5-Repetition Sit-To-Stand Test in Subjects With Chronic Stroke

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ORIGINAL ARTICLE

5-Repetition Sit-to-Stand Test in Subjects With ChronicStroke: Reliability and ValidityYiqin Mong, MSc, Tilda W. Teo, MSc, Shamay S. Ng, PhD

ABSTRACT. Mong Y, Teo TW, Ng SS. 5-repetition sit-to-stand test in subjects with chronic stroke: reliability and valid-ity. Arch Phys Med Rehabil 2010;91:407-13.

Objectives: To examine the (1) intrarater, interrater, andtest-retest reliability of the 5-repetition sit-to-stand test (5-repetition STS test) scores, (2) correlation of 5-repetition STStest scores with lower-limb muscle strength and balance per-formance, and (3) cut-off scores among the 3 groups of subjects: the young, the healthy elderly, and subjects with stroke.

Design: Cross-sectional study.Setting: University-based rehabilitation center.Participants: A convenience sample of 36 subjects: 12

subjects with chronic stroke, 12 healthy elderly subjects, and12 young subjects.

Interventions: Not applicable.Main Outcome Measures: 5-Repetition STS test time

scores; hand-held dynamometer measurements of hip exors,and knee exors and extensors; ankle dorsiexors and plantar-exors muscle strength; Berg Balance Scale (BBS); and limitsof stability (LOS) test using dynamic posturography.

Results: Excellent intrarater reliability of intraclass correla-tion coefcient (ICC) (range, .970.976), interrater reliability(ICC .999), and test-retest reliability (ICC range, .989.999)were found. Five-repetition STS test scores were also found tobe signicantly associated with the muscle strength of affectedand unaffected knee exors ( .753 to .830; P .00556) of the subjects with stroke. No signicant associations were foundbetween 5-repetition STS test and BBS and LOS tests insubjects with stroke. Cut-off scores of 12 seconds were foundto be discriminatory between healthy elderly and subjects withstroke at a sensitivity of 83% and specicity of 75%.

Conclusions: The 5-repetition STS test is a reliable mea-surement tool that correlates with knee exors muscle strengthbut not balance ability in subjects with stroke.

Key Words: Muscle strength; Rehabilitation; Stroke. 2010 by the American Congress of Rehabilitation

Medicine

T HE SIT-TO-STAND TEST was initially introduced as anoutcome measurement for functional lower limb musclestrength. 1 The 5-repetition STS test was rst used as a physicalperformance measure to detect the association s with predictionof mortality and disabilities in frail elderly 2 as well as to

differentiate older ad ults (age range, 6390y) with and withoutbalance dysfunction. 3 It was also used as an outcome measurefor evaluating effectiveness of intervention in subjec ts havingtotal hip and knee arthroplasty 4 and vibration therapy 5 and forcross-sectional correlation studi es in subjects with osteoarthri-tis6,7 and vestibular dysfunction. 8 The 5-repetition STS test hasalso been introduced as an outcome measure in studies inves-tigating strength training and functional performance in subjects with chronic stroke, 9,10 as well as cross-sectional studiesevaluating t he association of disabilities and falls in populationwith stroke. 11,12 Despite the common use of the 5-repetitionSTS test, test-retest reliability (I CC range, .890.960) wasestablished in health y older adults 13,14 and elderly with osteo-arthritis (ICC .960) 7 but not in subjects with stroke.

Besides lower limb muscle strength, balance capacity of subjects could also affect sit-to-stand performance. 13,15 From asitting position, more horizontal momentum was required toshift the posterior-located center of mass to rise to a standi ngposition, 16 which demanded relatively good balance control. 17Stroke-speci c lower limb muscle weakness 18-20 and balanceimpairments 21-23 could lead to poor sitting to standing perfor-mance; however, the relationship between 5-repetition STS testscores and balance performance was unclear.

The objectives of the present study were (1) to investigate theintrarater, interrater, and test-retest reliability of the 5-repetitionSTS test in subjects with chronic stroke; (2) to investigate therelationship between the 5-repetition STS test and BBS, lowerlimb muscle strength, and the measurements of LOS in subjectswith stroke; and (3) to determine the sensitivity of the 5-repetition

STS test in distinguishing differences in mobility among subjectswith stroke, healthy elderly, and young subjects.

