Establishing the Reliability of The Step Test Evaluation of Performance on Stairs (STEPS) in Multiple Sclerosis

Arch Phys Med Rehabil. 2024 Apr 7:S0003-9993(24)00909-2. doi: 10.1016/j.apmr.2024.03.015. Online ahead of print.


Objective: To establish the inter- and intra-rater reliability of The Step Test Evaluation of Performance on Stairs (STEPS) for people with multiple sclerosis (PwMS) and examine its relation to clinical mobility measures, cognition, and activity levels.

Design and setting: STEPS performance was rated by 3 raters at the initial visit. Two raters observed the STEPS performance via videotape at the initial visit and then 1 week later. Participants also completed in lab clinical mobility tests and cognitive assessments at their initial visit. Activity levels were tracked for the subsequent 6 months.

Participants: In total, 23 people with relapsing-remitting MS (N=23).

Interventions: Not applicable.

Main outcome measure(s): Intraclass correlation coefficients (ICCs) were used to assess intra-rater and inter-rater reliability, while correlation analyses compared STEPS performance with cognition, clinical mobility assessments, and activity levels. The inter-rater reliability analysis among the 3 raters included scoring from only the initial evaluation. For the intra-rater reliability, 2 raters viewed and rated the videotaped session for each of the participants and then repeated the same process 1 week later.

Results: Total STEPS scores demonstrated excellent agreement by ICC for inter- (ICC=0.97) and intra-rater reliability (ICC>0.95) and significant correlations with established clinical mobility assessments in PwMS. Better performance on STEPS was associated with information processing speed and prospective activity levels in PwMS.

Conclusions: Stair ambulation is a challenging task, integral for mobility and independence, therefore, having a sensitive and valid reliable assessment of stair performance is critical for PwMS. The STEPS assessment is a quick, easily administered, reliable, and valid tool for assessing stair ambulation in PwMS.

Keywords: Mobility; Multiple sclerosis; Physical function; Rehabilitation; Stair performance; Steps.