Proprioception assessment in stroke rehabilitation: a survey of Australian physiotherapists and occupational therapists

BACKGROUND:
Proprioception is the awareness of the position, movement, and muscular force generated by the body and its musculoskeletal parts, and is an important somatosensory impairment to assess in people with stroke. We know that rehabilitation clinicians self-report to assess proprioception in approximately two-thirds of people with stroke. What we do not know is what type of assessments are used, or the true frequency of their use in clinical practice. This study aimed to provide a preliminary description of the type and frequency of proprioception assessment used by clinicians working in stroke rehabilitation in Australia, and their knowledge about proprioception impairment.
METHODS:
We surveyed Australian physiotherapists and occupational therapists who were involved in the rehabilitation of people with stroke. The online cross-sectional survey ran from March to October 2020. While they were blind to the aims of the study, respondents answered questions about clinical decision-making in a case study of a person with stroke and proprioception impairment. Then, they were asked questions about proprioception.
RESULTS:
There was a total of 165 survey responses, of which 58 contained complete datasets suitable for analysis. Only 55% (n = 32) of respondents selected an assessment of proprioception for the person described in the case study. The majority of respondents defined proprioception to be the sense of joint / limb (n = 38, 65.5%) or body (n = 27, 46.6%) position and used ‘eyeball’ judgements of limb matching accuracy (56%, n = 33) as an assessment.
CONCLUSIONS:
These preliminary data suggest that proprioception is likely under-assessed in stroke rehabilitation and that clinicians understand proprioception to be the sense of joint position and movement, but lack awareness of other proprioceptive senses, such as the sense of muscle force. These factors may reduce the ability of clinicians to rehabilitate proprioception impairment in people with stroke.