CHAIR STAND Tests

CHAIR STAND Tests

This document reviews the one, five, and ten repetition timed sit to stand test, as well as those done in 30 seconds; this test is also known as timed chair stands. Although most of the literature pertains to an adult population, a section reviewing the test in a pediatric population is included in the One Time Sit to Stand section.

Type of test:

Time to administer: 5 minutes or less

Clinical Comments: Familiarity with stopwatch mechanism prior to administering test is important. Placing chair against a wall or stable surface prior to beginning test improves patient safety. Rising from a low chair may entail more than 100 degrees of knee flexion, 80 of hip flex and 25 degrees of ankle dorsiflexion.1

Purpose/population for which tool was developed: The timed chair stand, with variations in directions given to the subject has been referenced in literature more than 80 times since proposed by Csuka2 as a simple measure of lower extremity strength; there are multiple earlier, less validated references to sit to stand as a testing or exercise technique. It has also been used to examine functional status 3-7 lower extremity muscle force/strength 8-14, 15 , 16, 17, strength in subjects with CVA18-21 neuromuscular function 22-25 balance 26-29, vestibular dysfunction 30, and to distinguish between fallers and non-fallers 22, 31-33 in an older population and a subpopulation of people with Parkinsons Disease (PD)34 and in chronic CVA18. Bohannon 200835 reports that the frequency of sit to stand is 43 to 49 times per day. Body weight (40%) is required of the knee extensors to stand without use of arm push-off.36, 37

When appropriate to use: This tool has been used to evaluate patients with LE proximal weakness,2

patients with chronic low back pain 33, 38

patients with knee osteoarthritis 6, 7, 16, 17, 39-43

hip osteoarthritis 17, 43

weight-bearing asymmetry 40

rheumatoid arthritis, and other chronic diseases,8

Parkinsons Disease 34, 44

and after arthroscopy.14, 29

to compare methods of training, ,3, 45

as an assessment of fitness,10 or

frailty.46, 47,

as measures of function , strength and balance in CVA 18-21

as a tool to quantify the ability of people with balance disorders to perform transitional movements 48

to measure effects of supplementation 41

to help predict individuals with Parkinsons Disease at risk of falling34.

after total knee arthroplasty 49-51

Scaling: Results of the test are reported as a ratio data, either as the number of stands completed in (up to) 2 minutes or the time it took in seconds to complete 1, 5, or 10 chair stands. If a client cannot do the test without use of hands, timed results may be reported incorporating the amount of assistance required or as nominal data (Unable). For example, in a study of 1500 subjects in which 3 trials were allowed,52 87% were able to rise without use of hands on the first trial, 11% required use of hands which was allowed on the second trial, 1% required an assistive device which was allowed on the third trial, and 1% were unable to stand without the assistance of a person.

Equipment needed:

Stopwatch or clock with second hand

Sturdy, straight-backed, armless chair with seat height to attain knee angle of 90 degrees when subjects feet are on the floor. Chair heights, if reported, have varied from 35.56 cm to 46 cm. Clinicians monitoring change over time with a client need to use a consistent chair or chair height for reliability of results. Rising from a low chair may entail more than 100 degrees of knee flexion, 80 degrees of hip flexion and 25 degrees of ankle dorsiflexion1

Test variations: There are multiple variations of the sit to stand maneuver as a test including

total number possible in 10 seconds, 7, 53-55

total number possible in 30 seconds,42, 56-59

total number in 1 minute,60, 61 or

3 minutes.62

Other reported versions allow use of hands for push-off or descent, alter foot placement, or do not time the maneuver.63-69

Another version records time to perform 3 sit to stands.70

Clinically, the most common variations record time to perform one, five, or ten sit to stand repetitions. The Center for Disease Control fall prevention task force, in the United States, included the 30 second sit to stand test in the tool kit for health care providers. 71. Literature varies from no practice/test trials to a total of 3 trials with best time recorded.72 5 total trials with 2 practice trials 3 test trials with the mean used for data analysis 20two trials with the mean values for data analysis19

An additional variation includes placing the hands on the ASIS rather than crossed over the chest45

Christiansen 2011 looked at weight-bearing asymmetry when subjects with knee osteoarthritis performed 5TSTS on a force plate.

