Construct Validity of the Four Square Step Test in Multiple Sclerosis

Alon Kalron*, Uri Givon

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objective To expand the construct validity of the Four Square Step Test (FSST) in people with multiple sclerosis (PWMS). Design Cross-sectional study. Setting Multiple sclerosis center. Participants PWMS (N=218; 133 women, 85 men; mean age, 43.2±13.5y; mean disease duration, 7.5±7.7y since diagnosis) were enrolled in the study. The Expanded Disability Status Scale score was 3.1±1.3, indicating minimal to moderate neurologic disability. Interventions Not applicable. Main Outcome Measures The FSST, posturography measures, 2-minute walk test, timed Up & Go test, timed 25-foot walk, fall status, Falls Efficacy Scale International, Modified Fatigue Impact Scale, instrumented cognitive assessment, and 12-item Multiple Sclerosis Walking Scale. Results The FSST score of the total sample was 11.0±4.9. Significant differences were observed between the very mild, mild, and moderate disability groups: 8.8±3.4, 11.1±4.9, and 14.1±5.3, respectively. In terms of fall status, the fallers demonstrated a significant slower FSST score than the nonfallers (12.5±5.7 vs 9.0±2.6, respectively). Modest significant correlation scores were found between the FSST and the timed Up & Go test and 2-minute walk test (Pearson ρ=.652 and ρ=−.575, respectively). In terms of posturography, all measures were significantly associated with the FSST scores. A significant positive relation was observed with the visual spatial cognitive domain (Pearson ρ=−.207). Conclusions The current study supports and broadens the construct validity of the FSST in PWMS.

Original languageEnglish
Pages (from-to)1496-1501
Number of pages6
JournalArchives of Physical Medicine and Rehabilitation
Issue number9
StatePublished - 1 Sep 2016


  • Accidental falls
  • Gait
  • Multiple sclerosis
  • Postural balance
  • Rehabilitation
  • Walking


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