Validity of the four‐square step test in persons with haemophilia

Abstract

Introduction Recurrent bleeds into joints causes arthropathy leading to pain and reduced joint movement. This may cause a reduction in postural balance and increase the falls risk in patients with haemophilia (PWH). With an ageing PWH population the need to assess functional balance in clinic will be essential to monitor function and implement interventions to help maintain balance and prevent falls. Aim To assess the utility of the Four‐Square Step Test (FSST) in PWH. Methods 80 PWH of all severity types were recruited and underwent a battery of outcome measures: FSST, Timed up & go (TUG), Short performance physical battery (SPPB), Haemophilia Activity List (HAL), ABC confidence questionnaire, and Haemophilia Joint Health score (HJHS). Demographics were collected, together with self‐reported falls/trips history. Results All 80 participants were able to complete all test measures. Median age 44.5 years. Number of participants reporting falls ranged from 23% in severe to 3% in mild. Recent trips 53% severe to 17% mild. Excellent Inter and intra‐reliability, ICC of .981 (CI .953–.992), P < .001 and ICC .989 (.983‐.993) P < .001, respectively. Strong correlations between FSST and TUG/ SPPB .753 and ‐.728, moderate correlation between FSST and ABC/HAL ‐.484, ‐.464 P < .01. Conclusion FSST is a valid and safe measure to use in PWH. It correlates strongly with other functional measures, has excellent inter and intra rater reliability. FSST correlates with age rather than severity type and provides information to the clinician on the speed/ability to change direction and clear an obstacle. ABC questionnaire was able to differentiate between severities and offers insight into patient confidence to move. SPPB had a ceiling effect with 52/80 scoring 12 and may not be suitable for PWH.

Functional clinical motor performance tests to assess potential fall risks in patients with haemophilia: A case‐control study

“…Here the SPPB, gait speed and TUG, reveal that PwH possess lower physical functionality compared to the CG. These results are line with previously published study with 80 PwH (median age of 44.5 years) showing impaired performance in the SPPB (median: 11.5, IQR: 10−12) and TuG (median: 6.8, IQR: 5.5−7.6) 26 . Again, lowest performance was observed in orthopaedically most affected PwH.…”

Identifying performance‐based outcome measures of physical function in people with haemophilia (IPOP)

“…In Recent studies in persons with haemophilia suggest some of these tests; one leg balance, [25][26][27][28][29][30][31][32] 6-min walk test, 26,30,[33][34][35][36][37] timed up and down stairs 30,34 and timed up and go [38][39][40][41][42][43][44][45][46] may be responsive for monitoring physical function in people with haemophilia. However, confirmation of psychometric properties in people with haemophilia, such as test-retest repeatability, validity and minimal clinical important differences are required before recommendations can be made about longitudinal clinical use for all ages.…”