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Welcome to the Function in Sitting Test (FIST) Web-based Training
This website will train rehabilitation and medical professionals on how to administer a standardized test of sitting balance, the Function In Sitting Test or FIST, intended to be used in patients/clients who are suspected of having problems with balance and/or safety in a seated position. Thank you to the Department of Physical Therapy and Information Technology Services at SMU for hosting this training on their website.
This online module consists of an overview of the FIST, specifics related to each of the 14 FIST items, and documentation information. All FIST items have video examples showing different levels of performance. There is a brief quiz to assess competency available after you complete this tutorial.
First, some general information about the FIST.
The FIST can be useful for a variety of clinical uses including:
Is my patient appropriate for testing with the FIST?
The FIST is best suited for patients with:
Patients who may benefit from other types of balance testing include:
Please see the paper published in the Journal of Neurologic Physical Therapy detailing the development and validation of the FIST for more details, or view the abstract at PubMed .
The FIST was designed as a bedside clinical measure, so the required equipment is simple and readily available in clinics and hospitals.
Before having the patient perform any of the 14 items on the FIST, they should be positioned in the standard starting position. The therapist may help the patient and reposition them between items as needed.
Note the patient is on a normal hospital bed without a mattress overlay and the bed is fully flattened. The patient's feet are flat on the floor, with the hips and knees at approximately 90 degrees of flexion. You should use a step or stool to position the lower extremities and feet if the patient is shorter. The hips are positioned so that hip rotation is neutral and they are not in hip abduction or adduction. The patient's hands are in the lap.
Therapist positioning is determined by patient safety requirements to guard the patient appropriately and to allow the therapist to provide physical assistance to the patient should they need it during testing. Common positions for the therapist include sitting in front of the patient or to the side of the patient. The therapist can move between these positions as needed during testing.
It is important that prior to beginning testing you describe the FIST to the patient. Not only does this help confirm informed consent for testing with the FIST, but it allows the patient to better understand what you will be doing and why. It also allows you to review some of the general principles of the FIST and FIST scoring prior to starting the FIST. You may choose to read the following prepared description to your patients:
" I will be conducting a test with you today to see how well you balance yourself in a sitting position. It will involve you sitting with your best posture and balance, as well as moving in a seated position to reach and scoot. I might lightly push you to see how well your balance reactions work. I will be right here next to you to make sure you are safe if you lose your balance. I would prefer if you could perform the test without using your hands for balance, but if you need to use your hands, you can. I will remind you to try to not use your hands during the test. If you need a break, just let me know and we can pause to let you rest. Do you have any questions? [Pause, answer questions] Let's start. "
If you choose the paraphrase the directions for the FIST, be sure you include the following points:
Now you should be able to set up FIST testing, including what equipment is required, patient positioning, therapist positioning, and general FIST description to use when testing.
The scoring criteria on the FIST are the same for each item. The FIST was designed this way to make learning and using the scoring scale easy and to decrease the need to constantly refer to written directions when scoring each item. The items are scored on a 5 point ordinal scale ranging from 0 to 4, with 0 representing the lowest ability and 4 representing normal ability.
               1 Needs assistance
               2 Upper extremity support
               3 Verbal cues/increased time
Let's take a look at each point on the scale.
0 Dependent: Patient requires complete physical assistance to perform task successfully, patient is unable to complete task successfully even with physical assistance, or dependent
1 Physical Assistance: Patient is unable to complete task successfully without physical assistance
2 Upper Extremity Support:  If the patient requires the use of one or both of their upper extremities to support themselves or to maintain their balance during the performance of the task, they score a 2. Items involving grasping or picking up items should be scored a 2 if the patient uses their upper extremity for support or balance, not as a score of how they pick up the item. Items that involve a movement and require the patient return to the starting position should be scored a 2 if the patient requires the use of their hands for any part of the task. You may prompt the patient to try again without using their hands to see if they are able to successfully complete the task without their hands.
3 Verbal Cues/ Increased Time: A score of 3 indicates the patient required verbal cueing or an increased amount of time to complete the task. Otherwise, their performance was complete and they successfully completed the task. If a patient is unsafe but can otherwise complete the task, and providing verbal cueing would improve safety (i.e.,"slow down"), the patient is scored as a 3.
4 Independent: 4 is the highest score attainable for any individual item and represents performance that is normal. It also accounts for speed and safety.
Now you should be familiar with the scoring scale used for all the FIST items.
Read more about the FIST item overview .
Ensure accurate reporting of your patient's FIST results using the following:
Paper documentation : Templates are available for downloading to use in your facility/clinic.
Modification to include facility name/logo and patient ID stamp/sticker is acceptable. Otherwise, please do not modify these templates without express written permission of the author.
Here is an example of a completed documentation form.
Note the following aspects of this form, as described below.
Electronic Health Record (EHR) documentation :
The FIST can be imported into EHR systems. It is suggested that the brief descriptors of each item be included as a prompt for correct performance and documentation, and that scores be accessed via a drop down menu if possible. Please follow the same templates when converting to EHR as much as possible, and do not significantly alter the documentation template when converting to EHR without the express written consent of the author.
