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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 Chronic


Stroke: Reliability and Validity
Yiqin Mong, MSc, Tilda W. Teo, MSc, Shamay S. Ng, PhD
ABSTRACT. Mong Y, Teo TW, Ng SS. 5-repetition sit-tostand test in subjects with chronic stroke: reliability and validity. Arch Phys Med Rehabil 2010;91:407-13.
Objectives: To examine the (1) intrarater, interrater, and
test-retest reliability of the 5-repetition sit-to-stand test (5repetition STS test) scores, (2) correlation of 5-repetition STS
test scores with lower-limb muscle strength and balance performance, 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, and
12 young subjects.
Interventions: Not applicable.
Main Outcome Measures: 5-Repetition STS test time
scores; hand-held dynamometer measurements of hip flexors,
and knee flexors and extensors; ankle dorsiflexors and plantarflexors muscle strength; Berg Balance Scale (BBS); and limits
of stability (LOS) test using dynamic posturography.
Results: Excellent intrarater reliability of intraclass correlation coefficient (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 to
be significantly associated with the muscle strength of affected
and unaffected knee flexors (.753 to .830; P.00556) of
the subjects with stroke. No significant associations were found
between 5-repetition STS test and BBS and LOS tests in
subjects with stroke. Cut-off scores of 12 seconds were found
to be discriminatory between healthy elderly and subjects with
stroke at a sensitivity of 83% and specificity of 75%.
Conclusions: The 5-repetition STS test is a reliable measurement tool that correlates with knee flexors muscle strength
but not balance ability in subjects with stroke.
Key Words: Muscle strength; Rehabilitation; Stroke.
2010 by the American Congress of Rehabilitation
Medicine
HE SIT-TO-STAND TEST was initially introduced as an
T
outcome measurement for functional lower limb muscle
strength. The 5-repetition STS test was first used as a physical
1

differentiate older adults (age range, 6390y) with and without


balance dysfunction.3 It was also used as an outcome measure
for evaluating effectiveness of intervention in subjects having
total hip and knee arthroplasty4 and vibration therapy5 and for
cross-sectional correlation studies in subjects with osteoarthritis6,7 and vestibular dysfunction.8 The 5-repetition STS test has
also been introduced as an outcome measure in studies investigating strength training and functional performance in subjects with chronic stroke,9,10 as well as cross-sectional studies
evaluating the association of disabilities and falls in population
with stroke.11,12 Despite the common use of the 5-repetition
STS test, test-retest reliability (ICC range, .890 .960) was
established in healthy older adults13,14 and elderly with osteoarthritis (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 a
sitting position, more horizontal momentum was required to
shift the posterior-located center of mass to rise to a standing
position,16 which demanded relatively good balance control.17
Stroke-specific lower limb muscle weakness18-20 and balance
impairments21-23 could lead to poor sitting to standing performance; however, the relationship between 5-repetition STS test
scores and balance performance was unclear.
The objectives of the present study were (1) to investigate the
intrarater, interrater, and test-retest reliability of the 5-repetition
STS test in subjects with chronic stroke; (2) to investigate the
relationship between the 5-repetition STS test and BBS, lower
limb muscle strength, and the measurements of LOS in subjects
with stroke; and (3) to determine the sensitivity of the 5-repetition
STS test in distinguishing differences in mobility among subjects
with stroke, healthy elderly, and young subjects.
METHODS
Participants
An ICC value of .957 for the 5-repetition STS test was
previously shown in healthy subjects14; thus, the ICC value for
subjects with stroke was hypothesized to be .930. Therefore, to
detect an ICC value of .930 at a significance level of .050 for
test-retest reliability, a sample size of 12 subjects was required
to achieve 93% power of 2 observations a subject.

