Introduction: Visual assessment of lower extremity mechanics is used frequently in clinical practice, and objective scoring of the visual assessment is beneficial to improve objectivity of patient evaluation. In addition, lower extremity mechanics change with fatigue and these changes may increase the risk of lower extremity injury. The Forward-Step-Down Test (FSDT) is one such objective tool, but its ability to detect changes in movement quality in response to exertion are not known. Methods: This study utilized a repeated-measures design, where the participants were scored on the FSDT before performing the Bruce protocol for an exertion stimulus. The participants were re-scored on the FSDT at one, five, and ten minutes after completing the Bruce protocol. Results: Wilcoxon signed-rank tests showed a significant change in FSDT score between baseline and five minutes post-exertion (a< .017). Friedman’s ANOVA was non-significant across all four assessments. In addition, despite testing healthy young adults, 50% of participants scored as “poor” movement quality on the initial test. This number increased to 75% at significant five-minute post-exertion mark. Discussion: Median scores on the FSDT were significantly different at five minutes post-exertion. However, this statistically significant change is of questionable clinical relevance because the median score changed by 0.5. This small change from 3.5 to 4.0 may not represent a change in overall movement quality from “moderate” to “poor.” Results do indicate that the participants in this study overall had poorer than expected movement quality throughout the testing. These results suggest larger data collection and analysis may be warranted for this population and the general population prior to partaking in exercise. Conclusion: The FSDT detects changes in lower extremity mechanics five minutes following a single exertion stimulus. Participants’ scores returned to baseline by ten minutes post-exertion. The FSDT may be a viable tool to assess changes in lower extremity movement quality following a single bout of exertion, and may help determine when participants have recovered back to baseline movement quality.
McCallister E, Flowers DW. Can the Forward-Step-Down Test Be Used Reliably in the Clinical Setting to Assess Movement Changes Resulting from Maximal Exertion? A Pilot Study. The Internet Journal of Allied Health Sciences and Practice. 2020 Oct 12;18(4), Article 7.