Content » Vol 50, Issue 1

Original report

Reliability and convergent validity of the five-step test in people with chronic stroke

Shamay S.M. Ng, Mimi M.Y. Tse , Eric W.C. Tam, Cynthia Y.Y. Lai
Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong (SAR), Hong Kong. E-mail:
DOI: 10.2340/16501977-2291


Objectives: (i) To estimate the intra-rater, inter-rater and test-retest reliabilities of the Five-Step Test (FST), as well as the minimum detectable change in FST completion times in people with stroke. (ii) To estimate the convergent validity of the FST with other measures of stroke-specific impairments. (iii) To identify the best cut-off times for distinguishing FST performance in people with stroke from that of healthy older adults.
Design: A cross-sectional study.
Setting: University-based rehabilitation centre.
Participants: Forty-eight people with stroke and 39 healthy controls.
Interventions: None.
Main outcome measures: The FST, along with (for the stroke survivors only) scores on the Fugl-Meyer Lower Extremity Assessment (FMA-LE), the Berg Balance Scale (BBS), Limits of Stability (LOS) tests, and Activities-specific Balance Confidence (ABC) scale were tested.
Results: The FST showed excellent intra-rater (intra-class correlation coefficient; ICC = 0. 866–0. 905), inter-rater (ICC = 0. 998), and test-retest (ICC = 0. 838–0. 842) reliabilities. A minimum detectable change of 9. 16 s was found for the FST in people with stroke. The FST correlated significantly with the FMA-LE, BBS, and LOS results in the forward and sideways directions (r = –0. 411 to –0. 716, p < 0. 004). The FST completion time of 13. 35 s was shown to discriminate reliably between people with stroke and healthy older adults.
Conclusion: The FST is a reliable, easy-to-administer clinical test for assessing stroke survivors’ ability to negotiate steps and stairs.

Lay Abstract

The Five-Step Test (FST) could be used to assess the ability to negotiate steps and stairs. The objectives of the study were to determine the consistency of FST, to identify the relationships between performance of FST and motor functions of lower limbs and balance performance, and to compare the performance of FST in people with stroke and healthy older adults. Total 48 stroke survivors and 39 heathy older adults participated in this study. The results showed that FST completion time were highly consistent throughout the trials. The FST completion times had strong relationships with motor functions of lower limbs and balance performance. The FST completion time of people with stroke were nearly twice of those of healthy older adults. The FST is a reliable and easy-to administer clinical tool for assessing ability to negotiate steps and stairs in people with stroke.


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