performance measure to detect the associations with prediction


of mortality and disabilities in frail elderly2 as well as to
List of Abbreviations
From the Department of Physiotherapy, Tan Tock Seng Hospital (Mong), and
Inpatient Therapy Services, St Andrews Community Hospital (Teo), Singapore; and
the Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong
Kong (SAR), China (Ng).
No commercial party having a direct financial interest in the results of the research
supporting this article has or will confer a benefit on the authors or on any organization 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: shamay.ng@inet.polyu.edu.hk.
0003-9993/10/9103-00472$36.00/0
doi:10.1016/j.apmr.2009.10.030

AUC
BBS
COP
ICC
LOS
MVL
MXE
5-repetition STS test
RT

area under the receiver operating


characteristic curve
Berg Balance Scale
center of pressure
intraclass correlation coefficient
limits of stability
movement velocity
maximum excursion
5-repetition sit-to-stand test
reaction time

Arch Phys Med Rehabil Vol 91, March 2010

408

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

Convenience sampling was used to recruit 36 subjects, with 12


subjects 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 to
stand up independently from a chair without hand support.
Subjects with stroke were included if they were at least
1-year poststroke, were older than 50 years, were medically
stable, were able to ambulate more than 10m unassisted with or
without a walking aid, and had an Abbreviated Mental Test24
score of more than 7. Exclusion criteria were the presence of any
cerebellar involvement or other conditions that might affect muscle strength, balance, mobility status, or ability to follow instructions.
All subjects recruited in the healthy elderly and young
groups had to be more than 50 years of age or between 21 and
35 years old, respectively. Subjects having any conditions that
might affect the assessment protocol, such as uncontrolled
diabetes mellitus, were excluded from the study.
All subjects were required to sign written informed consent
forms before the commencement of the experimentation. Ethic
approval for this study was obtained from the ethics committee
of 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 the
sit-to-stand maneuver. All sit-to-stand maneuvers were performed from a chair without an arm rest at 43cm in height and
47.5cm in depth. All trials were videotaped with a videotaping
device. The first 2 trials were for familiarization purposes, and
the average of the next 3 trials was used for analysis. A
1-minute rest was given between trials to prevent fatigue.
Standardized instructions were given as follows: By the count
of 3, please stand up and sit down as quickly as possible for 5
times. Place your hands on your lap and do not use them
throughout the procedure. Lean your back against the chairs
backrest at the end of every repetition. The timing started once
the subjects back left the backrest and stopped once the back
touched the backrest.
Muscle strength of lower limb. Lower-limb muscle
strength was tested with a hand-held dynamometer. Good to
excellent reliability (ICC range, .840 .990)25,26 was reported
for lower-limb hand-held dynamometer strength measurements
in subjects with neurologic conditions. Isometric muscle strength
of hip flexors, knee flexors and extensors, and ankle plantarflexors and dorsiflexors were tested bilaterally with standardized
testing positions and dynamometer placement (table 1). Make
tests were performed on all muscle groups tested. Subjects
were secured on a high chair with safety belts to standardize the
assessment positions. The first 2 trials were for familiarization
purposes, and the mean reading of the last 3 trials were used for
analysis. One to 2 minutes of rest was given between trials to
prevent muscle fatigue. Subjects were instructed to Push
against my resistance as hard as you can.
Clinical balance performance: Berg Balance Scale. The
BBS was used to assess subjects ability to maintain stability.27
Excellent reliability of the BBS (ICC range, .980 .990)28,29
was found in patients with acute28 and chronic stroke.29 The
BBS 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 (Balance
Mastera), which measures the displacement of the COP during
voluntary movement in a designated direction without instability.30 A previous study demonstrated moderate reliability (ICC
range, .840 .880) in subjects with chronic stroke.29
Arch Phys Med Rehabil Vol 91, March 2010

Table 1: Muscle Strength Testing Position and Dynamometer


Placement
Muscle Group
Tested

Hip flexors

Knee flexors

Knee extensors

Ankle
dorsiflexors

Ankle
plantarflexors

Testing Position

Dynamometer Placement

High sitting
Hip: 90o flexion
Knee: 90o flexion
Ankle: neutral
High sitting
Hip: 90o flexion
Knee: 90o flexion
Ankle: neutral
High sitting
Hip: 90o flexion
Knee: 90o flexion
Ankle: neutral
High sitting
Hip: 90o flexion
Knee: full extension
Ankle: neutral
High sitting
Hip: 90o flexion
Knee: full extension
Ankle: neutral

