The 4-Stage Balance Test
Method of Use
Directions - There are four standing positions that get progressively harder to maintain.
1. Stand with your feet side-by-side
2.Place the instep of one foot so it is touching the big toe of the other foot.
3.Tandem stance Place one foot in front of the other, heel touching toe
4. Stand on one foot.
- You should describe and demonstrate each position to the patient.
- Then, stand next to the patient, hold their arm, and help them assume the correct position.
- When the patient is steady, let go, and time how long they can maintain the position, but remain ready to assist the patient if they should lose their balance.
- If the patient can hold a position for 10 seconds without moving their feet or needing support, go on to the next position.
- If not, STOP the test. Patients should not use an assistive device (cane or walker) and they should keep their eyes open 
- Not being able to hold the tandem stance (task number 3) for 10 seconds is an indication of increased risk of fall. 
- To reduce their risk of falling, consider implementing gait and balance exercises, or refer them to an evidence-based fall prevention program, such as Otago balance program, Tai Chi.
Interclass (Pearson) correlations, with time between test and re-test of 3-4 months, 187 subjects from the community) is reported as moderate (0.66) 
A robust correlation has been reported when comparing the scale with other measurements for balance, in the same subjects. 
- National centre of nutrition and aging 4 stage balance test Available from:https://nutritionandaging.org/4-stage-balance-test/#wbounce-modal (last accessed 16.10.2020)
- Phelan EA, Mahoney JE, Voit JC, Stevens JA. Assessment and management of fall risk in primary care settings. Medical Clinics. 2015 Mar 1;99(2):281-93.
- CDC 4 stage balance test Available from: https://www.cdc.gov/steadi/pdf/4-Stage_Balance_Test-print.pdf (last accessed 16.10.2020)
- Gardner MM, Buchner DM, Robertson MC, Campbell AJ. Practical implementation of an exercise‐based falls prevention programme. Age and ageing. 2001 Jan 1;30(1):77-83.
- Rossiter-Fornoff JE, Wolf SL, Wolfson LI, Buchner DM, FICSIT Group. A cross-sectional validation study of the FICSIT common data base static balance measures. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 1995 Nov 1;50(6):M291-7.