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Clinical Trial
. 2019 Mar 21;14(3):e0213698.
doi: 10.1371/journal.pone.0213698. eCollection 2019.

The Step Test Evaluation of Performance on Stairs (STEPS): Validation and reliability in a neurological disorder

Anne D Kloos  1 , Deb A Kegelmeyer  1 , Katherine Ambrogi  2 , David Kline  3 , Meredith McCormack-Mager  3 , Brittany Schroeder  1 , Sandra K Kostyk  2   4
Affiliations
Clinical Trial

The Step Test Evaluation of Performance on Stairs (STEPS): Validation and reliability in a neurological disorder

Anne D Kloos et al. PLoS One. .

Abstract

Background: Individuals with neurological disorders often have difficulty negotiating stairs that can lead to injurious falls. Clinicians lack a clinical tool to identify impairments in stair negotiation and to assist their decision making regarding treatment plans to improve stair performance and safety. We developed a new tool called the Step Test Evaluation of Performance on Stairs (STEPS) that is designed to assess stair performance and safety in neurological populations.

Objectives: This study aimed to determine interrater and intrarater reliability of STEPS and its concurrent content validity to various clinical balance and mobility measures using individuals with Huntington's disease (HD) as the first test population.

Methods: Forty individuals with HD (mean age 50.35) participated. Three observers rated live performances of the STEPS (interrater reliability) and seven observers rated videotaped performances twice (intrarater reliability). STEPS scores correlated with clinical mobility and balance test scores.

Results: Excellent inter- and intrarater reliability (ICCs = 0.91 and 0.89 respectively) and good internal consistency (α = 0.83) were found. Better STEPS performance correlated with better performance on co-administered motor and mobility measures and Stair Self-Efficacy scores. Per multivariable regression analysis, the Unified Huntington's Disease Rating Scale modified motor score and descent time were significant predictors of STEPS performance.

Conclusions: The STEPS tool is easy to administer, requires no special devices and can be completed in less than five minutes. In the HD test population, it shows high reliability and validity making it a potentially useful tool for assessing maneuverability and safety on stairs in HD. The results suggest that the STEPS tool warrants further study to determine STEPS cut-off values for fall prediction in HD and may prove useful as an assessment tool for other neurological disorders.

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Conflict of interest statement

The STEPS instrument is copyrighted by the Ohio State University. Dr. Kegelmeyer is on the board of Neuvanta LLC. Dr. Kostyk reports funding from Robert A Vaughan Family Development Fund and the Huntington’s Disease Society of America. Meredith McCormack-Mager’s funding source related to this research was the Center for Biostatistics. All other authors have declared that no competing interests exist. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Univariable regression of Tinetti Mobility Test (TMT) versus STEPS scores.
Higher scores on the TMT correlate with better gait and balance on flat terrain.
Fig 2
Fig 2. Scatterplot of total UHDRS motor examination scores versus STEPS scores with a Loess smoother.
In general, performance on the STEPS was high until the UHDRS total motor score reached 30 above which declines in performance were seen.
See this image and copyright information in PMC

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