Virtual 2-Minute Step Test: Validity, Reliability, and Correlates in Community Dwelling Older Adults

Purpose: Telehealth expansion offers physical therapists new opportunities; however, conducting virtual assessments raises concerns about validity, reliability, and safety. This study aimed to establish the concurrent validity, reliability, and correlations of the 2-minute step test (TMST) delivered virtually in community-dwelling older adults. Methods: A cross-sectional design was used. A sample of community-dwelling older adults underwent single-session testing of the TMST. Scoring was conducted simultaneously by an in-person rater and a synchronous telehealth rater. Video recordings were scored by an asynchronous rater on day 1 and day 30 to assess interrater and intrarater reliability. Concurrent validity was calculated using the 95% level of agreement, intracorrelation coefficient (ICC), and Pearson correlation coefficient between the in-person and remote TMST score. Interrater and intrarater reliability were obtained for virtual raters by calculating the ICC 2-way mixed model. Pearson correlation coefficient was used to identify the correlation between the virtual TMST and fall risk outcome measures. Results: Thirty older adults participated. Two-minute step test showed high levels of agreement between in-person and remote formats (ICC = 0.95–0.99, Pearson r = 0.96), good interrater reliability (ICC = 0.79), excellent interrater (ICC = 0.99), significant positive moderate relationship with the 30-second chair stand test, fair correlation with the activities-specific balance confidence scale, and a negative fair relationship with the Timed Up and Go test. Conclusions: Two-minute step test is a valid, reliable, and safe tool for virtual aerobic testing in older adults. Assessing the TMST virtually requires considerations of fall risk, physiological exercise responses, influences of the environment, camera positioning, and internet connectivity.