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Rehab Measures: 360 Degree Turn Test

Link to instrument

 

Title of Assessment

360 Degree Turn Test 

Acronym

360° Turn Test

Instrument Reviewer(s)

Terry Ellis PT, PhD, NCS and Laura Savella sPT, & the PD Edge Task Force of the Neurology Section of the APTA

Summary Date

5/1/2013 

Purpose

The 360° Turn Test is a measure of dynamic balance. The person tested turns in a complete circle (360 degrees) while time to complete and/or number of steps to complete the turn are recorded.

Description

  • The measure can be scored based on amount of time it takes to complete the turn (seconds) and/or number of steps taken to complete the turn
  • The participant can turn in either direction as long as he/she performs one complete turn each time
  • Administering the Test:
    •  Piece of masking taped on the floor to mark start position.
    • The participant stands with arms by his/her side and feet comfortably apart and pointing at the tape.
    • Start timing from the word “GO” and stop when the participant's shoulders are facing you again.
    • The participant is given two trials and the average of both trials is taken

Area of Assessment

Balance Non-Vestibular; Gait 

Body Part

Not Applicable 

ICF Domain

Activity 

Domain

Motor 

Assessment Type

Performance Measure 

Length of Test

05 Minutes or Less 

Time to Administer

< 5 minutes

Number of Items

Equipment Required

Stopwatch

Training Required

None
 

Type of training required

no training 

Cost

Free 

Actual Cost

Zero

Age Range

Adult: 18-64 years; Elderly adult: 65+ 

Administration Mode

Paper/Pencil 

Diagnosis

Geriatrics; Movement Disorders; Parkinson’s Disease 

Populations Tested

Older Adults
Parkinson's Disease

Standard Error of Measurement (SEM)

Not Established

Minimal Detectable Change (MDC)

Not Established

Minimally Clinically Important Difference (MCID)

Not Established

Cut-Off Scores

Older Adults

(Gill et al, 1995; n = 563; mean age = 79.1(4.7); community dwelling adults > 70 years old)

  • 360 Degree Turn Test (seconds) “threshold phenomenon” with > 3.8 seconds a critical point after which rate of dependence increased significantly

Normative Data

Older Adults

(Gill et al, 1995)

Descriptive data; Sample divided into 4 quartiles & “unable” group based on time to complete 360 Degree Turn (seconds)

Inter-quartile Ranges for 360 Degree Turn Test (seconds): Range (seconds) and number of subjects

1st

2nd

3rd

4th

Unable to complete turn

1.1 - 2.4

n = 137

2.5 - 2.9

n = 129

3.0 - 3.8

n = 132

3.9 - 23

n = 150

 

n = 12

(Dai et al, 2012; Non-fall group: n = 372; mean age = 71(9.3); Fall group: n = 139; mean age = 75(11); recruited from senior center)

Descriptive data on 360 Degree Turn Test (seconds)

  • Non-fall group: Mean = 2.2(0.9) seconds
  • Fall group: Mean = 2.7(1.5) seconds

Parkinson’s Disease

Descriptive data

(Schenkman et al, 1997; n = 15 total, mean age 74.5; H&Y Stage 2: n = 8 and H&Y Stage 3: n = 7)

n = 14 subjects tested

  • 360 Degree Turn (seconds): Mean = 6.0(2.5)seconds; Range = 3.8-15.9
  • 360 Degree Turn (steps): Mean = 9.5(2.9) steps; Range = 5.5-18.5

Descriptive data;

(Schenkman et al, 2011: n = 150 participants (derived from multiple studies); mean age unknown; H&Y Range = 1-3)

H&Y Stage

360 Degree Turn Time (s)

360 Degree Turn Steps (#)

1-1.5

3.33(0.98)

6.33(0.93)

2

3.91(1.37)

7.55(1.96)

2.5

4.81(1.58)

8.66(2.66)

3

7.34(3.60)

11.04(3.61

Cohen’s f

0.30

0.25

(Franzen et al, 2009; n = 15 male subjects with dx PD H&Y stages 2-3; mean age = 64(9); n = 15 healthy, age& sex matched controls; Allowed subjects to initiate 360 Degree Turn)

Descriptive data mean scores on 360 Degree Turn Test (seconds)

  • Control group = 3.8 (0.7) seconds
  • PD group “OFF” State = 5.3 (1.6) seconds
  • PD group “ON” State = 5.1 (1.9) seconds

Test-retest Reliability

Older Adults:

Test-retest reliability (Tager et al, 1998; n = 199; 42% aged 55-69, 60% aged > 70; ambulatory community dwellers)

  • 360 degree Turn Test (steps)
    • Excellent (by ICC = 0.92)
    • Acceptable (by Pearson Correlation Coefficient = 0.83)

Significant improvements (practice effects) found on 360 degree turn test (# of steps); measured 48 hours apart

Parkinson’s Disease

Test-retest reliability (Schenkman et al, 1997)

  • 360 Degree Turn (seconds): Acceptable test-retest reliability (ICC = 0.77)
  • 360 Degree Turn (steps): Acceptable test-retest reliability (ICC = 0.80)

Interrater/Intrarater Reliability

Older Adults

(Berg, 1989 n = 38 participants who had a fall in the last 2 months; mean age = 73; a variety of diagnostic categories (none excluded))

Inter-rater Reliability of 360 Degree Turn Test (seconds) (within the Berg Balance Test)

  • ICC for all individual items on BERG (360 degree turn (seconds) included given as a range: ICC = 0.71 - 0.99 across items

Intra-rater reliability (for 360 degree turn item)

  • For time 1: Excellent (ICC = 0.89)
  • For time 2: Excellent (ICC = 0.94)

