Assessing lower limb position sense in stroke using the gradient discrimination test (GradDT™) and step-height discrimination test (StepDT™): a reliability and validity study

Abstract

Purpose: To evaluate the psychometric properties of two novel tests of lower limb position sense.

Methods: 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 (n = 32) and age matched controls (n = 32) were tested. Inter- and intra-rater reliability and agreement, sensitivity and specificity, discriminant and convergent validity were evaluated.

Results: 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 (p < 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 (r = 0.40–0.60); the Erasmus modified Nottingham Sensory Assessment did not.

Conclusions: 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 rehabilitation

• The 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

Keywords:

• Stroke
• lower-limb
• position sense
• measurement

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Acknowledgements

We wish to thank all participants, particularly those involved with test development. Adam Carter for his assistance in test construction and Suzanne Maddocks for assisting with data collection.

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

This research was supported by a research grant from the Chartered Society of Physiotherapy Charitable Trust [Ref: PRF/14/B06].