Test-Retest Reliability and Convergent and Discriminant Validity of the Proprioception Measures in Poststroke Patients.

Abstract

To investigate the test-retest reliability and validity of the threshold to detect passive motion (TDPM) and joint position sense (JPS) tests using an image-capture technique compared with the Fugl-Meyer Assessment (FMA) and the Erasmus MC modifications to the Nottingham Sensory Assessment (EmNSA) for evaluating proprioceptive impairment in poststroke patients. Repeated-measures design. A rehabilitation department in a hospital. Fifty patients with acute or subacute stroke, with stroke severity ranging from mild to moderate, assessed based on the National Institutes of Health Stroke Scale. Not applicable. TDPM, JPS, FMA, and EmNSA assessments were performed twice at a 24-h interval. Reliability was assessed using the intraclass correlation coefficient (ICC) and Bland-Altman analysis, and the minimal detectable change (MDC) was calculated. Convergent and discriminant validity of the proprioceptive measures were evaluated using Spearman's rank correlation coefficients (r_s). TDPM demonstrated moderate-to-good reliability (ICC=0.63-0.84; MDC=4.26°-8.34°) without systematic bias. Furthermore, TDPM demonstrated discriminant validity (r_s=-0.40 to 0.11) with JPS, FMA, and EmNSA. Multijoint TDPM demonstrated excellent reliability (ICC=0.91-0.93; MDC=14.57°-15.57°), and convergent validity (r_s=0.80-0.92) was confirmed between TDPM measures corresponding to different movement patterns. FMA and EmNSA demonstrated good-to-excellent reliability (ICC=0.85-0.93; MDC=0.71 score) and convergent validity (r_s=0.72). However, a ceiling effect was observed in 74% of the participants. Conversely, JPS exhibited low reliability (ICC<0.44) and poor validity. TDPM and multijoint TDPM using the image-capture technique are reliable and useful measures for evaluating proprioception in poststroke patients. Both measures evaluate dimensions distinct from those captured by FMA and EmNSA, indicating the variability of proprioceptive function in poststroke patients.