Internal Consistency

Not Established

Criterion Validity (Predictive/Concurrent)

Not Established

Construct Validity (Convergent/Discriminant)

Older Adults

(Schubert et al, 2006 n = 195 community dwelling older adults; mean age = 80.9(5.9))

Convergent validity of the 360 degree turn test (seconds) with:

  • Tandem stance test: Adequate (r = 0.46)
  • Walking Speed: Excellent (r = 0.70)
  • Timed Chair Rise(s): Poor (r = 0.26)

Patients who score < 3.8 seconds on the 360 degree Turn Test were more likely to perform well on tasks of walking speed (Odds Ratio = 20.7) and Timed Chair Rise(s) (Odds Ratio = 8.5) compared to those who performed well on the Tandem Stance Test

(Dite et al, 2002) Convergent validity of the 360 Degree Turn Test (seconds) with

  • 180 Degree Turn Test (seconds): Excellent (r = 0.67)
  • 180 degree Turn Test (steps): Excellent (r = 0.76)

(Lipsitz et al, 1991; Fallers (2+ falls in past 6 months); n = 70; mean age = 87(6); Non-fallers: no falls past 6 months and no more that 1 fall in 2 years prior; n = 56; mean age = 87 (5); Independent and partially dependent ambulatory nursing home residents)

  • Slower time (> 9.1 seconds) to turn a full circle (360 degree turn test) more common among fallers
    • Unadjusted odds ratio = 2.94 (1.38 - 6.25)
  • More steps (> 12 steps) to turn a full circle more common among fallers
    • Unadjusted odds ratio = 6.52 (2.86 - 14.88)

Parkinson’s Disease

(Schenkman et al, 2002; n = 34; subset of Total Sample: n = 42 independent community dwelling adults with PD; mean age = 63.7(11.5); H&Y Stage mean = 2.07(0.79))

Convergent Validity of 360 Degree Turn Test (seconds) with:

  • CS-PFP: Adequate Convergent Validity (r = -0.53)

Convergent Validity of 360 Degree Turn Test (steps) with:

  • CS-PFP: Adequate Convergent Validity (r = -0.54)

Content Validity

Not Established

Face Validity

Not Established

Floor/Ceiling Effects

Not Established

Responsiveness

Older Adults

(Gill et al, 1997; Primary study group: n = 586, mean age = 78.9 (4.8); ADL Independent at baseline & 1 year, alive for 3 year follow up; Secondary group: n = 775; mean age = 79.3(5.1); ADL Independent at baseline & alive at 1 year follow up; data set included people with chronic diseases including Parkinson’s)

  • Those subjects dependent at 1-year follow-up took longer (seconds) to complete the 360 Degree Turn Test compared to those who remained independent at 1 year [2.31(8.80) verses 0.37(3.57)] seconds.

Professional Association Recommendations

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (VEDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

 

For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

 

Abbreviations:

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

 

Recommendations Based on Parkinson Disease Hoehn and Yahr stage:

 

I

II

III

IV

V

PD EDGE

R

R

R

R

R

 

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

PD EDGE

 

No

No

Not reported

VEDGE

 

Yes

No

 

Considerations

  • Psychometric properties for the 360 Degree Turn Test were tested on populations of patients primarily in H&Y Stages 1-3; no studies on this measure have included H&Y Stages 4 or 5.

Bibliography

Berg, K. (1989). "Measuring balance in the elderly: preliminary development of an instrument." Physiotherapy Canada 41(6): 304-311.

Dai, B., Ware, W. B., et al. (2012). "A structural equation model relating physical function, pain, impaired mobility (IM), and falls in older adults." Arch Gerontol Geriatr 55(3): 645-652. Find it on PubMed

Dite, W. and Temple, V. A. (2002). "Development of a clinical measure of turning for older adults." Am J Phys Med Rehabil 81(11): 857-866; quiz 867-858. Find it on PubMed

Gill, T. M., Williams, C. S., et al. (1997). "The role of change in physical performance in determining risk for dependence in activities of daily living among nondisabled community-living elderly persons." Journal of clinical epidemiology 50(7): 765-772. 

Gill, T. M., Williams, C. S., et al. (1995). "Assessing risk for the onset of functional dependence among older adults: the role of physical performance." Journal of the American Geriatrics Society 43(6): 603-609.

Lipsitz, L. A., Jonsson, P. V., et al. (1991). "Causes and correlates of recurrent falls in ambulatory frail elderly." J Gerontol 46(4): M114-122. Find it on PubMed

Schenkman, M., Cutson, T. M., et al. (1997). "Reliability of impairment and physical performance measures for persons with Parkinson's disease." Phys Ther 77(1): 19-27. Find it on PubMed

Schenkman, M., Cutson, T. M., et al. (2002). "Application of the continuous scale physical functional performance test to people with Parkinson disease." Journal of Neurologic Physical Therapy 26(3): 130-138. Find it on PubMed

Schenkman, M., Ellis, T., et al. (2011). "Profile of functional limitations and task performance among people with early- and middle-stage Parkinson disease." Phys Ther 91(9): 1339-1354. Find it on PubMed 

Shubert, T. E., Schrodt, L. A., et al. (2006). "Are scores on balance screening tests associated with mobility in older adults?" J Geriatr Phys Ther 29(1): 35-39. Find it on PubMed

Tager, I. B., Swanson, A., et al. (1998). "Reliability of physical performance and self-reported functional measures in an older population." J Gerontol A Biol Sci Med Sci 53(4): M295-300. Find it on PubMed

Year published

 

Instrument in PDF Format

Yes 
Approval Status Approved 
 
Attachments
Created at 12/18/2013 3:31 PM  by Jason Raad 
Last modified at 8/28/2014 2:46 PM  by Jason Raad