Function in Sitting Test (FIST)

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 Techonology 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.

What is the FIST?

  • Useful: The FIST is a clinical examination of sitting balance, designed to be conducted at the patient's bedside
  • Practical: Consists of 14 functional, everyday activities as test items
  • Easy: Performance is scored by therapist using a single set of scoring criteria for all 14 items
  • Quick: Most patients can easily complete the FIST in under 10 minutes

Purposes of the FIST

The FIST can be useful for a variety of clinical uses including:

  • Assess functional sitting abilities
  • Describe sitting balance dysfunction
  • Focus interventions
  • Track changes in sitting balance over time
  • Assessment of lower level patients, especially if other balance tests may be too difficult for the patient

Is my patient appropriate for testing with the FIST?

The FIST is best suited for patients with:

  • The ability to follow simple directions, either verbal or nonverbal 
  • Known or suspected sitting balance deficits
  • Impulsiveness
  • Safety issues in sitting
  • Slow movement
  • Poor seated motor control
  • Lower level patients who...
    • cannot tolerate other balance tests
    • are unable to stand or ambulate without excessive assistance or devices

Patients who may benefit from other types of balance testing include:

  • Patients who can...
    • stand or perform more complex ADLs
    • ambulate
  • Patients who aren't yet...
    • medically stable for sitting
    • cleared for the motions or tasks on the FIST

Creation of the FIST

Creation and validation process

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.

Psychometrics of the FIST

  • FIST reliability & validity summary
    • Functional sitting balance ability explains 83.33% of score variance between persons
    • Cronbach's alpha = 0.98
      • In nonambulatory persons with MS = 0.91
    • Person separation reliability = 0.978
    • Standard error of measurement = 1.40
    • Minimal detectable change (95% confidence) = 5.5 points
    • Test-retest reliability (ICC, 95% confidence) = 0.97
      • In nonambulatory persons with MS (ICC, 95% confidence) = 0.92
    • Inter-tester and intra-tester reliability (ICC 95% confidence) = 0.99
    • Standardized response mean = 1.04
    • Index of responsiveness = 1.07
    • Effect size = 0.83
    • Concurrent validity with FIM and Berg Balance Scale at inpatient rehab admission (r=0.71 to 0.85)
    • Minimal clinically important difference during inpatient rehab was change in FIST greater than 6.5 points
    • FIST cutoff score indicating higher likelihood of discharge NOT to home (with or without assistance) measured within first 5 days of inpatient rehabilitation < 42 points.
    • FIST significantly correlated with virtual time to contact in sitting in nonambulatory persons with MS (spearman's rho = 0.487, p = 0.02)
  • See the References page for studies and publications associated with the above listed reliability & validity results.


  • Studies to determine evaluative validity in other applicable patient populations, predictive validity, and fall risk are underway and/or in planning stages. See our Research Collaboration page if you would like to participate in current/upcoming studies.


Next, how to set up the environment, patient, and therapist to conduct the FIST .

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