On anterior aspect of
femur, 5cm proximal
to superior border of
patella
On posterior aspect of
tibia, 5cm proximal
from inferior tip of
medial malleoli
On anterior aspect of
tibia, 5cm proximal
from inferior tip of
medial malleoli
On ventral aspect of foot,
across 1st to 5th
metatarsophalangeal
joints
On dorsum aspect of foot,
across 1st to 5th
metatarsophalangeal
joints

Three parameters of LOS were measured:


1. RT, measured in seconds, refers to the time between the
appearance of the signal for movement and the initiation
of the first movement.30
2. MVL, measured in degrees a second, is defined as the
average speed of COP displacement during the first
movement toward the given target.30
3. MXE, expressed as the percentage of the target distance
being tested, refers to the maximal displacement of COP
during the entire LOS testing for each target.30
Subjects were instructed to Begin each trial with the cursor
in the middle box. On hearing a Ding, move the cursors as
fast and as accurately as possible into the box where the circle
appeared. Shift your body weight to control the position and
direction of the cursors. Maintain your balance and keep your
feet firmly on the platform throughout the assessment.
Procedures
Five trials of the 5-repetition STS test were measured simultaneously by the 2 examiners with 3 years of clinical experience. These trials were videotaped and shown to 3 physiotherapists with 3 to 7 years of clinical experience and 3 tertiary
students without a medical or health care background. Procedures for data collection of intrarater, interrater, and test-retest
reliability are illustrated in figure 1. The BBS, muscle strength,
and dynamic posturography measurements of LOS were tested
in random order by either examiner A or examiner B.
Statistical Analysis
Data analysis was done with SPSS version 17.0.b The Kolmogorov-Smirnov test and F test were used to assess the
normal distribution and equal variance of the test score. Descriptive statistics were used for sociodemographic characteristics evaluation. Differences between the mean test score
across the 3 groups were calculated by 1-way analysis of
variance. ICC was used to calculate the degree of intrarater
(ICC3,1), interrater (ICC3,2), and test-retest reliability (ICC2,1).
The relationship between the 5-repetition STS test score and

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

409

Fig 1. Procedure of data collection.

the muscle strength of affected and unaffected limbs and balance performance in subjects with stroke was established by
the Spearman correlation coefficient because the data were not
normally distributed. When multiple correlation tests were
performed, the Bonferroni adjustment was applied to adjust for
the alpha level.31 In order to assess the correlation between the
5-repetition STS test and 9 primary outcomes (affected and
unaffected knee extensors strength, affected and unaffected
knee flexors strength, affected and unaffected ankle dorsiflexors, BBS, and maximal excursion in forward and backward
direction of LOS), the P value after Bonferroni correction is
.05/9 (ie, .00556). The strength of the correlation was defined
by the correlation coefficient obtained as little or no (.250),
fair (.250 .500), moderate to good (.500 .750), or good
to excellent (.750) relationship.31 A significance level of
.050 was set for all analyses.
Sensitivity indicates the true-positive probability, whereas
specificity indicates the false-positive probability.31 A trade-off
between sensitivity and 1 minus specificity was performed
using the Youden index32 to obtain the most appropriate 5-repetition STS test cut-off score. The AUC then provides a quantitative measure of the accuracy of the test based on the null
hypothesis of AUC equal to 0.5.31
RESULTS
Descriptive statistics of all subjects and mean values of all
outcome measures are presented in tables 2 and 3, respectively.

