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Table 3 Validity, reliability and responsiveness of clinical assessments of lower limb functions and activities

From: Robot-aided assessment of lower extremity functions: a review

Measure

Instrument/test

Properties

Study

  

Validity

Inter-rater reliability

Intra-rater reliability

Responsiveness

 

pROM

Universal goniometer

Knee angle : ICC ≥ 0.98 [219]

Hip flex: 0.56 ≤ ICC ≥ 0.91, SEM = 6.16° [32, 220, 221]

Hip ext: 0.20 ≤ ICC ≥ 0.68, SEM = 4.45° [32, 220, 221]

Hip abduction: 0.45 ≤ ICC ≥ 0.63, SEM = 6.08°[220, 221]

Hip adduction: 0.14 ≤ ICC ≥ 0.65, SEM = 4.4° [220, 221]

Knee flex: 0.84 ≤ ICC ≤ 0.93, SEM = 8.21° [32, 220]

Knee ext: 0.59 ≤ ICC ≤ 0.86, SEM = 3.48° [32, 220]

Ankle DF: 0.26 ≤ ICC ≤ 0.87 [32]

Ankle PF: ICC = 0.74 [32]

Knee flex: 0.97 ≤ ICC ≥ 0.99

Knee ext: 0.91 ≤ ICC ≥ 0.98

[222, 223]

Hip sagittal angle: 0.51 ≤ ICC ≥ 0.54, SEM = 4° [224]

Ankle DF: 0.72 ≤ ICC ≥ 0.89 [34]

-

[32, 34, 219224]

aROM

Universal goniometer

Knee flex: r ≥ 0.975

Knee ext: r ≥ 0.390

Knee flex: ICC ≥ 0.977

Knee ext: ICC ≥ 0.893

Knee flex: ICC = 0.997

Knee ext: ICC ≥ 0.972

-

[29]

End-feel

Manual examination

-

Hip flex: 0.21 ≤ k ≤ 0.41

Hip ext: k = − 0.13

Knee flex: − 0.01 ≤ k ≤ 0.31

Knee ext: 0.25 ≤ k ≤ 0.43

Knee flex: k = 0.76

Knee ext: k = 1.00

-

[32], [225]

Muscle strength

MMT

Knee flex (vs isokinetic dynamometer): ρ = 0.74

Knee ext: r = 0.70

[11]

Lower extremities: 0.66 ≤ ICC ≤ 1 [226]

MRC score: 0.62 ≤ ICC ≤ 0.88 [227]

Lower extremities: 0.77 ≤ ρ ≤ 0.99 [228]

External resp.: Sensitivity: 60.9 % to 70.3 % [77]

[11, 77, 226228]

HHD

Knee ext: 0.43 ≤ r ≤ 0.99

Knee flex: 0.83 ≤ ICC ≤ 0.85

Ankle PF: r = 0.93

Ankle DF: r = 0.60 [79]

Knee flex: ICC = 0.95

Knee ext: ICC = 0.88

Ankle DF: ICC = 0.69 [78]

Hip: ICC = 0.82 (belt), ICC = 0.80 (therapist) [229]

Knee flex: ICC = 0.97

Knee ext: ICC = 0.93

Ankle DF: ICC = 0.91 [78]

95 % CI = 32.5 N (72 %)

95 % CI = 57.1 N (79 %) [229]

[78, 79, 230]

Proprioception

Romberg test

-

-

-

-

 

Toe-test

-

-

-

-

 

Joint impedance

MAS

vs ankle measurement device: r = 0.09

vs H-reflex: r = 0.47

vs Pendulum test: r = − 0.69

0.16 ≤ k ≤ 0.61

Ankle PF: r = 0.727

0.4 ≤ ICC ≤ 0.75

-

[230]

Pendulum test

vs MAS: − 0.63 ≤ ρ ≤ −0.89

-

0.651 ≤ ICC ≤ 0.844

-

[153]

Walking function/Gait pattern

WISCI II

Construct validity:

vs TUG: r = −0.76

vs 10MWT: r = −0.68

vs 6MWT: r = 0.60

0.98 ≤ ICC ≤ 1

ICC = 1

MDC: 1 level

Effect size 2.05, moderate change – discrimination between 1 and 3 months post injury

Effect size 0.73, small change – discrimination between 3 and 6 months post injury

[230]

10MWT

vs TUG: ρ = 0.89

vs 6MWT: ρ = − 0.95

vs WISCI II: ρ = 0.795

r = 0.97

LOA = ± 7.0 s

r = 0.98

LOA = ± 6.0 s

Effect size: 0.92 - discrimination between 1 and 3 months post injury

Effect size: 0.47 - discrimination between 3 and 6 months post injury

[181, 230, 231]

  1. ρ indicates Spearman rank correlation, r Pearson’s correlation, k Cohen’s Kappa, CI confidence intervals, DF dorsiflexion, PF plantarflexion