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FIST Instructions & Setup

The FIST was designed as a bedside clinical measure, so the required equipment is simple and readily available in clinics and hospitals.

Equipment for FIST testing:

  1. Stopwatch, or watch with second hand--to time 30 seconds of performance (2 items)
  2. Tape measure--to measure 2 inches required to scoot (3 items), and to use as a lightweight object for patient to pick up (2 items)

You may also need:

  1. Small lightweight object, if not using the tape measure.  A pen or cone could be used.
  2. Stool or step to position the patients lower extremities depending on patient height and bed height.
  3. Chair for therapist positioning.

 

FIST equipment

 

Position the patient:

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.

Position yourself:

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.

Describe the FIST to the patient:

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:

  • The FIST tests balance in seated position
  • The patient should perform items with their best posture and balance, and while moving in a seated position
  • The therapist will give them occasional light pushes to test for balance reactions
  • The therapist will make sure they won't lose their balance
  • The patient should try not to use their hands, but they can if they must
  • The therapist will remind the patient to try to not use their hands
  • Breaks are allowed-if the patient needs one, they should tell the therapist
  • The therapist should ask the patient if they have questions, and answer them before proceeding

 

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.

Next, the FIST scoring scale