School of Health Professions, University of Plymouth, Plymouth, UK.
Department of Psychology, City, University of London, London, UK.
PM R. 2019 Oct;11(10):1083-1092. doi: 10.1002/pmrj.12085. Epub 2019 Apr 17.
The plantar foot represents a sensory dynamometric map and is essential for balance and gait control. Sensory impairments are common, yet often difficult to quantify in neurological conditions, particularly stroke. A functionally oriented and quantifiable assessment, the Foot Roughness Discrimination Test (FoRDT), was developed to address these shortcomings.
To evaluate inter- and intrarater reliability, convergent and discriminant validity of the FoRDT.
Test-retest design.
Hospital outpatient.
Thirty-two people with stroke (mean age 70 years) at least 3 months after stroke, and 32 healthy, age-matched controls (mean age 70).
Roughness discrimination thresholds were quantified utilizing acrylic foot plates, laser cut to produce graded spatial gratings. Stroke participants were tested on three occasions, and by two different raters. Inter- and intrarater reliability and agreement were evaluated with Intraclass Correlation Coefficients and Bland-Altman plots. Convergent validity was evaluated through Spearman rank correlation coefficients (rho) between the FoRDT and the Erasmus modified Nottingham Sensory Assessment (EmNSA).
Intra- and interrater reliability and agreement were excellent (ICC =0.86 [95% CI 0.72-0.92] and 0.90 [95% CI 0.76-0.96]). Discriminant validity was demonstrated through significant differences in FoRDT between stroke and control participants (P < .001). Stroke fallers had statistically significant higher FoRDT scores compared with nonfallers (P = .01). Convergent validity was demonstrated through significant and strong correlations (rho) with the Erasmus MC Nottingham Sensory Assessment (r = .69, P < .01). Receiver operator characteristic curve analysis indicated the novel test to have excellent sensitivity and specificity in predicting the presence of self-reported sensory impairments. Functional Reach test significantly correlated with FoRDT (r = .62, P < .01) whereas measures of postural sway and gait speed did not (r = .16-.26, P > .05).
This simple and functionally oriented test of plantar sensation is reliable, valid, and clinically feasible for use in an ambulatory, chronic stroke and older population. It offers clinicians and researchers a sensitive and robust sensory measure and may further support the evaluation of rehabilitation targeting foot sensation.
III.
足底代表了一种感觉动力测压图，对于平衡和步态控制至关重要。感觉障碍很常见，但在神经疾病中，尤其是在中风中，往往难以量化。为了解决这些不足，开发了一种功能导向和可量化的评估方法，即足底粗糙度辨别测试（Foot Roughness Discrimination Test，FoRDT）。
评估 FoRDT 的组内和组间信度、会聚和判别效度。
测试-再测试设计。
医院门诊。
32 名中风后至少 3 个月的中风患者（平均年龄 70 岁）和 32 名年龄匹配的健康对照组（平均年龄 70 岁）。
利用激光切割的丙烯酸足底板来量化粗糙度辨别阈值，以产生分级空间光栅。中风参与者在三个时间点接受测试，由两名不同的评估者进行评估。采用组内相关系数和 Bland-Altman 图评估组内和组间信度和一致性。通过 FoRDT 与 Erasmus 改良诺丁汉感觉评估（Erasmus modified Nottingham Sensory Assessment，EmNSA）之间的 Spearman 秩相关系数（rho）评估会聚效度。
组内和组间信度和一致性都非常好（ICC =0.86 [95% CI 0.72-0.92] 和 0.90 [95% CI 0.76-0.96]）。通过 FoRDT 区分中风患者和对照组的差异，证明了判别效度（P < .001）。与非跌倒者相比，中风跌倒者的 FoRDT 评分有统计学意义上的显著升高（P = .01）。通过与 Erasmus MC 诺丁汉感觉评估（r = .69，P < .01）的显著和强相关性证明了会聚效度。受试者工作特征曲线分析表明，该新测试在预测自我报告的感觉障碍方面具有极好的敏感性和特异性。功能性伸展测试与 FoRDT 显著相关（r = .62，P < .01），而姿势摆动和步态速度的测量值则不相关（r = .16-26，P > .05）。
这项足底感觉的简单而具有功能性导向的测试具有可靠性、有效性，并且在门诊、慢性中风和老年人群中是可行的。它为临床医生和研究人员提供了一种敏感且强大的感觉测量方法，可能进一步支持针对足部感觉的康复评估。
III 级。
