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Is stair negotiation measured appropriately in functional assessment scales?

St James's Hospital, Leeds; University Hospital Nijmegen, Nijmegen

Marcel GM Olde Rikkert

University Hospital Nijmegen, Nijmegen, The Netherlands

Graham P Mulley

St James's University Hospital, Leeds, UK

Background: A decline in mobility may result in problems with the negotiation of stairs, which can potentially be hazardous. In practice, stair negotiation is an important aspect of daily living and therefore needs to be assessed carefully.

Methods: We conducted a systematic literature review to identify the way functional assessment scales assess stair negotiation. We evaluated whether stair negotiation could be assessed in a valid and reliable way with these scales.

Results: Forty-three of the 92 identified scales have an item on stair negotiation. In these scales, the definition of ‘negotiation of stairs’ varies, as does the definition of independence. Important aspects such as safety on stairs are missing from all scales. In contrast to older scales, newer scales consist of items that have been tested for validity and reliability. In none of the scales was the stair negotiation item tested separately for validity. Only two scales examined test–retest reliability and only one measured inter-observer agreement.

Discussion: In current functional assessment scales stair negotiation is measured with great heterogeneity and insufficient validity. In patients and in studies in which assessment of stair negotiation ability is a key part of functional assessment, an improved, well-validated scale is needed. This scale should include not only the subject's physical ability to negotiate stairs, but also safety and change in ability over time.

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