Quantitative clinical assessment of wrist proprioception with stroke survivors

Objective The aims of this study were to characterise proprioceptive impairment in individuals after stroke using the Wrist Position Sense Test (WPST) in a relatively large pooled sample, to re-establish the criterion of abnormality of the WPST, and to determine the sensitivity and specificity of a briefer test version for use in clinical settings. Design Cross-sectional observation study with pooling of data across studies. Setting Rehabilitation or outpatient settings. Subjects Stroke survivors (n = 205) and neurologically healthy controls (n = 93) were assessed at baseline. Main measure Wrist proprioception assessed using the WPST. Methods Baseline data from stroke survivors and healthy controls assessed on the WPST was extracted from six studies. Raw data were pooled and analysed to determine an updated criterion of impairment and ability of a brief 10-trial version to detect proprioceptive impairment. Results Proprioceptive impairment was common for the contralesional wrist (66%) and present in the ipsilesional wrist (21%). The new criterion of abnormality was established as 11.1 0 average error. High sensitivity and specificity were found for the brief 10-trial version, with 85.3% sensitivity and 95.7% specificity. Conclusion Clinicians can quantitatively and confidently identify proprioceptive impairment in the upper limb after stroke using either the original or brief version of the WPST. Routine use of this quantitative, standardised clinical assessment can contribute to improved identification, monitoring, and access to targeted intervention for proprioceptive impairment following stroke.