The Four Square Step Test and its Use Clinically in Different Populations

Abstract

This review will summarize and appraise the most recent literature that has been published on the Four Square Step Test (FSST) so that clinicians can make informed decisions about its appropriate use with patients. The FSST is a valid and reliable measure of dynamic balance that has been successfully utilized across age cohorts and in multiple patient populations including those with neurologic diagnoses, musculoskeletal pathologies, and lower limb amputations. Performance on the FSST correlates with the functioning of multiple body structures, processes, and systems and it may be useful in predicting the care needs of older adults. The FSST does have some limitations; however, and in order to address these limitations, alternative administrations have been developed. The initial literature on these variations shows promise in their ability to build on the clinical utility of the traditional FSST. The FSST is quick, easy, and inexpensive to administer. It has robust psychometric properties, and there is a rapidly growing body of literature on its use in diverse circumstances. When using the FSST with specific populations, clinicians should refer to the available literature to determine the appropriateness of the test, how to interpret scores, and the potential utility of alternative administration methods. Future research should continue to explore the utility of these alternative administrations, as well as the use of the FSST in combination with other balance and mobility measures, and the relationship between FSST score and various body structures, functions, and systems.