Step Test Evaluation of Performance on Stairs (STEPS): Assessing Stair Function in Older Adults

Abstract

ABSTRACT Background and Purpose: Stair negotiation is crucial for functional independence and is a leading cause of fall-related injuries in older adults. The Step Test Evaluation of Performance on Stairs (STEPS) is a quick and easily administered outcome measure for assessing stair negotiation. This study investigated the reliability and concurrent content validity of the STEPS test to determine its usefulness in older adults. Methods: Eighty-two community-dwelling older adults (mean age 81.2 years, 51 females) were assessed on the STEPS test, Timed Up and Go (TUG), 5-times sit to stand (5XSTS), stair self-efficacy (SSE) questionnaire, and time to ascend and descend stairs. Participants repeated the STEPS test 7 to 14 days later for intrarater reliability by the same rater. Spearman rank and intraclass correlations were used to determine the association of measures and intrarater reliability. Results and Discussion: The mean STEPS score was 15.6 (SD = 3.7) out of 20. The STEPS total score demonstrated excellent intra- and interrater reliability. It had moderate to good and significant correlations with TUG, 5XSTS, SSE, and time to ascend and descend measures. Faster performance on the 5XSTS, TUG, and time to ascend and descend correlated with better performance on the STEPS test, indicating validity for assessing balance and mobility during stair negotiation in older adults. Lower SSE correlated with lower observer ratings of performance on stairs (STEPS scores), indicating agreement between participant reports of self-efficacy and observer ratings of performance. Step Test Evaluation of Performance on Stairs items that demonstrated the most frequent loss of points were balance (use of handrail), step continuity, foot placement, and self-propulsion (ascent only). Conclusions: Assessment of older adults’ safety and performance on stairs is vital given the increased difficulty of stair navigation and the high risk for injurious falls in this population. This study demonstrates that the STEPS test is a reliable and valid outcome measure for assessing stair performance in older adults.