{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T09:52:36Z","timestamp":1791453156521,"version":"4.3.3"},"reference-count":22,"publisher":"American Spinal Injury Association","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026]]},"abstract":"\n Background:<\/jats:title>\n Clinicians require reliable and valid measures to assess dynamic balance and fall risk in individuals with incomplete spinal cord injury (iSCI). Currently, no psychometrically sound measures exist for capturing higher-level balance impairments in this population. The Four Square Step Test (FSST) is a dynamic balance measure assessing a person's ability to step quickly in multiple directions over obstacles. The FSST has been established as reliable and valid for various neurological populations and is particularly suited for individuals who ambulate without assistance.<\/jats:p>\n <\/jats:sec>\n \n Objectives:<\/jats:title>\n This study aimed to evaluate the validity and interrater reliability of the FSST in an ambulatory, chronic iSCI population.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n We used data from 23 participants to assess FSST convergent validity with established gait and balance measures. We used data from 11 participants, each assessed by multiple raters, to evaluate interrater reliability.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Spearman's rank correlations (\u03c1) revealed strong, significant correlations (all\n P<\/jats:italic>\n s < .01) between the FSST and the Berg Balance Scale (\u03c1 = \u22120.81), 10-Meter Walk Test self-selected (\u03c1 = \u22120.77), 10-Meter Walk Test fast (\u03c1 = \u22120.84), and Timed Up and Go (\u03c1 = 0.81), indicating convergent validity. The intraclass correlation coefficient (ICC) between expert and novice raters was excellent (ICC = 1.0), confirming interrater reliability.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n Overall, the FSST demonstrated excellent reliability and validity, suggesting it is suitable for evaluating dynamic balance in high-functioning individuals with iSCI.<\/jats:p>\n <\/jats:sec>","DOI":"10.46292\/sci25-00141","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T09:23:33Z","timestamp":1791451413000},"page":"56-62","source":"Crossref","is-referenced-by-count":0,"title":["Psychometric Properties of the Four Square Step Test in Incomplete Spinal Cord Injury"],"prefix":"10.46292","volume":"32","author":[{"given":"Jennifer H.","family":"Kahn","sequence":"first","affiliation":[{"name":"Northwestern University, Feinberg School of Medicine, Department of Physical Therapy and Human Movement Sciences, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kadi","family":"Glaser","sequence":"additional","affiliation":[{"name":"Northwestern University, Feinberg School of Medicine, Department of Physical Therapy and Human Movement Sciences, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Kyburz","sequence":"additional","affiliation":[{"name":"Northwestern University, Feinberg School of Medicine, Department of Physical Therapy and Human Movement Sciences, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kylee","family":"Mosehart","sequence":"additional","affiliation":[{"name":"Northwestern University, Feinberg School of Medicine, Department of Physical Therapy and Human Movement Sciences, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane L.","family":"Woodward","sequence":"additional","affiliation":[{"name":"Northwestern University, Feinberg School of Medicine, Department of Physical Therapy and Human Movement Sciences, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith E.","family":"Gordon","sequence":"additional","affiliation":[{"name":"Northwestern University, Feinberg School of Medicine, Department of Physical Therapy and Human Movement Sciences, Chicago, Illinois"},{"name":"Research Service, Edward Hines Jr. VA Hospital, Hines, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"25425","reference":[{"key":"b1","series-title":"Spinal Cord","first-page":"526","article-title":"Falls after spinal cord injury: A systematic review and meta-analysis of incidence proportion and contributing factors","volume":"57","author":"Khan A","year":"2019","unstructured":"Khan A, Pujol C, Laylor M, et al. Falls after spinal cord injury: A systematic review and meta-analysis of incidence proportion and contributing factors. Spinal Cord. 2019;57:526-539. doi: 10.1038\/s41393-019-0274-4."},{"key":"b2","series-title":"Handb Clin Neurol","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/B978-0-444-63916-5.00024-0","article-title":"Balance, gait, and falls in spinal cord injury","volume":"159","author":"Wirz M","year":"2018","unstructured":"Wirz M, van Hedel HJA. Balance, gait, and falls in spinal cord injury. Handb Clin Neurol. 2018;159:367-384. doi: 10.1016\/B978-0-444-63916-5.00024-0."},{"key":"b3","series-title":"Spinal Cord","first-page":"245","article-title":"Standing balance assessment in ASIA D paraplegic and tetraplegic participants: Concurrent validity of the Berg Balance Scale","volume":"48","author":"Lemay JF","year":"2010","unstructured":"Lemay JF, Nadeau S. 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Top Spinal Cord Inj Rehabil. 2020;26:268-274. doi: 10.46292\/sci19-00069."},{"key":"b12","series-title":"Arch Phys Med Rehabil","first-page":"1566","article-title":"A clinical test of stepping and change of direction to identify multiple falling older adults","volume":"83","author":"Dite W","year":"2002","unstructured":"Dite W, Temple VA. A clinical test of stepping and change of direction to identify multiple falling older adults. Arch Phys Med Rehabil. 2002;83:1566-1571. doi: 10.1053\/apmr.2002.35469."},{"key":"b13","series-title":"Syst Rev","first-page":"187","article-title":"The validity and reliability of the Four Square Step Test in different adult populations: A systematic review","volume":"6","author":"Moore M","year":"2017","unstructured":"Moore M, Barker K. The validity and reliability of the Four Square Step Test in different adult populations: A systematic review. 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Presented at the American Society of Biomechanics Annual Meeting; 2021."},{"key":"b16","series-title":"Arch Phys Med Rehabil","first-page":"190","article-title":"Assessing walking ability in subjects with spinal cord injury: Validity and reliability of 3 walking tests","volume":"86","author":"van Hedel HJ","year":"2005","unstructured":"van Hedel HJ, Wirz M, Dietz V. Assessing walking ability in subjects with spinal cord injury: Validity and reliability of 3 walking tests. Arch Phys Med Rehabil. 2005;86:190-196. doi: 10.1016\/j.apmr.2004.02.010."},{"key":"b17","series-title":"Health Sci Rep","first-page":"e98","article-title":"Examining the reliability, correlation, and validity of commonly used assessment tools to measure balance","volume":"1","author":"Dawson N","year":"2018","unstructured":"Dawson N, Dzurino D, Karleskint M, Tucker J. Examining the reliability, correlation, and validity of commonly used assessment tools to measure balance. 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Arch Rehabil Res Clin Transl. 2021;3:100096. doi: 10.1016\/j.arrct.2020.100096."},{"key":"b22","series-title":"J Spinal Cord Med","first-page":"439","article-title":"Functional assessments for predicting a risk of multiple falls in independent ambulatory patients with spinal cord injury","volume":"38","author":"Srisim K","year":"2015","unstructured":"Srisim K, Saengsuwan J, Amatachaya S. Functional assessments for predicting a risk of multiple falls in independent ambulatory patients with spinal cord injury. 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