METHODS

ParticipantsAn ICC value of .957 for the 5-repetition STS test was

previously shown in healthy subjects 14 ; thus, the ICC value forsubjects with stroke was hypothesized to be .930. Therefore, todetect an ICC value of .930 at a signicance level of .050 fortest-retest reliability, a sample size of 12 subjects was requiredto achieve 93% power of 2 observations a subject.

From the Department of Physiotherapy, Tan Tock Seng Hospital (Mong), andInpatient Therapy Services, St Andrews Community Hospital (Teo), Singapore; andthe Department of Rehabilitation Sciences, Hong Kong Polytechnic University, HongKong (SAR), China (Ng).

No commercial party having a direct nancial interest in the results of the researchsupporting this article has or will confer a benet on the authors or on any organi-zation with which the authors are associated.

Reprint requests to Shamay S. Ng, PhD, Department of Rehabilitation Sciences,The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong (SAR),e-mail: [email protected] .

0003-9993/10/9103-00472$36.00/0doi:10.1016/j.apmr.2009.10.030

List of Abbreviations

AUC area under the receiver operatingcharacteristic curve

BBS Berg Balance ScaleCOP center of pressureICC intraclass correlation coefcientLOS limits of stabilityMVL movement velocityMXE maximum excursion5-repetition STS test 5-repetition sit-to-stand testRT reaction time

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Arch Phys Med Rehabil Vol 91, March 2010
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Convenience sampling was used to recruit 36 subjects, with 12subjects in each of the 3 subjects groups: stroke, healthy elderly,and young. Young subjects were recruited to determine the cut-off score of the 5-repetition STS test. All subjects had to be able tostand up independently from a chair without hand support.

Subjects with stroke were included if they were at least1-year poststroke, were older than 50 years, were medicallystable, were able to ambulate more than 10m unassisted with orwithout a walking aid, and had an Abbreviated Mental Test 24

score of more than 7. Exclusion criteria were the presence of anycerebellar involvement or other conditions that might affect mus-cle strength, balance, mobility status, or ability to follow instruc-tions.

All subjects recruited in the healthy elderly and younggroups had to be more than 50 years of age or between 21 and35 years old, respectively. Subjects having any conditions thatmight affect the assessment protocol, such as uncontrolleddiabetes mellitus, were excluded from the study.

All subjects were required to sign written informed consentforms before the commencement of the experimentation. Ethicapproval for this study was obtained from the ethics committeeof the local institution.

Outcome Measurements 5-repetition sit-to-stand test. The 5-repetition STS test

measured the time taken to complete 5 repetitions of thesit-to-stand maneuver. All sit-to-stand maneuvers were per-formed from a chair without an arm rest at 43cm in height and47.5cm in depth. All trials were videotaped with a videotapingdevice. The rst 2 trials were for familiarization purposes, andthe average of the next 3 trials was used for analysis. A1-minute rest was given between trials to prevent fatigue.Standardized instructions were given as follows: By the countof 3, please stand up and sit down as quickly as possible for 5times. Place your hands on your lap and do not use themthroughout the procedure. Lean your back against the chairsbackrest at the end of every repetition. The timing started oncethe subjects back left the backrest and stopped once the back

touched the backrest. Muscle strength of lower limb. Lower-limb musclestrength was tested with a hand-held dyna mometer. Good toexcellent reliability (ICC range, .840.990) 25,26 was reportedfor lower-limb hand-held dynamometer strength measurementsin subjects with neurologic conditions. Isometric muscle strengthof hip exors, knee exors and extensors, and ankle plantarex-ors and dorsiexors were tested bilaterally wit h standardizedtesting positions and dynamometer placement ( table 1). Maketests were performed on all muscle groups tested. Subjectswere secured on a high chair with safety belts to standardize theassessment positions. The rst 2 trials were for familiarizationpurposes, and the mean reading of the last 3 trials were used foranalysis. One to 2 minutes of rest was given between trials toprevent muscle fatigue. Subjects were instructed to Push

against my resistance as hard as you can.Clinical balance performance: Berg Balance Scale. TheBBS was used to assess subjects ability to maintain stabili ty. 27Excellent reliability of the BBS (ICC range, .980.9 90)28,29was found in patients with acute 28 and chronic stroke. 29 TheBBS involves 14 tasks; each has a score between 0 and 4,adding up to a total score of 56.

