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  2. Function in Sitting Test

Function in Sitting Test

Last Updated

Purpose

The Function in Sitting Test (FIST) is a bedside evaluation of sitting balance that evaluates sensory, motor, proactive, reactive, and steady state balance factors.

Link to Instrument

Instrument Details

Acronym FIST

Area of Assessment

Bodily Functions

Assessment Type

Performance Measure

Administration Mode

Paper & Pencil

Cost

Free

CDE Status

Not a CDE--last searched 10/26/2025 

Diagnosis/Conditions

  • Brain Injury Recovery
  • Stroke Recovery

Populations

Multiple Sclerosis
Spinal Cord Injuries
Stroke
Vestibular Disorders

Key Descriptions

  • 14 items with an ordinal scale (0-4) for each test item:
    4) Independent, completes the task independently and successfully
    3) Needs Cues, completes the task independently and successfully; may need verbal / tactile cues or more time
    2) Upper extremity support, unable to complete task without using upper extremities for support or assistance
    1) Needs assistance, unable to complete task successfully without physical assistance
    0) Complete assistance, requires complete physical assistance to perform task successfully, is unable to complete task successfully with physical assistance, or dependent
  • Testing Instructions:
    1) One trial of each item is allowed
    2) Verbal directions and demonstration are given as needed by the therapist
    3) Standard position: Individual seated at edge of hospital bed with half of upper leg supported (neutral abduction / adduction / rotation), hips and knees at 90 degrees, and feet flat in support
    4) Hands are placed in lap unless needed for support
    5) Items are ordered by difficulty, so have the patient perform the items in order
    6) Nudges should be randomly inserted into the test by the therapist
    7) Give the patient instructions and demonstrate the task if needed prior to each item
    8) It is preferable to score the patient's first attempt
    9) Multiple attempts for each item are acceptable if the therapist is providing cues, prompts the patient to attempt with/without hands to improve performance, or to ensure full movement through the task
    10) Try to limit the attempts of any particular item to 3 or less to minimize testing effects
  • Score range 0-54, with higher scores indicating more independent sitting balance
  • See Gorman et al., 2010 for measure

Number of Items

14

Equipment Required

  • Standard hospital bed (without air mattress)
  • Stopwatch
  • Tape measure
  • Step stool or riser (for foot positioning, depending on patient height)
  • Small, lightweight object (can use tape measure or stopwatch

Time to Administer

Less than 15 minutes

Required Training

Reading an Article/Manual

Required Training Description

FIST Manual: https://drive.google.com/file/d/1LRBxtFxxUF-UJwJlEdQax8Axp4UZxz5S/view?usp=sharing
FIST Item Overview: https://www.samuelmerritt.edu/fist/items
FIST Quiz: https://web.samuelmerritt.edu/fistquiz/

Age Ranges

Adults

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Reviewed by Heidi Roth, DHS, PT, NCS and the TBI EDGE task force of the Neurology Section of the APTA in 5/2012. Updated in September 2025 by Nikol Brevik, OTS, CUW, Andrea Hermsen, OTS, McKenzie Johnson OTS, and reviewed by Jessica Schmidt, OTD, OTR/L, from Concordia University of Wisconsin.

Body Structure

Head
Neck
Upper Extremity
Back
Lower Extremity

ICF Domain

Activity
Body Function

Measurement Domain

Activities of Daily Living
Motor
Sensory

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology
Section of the American Physical Therapy Association’s Multiple
Sclerosis Taskforce (MSEDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit: ANPT Outcome Measures Recommendations (EDGE)

Abbreviations:

 

HR

Highly recommend

R

Recommend

LS/UR

Reasonable to use, but limited study in target group/Unable to recommend

NR

Not recommended

 

Recommendations based on level of care in which the assessment is taken:

 

Acute Care

Inpatient Rehab

Skilled Nursing Facility

Outpatient

Home Health

StrokEDGE

LS

LS

LS

UR

UR

MS EDGE

UR

UR

UR

NR

UR

TBI EDGE

LS

LS

LS

LS

LS

 

Recommendations for use based on acuity level of the patient:

 

Acute 

(CVA < 2 months post)

Subacute

(CVA 2 to 6 months)

 

Chronic

(CVA > 6 months)

 

StrokEDGE

LS

LS

LS

 

Recommendations based on EDSS Classification:

 

EDSS 0.0 - 3.5

EDSS 4.0 - 5.5

EDSS 6.0 - 7.5

EDSS 8.0 - 9.5

MS EDGE

NR

NR

NR

UR

 

Recommendations for use based on ambulatory status after brain injury:

 

Completely independent

Mildly dependent

Moderately dependent

Severely dependent

TBI EDGE

NR

LS

LS

LS

 

Recommendations for entry-level physical therapy education and use in research:

 

Students should
learn to administerthis tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

 

StrokEDGE

 

No

Yes

No

Yes

MS EDGE

No

No

No

Yes

TBI EDGE

No

No

No

Not reported

 

Considerations

  • The FIST may be too simple, inadequate, or not sensitive enough to provide useful information for patients who do not have a problem moving in sitting or who can tolerate standing or walking.
  • The FIST-SCI maybe be considered for SCI population