Akram 201173looked at movement of the body and stability with 1TST

Directions: The subject is to sit in the chair with arms crossed over his/her chest. Instruct the subject to stand up as quickly as possible safely without using his/her arms (1, 5, or 10 times or 30 seconds) on the word Go. Begin timing on the word Go and stop timing when the person comes to the last complete stand or sits after the last stand. Record the time in seconds or number of completed stands for the 30 second version12, 16, 17, CDC 2013, 22, 33, 34, 39, 41, 43, 50, 55, 64

Ceiling or floor effect: People need to be able to rise independently from a chair for the test; thus it would not be appropriate for very low functioning and dependent individuals.

Interpreting results: This test has been interpreted as a measure of one component of balance and as a measure of strength of knee extensor and back muscles.

Other: In one study of persons with Alzheimer Disease 74, instructions were modified.

One Time Sit to Stand (1TSTS)

Directions: The subject is to sit in the chair with arms crossed over his/her chest. Instruct the subject to stand up as quickly as possible safely without using his/her arms on the word Go. Begin timing on the word Go and stop timing when the person comes to a complete stand. Record time in seconds.

Reliability:

Reference

N=

Sample Description

Reliability Statistic

Intrarater Reliability: same rater within one session (or day)

Nevitt 1989 22

27

Community dwellers with 1 or more falls in past 12 months

ICC = .89 - .96

Interrater Reliability:

Nevitt 1989 22

27

Community dwellers with 1 or more falls in past 12 months

ICC = .93 - .99

Test-retest Reliability

Jette 1999 64

105

Frail community elders. Mean 14 days between testing dates (range 0-132)

ICC = .25

Validity

Construct/Concurrent Validity: It is difficult to always differentiate between these 2 types of validity. Evaluating this property requires a gold standard measure with which to compare the test results. Such a gold standard is often not available.

Population

N=

Support for Validity

Community-dwellers

Age range 56 95 years13

50

Ratio of leg ext peak isometric torque to body wt explains 33% of time variance in multiple regression model of 1TSTS performance; age and steadiness were not predictive of 1TSTS.

Persons with chronic CVA23

22

Pearson correlations (p12 seconds. If the person is unable to arise independently, they may use their hands initially (norms do not then apply) with goals adjusted to reach the 12 second time with no hands.

Population

N=

Reference and Intervention

Responsive

Yes/No

Average change post intervention

Clients with Central vestibular dysfunction at hospital-based rehab center

12

30 custom designed Vestibular PT; 5 visits over 5 months; retrospective study

Yes

6.8 (6.)

Persons with cerebellar disorders had least improvement (n=2)

Community dwelling renal dialysis patients

12

(12 healthy controls)

108

1 time comparison testing, age & sex matched controls

Yes

Dialysis: 10.1(1.6) s

Control: 7.3(1.1) s

(P 75

620

122 2x/wk x 12 months

Extensive Intervention Group EIG; individualized interventions comprising ex and strategies for max vision and sensation

Minimal Intervention Group MIG: brief advice

Control CG

no feedback until 12 mos

Yes

EIG group:

pre 13.7(6.4)sec

post 11.7(4.6)

Post-hoc test differences between EIG CG &MIG-CG:

No significant differences between

EIG and MIG

Healthy, not active

Community-dwelling, age 60 -92

108

903x/week x 16 weeks

Cobblestone mat walking group n=54

Conventional walking group;

Yes

Mean difference

1.21(0.32)

Community dwellers,

Age 65-79

53

7224 weeks 3 sets of 8 ex

EX 1 n=14,: 1x/week

EX 2, n=14: 2x/week

EX 3, n=11: 3x/week

Control, n=14: no exercise

Yes

5TSTS times decreased for all exercise groups, no sig. change in control improved 5TSTS assoc w/% quad strength increase (-0.4): leg press (-0.39)

Community dwelling adults

Age 66 97 years

15

753x/week x 8 week low to moderate intensity group exercise

Yes

Pre: 19.3(7.9)