FEASIBILITY OF FOUR SQUARE STEP TEST IN HIP FRACTURE PATIENTS

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The Four Square Step Test (FSST) is a clinical tool testing dynamic balance for predicting falls in older adults. The FSST has not been widely used in hip fracture patients. The purpose of this study was to assess the feasibility of FSST after hip fracture and consider the impact of cognitive impairment (which is high after hip fracture) on FSST performance. Baseline data are from an ancillary study of a randomized trial, Community Ambulation Project-Mechanistic Pathways (CAP-MP; n=40). Subjects walked <0.8m/s by <26wks post hip fracture surgery and completion of standard rehabilitation. Cognitive measures included Modified Mini Mental State Examination, Hooper Visual Organization Test, and Trails A&B. Descriptives, bivariate-correlations, and ANCOVA models tested the association of FSST performance with cognitive measures, demographics, physical function, and fracture-side. Of the 40 CAP-MP participants, 27(68%) completed the FSST. Of those who did not attempt, 25%(n=3) refused and 74%(n=9) were deemed unsafe or unable. Participants who did complete had slow FSST times (26.85 + 18.4s), with 74%(n=20)>15seconds. FSST was significantly (p≤.05) correlated with Hooper(r=-0.45), Trails A(r=0.39), gait speed(r=-0.37), fracture-side(r=-0.61), male sex(r=-0.40), and age(r=0.38). In models of FSST, only fracture side remained significant, with a borderline interaction with Hooper(p=.07). Those with lower Hooper scores and left side fracture performed slower, while right side fracture performed faster (regardless of Hooper). Many CAP-MP hip fracture patients were unable (23%) or failed (50%) the FSST. The influence of fracture side and cognition merit further exploration to improve FSST testing in hip fracture patients.

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