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Stroke

back to Populations

Standard Error of Measurement (SEM)

Acute Stroke:  (Gorman et al, 2010; n=31, age 61.5 (10.9) years, <=3 months post stroke, Modified Rankin Scale of moderate / moderately severe / severe)

  • SEM= 2.03

Minimal Detectable Change (MDC)

Acute Stroke: (Calculated from Gorman et al, 2010)

  • MDC=5.63

Stroke: (Alzyoud et al., 2022; n = 40; mean age (SD) = 71.6 (11.4) years; age range = 47-96 years; male = 23 (57.5%); mean time post CVA (SD) = 106 (247.7) days; skilled nursing facility sample)

  • MDC95 for entire group (n = 40): 4.63
 

Minimally Clinically Important Difference (MCID)

Stroke: (Alzyoud et al., 2022)

  • Distribution-based on ≥2 point improvement on Barthel Index: 4.8 score units (p < .03)
  • Anchor-based on patient reports of improvement: 3.5 score units (p < .03)

 

Internal Consistency

Acute Stroke: (Gorman et al, 2010)

  • Excellent internal consistency (Cronbach’s alpha = 0.98)

Floor/Ceiling Effects

Stroke: (Alzyoud et al., 2022)

  • Excellent: No floor effects
  • Excellent: No ceiling effects

 

Responsiveness

Stroke: (Alzyoud et al., 2022)

  • Moderate external responsiveness  to changes in Barthel Index score (r = 0.60, p < .01)
  • Large internal responsiveness (ES = 1.11, SRM = 1.49)

 

 

Vestibular Disorders

back to Populations

Standard Error of Measurement (SEM)

Adults With Sitting Balance Dysfunction: (Gorman, Harro, Platko and Greenwald, 2014, n=125, age=60.0 (16.6) years)

  • SEM= 1.40

 

Balance Participants: (Gorman, Rivera, and McCarthy, 2014) (n=6; Mean Age= 68.7)
***Medical diagnoses of the balance participants included Parkinson’s disease (n=1), multiple sclerosis (n=1), and cerebrovascular accident (n=5).

  • SEM= 3.58

Minimal Detectable Change (MDC)

Adults With Sitting Balance Dysfunction: (Gorman, Harro, Platko & Greenwald, 2014)

  • MDC=5.5

Minimally Clinically Important Difference (MCID)

Adults With Sitting Balance Dysfunction: (Gorman, Harro, Platko & Greenwald, 2014)

  • MCID> 6.5

Test/Retest Reliability

Balance Participants: (Gorman, Rivera, and McCarthy, 2014), n=6; mean age = 68.7
***Medical diagnoses of the balance participants included Parkinson’s disease (n=1), multiple sclerosis (n=1), and cerebrovascular accident (n=5).

  • Excellent: ICC=0.97

Interrater/Intrarater Reliability

Balance Participants: (Gorman, Rivera, and McCarthy, 2014), n=6; mean age = 68.7
***Medical diagnoses of the balance participants included Parkinson’s disease (n=1), multiple sclerosis (n=1), and cerebrovascular accident (n=5).

  • Intra-rater Reliability: Excellent ICC=0.99
  • Inter-rater Reliability: Excellent ICC=0.991

Criterion Validity (Predictive/Concurrent)

Adults With Sitting Balance Dysfunction: (Gorman, Harro, Platko & Greenwald, 2014)

Concurrent Validity: Good to Excellent concurrent validity with the Berg Balance Scale and Functional Independence Measure at both admission and discharge (Spearman ρ=.71–.85).

Responsiveness

Adults With Sitting Balance Dysfunction: (Gorman, Harro, Platko and Greenwald, 2014, n=125, age=60.0 (16.6) years)

Responsiveness: Strong as evidenced by the large effect size (.83), standardized response mean (1.04), and index of responsiveness (1.07).

Spinal Cord Injuries

back to Populations

Standard Error of Measurement (SEM)

SCI: (Abou et al., 2020; n = 26; mean age (SD) = 39 (15) years; age range = 20-72 years; female = 16 (61.5%); mean time post injury (SD) = 21(18) years; Cervical and thoracic injuries with AIS A-D and non-ambulatory)

  • SEM for entire group (n = 26): 1.45 unit points

SCI: (Palermo et al., 2020; n = 38; mean age (SD) = 39.67 (11.78) years; age range = 20-72 years; mean time post injury (SD) = 14.1 (11.5) years; C1 to T10 with AIS A-C; FIST modified into FIST-SCI to evaluate functional seated balance in persons with SCI)

  • SEM for entire group (n = 38): 1.3 unit points

 

Minimal Detectable Change (MDC)

SCI: (Abou et al., 2020)

  • MDC for entire group (n = 26): 4 unit points

SCI: (Palermo et al., 2020)

  • MDC for entire group (n = 38): 3.5 unit points

 

Cut-Off Scores

SCI: (Palermo et al., 2020, n = 37)

  • >45 FIST-SCI score indicated ability to transfer independently (sensitivity 92%; specificity 92%)

 

Test/Retest Reliability

SCI: (Abou et al., 2020)

  • Excellent test-retest reliability: (ICC = 0.95)

 

Interrater/Intrarater Reliability

SCI: (Palermo et al., 2020)

  • Excellent intra-rater reliability: (ICC = 0.98)
  • Excellent inter-rater reliability: (ICC = 0.99)

 

Internal Consistency

SCI: (Abou et al., 2020; n = 26)

  • Excellent: Cronbach’s alpha = 0.81

 

SCI: (Palermo et al., 2020; n = 38)

  • Excellent: Cronbach’s alpha = 0.94*

*Scores higher than 0.9 may indicate redundancy in the scale questions.

