Rehab Measures - Step Test

Title of Assessment

Step Test

Link to instrument

Purpose

The Step Test measures dynamic balance during an activity requiring weight-shift and movement while in single-leg stance as well as measures paretic-lower-extremity motor control in patients with stroke.

Acronym

Instrument Reviewer(s)

Initially reviewed by Krishneshwar Kamineni, PT, MPT in 12/2012

Summary Date

15 02 2013

Description

One Item
Participants who were unable to stand unsupported were given a score of 0 for both lower extremities. (Mercer et al, 2009)
The ST assesses an individual’s ability to place one foot onto a 7.5-cm-high step and then back down to the ﬂoor repeatedly as fast as possible for 15 seconds. The score is the number of steps completed in the 15-second period for each lower extremity. (Mercer et al, 2009)

ICF Domain

Activity, Participation

Time to Administer

Less than 5 minutes

Number of Items

1 item

Equipment Required

• A 7.5-cm-high step
• Stop Watch

Training Required

No training is required

Actual Cost

Cost of equipment

Populations Tested

Elderly
Stroke

Standard Error of
Measurement (SEM)

Not Established

Minimal Detectable
Change (MDC)

Not Established

Minimally Clinically
Important Difference (MCID)

Not Established

Cut-Off Scores

Chronic Stroke: (Hong et al, 2012; n = 30; where n =15 were stroke patients with mean age 57.7 (8.2) years; duration average post-stroke 5.6 (3.8) years; and n = 15 were healthy adults with mean age 57.3 (3.6) years)

A cutoff score of 13 on the paretic side was found to distinguish the patients with stroke from the healthy adults older than 50 years at a sensitivity of 87% and a specificity of 87%. A cutoff score of 11 on the non-paretic side was found to distinguish the patients with stroke from the healthy adults at a sensitivity of 100% and a specificity of 67%. (Hong et al, 2012)

Stroke: (Blennerhassett et al, 2012; n = 30; mean age 66.0 (49.3–72.0) years; median of inpatient stay 43.5 (20.5–72.0) days; median of time since discharge 14.5 (9.0–27.0) months)

The cutoff scores were < 250m for the 6MWT, <10 steps on the ST, and a failure or ≥ 15 seconds to complete the FSST. (Blennerhassett et al, 2012)

Normative Data

Chronic Stroke: (Hong et al, 2012)

Mean Values of Demographics and ST Scores in 2 Subject Groups:

Descriptor	Mean Values
	Healthy (n=15)	Stroke (n=15)	P
Age (y)	57.3(3.6)	57.7(8.2)	.841
Ethnicity	Chinese	Chinese	NA
Sex (M/F)	2/13	11/4	.001*
Height (m)	1.56(0.08)	1.63(0.08)	.012*
Weight (kg)	56.4(10.04)	68.1(11.79)	.007*
Body Mass Index (kg/m^2)	23.1(2.55)	25.3(2.76)	.035*
Right/nonparetic side	18.7(4.0)	11.0(4.2)	NA
Left/paretic side	18.6(4.0)	8.1(4.1)	NA
NOTE: Values are mean +/- SD or as otherwise noted; Abbreviations: F, femal; M, male; NA, not applicable; *Significant difference at P<.05.

Stroke: (Blennerhassett et al, 2012)

Details of 30 Participants:

Characteristics	Data
Age (y)	66(49.3-72.0)
Inpatient Stay (d)	43.5(20.5-72.0)
Time Since Discharge (mo)	14.5(9.0-27.0)
Men	20(69)
Infarct	24(83)
Hemorrhage	5(17)
Side Affected	Right 12; Left 14; Bilateral 4
Using a Gait Aid	SPS 7; 4WhF4
Living Situation	Alone 7; with others 22; at college 1
NOTE: Values are median (interquartile range), n (%), or n. Abbreviations: SPS, single point stick; 4WhF, 4-wheeled frame

Test-retest Reliability

Stroke: (Hill et al, 1996; n = 82; mean age 72.5 years, mean 54 days post-stroke)

Excellent test-retest reliability was high in a subgroup (ICC>0.90) and 21 stroke patients (ICC>0.88).

Interrater/Intrarater

Reliability

Chronic Stroke: (Hong et al, 2012)

Excellent interrater reliability ICC from 0.996 to 0.999
Excellent intrarater reliability ICC from 0.981 to 0.995

Internal Consistency

Not Established

Criterion Validity

(Predictive/Concurrent)

Stroke: (Blennerhassett et al, 2012)

Risk Ratios and Ability of Balance and Mobility Tests to Predict Falls:

Variable	FSST	ST	6MWT
	≥ 15s or Fail	<10 reps	<250m
Sensitivity (%)	92	85	64
Specificity (%)	69	59	88
Positive Predictive (%)	92	83	78
Negative Predictive (%)	69	61	78
Risk Ratio (95% CI)	2.9(1.4-6.2)	2.1(1.0-3.8)	3.5(1.0-12.2)
Abbreviation: reps, repetitions; FSST: Four Square Step Test; ST: Step Test; 6MWT: 6-Minute Wakl Test

Construct Validity

(Convergent/Discriminant)

Not Established

Content Validity

Not Established

Face Validity

Not Established

Floor/Ceiling Effects

Not Established

Responsiveness

Not Established

Professional Association Recommendations

Considerations

ST is fast and easy to conduct, and it has now been shown to be reliable when the number of steps was counted by either experienced or inexperienced examiners by viewing the video tapes. (Hong et al, 2012)
ST counts can distinguish subjects with chronic stroke from healthy adults older than 50 years. (Hong et al, 2012)
ST results correlate well with lower-limb muscle strength, walking speed, lower-limb motor coordination, and balance. (Hong et al, 2012)
Cutoff scores for the FSST, ST, and 6MWT could accurately classify falls risk at discharge. (Blennerhassett et al, 2012)

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Bibliography

Blennerhassett, J. M., Dite, W., et al. (2012). "Changes in balance and walking from stroke rehabilitation to the community: a follow-up observational study." Arch Phys Med Rehabil 93(10): 1782-1787. Find it on PubMed

Hill, K. D. (1996). "A new test of dynamic standing balance for stroke patients: reliability, validity and comparison with healthy elderly." Physiotherapy Canada 48(4): 257-262.

Hong, S. J., Goh, E. Y., et al. (2012). "Reliability and validity of step test scores in subjects with chronic stroke." Arch Phys Med Rehabil 93(6): 1065-1071. Find it on PubMed

Mercer, V. S., Freburger, J. K., et al. (2009). "Step Test scores are related to measures of activity and participation in the first 6 months after stroke." Phys Ther 89(10): 1061-1071. Find it on PubMed