- The Five Times Sit to Stand Test (5XSST) is a test that measures the amount of time a patient is able to transfer from a seated to a standing position and back to sitting five times.
- It assesses the functional lower limbs strength, transitional movements, balance, and fall risk.
Clinical Considerations
The 5XSST is widely used in many populations, including older adults and ambulatory individuals with SCI.
ICF Domain
Activity ▶ Mobility
Administration
Clinician-administered.
Length
Less than five minutes.
Equipment
- Standard height chair (43-45 cm, 17-18 inches) with a backrest.
- Countdown timer.
Scoring
The amount of time (to the nearest decimal in seconds) it takes the patient to transfer from a seated to a standing position and back to sitting five times.
Languages
N/A
Training Required
None.
Availability
Measurement Property Summary
# of studies reporting psychometric properties: 5
Interpretability
MCID:
- 2.27 s with arms on a walking device
- >2 s with arms on knees, arms by sides, and arms folded over the chest
(Amatachaya et al. 2023; n=109; 87 males, 14 females; ASIA C-D; 67 paraplegia, 42 tetraplegia; mean (SD) time since injury: 76.3 (72.1) months)
SEM:
- 1.09 s (arms on a walking device)
- 0.88 s (arms on knees)
- 0.55 s (arms by sides)
- 1.05 s (arms crossed over the chest)
MDC:
- 3.01 s (arms on a walking device)
- 2.44 s (arms on knees)
- 1.53 s (arms by sides)
- 2.93 s (arms crossed over the chest)
(Khuna et al. 2020; n=82; 69 males, 13 females; ASIA C-D; 55 paraplegia, 26 tetraplegia; mean time since injury: 89.8 months)
Reliability – High
- High Test-retest Reliability (ICC = 0.956-0.989)
(Khuna et al. 2020; n=82; 69 males, 13 females; ASIA C-D; 55 paraplegia, 26 tetraplegia; mean time since injury: 89.8 months)
- High Inter-rater Reliability (ICC = 0.997-1.000)
(Khuna et al. 2020; n=82; 69 males, 13 females; ASIA C-D; 55 paraplegia, 26 tetraplegia; mean time since injury: 89.8 months)
(Poncumhak et al. 2013; n=66, 46 male, incomplete SCI)
- High Intra-rater Reliability (ICC = 0.998-1.000)
(Khuna et al. 2020; n=82; 69 males, 13 females; ASIA C-D; 55 paraplegia, 26 tetraplegia; mean time since injury: 89.8 months)
Validity – Low to High
- Moderate correlation of 5XSST (without hands) with knee extensor muscle strength (r = -0.45)
(Mato et al. 2022; n=44; 31 males, 13 females; incomplete SCI; injury level: 9 cervical, 12 thoracic, 18 lumbar, 5 sacral; mean time since injury: 73.14 months)
- Low to Moderate correlation of 5XSST (without hands) with lower extremity motor strength (ρ = –0.38 to –0.70)
- Low to Moderate correlations of 5XSST with 10-MWT:
- Without hands: Moderate (ρ = –0.68)
- With hands: Low (ρ = –0.40)
- Moderate correlations of 5XSST with TUG test:
- Without hands: (ρ = –0.69)
- With hands (ρ = 0.52)
- Low to High correlations of 5XSST with 6-MWT:
- Without hands (High – ρ = –0.71)
- With hands (Low ρ = –0.47)
- Moderate correlation of 5XSST (without hands) with WISCI II (ρ = –0.58)
(Khuna et al. 2022; n=56; 44 males, 12 females; incomplete SCI; level of injury: 12 C5-C8, 7 T1-T6, 4 T7-T12, and 33 L1-L5; and mean time since injury: 80.7 months)
Responsiveness
Arms on walking device:
- 0-1 month, SRM = 0.91
- 1-3 months, SRM = 1.03
- 3-6 months, SRM = 0.99
Arms on knees:
- 0-1 month, SRM = 1.13
- 1-3 months, SRM = 0.85
- 3-6 months, SRM = 1.12
Arms on by sides:
- 0-1 month, SRM = 1.04
- 1-3 months, SRM = 1.00
- 3-6 months, SRM = 1.22
Arms on walking device:
- 0-1 month, SRM = 0.95
- 1-3 months, SRM = 0.83
- 3-6 months, SRM = 1.09
(Amatachaya et al. 2023; n=109; 87 males, 14 females; ASIA C-D; 67 paraplegia, 42 tetraplegia; mean (SD) time since injury: 76.3 (72.1) months)
Floor/Ceiling Effect
No values were reported for the presence of floor/ceiling effects in the 5XSST for the SCI population.
Reviewers
Dr. Janice Eng, Dr. Carlos L. Cano-Herrera, Matthew Querée
Date Last Updated
31 December 2024
Amatachaya S, Khuna L, Thaweewannakij T. Responsiveness and minimal clinically important difference of the five times sit-to-stand test in ambulatory individuals with spinal cord injury: A six-month prospective cohort study. Clin Rehabil. 2023; 37: 109-118. doi: 10.1177/02692155221122672.
https://pubmed.ncbi.nlm.nih.gov/36046885/
Khuna L, Thaweewannakij T, Wattanapan P, Amatachaya P, Amatachaya S. Five times sit-to-stand test for ambulatory individuals with spinal cord injury: a psychometric study on the effects of arm placements. Spinal Cord. 2020; 58: 356-364. doi: 10.1038/s41393-019-0372-3.
https://pubmed.ncbi.nlm.nih.gov/31664188/
Khuna L, Phadungkit S, Thaweewannakij T, Amatachaya P, Amatachaya S. Outcomes of the five times sit–to–stand test could determine lower limb functions of ambulatory people with spinal cord injury only when assessed without hands. J Spinal Cord Med. 2022; 45: 402-409. doi: 10.1080/10790268.2020.1803658.
https://pubmed.ncbi.nlm.nih.gov/32808892/
Mato L, Chankavee N, Amatachaya S, Thaweewannakij T. Knee Extensor Muscle Strength to Measure the Ability of Five Times Sit to Stand Independently in Patients with Incomplete Spinal Cord Injury. Malays J Med Sci. 2022; 29: 74-82. doi: 10.21315/mjms2022.29.5.8.
https://pubmed.ncbi.nlm.nih.gov/36474537/
Poncumhak P, Saengsuwan J, Kamruecha W, Amatachaya S. Reliability and validity of three functional tests in ambulatory patients with spinal cord injury. Spinal Cord. 2013; 51: 214-7. doi: 10.1038/sc.2012.126.
https://pubmed.ncbi.nlm.nih.gov/23147127/
