Development of a clinical assessment test of 180-degree standing turn strategy (CAT-STS) and investigation of its reliability and validity

[Purpose] To develop a clinical assessment test of 180-degree standing turn strategy (CAT-STS) and quantify its reliability and construct validity. [Subjects] Outpatients with stroke that occurred at least 6 months previously (N = 27) who could walk 10 m without physical assistance were included. [Methods] The CAT-STS was based on the literature and discussion with four physical therapists. The final version of the CAT-STS includes seven items: direction, use of space, foot movement, initiation, termination, instability, and non-fluidity. Patients were videotaped performing a 180-degree turn while standing. The Motricity Index, gait speed and Functional Ambulation Category were also evaluated. Two raters evaluated the turn on two occasions, and inter- and intra-rater reliability were calculated. Construct validity was also calculated. [Results] Inter-rater reliability was fair or moderate for many items (kappa = 0.221-0.746). Intra-rater reliability was good-to-excellent for all items (kappa = 0.681-0.846) except direction and termination. Inter- and intra-rater reliability of the total CAT-STS score were substantial and excellent, respectively (intraclass correlation coefficient = 0.725 and 0.865, respectively). The total CAT-STS score was associated with walking ability and the time and number of steps taken to turn. [Conclusion] The total CAT-STS score is a reliable and valid measure.