Laboratory balance performance: limits of stability test. LOS was assessed by dynamic posturography (BalanceMaster a ), which measures the displacement of the COP duringvoluntary movement in a designated direction without instabil-ity. 30 A previous study demonstrated moderate rel iability (ICCrange, .840.880) in subjects with chronic stroke. 29

Three parameters of LOS were measured:1. RT, measured in seconds, refers to the time between the

appearance of the sign al for movement and the initiationof the rst movement. 30

2. MVL, measured in degrees a second, is dened as theaverage speed of COP displacem ent during the rstmovement toward the given target. 30

3. MXE, expressed as the percentage of the target distancebeing tested, refers to the maximal displaceme nt of COPduring the entire LOS testing for each target. 30

Subjects were instructed to Begin each trial with the cursorin the middle box. On hearing a Ding, move the cursors asfast and as accurately as possible into the box where the circleappeared. Shift your body weight to control the position anddirection of the cursors. Maintain your balance and keep yourfeet rmly on the platform throughout the assessment.

ProceduresFive trials of the 5-repetition STS test were measured simul-

taneously by the 2 examiners with 3 years of clinical experi-ence. These trials were videotaped and shown to 3 physiother-apists with 3 to 7 years of clinical experience and 3 tertiarystudents without a medical or health care background. Proce-dures for data collection o f intrarater, interrater, and test-retestreliability are illustrated in gure 1. The BBS, muscle strength,

and dynamic posturography measurements of LOS were testedin random order by either examiner A or examiner B.

Statistical AnalysisData analysis was done with SPSS version 17.0. b The Kol-

mogorov-Smirnov test and F test were used to assess thenormal distribution and equal variance of the test score. De-scriptive statistics were used for sociodemographic character-istics evaluation. Differences between the mean test scoreacross the 3 groups were calculated by 1-way analysis of variance. ICC was used to calculate the degree of intrarater(ICC 3,1 ), interrater (ICC 3,2 ), and test-retest reliability (ICC 2,1 ).The relationship between the 5-repetition STS test score and

Table 1: Muscle Strength Testing Position and DynamometerPlacement

Muscle GroupTested Test ing Position Dynamometer Placement

Hip exors High si tt ingHip: 90 o exionKnee: 90 o exionAnkle: neutral

On anterior aspect of femur, 5cm proximalto superior border of patella

Knee exors High sittingHip: 90 o exionKnee: 90 o exionAnkle: neutral

On posterior aspect of tibia, 5cm proximalfrom inferior tip of medial malleoli

Knee extensors High sittingHip: 90 o exionKnee: 90 o exionAnkle: neutral

On anterior aspect of tibia, 5cm proximalfrom inferior tip of medial malleoli

Ankledorsiexors

High sittingHip: 90 o exionKnee: full extensionAnkle: neutral

On ventral aspect of foot,across 1st to 5thmetatarsophalangeal joints

Ankleplantarexors

High sittingHip: 90 o exionKnee: full extension

Ankle: neutral

On dorsum aspect of foot,across 1st to 5thmetatarsophalangeal

joints

408 5-REPETITION SIT-TO-STAND TEST IN PATIENTS WITH STROKE, Mong



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the muscle strength of affected and unaffected limbs and bal-ance performance in subjects with stroke was established bythe Spearman correlation coefcient because the data were notnormally distributed. When multiple correlation tests wereperformed, the Bonferroni adjustment was applied to adjust forthe alpha level. 31 In order to assess the correlation between the5-repetition STS test and 9 primary outcomes (affected andunaffected knee extensors strength, affected and unaffectedknee exors strength, affected and unaffected ankle dorsiex-ors, BBS, and maximal excursion in forward and backwarddirection of LOS), the P value after Bonferroni correction is.05/9 (ie, .00556). The strength of the correlation was denedby the correlation coefcient obtained as little or no ( .250),fair ( .250.500), moderate to go od ( .500.750), or good

to excellent ( .750) relationship.31

A signicance level of .050 was set for all analyses.Sensitivity indicates the true-positive probab ility, whereas

specicity indicates the false-positive probability. 31 A trade-off between sensitivity an d 1 minus specicity was performedusing the Youden index 32 to obtain the most appropriate 5-rep-etition STS test cut-off score. The AUC then provides a quan-titative measure of the accuracy of the test based on the nullhypothesis of AUC equal to 0.5. 31

RESULTSDescriptive statistics of all subje cts and mean values of all

outcome measures are presented in tables 2 and 3, respectively.

