Fukuda Stepping Test: Sensitivity and Specificity

Division of Audiology, Mayo Clinic, Rochester, MN 55905, USA.
Journal of the American Academy of Audiology (Impact Factor: 1.58). 06/2009; 20(5):311-4; quiz 335. DOI: 10.3766/jaaa.20.5.4
Source: PubMed


A vestibulospinal test known as the Fukuda stepping test (FST) has been suggested to be a measure of asymmetrical labyrinthine function. However, an extensive review of the performance of this test to identify a peripheral vestibular lesion has not been reported.
The purpose of this study was to evaluate the sensitivity and specificity of the standard FST and a head shaking variation for identification of a peripheral vestibular system lesion.
In this retrospective review, we compared performance on the FST with and without a head shaking component to electronystagmography (ENG) caloric irrigation unilateral weakness results.
We studied these factors in 736 chronic dizzy patients.
Receiving operating characteristics (ROC) analysis and area under the curve (AUC) indicated no significant benefit to performance from the head shaking variation compared to the standard FST in identifying labyrinthine weakness as classified by caloric unilateral weakness results.
These findings suggest that the FST with and without head shake component is not a reliable screening tool for peripheral vestibular asymmetry in chronic dizzy patients; however, future research may hold promise for the FST as a tool for patients with acute unilateral disorders.

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Available from: Julie A Honaker, Oct 13, 2015
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    • "This finding further concludes that FST following head shake is not clinically useful to further discern a vestibular asymmetry. It should again be noted that a limitation of this work, first identified in Honaker et al (2009) and a previous analysis of the data (Shepard et al 1994), is that there were no correlations with FST and traditional indicators of the state of compensation. While the use of the FST in the acute (symptom complaints ,2 wk) patient population with the addition of analysis of the state of compensation has not been reported, it is anticipated that test performance would not surpass other bedside evaluation tools as described in Table 3. "
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    ABSTRACT: The purpose of the Fukuda Stepping Test (FST) is to measure asymmetrical vestibulospinal reflex tone resulting from labyrinthine dysfunction. The FST is a low cost evaluation for dizzy patients; however, when compared with gold standard caloric irrigation unilateral weakness (UW) value ≥25%, the FST has not been shown to be a sensitive tool for identifying unilateral vestibular hypofunction. The purpose of this technical report is to further evaluate the clinical utility of FST with and without headshake as a function of increased caloric asymmetry for individuals with unilateral peripheral vestibular pathology. Retrospective review of FST results with and without head shaking component as compared to gold standard, caloric irrigation UW outcome values at four severity levels: 0-24% UW (normal caloric value); 25-50% UW (mild caloric UW); 51-75% UW (moderate caloric UW); 76-100% UW (severe caloric UW). Study Sample: 736 chronic (≥8 wk symptom complaints) dizzy patients. Standard FST and FST following a head shake task are insensitive to detecting mild to moderate peripheral vestibular paresis. Increased test performance was observed for patients with severe canal paresis (>76% UW); however, continued inconsistencies were found in turn direction toward the severe unilateral vestibular dysfunction. Overall, the FST provides little benefit to clinicians when used in the vestibular bedside examination.
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