The Four Square Step Test is a useful mobility tool for discriminating older persons with frailty syndrome

Marcos Paulo Miranda de Aquino; Nayara Tasse de Oliveira Cirino; Camila Astolphi Lima; Mauricio de Miranda Ventura; Keith Hill; Monica Rodrigues Perracini

doi:10.1016/j.exger.2022.111699

The Four Square Step Test is a useful mobility tool for discriminating older persons with frailty syndrome

Exp Gerontol. 2022 May:161:111699. doi: 10.1016/j.exger.2022.111699. Epub 2022 Jan 21.

Authors

Marcos Paulo Miranda de Aquino¹, Nayara Tasse de Oliveira Cirino¹, Camila Astolphi Lima¹, Mauricio de Miranda Ventura², Keith Hill³, Monica Rodrigues Perracini⁴

Affiliations

¹ Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil.
² Geriatrics Unit, Hospital do Servidor Público Estadual, São Paulo, São Paulo, Brazil. Electronic address: mauriciomventura@uol.com.
³ School of Primary and Allied Health Care, Monash University, Melbourne, Australia. Electronic address: Keith.Hill@monash.edu.
⁴ Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil; Master's and Doctoral Programs in Gerontology, Faculty of Medical Sciences, Universidade Estadual de Campinas, Campinas, Brazil. Electronic address: monica.perracini@unicid.edu.br.

PMID: 35066122
DOI: 10.1016/j.exger.2022.111699

Abstract

Purpose: To identify the usefulness of Four Square Step Test (FSST) in discriminating balance control in non-frail, pre-frail, and frail community-dwelling older adults.

Design: Cross-sectional study.

Methods: Cross- sectional study conducted in specialized outpatient geriatric care settings. One hundred and fifty-six consecutive patients without severe cognitive impairment and who could walk were included. We classified participants as non-frail, pre-frail, and frail using the Fried frailty phenotype. FSST was assessed by measuring the time (seconds) participants took to step into each of the four quadrants formed by four sticks arranged on the floor (clockwise and counterclockwise as quickly as possible) without knocking the sticks.

Results: Of all participants, 36% were non-frail, 37% pre-frail, and 27% frail. Frail and pre-frail older adults took significantly more time to execute the FSST (23.1, 95% CI 18.8-27.4; p < 0.001 and 17.9; 95% CI 14.3-21.5; p = 0.003, respectively) compared to with non-frail (11.6, 95% CI 11.0-12.3). Frail and pre-frail older adults were not significantly different (p = 0.058). Most participants who failed to perform the test were frail (n = 15; 36%), followed by pre-frail (n = 7; 12%) and non-frail (n = 2; 3.5%).

Discussion: Our results showed that pre-frail and frail older adults had poorer performance in FSST when compared to non-frail older adults. It is important to use instruments that allow early identification, especially of pre-frail older adults, as they are still at the beginning of the frailty process when the control and reversal of adverse outcomes are promising. Failing the test could be a sign of mobility loss, particularly due to balance and cognitive problems. Clinical practitioners could use the test to compare individual's performance attending rehabilitation programs over different periods of time.

Conclusion: FSST is a useful and safe measure of dynamic balance and discriminates frail and pre-frail from non-frail older adults. Further diagnostic accuracy studies should be conducted to determine FSST predictive capacity.

Keywords: Balance; Four Square Step Test; Frailty; Mobility; Older people.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Cross-Sectional Studies
Exercise Test
Frail Elderly*
Frailty* / diagnosis
Geriatric Assessment / methods
Humans
Independent Living