Excellent intrarater reliability (ICC .970 .976) ( table 4), in-terrater reliability (ICC .999), and test-retest reliability of experienced physiotherapists (ICC 1.000) and students(ICC .994) were achieved in the present study.

Table 5 demonstrates the Spearman correlation analysesof 5-repetition STS test scores in lower limb musclestrength, BBS, and LOS. Five-repetition STS test scores hadsignicant negative correlation after Bonferroni correctionwith affected ( .753; P .005) and unaffected ( .830;P .001) knee exors of subjects with stroke. No signicantassociations were found between 5-repetition STS test scorewith BBS and LOS performance in subjects with stroke.

Five-repetition STS test cut-off scores of 9.4 seconds and12.2 seconds were found to be the best discriminators between

our young versus healthy elderly (sensitivity 75%; speci-city 75%) and healthy elderly versus subjects with stroke (sen-sitivity 83%; spec icity 75%), respectively. AUC analysis isshown in gures 2a and 2b.

DISCUSSION

Reliability of the 5-Repetition Sit-to-Stand TestThis is the rst study to investigate the intrarater, interrater,

and test-retest reliability of the 5-repetition STS test in peoplewith chronic stroke. A better reliability range of the 5-repeti-tion STS test was noted in subjects with stroke (ICC range,.971.999) than those previously reported in community-dwell-

Fig 1. Procedure of data collection.

4095-REPETITION SIT-TO-STAND TEST IN PATIENTS WITH STROKE, Mong



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ing elderly ( ICC range, .640.960) 13,14,33-35 and frail elderly(ICC .670). 36 Unlike in other studies, 13,14,33-36 the experi-enced and inexperienced assessors were shown video clips of the test on both occasions, and this could have contributed tobetter reliability by minimizing participant-related factors on

the performance of the 5-repetition STS test. The well d enedassessment protocol with standardized use of instructions 14 andequipment reduced variations in measurements, which couldhave contributed to the excellent reliability in this study.

This was the pioneering study to determine the effect of assessors training background on the reliability of the 5-rep-etition STS test. The results strongly indicated that reliabilitycan be preserved regardless of the assessors training back-ground. This could promote the use of the 5-repetition STS testin clinical settings with patients with stroke. The inuence of assessors on the reliability of the 5-repetition STS test wasformerly reported to be minimal, because assessors were foundto contribute .028% to .030% of the estimated source of thevariance component. 33

Performance of 5-Repetition Sit-to-Stand Test in SubjectsWith StrokeThe mean 5-repetition STS test scores of the subjects with

stroke (17.1 7.5s) were comparable to timing achieved byparticipants (17.9 7.7s) of a similar age group (approximately60y)11 but superior to the score (time range, 19.323.6s) re-ported in an older age group (65.870y). 9,10,12 It was noted that

the elderly clocked a lo nger duration for the 5-repetition ST Stest with increased age. 14 Consistent with a previous study, 37the subjects with stroke had a longer sit-to-stand durationbecause of strok e-specic impairments such as lower-limbmuscle weakness 38,39 and poor balance. 37 Poststroke muscle

weakness caused by the fail ure in motor unit recruitment and adecrease in ring fr equency 40 as well as localized adaption of paretic muscle ber 41 could impede sit-to-stand performance.

Correlations of 5-Repetition Sit-to-Stand Test ScoresWith Other Outcome Measures

Relationship of 5-repetition sit-to-stand test with muscle strength. It is interesting to note the signicant correlationbetween 5-repetition STS test scores and bilateral knee exorsstrength (affected .753; unaffected .830) in this study.Although previous investigations on the correlation betweenknee exors strength and sit-to-stand performance were absent,knee exors were known to maintain knee joint stability a ndassist in extending hip joints during sit-to-stand performance. 38

It is reasonable to observe an involvement of knee exors inproviding more stability to the knee joint and higher extensionforce in the hip joint during a fa st-paced 5-repetition STS test.