Excellent intrarater reliability (ICC.970 .976) (table 4), interrater reliability (ICC.999), and test-retest reliability of
experienced physiotherapists (ICC1.000) and students
(ICC.994) were achieved in the present study.
Table 5 demonstrates the Spearman correlation analyses
of 5-repetition STS test scores in lower limb muscle
strength, BBS, and LOS. Five-repetition STS test scores had
significant negative correlation after Bonferroni correction
with affected (.753; P.005) and unaffected (.830;
P.001) knee flexors of subjects with stroke. No significant
associations were found between 5-repetition STS test score
with BBS and LOS performance in subjects with stroke.
Five-repetition STS test cut-off scores of 9.4 seconds and
12.2 seconds were found to be the best discriminators between
our young versus healthy elderly (sensitivity75%; specificity75%) and healthy elderly versus subjects with stroke (sensitivity83%; specificity75%), respectively. AUC analysis is
shown in figures 2a and 2b.
DISCUSSION
Reliability of the 5-Repetition Sit-to-Stand Test
This is the first study to investigate the intrarater, interrater,
and test-retest reliability of the 5-repetition STS test in people
with chronic stroke. A better reliability range of the 5-repetition STS test was noted in subjects with stroke (ICC range,
.971.999) than those previously reported in community-dwellArch Phys Med Rehabil Vol 91, March 2010

410

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


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

Young (n12)

Healthy Elderly
(n12)

Demographics
Age (y)
Sex (M/F)
Height (cm)
Weight (kg)
Body mass index (kg/m2)
5-repetition STS test (s)

26.22.9
9/3
160.85.5
57.511.0
22.13.4
8.90.7

56.03.7
10/3
155.36.0
57.911.5
23.93.8
10.81.7

P (Post Hoc Comparisons)


Stroke (n12)

60.04.8
6/6
157.612.7
61.612.1
24.62.0
17.17.5

.001*
.194
.311
.628
.160
.001*

Young vs
Stroke

Healthy Elderly
vs Stroke

.001

.001*

.013
NA
NA
NA
NA
.004*

Young vs Healthy
Elderly

.001

.569

NOTE. Values are mean SD.


Abbreviations: F, female; M, male; NA, not applicable.
*Denotes significant difference at P.05.

Denotes significant difference at P.05 using Tukey Honestly Significant Difference adjustment.

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 experienced and inexperienced assessors were shown video clips of
the test on both occasions, and this could have contributed to
better reliability by minimizing participant-related factors on
the performance of the 5-repetition STS test. The well defined
assessment protocol with standardized use of instructions14 and
equipment reduced variations in measurements, which could
have 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-repetition STS test. The results strongly indicated that reliability
can be preserved regardless of the assessors training background. This could promote the use of the 5-repetition STS test
in clinical settings with patients with stroke. The influence of
assessors on the reliability of the 5-repetition STS test was
formerly reported to be minimal, because assessors were found
to contribute .028% to .030% of the estimated source of the
variance component.33
Performance of 5-Repetition Sit-to-Stand Test in Subjects
With Stroke
The mean 5-repetition STS test scores of the subjects with
stroke (17.17.5s) were comparable to timing achieved by
participants (17.97.7s) of a similar age group (approximately
60y)11 but superior to the score (time range, 19.323.6s) reported in an older age group (65.8 70y).9,10,12 It was noted that

the elderly clocked a longer duration for the 5-repetition STS


test with increased age.14 Consistent with a previous study,37
the subjects with stroke had a longer sit-to-stand duration
because of stroke-specific impairments such as lower-limb
muscle weakness38,39 and poor balance.37 Poststroke muscle
weakness caused by the failure in motor unit recruitment and a
decrease in firing frequency40 as well as localized adaption of
paretic muscle fiber41 could impede sit-to-stand performance.
Correlations of 5-Repetition Sit-to-Stand Test Scores
With Other Outcome Measures
Relationship of 5-repetition sit-to-stand test with muscle
strength. It is interesting to note the significant correlation
between 5-repetition STS test scores and bilateral knee flexors
strength (affected .753; unaffected .830) in this study.
Although previous investigations on the correlation between
knee flexors strength and sit-to-stand performance were absent,
knee flexors were known to maintain knee joint stability and
assist in extending hip joints during sit-to-stand performance.38
It is reasonable to observe an involvement of knee flexors in
providing more stability to the knee joint and higher extension
force in the hip joint during a fast-paced 5-repetition STS test.
In contrast with other studies,9,39 a lack of significant correlations was noted between 5-repetition STS test scores and the
other muscle groups (see table 5). Five-repetition STS test
scores were previously reported to have significant negative
correlations with affected hip flexor,9 affected knee extensor,39

