Arvidsson Lindvall M.1, Anderzén Karlsson A.1, Appelros P.1, Forsberg A.2
1Örebro University, University Health Care Research Centre, Faculty of Medicine and Health, Örebro, Sweden, 2Örebro University, Department of Physiotherapy, Faculty of Medicine and Health, Örebro, Sweden
Background: Persons who have suffered a stroke often have hemiparesis with muscle weakness and spasticity, and consequently take more load on the non-paretic leg during standing. There is a need for a valid and reliable instrument that combines straight walking and taking load on each leg during single-leg standing. The Six Spot Step Test (SSST) includes walking 5 m and shoving blocks with one leg.
Purpose: The aim of the present study was to investigate construct convergent validity and test- retest reliability of the SSST in persons with gait and balance impairment after stroke.
Methods: The study was a cross-sectional study with measurement of dynamic balance and walking ability, which was repeated 3- 7 days apart, using a convenience sample of persons with diagnosis of stroke > 6 months previously. The measurements were made in a standardized order, starting with the Activities-specific Balance Confidence (ABC scale), followed by the Timed Stands Test (TST), the Four Square Step Test (FSST), the Dynamic Gait Index (DGI), the Time Up and Go (TUG) test, and the SSST. On the second test occasion only the SSST was performed.
Results: Eighty-one persons were included. Participants performed the SSST significantly faster during single-leg standing taking load on their paretic leg. The SSST demonstrated strong construct convergent validity with the TUG, DGI, and FSST instruments, and moderate convergent validity with the TST and the ABC scale. The test-retest was good. The Standard Error of the Measurements, SEM% values were between 14.7 and 20.0%, and the Smallest Real Difference, SRD%, ranged from 40.8% to 55.4 %, based on the lowest value calculated for the mean of four trials taking load alternatively on the paretic and non- paretic leg.
Conclusion(s): The SSST is a valid and reliable instrument for measuring walking balance post stroke.
Implications: In physical therapy practice, for persons with hemiparesis after stroke, the SSST is a valid and reliable complementary instrument of gait and balance including a challenging weight transfer from the paretic to the non-paretic side. The mean time of four rounds shoving with both the paretic and the non-paretic foot is preferred as the total score; a practice trial should be performed for the person to become familiarized with the test.
Funding acknowledgements: This work was supported by the Research Committee Örebro County Council (OLL-575951).
Topic: Neurology: stroke
Ethics approval: The study was approved by the Regional Ethics Committee of Uppsala/ Örebro, Sweden (2014/058).
All authors, affiliations and abstracts have been published as submitted.