In contrast with other studies, 9,39 a lack of signicant corre-lations was noted between 5-repetit ion STS test scores and theother muscle groups (see table 5). Five-repetition STS testscores were previously reported to have signicant negati vecorrelations with affected hip exor, 9 affected knee extensor, 39

Table 2: Mean Values of Demographics and 5-Repetition Sit-to-Stand Test in 3 Subject Groups

Parameters

Mean Values

P

P (Post Hoc Comparisons)

Young (n 12)Healthy Elderly

(n 12) Stroke (n 12)Young vs

StrokeHealthy Elderly

vs StrokeYoung vs Healthy

Elderly

DemographicsAge (y) 26.2 2.9 56.0 3.7 60.0 4.8 .001* .001 .013 .001

Sex (M/F) 9/3 10/3 6/6 .194 NAHeight (cm) 160.8 5.5 155.3 6.0 157.6 12.7 .311 NAWeight (kg) 57.5 11.0 57.9 11.5 61.6 12.1 .628 NABody mass index (kg/m 2 ) 22.1 3.4 23.9 3.8 24.6 2.0 .160 NA

5-repetition STS test (s) 8.9 0.7 10.8 1.7 17.1 7.5 .001* .001* .004* .569

NOTE. Values are mean SD.Abbreviations: F, female; M, male; NA, not applicable.*Denotes signicant difference at P .05. Denotes signicant difference at P .05 using Tukey Honestly Signicant Difference adjustment.

Table 3: Mean Values of All Outcome Measures in Subjects With Stroke (n 12)

Parameters

Mean Values

Affected Unaffected Forward Backward

Muscle strength (kg)Hip exors 13.9 4.5 19.0 4.7 NAKnee exors 6.8 3.7 14.5 3.6Knee extensors 14.8 4.7 21.7 5.8Ankle dorsiexors 6.1 4.1 12.8 3.7Ankle plantarexors 13.0 5.4 21.7 6.6

Balance assessmentsBBS 49.1 7.1LOS

Reaction time (s) 0.9 0.4 1.0 0.4 1.1 0.5 0.7 0.5Movement velocity (/s) 2.8 1.3 4.2 2.3 2.8 1.5 1.6 1.1Maximal excursion (%) 60.3 22.1 70.3 23.1 55.9 17.9 35.6 17.3

NOTE. Values are mean SD.Abbreviation: NA, not applicable.




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and affected ankle dorsiexor muscle strength. 39 According tothe graph, which showed the changes of signicant values of correlation c oefcients in function of sample size for 1 to 100

correlations,42

the correlation between affected knee extensor( .687) and unaffected ankle dorsiexor ( .629) wouldapproach signicant if the sample size were increased to 20subjects. Besides the small sample recruited, the discrepancybetween our ndings and other studies may be a result of thedifferences in the methods used to quantify muscle strength,the testing positions (gravity-assisted or gravity-eliminated po-sitions) adopted during muscle testing, and the characteristicsof the subjects with stroke.

Relationship of 5-repetition sit-to-stand test with balance measures. No signicant correlations were found between5-repetition STS test scores and BBS in the subjects with strokein this study. The BB S was a valid measure of standing balancein people with stroke, 43 and the lower-limb muscle strength asmeasured by the 5-repetition STS test was found to contribute

43% of a total variance in BBS in patients with chronicstroke. 11 The small sample size recruited might have resulted inthe lack of signicant correlation between the 5-repetition STStest and BBS. Another possible explanation is the differencein the measurement domains of both tests. While the BBSgrades the quality of balance performance, the 5-repetition STStest measures solely the speed (ie, time scores) at which sit-to-

stand maneuvers are p erformed. In addition, the BBS is knownfor its ceiling effects, 44,45 which may account for the lack of correlation with the 5-repetition STS test.

It is surprising to note that no signicant correlations werefound between the 5-repetition STS test and LOS MXE in the

Table 4: Intrarater Reliability of 5-Repetition STS Test Scores inSubjects With Stroke

AssessorMean 5-RepetitionSTS test score (s) ICC (3,1) (95% CI)

ExaminerA 17.1 7.5 .975 (.935.992)B 16.9 7.6 .976 (.937.992)

Experienced

C 16.9 7.6 .976 (.939.992)D 16.7 7.6 .971 (.925.991)E 17.0 7.5 .974 (.932.992)

InexperiencedF 16.9 7.6 .970 (.932.990)G 16.8 7.5 .970 (.924.991)H 16.8 7.5 .972 (.929.991)

NOTE. Values are mean SD.Abbreviation: CI, condence interval.