Table 3: Mean Values of All Outcome Measures in Subjects With Stroke (n12)
Mean Values
Parameters

Muscle strength (kg)


Hip flexors
Knee flexors
Knee extensors
Ankle dorsiflexors
Ankle plantarflexors
Balance assessments
BBS
LOS
Reaction time (s)
Movement velocity (/s)
Maximal excursion (%)
NOTE. Values are mean SD.
Abbreviation: NA, not applicable.

Arch Phys Med Rehabil Vol 91, March 2010

Affected

13.94.5
6.83.7
14.84.7
6.14.1
13.05.4

Unaffected

Forward

19.04.7
14.53.6
21.75.8
12.83.7
21.76.6

Backward

NA

49.17.1
0.90.4
2.81.3
60.322.1

1.00.4
4.22.3
70.323.1

1.10.5
2.81.5
55.917.9

0.70.5
1.61.1
35.617.3

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

411

Table 4: Intrarater Reliability of 5-Repetition STS Test Scores in


Subjects With Stroke
Assessor

Mean 5-Repetition
STS test score (s)

ICC(3,1) (95% CI)

17.17.5
16.97.6

.975 (.935.992)
.976 (.937.992)

16.97.6
16.77.6
17.07.5

.976 (.939.992)
.971 (.925.991)
.974 (.932.992)

16.97.6
16.87.5
16.87.5

.970 (.932.990)
.970 (.924.991)
.972 (.929.991)

Examiner
A
B
Experienced
C
D
E
Inexperienced
F
G
H

NOTE. Values are mean SD.


Abbreviation: CI, confidence interval.

and affected ankle dorsiflexor muscle strength.39 According to


the graph, which showed the changes of significant values of
correlation coefficients in function of sample size for 1 to 100
correlations,42 the correlation between affected knee extensor
(.687) and unaffected ankle dorsiflexor (.629) would
approach significant if the sample size were increased to 20
subjects. Besides the small sample recruited, the discrepancy
between our findings and other studies may be a result of the
differences in the methods used to quantify muscle strength,
the testing positions (gravity-assisted or gravity-eliminated positions) adopted during muscle testing, and the characteristics
of the subjects with stroke.
Relationship of 5-repetition sit-to-stand test with balance
measures. No significant correlations were found between
5-repetition STS test scores and BBS in the subjects with stroke
in this study. The BBS was a valid measure of standing balance
in people with stroke,43 and the lower-limb muscle strength as
measured by the 5-repetition STS test was found to contribute
43% of a total variance in BBS in patients with chronic
stroke.11 The small sample size recruited might have resulted in
the lack of significant correlation between the 5-repetition STS
test and BBS. Another possible explanation is the difference
in the measurement domains of both tests. While the BBS
grades the quality of balance performance, the 5-repetition STS
test measures solely the speed (ie, time scores) at which sit-toTable 5: Spearman Correlation Coefficient Between 5-Repetition
STS Test and Muscle Strength, BBS and LOS in Subjects With
Stroke
Parameters

Muscle strength (kg)


Hip flexors
Knee flexors
Knee extensors
Ankle dorsiflexors
Ankle plantarflexors
BBS
LOS
Reaction time (s)
Movement velocity (/s)
Maximal excursion (%)

Affected

Unaffected

Forward

.587
.753*
.687
.007
.406

.336
.830*
.483
.629
.510
.551

.210
.147
.084

.210
.147
.084

Backward

NA
NA
NA
NA
NA

.531
.480
.578

Fig 2. ROC curves for 5-repetition STS test scores between (A)
young versus healthy elderly (AUC.816) and (B) healthy elderly
versus stroke (AUC.840). The curved line indicates ROC curve. The
straight line indicates nondiscriminating characteristics of the test.
Abbreviation: ROC, receiver operating characteristic.
.255
.179
.267

Abbreviation: NA, not applicable.


