Trials needed to assess knee proprioception following stroke

Abstract

Background and purpose: This study explores the number of trials required to identify clinically significant impairments in knee joint position sense and movement sense following stroke.

Method: Proprioception was assessed in 33 stroke patients aged 37-87 years. Ten trials for each assessment were performed in sitting and supine positions using both verbal response techniques and contralateral limb matching.

Results: Forty-six percent of participants were identified with a proprioceptive deficit. The trial where the first incorrect response occurred varied across individuals and testing positions. Performing only one trial detected proprioceptive impairments in less than 10% patients, and incorrect responses did not always occur in the first 5 trials. In sitting, no participant failed the assessment of knee joint position sense using the verbal response technique after only 6 trials. In supine, no participant failed the assessment of knee movement sense using the verbal response technique after only 6 trials. For the assessment of knee joint position sense in sitting using contralateral limb matching an estimated 9.4% of patients with a deficit would be missed if only 3 trials were used in preference to 5. For assessment of knee joint position sense in sitting, an estimated 18.8% of patients with deficits would be missed if only 3 trials were used rather than 10 trials.

Conclusions: Clinicians should perform at least 10 trials in either sitting or supine to quantify joint position sense and movement sense at the knee following stroke.