Table 5: Spearman Correlation Coefcient Between 5-RepetitionSTS Test and Muscle Strength, BBS and LOS in Subjects With

Stroke

Parameters Affected Unaffected Forward Backward

Muscle strength (kg)Hip exors .587 .336 NAKnee exors .753* .830* NAKnee extensors .687 .483 NAAnkle dorsiexors .007 .629 NAAnkle plantarexors .406 .510 NA

BBS .551LOS

Reaction time (s) .210 .210 .531 .255Movement velocity (/s) .147 .147 .480 .179Maximal excursion (%) .084 .084 .578 .267

Abbreviation: NA, not applicable.*Signicant difference after Bonferroni correction at P .05/ 9 (P .00556).

Fig 2. ROC curves for 5-repetition STS test scores between (A)young versus healthy elderly (AUC .816) and (B) healthy elderlyversus stroke (AUC .840). The curved line indicates ROC curve. Thestraight line indicates nondiscriminating characteristics of the test.Abbreviation: ROC , receiver operating characteristic.




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forward direction in subjects with stroke. In the transitionphase of sitting to standing, the initiation of acceleratinghorizontal mome ntum occurred, followed by vertical deceler-ating momentum. 46 This motion allowed erect standing to takeplace from a sitting position. In LOS testing, horizontal move-ments of the subjects with stroke were examined in terms of their RT, MVL, and MXE. During fast-paced sit-to-s tandmovement, increased generation of forward momentum 16,39and anteroposterior sway were demonstrated in subjects withstroke. 37 The LOS required subjects to possess acceptablevisual perceptual capabilities, with a sufcient amount of con-centration and attention to track the cursor and move theircenter of mass toward the designated direction. 44 However, the5-repetition STS test was considerably less challenging be-cause subjects did not need to rely heavily on visual cues orextra concentration to perform the task correctly. The smallsample size recruited in this study might also have contributedto the lack of correlation found between the 5-repetition STStest and LOS.

Sensitivity of 5-Repetition Sit-to-Stand Test ScoresThis was the rst study to investigate cut-off scores among

the young, healthy elderly, and subjects with stroke. We found

that our 5-repetition STS test scores were sensitive at discrim-inating subjects from the 3 groups of the young, healthy el-derly, and subjects with stroke with AUC of more than 80%.Moreover, we found a cut-off score of 9.4 seconds between theyoung and healthy elderly. This is similar to the cut-off scoreof 10 seconds reported in subjects younger than 60 years. 3 It isalso interesting to nd that the difference between the cut-off scores between the 2 groups (young vs healthy elderly andhealthy elderly vs stroke) is only 3 seconds. This might beattributed to the high functional status of our chronic strokesample.

Study LimitationsThe 5-repetition STS test could assess functional lower-limb

muscle strength but could not differentiate specic weakness ineach lower limb. The quality of performing the sit-to-stand task might be overlooked because speed is the main focus of the5-repetition STS test. Our study has several limitations. First,the height of the chair used may not be optimal for all subjectsbecause of variations in the subjects le g lengths. Second,factors such as weight-bearing asymmetry 47 and foot place-ment 48 were known to inuence sit-to-stand performance butwere not measured in the present study. Third, our resultscannot be generalized to other disease-specic populationsbecause of our subjects selection criteria. Fourth, becausesome of the muscle groups were not tested in gravity-elimi-nated positions, the effect of gravity might have affected themuscle strength reading obtained. Fifth, our sample size esti-mation was based on the test-retest reliability of the 5-repeti-tion STS test, which might be not sufcient to detect signicantcorrelation among 5-repetition STS test scores, muscle strength,and balance ability. 42 In addition, our study could not establishany causal relationship between variables because of its cross-sectional design. Future investigations with larger sample sizeswill be essential for prediction and regression analysis as well asestablishing the validity of the 5-repetition STS test in subjectswith stroke of different mobility levels.

CONCLUSIONSThe 5-repetition STS test is an easy-to-administer clinical

tool, suitable for both experienced and nonexperienced clini-cians, with excellent intrarater, interrater, and test-retest reli-

ability. Signicant negative correlations with lower-limb mus-cle strength indicated that the 5-repetition STS test could beused as a functional muscle strength assessment tool in peoplewith stroke.

Acknowledgment: We thank Dr. Raymond C.K. Chung for hisstatistical advice.

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Suppliersa. NeuroCom International, Inc, 9570 SE Lawneld Rd, Clackamas,

OR 97015.b. SPSS Inc, 233 S Wacker Dr, 11th Fl, Chicago, IL 60606.


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5-Repetition Sit-To-Stand Test in Subjects With Chronic Stroke