Reliability of the maximal step length test and its correlation with motor function in chronic stroke survivors

Abstract

Objective. This study aimed to (1) investigate the interrater, intrarater, and test-retest reliabilities, as well as the minimal detectable change, of the Maximal Step Length test (MSL) in stroke survivors, (2) examine the concurrent validity of MSL with other stroke-specific impairment measurements in stroke survivors, and (3) compare the MSL performances of stroke survivors and those of age-matched healthy older adults in different directions. Design. Cross-sessional study. Setting. University-based research laboratory. Participants. Stroke survivors (n = 48) and age-matched healthy older adults (n = 39). Methods. Stroke survivors were assessed with MSL, lower limb muscle strength, Limits of Stability (LOS) Test, Berg Balance Scale (BBS), 5-meter walk test, and Activities-specific Balance Confidence (ABC) scale by two trained assessors in 1 session. Their performance on MSL was reassessed 1 week later to establish the test-retest reliability. Healthy older adults were assessed with MSL only. Intraclass correlation coefficient (ICC) was used to assess the reliability of MSL and Spearman's rho was used to quantify the strength of correlations between MSL and secondary outcomes. Between-group differences of MSL were assessed with the independent t-test. Results. The MSL exhibited excellent intrarater, interrater, and test-retest reliabilities [ICC: 0.885-1.000]. Significant correlations (: 0.447-0.723) were demonstrated between MSLs in most directions and muscle strengths of the affected legs, BBS scores, and walking speeds. The step lengths differed significantly between stroke survivors and healthy older adults in the forward, backward, and sideways directions on both the affected and less affected sides. Conclusions. The MSL is a reliable, valid, and easily administered test of the stepping capabilities of stroke survivors. Stroke survivors had significant shorter MSLs in all directions than the age-matched healthy older adults.