Four Square Step Test (FSST)


Author of Tool: 

Wayne Dite and Viviene A. Temple

Key references: 

Blennerhassett, J. M. and Jayalath, V. M. (2008). “The Four Square Step Test is a feasible and valid clinical test of dynamic standing balance for use in ambulant people poststroke.” Arch Phys Med Rehabil 89(11): 2156-2161.

Dite, W., Connor, H. J., et al. (2007). “Clinical identification of multiple fall risk early after unilateral transtibial amputation.” Arch Phys Med Rehabil 88(1): 109-114.

Dite, W. and Temple, V. A. (2002). A clinical test of stepping and change of direction to identify multiple falling older adults.” Arch Phys Med Rehabil 83(11): 1566-1571.

Whitney, S. L., Marchetti, G. F., et al. (2007). “The reliability and validity of the Four Square Step Test for people with balance deficits secondary to a vestibular disorder.” Arch Phys Med Rehabil 88(1): 99-104.

Primary use / Purpose: 

The FSST clinically assesses the ability to change directions while stepping. As a clinical test, the FSST is reliable, valid, easily interpreted and administered, requires little space, and needs no equipment. It is incremental in that it involves stepping over low objects (2.5cm) and movement in 4 directions.


According to the CDC, in 2001, nearly 12,000 people age 65+ died from fall-related injuries. It is apparent that a clinical assessment tool that will detect the complex nature related to balance and falls in the elderly population before, as well as after sustaining a fall, is necessary. One instrument developed to do this is the Four Square Step Test (FSST). This is a timed test, intended to perturb the rapid change in direction while stepping forward, backward and sideways over a low obstacle.


Psychometric data are presented in Dite and Temple (2002).




Digital Object Identifier (DOI):


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