Patients may change in 3 distinct ways, as shown in this example.
The minimal detectable change (change that exceeds error) is a change greater than 5 points. The minimal clinically important difference during inpatient rehabilitation is a change greater than 6 points. (see References for details)
Now you have covered the entire FIST and should be ready to begin testing using the FIST.
When administering the FIST, remember...
The following written resources are available for you to download.
You've completed training in the administration of the FIST. Congratulations!
Directions: Please select the BEST answer. Click this link to launch the quiz.
The Function In Sitting Test (FIST) was created to allow healthcare providers to better describe patient abilities to move and perform functional tasks in sitting. Administration of the FIST was intended for persons who are cleared for sitting and do not have any contraindications for moving in the prescribed manner for the individual test items. Determination of a patient's ability to safely perform the FIST lies solely with the healthcare provider administering the FIST. Additionally, as a test of balance in a seated position, it is the healthcare provider's responsibility to guard and supervise the patient at all times during the administration of the FIST to prevent falls or other unwanted or unexpected outcomes.
Cabanas-Valdés R, Bagur-Calafat C, CaballeroGómez FM, et al. Validation and reliability of the Spanish version of the Function in Sitting Test (S-FIST) to assess sitting balance in subacute post-stroke adult patients. Topics Stroke Rehabil , 2017; e-pub April 13, 2017. DOI:10.1080/10749357.2017.1316548 [ View the abstract online ]
Sung JH, Ousley CM, Shen S, Isaacs ZJK, Sosnoff JJ, Rice LA. Reliability and validity of the function in sitting test in nonambulatory individuals with multiple sclerosis. Int J Rehabil Res . 2016;39(4):308-312.[ View the abstract online ]
Gorman S, Harro C. Function In Sitting Test admission score predicts inpatient rehabilitation discharge destination.. Poster Presentation. IV STEP Conference, American Physical Therapy Association, Columbus, OH, July 17, 2016. [ View the abstract online ]
Gorman SL, Harro C, Platko C, Greenwald C. Examining the Function In Sitting Test (FIST) for validity, responsiveness, and minimal clinically important difference. J Arch Phys Med Rehabil . 2014;95(12):2304–2311. [ View the abstract on PubMed ]
Ousley CM, Isaac ZJK, Wajda DA, Rice LA, Sosnoff JJ. Validation of seated postural control measures in persons with multiple sclerosis. (poster) 4th International Symposium of Gait and Balance in Multiple Sclerosis. Cleveland, Ohio, Oct 10-11, 2014.
Gorman SL, Rivera M, McCarthy L. Reliability of the Function In Sitting Test (FIST). Rehabil Res Prac . 2014;Article ID 593280,http://dx.doi.org/10.1155/2014/593280. [ View the open access article here ]
Mustille R, Petersen H, Abele J, et al. A pilot study of the FIST as a functional outcomes measure in a neurological acute care population (abstract). J Acute Care Phys Ther. 2013;4(3):129-130. [ View the abstract here ]
Rideout D, Nordstrom TM, Lazaro RT. Case 6: Coccidioidomycosis meningitis. In: Jobst E, ed. Case Files in Physical Therapy (Neurological Rehabilitation) . Boston, MA:McGraw-Hill; 2014.
Gorman SL, Harro C, Platko C. Validity and responsiveness of the Function In Sitting Test (FIST) in adults in inpatient rehabilitation: preliminary results (abstract). J Rehabil Med . 2013;6(Suppl 53):99. [ View the conference proceedings open access ]
Gorman SL. Case 1: Acute cerebrovascular accident. In: Jobst E, ed . Case Files in Physical Therapy (Acute Care). Boston, MA:McGraw-Hill; 2013.
Gorman SL, Radtka S, Melnick M, Abrams G, Byl NN. Development and validation of the Function In Sitting Test (FIST) in adults with acute stroke. J Neuro Phys Ther . 2010:34(3);150-160. [ View the abstract on PubMed ]
How to cite this web-based training (AMA 10 th edition):
Gorman SL. Function In Sitting Test Web-Based Training. Samuel Merritt University website. https://www.samuelmerritt.edu/fist. Published June 2011. Updated May 2015. Accessed [insert date].
Thank you to the many people who helped during the development of the FIST and with this web-based training:
The FIST is available in the following translations:
Other translations of the FIST are underway:
If you would like to work on an underway translation or volunteer to translate the FIST into another language, please contact us for more information.
If you still have questions about FIST administration or scoring, or would like to work on a translation of the FIST, please contact the creator, Sharon Gorman, PT, DPTSc, GCS, FNAP.
There is an active research agenda underway involving the FIST. The following projects are currently in progress. If your facility would like more information on potential research collaborations, please get in touch with the contact person listed below.
If you or your facility would like to collaborate on another project using the FIST, please contact us to discuss future opportunities and collaborations.
Samuel Merritt University offers undergraduate, graduate, doctoral, and nursing certificate programs at three campuses in Northern California and online.
2710 N. Gateway Oaks Dr., Suite 360
1720 South Amphlett Boulevard, Suite 300
800.607.6377
3100 Telegraph Ave
Oakland, California 94609 admission@samuelmerritt.edu
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