School of Health Professions, Peninsula Allied Health Centre, University of Plymouth, Plymouth, UK.
Dept of Psychology, City, University of London, London, UK.
Disabil Rehabil. 2020 Jul;42(15):2215-2223. doi: 10.1080/09638288.2018.1554008. Epub 2019 Jan 14.
To evaluate the psychometric properties of two novel tests of lower limb position sense. Our newly developed tests assess the discrimination thresholds of under-foot slope and step height perception using a two alternative forced choice approach. Stroke participants ( = 32) and age matched controls ( = 32) were tested. Inter- and intra-rater reliability and agreement, sensitivity and specificity, discriminant and convergent validity were evaluated. Intra-rater reliability for both variants of the gradient discrimination test was excellent; intraclass correlation coefficients (ICC) =0.91 and 0.89. The step height discrimination test had excellent intra-rater reliability and agreement: ICC =0.95. Inter-rater reliability was also excellent in both tests (ICC= 0.85-0.93). Discriminant validity was demonstrated with significant differences in test performance between stroke and control participants ( < 0.001). Our novel tests did not significantly correlate with the proprioceptive component of the Erasmus modified Nottingham Sensory Assessment. Receiver Operating Characteristic curve analysis indicated both novel tests to have greater sensitivity and specificity than the proprioceptive component of the Erasmus modified Nottingham Sensory Assessment in predicting the presence of self-reported sensory impairments. Functional reach test, 10 meter walk test, centre of pressure measurement and reported falls showed significant and moderate to strong correlations with novel test performance ( = 0.40-0.60); the Erasmus modified Nottingham Sensory Assessment did not. Our novel, functionally oriented tests of lower limb position sense are reliable, valid and feasible for use in an ambulatory chronic stroke and elderly population.Implications for rehabilitationThe GradDT™ and StepDT are two novel tests of lower limb position sense which are reliable and valid in a chronic stroke sample.They offer clinicians and researchers sensitive, accurate and clinically usable measures of lower limb position sense.
评估两种新型下肢位置感测试的心理测量特性。我们新开发的测试使用二选一强制选择方法评估足底斜率和步高感知的辨别阈值。纳入了 32 名脑卒中患者和 32 名年龄匹配的对照组进行测试。评估了组内和组间的可靠性和一致性、敏感性和特异性、判别和收敛效度。两种梯度辨别测试变体的组内可靠性均非常好；组内相关系数（ICC）为 0.91 和 0.89。步高辨别测试的组内可靠性和一致性也非常好：ICC =0.95。两种测试的组间可靠性也非常好（ICC=0.85-0.93）。在脑卒中患者和对照组之间的测试表现存在显著差异，表明具有判别效度（ < 0.001）。我们的新型测试与 Erasmus 改良诺丁汉感觉评估的本体感觉分量无显著相关性。受试者工作特征曲线分析表明，在预测自我报告的感觉障碍存在方面，两种新型测试比 Erasmus 改良诺丁汉感觉评估的本体感觉分量具有更高的敏感性和特异性。功能性伸展测试、10 米步行测试、压力中心测量和报告的跌倒与新型测试表现有显著的中度至强相关性（ = 0.40-0.60）；而 Erasmus 改良诺丁汉感觉评估则没有。我们的新型、功能导向的下肢位置感测试可靠、有效且适用于慢性脑卒中及老年人群的日常活动。
GradDT™和 StepDT 是两种新型的下肢位置感测试，在慢性脑卒中患者中具有可靠性和有效性。它们为临床医生和研究人员提供了敏感、准确且具有临床实用性的下肢位置感测量方法。
