Abstract
Quantitative assessments of position sense are essential for the investigation of proprioception, as well as for diagnosis, prognosis and treatment planning for patients with somatosensory deficits. Despite the development and use of various paradigms and robotic tools, their clinimetric properties are often poorly evaluated and reported. A proper evaluation of the latter is essential to compare results between different studies and to identify the influence of possible confounds on outcome measures. The aim of the present study was to perform a comprehensive evaluation of a rapid robotic assessment of wrist proprioception using a passive gauge position matching task. Thirty-two healthy subjects undertook six test-retests of proprioception of the right wrist on two different days. The constant error (CE) was 0.87°, the absolute error (AE) was 5.87°, the variable error (VE) was 4.59° and the total variability (E) was 6.83° in average for the angles presented in the range from 10° to 30°. The intraclass correlation analysis provided an excellent reliability for CE (0.75), good reliability for AE (0.68) and E (0.68), and fair reliability for VE (0.54). Tripling the assessment length had negligible effects on the reliabilities. Additional analysis revealed significant trends of larger overestimation (constant errors), as well as larger absolute and variable errors with increased flexion angles. No proprioceptive learning occurred, despite increased familiarity with the task, which was reflected in significantly decreased assessment duration by 30%. In conclusion, the proposed automated assessment can provide sensitive and reliable information on proprioceptive function of the wrist with an administration time of around 2.5 min, demonstrating the potential for its application in research or clinical settings. Moreover, this study highlights the importance of reporting the complete set of errors (CE, AE, VE, and E) in a matching experiment for the identification of trends and subsequent interpretation of results.
Highlights
Assessment of proprioception after neurological injuries and diseases has received increased attention, as there is growing evidence that somatosensory impairment leads to a poor prognosis for functional recovery after neurological injuries in patients with severe and persistent somatosensory dysfunction, such as after stroke (Kusoffsky et al, 1982; Feys et al, 2000; Han et al, 2002; Abela et al, 2012)
The primary aim of the present study was to evaluate the test-retest reliability of a rapid robotic assessment of wrist proprioception using a passive gauge position matching task based on the Wrist Position Sense Test (WPST) from Carey et al (1996) in young healthy subjects undertaking six test-retests
For completeness and to compare to other studies in the literature, we report constant error (CE = average error), absolute error (AE = average absolute error), variable error (VE = standard deviation of errors) and total variability (E = root mean square of errors) in degrees as proprioceptive outcome measures
Summary
Assessment of proprioception after neurological injuries and diseases has received increased attention, as there is growing evidence that somatosensory impairment leads to a poor prognosis for functional recovery after neurological injuries in patients with severe and persistent somatosensory dysfunction, such as after stroke (Kusoffsky et al, 1982; Feys et al, 2000; Han et al, 2002; Abela et al, 2012) This may be a consequence of the fact that proprioception is essential for the generation or correction of coordinated movements (Hasan, 1992; Sober and Sabes, 2003; Butler et al, 2004; Konczak et al, 2009) and critical for fine movements of the upper limb, e.g., aiming, reaching and grasping. In accordance with these limitations, a cross-sectional survey of occupational therapists and physiotherapists reported that more than half agreed that current methods of assessing somatosensation should be improved (Pumpa et al, 2015)
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