This study aimed to validate the proprioceptive examination’s construct validity and responsiveness to clarify the constructs being measured and the ability of an outcome measure to detect change over time, thereby ensuring its applicability for individuals with stroke.
This study included 35 individuals (mean age 75.82 ± 9.64 years) with stroke who had no signs of unilateral spatial neglect, agnosia, or aphasia and no history of lower limb conditions. The proprioception measure included the threshold to detect passive motion (TDPM) for six movement directions: hip external and internal rotation, knee flexion and extension, and ankle dorsiflexion and plantarflexion. The participants were initially positioned in a seated posture with the knee joint flexed at 90° and the soles of the feet lifted off the floor. The vision was occluded using an eye mask. The TDPM was performed by capturing photographs using a smartphone paired with a Bluetooth remote controller at the moment participants first perceived movement, which was guided by the examiner at a velocity of approximately 5.00°/s. The difference between the joint angle acquired from the image data using ImageJ and the starting angle was considered the TDPM value. The TDPM was randomly performed thrice. Additionally, the average TDPM values for each direction were combined to define the lower limb flexion pattern (hip external rotation, knee flexion, and ankle dorsiflexion) and extension pattern (hip internal rotation, knee extension, and ankle plantarflexion) that resulted in a multi–joint TDPM. These measurements were repeated 1 week later, using an average of 2.85 days after stroke as the baseline in conjunction with risk management. Statistical analyses were performed using Spearman’s rank correlation coefficient (rs) to assess construct validity, predictive validity, and external responsiveness in relation to clinical assessments, namely the Berg Balance Scale (BBS), 10–meter walk test (10MWT), and Barthel Index (BI).
For the multi-joint TDPM, a moderate to strong correlation was observed between the TDPM of each movement direction constituting flexion or extension patterns and the corresponding multi-joint TDPM (rs: 0.56–0.92). This multi-joint TDPM demonstrated a moderate correlation with the BBS, 10MWT, and BI measured 1 week later (rs: −0.52 to −0.60). Among these, only the 10MWT demonstrated external responsiveness (rs: 0.53–0.55).
The multi-joint TDPM serves as a measure that encompasses the TDPM of each movement direction and is associated with changes in cyclical movements such as walking.
In clinical practice, the multi-joint TDPM can be used for the evaluation of movement sense in individuals with stroke. Furthermore, the findings of this study contribute to future research that examines the impact of impaired proprioceptive deficits on movement deficit after stroke by complementing kinematic evaluations.
Proprioception
Psychometric properties
