Reliability of the four square step test in children with typical development age between seven to twelve years old
Keywords:
dynamic balance, inter-rater reliability, intra-rater reliability, four square step testAbstract
Background: Balance consists of both static and dynamic components. Dynamic balance involves motor planning and coordination which are essential for children’s daily activities and development. Although several measurement tools are available, the Four Square Step Test (FSST) is a practical and cost-effective tool for assessing dynamic balance, coordination, and agility. It has been examined of reliability in various population; however, the FSST in Thai children with typical development (TD) remains unexplored. This study aimed to assess the inter- and intra-rater reliability of the FSST in Thai children with TD aged 7–12 years.
Materials and Methods: This study included 23 children with TD (mean age: 9.43 ± 1.75 years; 11 boys, 12 girls). Two raters conducted inter-rater reliability assessments, while intra-rater assessments were performed over a three-hour period. Reliability was examined using the intraclass correlation coefficient (ICC): inter-rater ICC (2,1) and intra-rater ICC (3,1). Values for ICC were classified as weak (<0.5), moderate (0.51–0.75), good (0.76–0.89), and excellent (>0.90).
Results: Both groups exhibited an increase of peak MUAP. TKE with audible cues showed a greater change (40.16%) than without audible cues (10.03%). A decreased average MUFR after TKE exercise was observed in both with (41.62%) and without (8.10%) audible cues.
Conclusion: The FSST demonstrated excellent inter- and intra-rater reliability in Thai children with TD, supporting its use in clinical and research settings to assess dynamic balance.
References
Oates J. Motor Control and Physical Therapy: Theoretical Framework and Practical Applications. Philadelphia: LWW; 1992.
Huxham FE, Goldie PA, Patla AE. Theoretical considerations in balance assessment. Aust J Physiother. 2001;47(2):89-100.
Tecklin JS. Pediatric Physical Therapy. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2015.
Nolan L, Grigorenko A, Thorstensson A. Balance control: sex and age differences in 9- to 16-year-olds. Dev Med Child Neurol. 2005;47(7):449-54.
Dite W, Temple VA. A clinical test of stepping and change of direction to identify multiple falling older adults. Arch Phys Med Rehabil. 2002;83(11):1566-71.
Goh EY, Chua SY, Hong SJ, Ng SS. Reliability and concurrent validity of Four Square Step Test scores in subjects with chronic stroke: a pilot study. Arch Phys Med Rehabil. 2013;94(7):1306-11.
Boddy A, Mitchell K, Ellison J, Brewer W, Perry LA. Reliability and validity of modified Four Square Step Test (mFSST) performance in individuals with Parkinson's disease. Physiother Theory Pract. 2023;39(5):1038-43.
McKee KE, Hackney ME. The Four Square Step Test in individuals with Parkinson's disease: association with executive function and comparison with older adults. NeuroRehabilitation. 2014;35(2):279-89.
Aldirmaz E, Ugur F, Yilmaz O, Karaduman A, Alemdaroglu-Gurbuz I. A new instrument to assess dynamic balance in children with Duchenne muscular dystrophy: Four Square Step Test and its validity, reliability and feasibility. Dev Neurorehabil. 2023;26(1):27-36.
Bandong AN, Madriaga GO, Gorgon EJ. Reliability and validity of the Four Square Step Test in children with cerebral palsy and Down syndrome. Res Dev Disabil. 2015;47:39-47.
Brincks J, Callesen J. Examining the test-retest reliability and construct validity of the Six-Spot Step Test in older adults with self-reported balance problems. Clin Rehabil. 2021;35(10):1478-87.
Weir JP. Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM. J Strength Cond Res. 2005;19(1):231-40.
Orendorz-Fraczkowska K, Kubacka M. The development of postural control in 6-17-year-old healthy children. Part I: Postural control evaluation in modified Clinical Test for the Sensory Interaction on Balance in 6-17-year-old children (mCTSIB). Otolaryngol Pol. 2019;74(1):1-7.
Wolff DR, Rose J, Jones VK, Bloch DA, Oehlert JW, Gamble JG. Postural balance measurements for children and adolescents. J Orthop Res. 1998;16(2):271-5.
Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Phys Ther. 2000;80(9):896-903.
Tüzün EH, Levent E, Uzuner S, Sezerel B, Tomaç H, Mihçioğlu S, et al. Validity and reliability of the Four Square Step Test in typically developed children. Turk J Physiother Rehabil. 2020;31(3):240-6.
Shumway-Cook A, Woollacott MH. Motor Control: Translating Research into Clinical Practice. 5th ed. Philadelphia: Wolters Kluwer; 2017.
Kirshenbaum N, Riach CL, Starkes JL. Non-linear development of postural control and strategy use in young children: a longitudinal study. Exp Brain Res. 2001;140(4):420-31.
Verma A, Samuel AJ, Aranha VP. The Four Square Step Test in children with Down syndrome: reliability and concurrent validity. J Pediatr Neurosci. 2014;9(3):221-6.
Sá CDSC, Boffino CC, Ramos RT, Tanaka C. Development of postural control and maturation of sensory systems in children of different ages: a cross-sectional study. Braz J Phys Ther. 2018;22(1):70-6. doi:10.1016/j.bjpt.2017.10.006.
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