*Significant difference after Bonferroni correction at P.05/
9 (P.00556).

stand maneuvers are performed. In addition, the BBS is known


for 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 significant correlations were
found between the 5-repetition STS test and LOS MXE in the
Arch Phys Med Rehabil Vol 91, March 2010

412

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

forward direction in subjects with stroke. In the transition


phase of sitting to standing, the initiation of accelerating
horizontal momentum occurred, followed by vertical decelerating momentum.46 This motion allowed erect standing to take
place from a sitting position. In LOS testing, horizontal movements of the subjects with stroke were examined in terms of
their RT, MVL, and MXE. During fast-paced sit-to-stand
movement, increased generation of forward momentum16,39
and anteroposterior sway were demonstrated in subjects with
stroke.37 The LOS required subjects to possess acceptable
visual perceptual capabilities, with a sufficient amount of concentration and attention to track the cursor and move their
center of mass toward the designated direction.44 However, the
5-repetition STS test was considerably less challenging because subjects did not need to rely heavily on visual cues or
extra concentration to perform the task correctly. The small
sample size recruited in this study might also have contributed
to the lack of correlation found between the 5-repetition STS
test and LOS.
Sensitivity of 5-Repetition Sit-to-Stand Test Scores
This was the first 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 discriminating subjects from the 3 groups of the young, healthy elderly, and subjects with stroke with AUC of more than 80%.
Moreover, we found a cut-off score of 9.4 seconds between the
young and healthy elderly. This is similar to the cut-off score
of 10 seconds reported in subjects younger than 60 years.3 It is
also interesting to find that the difference between the cut-off
scores between the 2 groups (young vs healthy elderly and
healthy elderly vs stroke) is only 3 seconds. This might be
attributed to the high functional status of our chronic stroke
sample.
Study Limitations
The 5-repetition STS test could assess functional lower-limb
muscle strength but could not differentiate specific weakness in
each lower limb. The quality of performing the sit-to-stand task
might be overlooked because speed is the main focus of the
5-repetition STS test. Our study has several limitations. First,
the height of the chair used may not be optimal for all subjects
because of variations in the subjects leg lengths. Second,
factors such as weight-bearing asymmetry47 and foot placement48 were known to influence sit-to-stand performance but
were not measured in the present study. Third, our results
cannot be generalized to other disease-specific populations
because of our subjects selection criteria. Fourth, because
some of the muscle groups were not tested in gravity-eliminated positions, the effect of gravity might have affected the
muscle strength reading obtained. Fifth, our sample size estimation was based on the test-retest reliability of the 5-repetition STS test, which might be not sufficient to detect significant
correlation among 5-repetition STS test scores, muscle strength,
and balance ability.42 In addition, our study could not establish
any causal relationship between variables because of its crosssectional design. Future investigations with larger sample sizes
will be essential for prediction and regression analysis as well as
establishing the validity of the 5-repetition STS test in subjects
with stroke of different mobility levels.
CONCLUSIONS
The 5-repetition STS test is an easy-to-administer clinical
tool, suitable for both experienced and nonexperienced clinicians, with excellent intrarater, interrater, and test-retest reliArch Phys Med Rehabil Vol 91, March 2010

ability. Significant negative correlations with lower-limb muscle strength indicated that the 5-repetition STS test could be
used as a functional muscle strength assessment tool in people
with stroke.
Acknowledgment:
statistical advice.

We thank Dr. Raymond C.K. Chung for his

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Suppliers
a. NeuroCom International, Inc, 9570 SE Lawnfield Rd, Clackamas,
OR 97015.
b. SPSS Inc, 233 S Wacker Dr, 11th Fl, Chicago, IL 60606.

Arch Phys Med Rehabil Vol 91, March 2010

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