The Modified 30-Second Sit-to-Stand Test

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Original Editor - Mason Trauger

Top Contributors - Mason Trauger  

Objective

Sit to stand tests are a functional outcome measure for older adult populations, as the ability to safely stand from a chair and sit back down is one of the most basic Activities of Daily Living. The most commonly used sit to stand tests include the Five Times Sit to Stand Test and 30 Seconds Sit To Stand Test. However, these assessments do not allow for the use of the upper extremities. The Modified 30-Second Sit to Stand Test (m30STS) is a variant of the 30 Seconds Sit to Stand Test which allows for upper extremity use on the armrests of a chair.

Intended Population

Older adults with diminished physical function who cannot perform the 5 Times Sit to Stand or 30 Seconds Sit to Stand Tests.

Method of Use

• The m30STS is administered using a standard chair with armrests [seat height 17 inches (43.2 cm), seat width 18 inches (45.72 cm)]. Traditionally, the chair is placed against a wall to prevent it from moving.
• The participant is seated in the middle of the chair, back straight; feet approximately a shoulder width apart and placed on the floor at an angle slightly back from the knees, with one foot slightly in front of the other to help maintain balance.
• The participant is instructed to place their hands on the armrests.
• The participant is instructed to complete as many full stands as possible within the 30 seconds, and may use their hands to help stand as needed. Participants are encouraged to fully sit between each stand, but must let go of the armrests and bring their upper extremities to midline of the body to maintain a fully upright posture.
• The participant is allowed 1 to 2 practice rises to clarify correct technique as needed prior to the test.
• The use of an assistive device for balance upon standing is not permitted.
• While monitoring the participant's performance, the tester silently counts the number of correct stands completed in 30 seconds. Incorrectly executed stands are not counted.
• The score is the total number of stands completed in 30 seconds; more half-way up at the end of 30 seconds counts as a stand.

Evidence

Institutionalized Older Adults

• 54 institutionalized older adult male veterans (age = 91 ± 3 years) performed the m30STS twice within a span of 3 to 7 days
  • Good test-retest reliability [Intraclass correlation coefficient (ICC) = 0.84]
  • Convergent validity with the Timed Up and Go Test (r = -0.62)
• 53 institutionalized older adult veterans (49 men, 4 women; age = 91±4 years
  • Strong correlation between TUG and m30STS performance (r= -0.63, p<0.01), and a moderate correlation between m30STS and number of falls (r= -0.30, p =0.03)
  • Through a negative binomial regression analysis (while controlling for age, history of falls, comorbidities, and cognition), the m30STS significantly (Wald χ2 = 4.57, p = 0.03) explained the variance in number of falls, with an increased number of m30STS repetitions being associated with a decreased number of falls over one year. However, the overall model was not significant (χ2 = 10.55, p = 0.06). Analyses were underpowered for these models.
  • Receiver Operator Characteristics analyses suggest that m30STS can "predict" which participants would fall (area under the curve = 0.67; 95% confidence interval = 0.48, 0.81, p=0.04), with an optimal cut-off of 7 repetitions (sensitivity = 0.97; specificity = 0.35). This suggests that if a participant can perform 7 repetitions during the m30STS, they were unlikely to fall within the next year, but less than 7 repetitions cannot accurately predict fall status.

Physically Challenged Older Adults 65 Years of Age and Older

• Population for reliability: a convenience sample of 7 participants from 2 assisted living facilities and the outpatient caseload of a skilled nursing facility (SNF)
• Population for validity: 33 participants from the physical therapy caseload from a SNF research site.
• Reliability:
  • Inter-rater reliability: intraclass correlation coefficient (ICC) = 0.737 (p≤0.001)
  • Test-retest intrarater reliability: ICC = 0.987 (p≤0.001)
• Validity:
  • Concurrent validity of the initial 30mSTS significantly correlates with:
    • initial Berg Balance Scale (Spearman ρ = 0.737, P = .01)
    • discharge Berg Balance Scale (Spearman ρ = 0.578, P = .01)
    • initial modified Barthel Index (Spearman ρ = 0.711, P = .01), and the following sub-scale items:
      • bathing (Spearman ρ = 0.511, P = .01)
      • toileting (Spearman ρ = 0.581, P = .01)
      • stair climbing (Spearman ρ = 0.566 P = .01)
      • ambulation (Spearman ρ = 0.653, P = .01)
      • transfers (Spearman ρ = 0.574, P = .01)
    • discharge modified Barthel index sub-scale items:
      • bathing (Spearman ρ = 0.498, P = .010)
      • ambulation (Spearman ρ = 0.504, P = .009)
  • Predictive validity
    • Linear regression analysis for initial m30STS to predict discharge Berg Balance Scale equation of discharge Berg Balance Scale = 2.119 (m30STS) + 27.970 (P ≤ .001). Adjusted R²=0.315, suggesting initial m30STS predicts 31.5% of the variability.
• Minimal Detectable Change (MDC):
  • MDC₉₀=0.70; standard error of measurement (SEM) = 0.30
  • An increase of 1 additional repetition is a change beyond error

COVID-19

• 92 participants hospitalized with moderate COVID-19 in Indonesia
  • Mean age of 47 years, standard deviation (SD) of 12.36 years
  • All maintained oxygen saturations ≥95% with or without oxygen supplementation at baseline
• Mean score on m30STS was 13.3 repetitions, SD of 4.76
• No participants had demonstrable oxygen desaturation post-assessment, suggesting the m30STS may be an appropriate functional measure to utilize for COVID-19 patients as part of early mobilization initiation.