = 0.81), and moderately with the BBS (ρ = -0.62). A cut-off of 10.7 seconds indicated fall risk (sensitivity: 75%; specificity: 73%; AUC = 0.82, 95% CI: 0.71-0.94, p < 0.001).
Conclusion:
The SSST is a reliable and valid tool for assessing mobility in THA patients. It effectively identified fall risk in this sample, supporting its clinical use. However, further validation in different samples is required.
Clinical Trial Registration Number:
NCT06704217 CONTRIBUTION OF PAPER.