 

Criterion Validity (Predictive/Concurrent)

Concurrent validity:

SCI: (Abou et al., 2020)

  • Excellent concurrent validity with the lateral Modified Functional Reach Test (r = 0.64)
  • Poor concurrent validity with the forward Modified Functional Reach Test (r = 0.16)
  • Poor concurrent validity with posturography assessment virtual time to contact (r = 0.23)

 

Construct Validity

Convergent validity:

SCI: (Palermo et al., 2020)

  • Adequate convergent validity between average FIST-SCI scores and Motor Assessment Scale (MAS-SCI) scores (ρ = 0.52, p < 0.05)

 

Discriminate validity:

SCI: (Palermo et al., 2020)

  • Significant ability of average FIST-SCI scores to discriminate between those requiring assistance to transfer from those who were independent (t = 4.51, p < 0.05)

 

 

Face Validity

Palermo et al. (2020) established face validity for the FIST-SCI through discussion of expert clinicians and researchers (one of whom was a physical therapist working in the SCI field and the other an individual with SCI) (p. 1962).

 

Floor/Ceiling Effects

SCI: (Abou et al., 2020)

  • Poor: Ceiling effects of 21% were observed for the FIST

 

Multiple Sclerosis

back to Populations

Test/Retest Reliability

Multiple Sclerosis: (Sung et al., 2016; n = 20; mean age (SD) = 56.8 (10.9) years (range = 27-83 years); mean MS duration (SD) = 17.8 (9.2) years (range = 7-35 years); non-ambulatory w/mean wheelchair usage duration = 5.9 (4.7) years (range = 1-19 years))

  • Excellent test-retest reliability (n = 10): (ICC = 0.92)

 

Internal Consistency

Multiple Sclerosis: (Sung et al., 2016)

  • Excellent: Cronbach’s alpha (n = 20): 0.91*

 

*Scores higher than 0.9 may indicate redundancy in the scale questions.

 

Criterion Validity (Predictive/Concurrent)

Concurrent validity

Multiple Sclerosis: (Sung et al., 2016)

  • Adequate correlation with virtual time to contact (VTC) on posturography assessment (ρ = 0.487, p = 0.02)
  • Poor correlation with seated postural sway area on posturography assessment (ρ = -0.267, p = 0.25)

 

Floor/Ceiling Effects

Multiple Sclerosis: (Sung et al., 2016) 

  • Poor ceiling effect of 80% found for the static balance measures of the FIST

 

Bibliography

Abou, L., Sung, J., Sosnoff, J. J., & Rice, L. A. (2020). Reliability and validity of the Function in Sitting Test among non-ambulatory individuals with spinal cord injury. The Journal of Spinal Cord Medicine, 43(6), 846–853. https://doi.org/10.1080/10790268.2019.1605749

Alzyoud, J., Medley, A., Thompson, M., & Csiza, L. (2022). Responsiveness, minimal detectable change, and minimal clinically important difference of the Sitting Balance Scale and Function in Sitting Test in people with stroke. Physiotherapy Theory and Practice, 38(2), 327–336. https://doi.org/10.1080/09593985.2020.1756016

Gorman, SL, Radtka, S, et al. "Development and validation of the function in sitting test in adults with acute stroke." Journal of Neurologic Physical Therapy 34(3)(2010): 150-160. Find it on PubMed

Gorman, SL, et al. "Examining the Function in Sitting Test for Validity, Responsiveness, and Minimal Clinically Important Difference in Inpatient Rehabilitation." Archives of Physical Medicine and Rehabilitation 95.12 (2014): 2304-11.

Gorman SL, Rivera M, McCarthy L. "Reliability of the Function in Sitting Test (FIST)." Rehabilitation research and practice. 2014; 2014:593280.

Palermo, A. E., Cahalin, L. P., Garcia, K. L., & Nash, M. S. (2020). Psychometric testing and clinical utility of a modified version of the Function in Sitting Test for individuals with chronic spinal cord injury. Archives of Physical Medicine and Rehabilitation, 101(11), 1961–1972. https://doi.org/10.1016/j.apmr.2020.06.014

Sung, J., Ousley, C. M., Shen, S., Isaacs, Z. J. K., Sosnoff, J. J., & Rice, L. A. (2016). Reliability and validity of the Function in Sitting Test in nonambulatory individuals with multiple sclerosis. https://doi.org/10.1097/MRR.0000000000000188

 

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