Scapulohumeral control after stroke: a preliminary study of the test-retest reliability and discriminative validity of a clinical scapular protocol (ClinScaP)

Abstract

BACKGROUND: Clinical scapulohumeral tests are lacking post-stroke OBJECTIVE: To test reliability and discriminant validity of clinical scapulohumeral assessments post-stroke METHODS: Following tests were assessed in 57 individuals with stroke (IwS) (subdivided in a low, moderate, high proximal arm function (PAF) group) and 15 healthy controls: (1) Observation of tilting/winging; (2) shoulder girdle position tests (pectoralis minor index, acromial index, scapular distance test); (3) scapular lateral rotation measurement; (4) maximal humeral elevation and (5) medial rotation test were executed. 15 IwS were measured twice by the same assessor to determine test-retest reliability. Differences between controls and IwS and between IwS with different levels of PAF were assessed. RESULTS: ICCs were very high for all tests (>0.80), except the pectoralis minor index (0.66). Weighted Kappas were high for observation and the medial rotation test (>0.70). Group differences were found for observation, lateral rotation and humeral elevation. IwS compared to controls, and IwS with lower compared to higher PAF generally showed increased lateral rotation (p<.01); decreased maximal active humeral elevation (p<.001); and more often tilting and winging (p<.05). CONCLUSIONS: The use of these tests in clinical settings will allow for identification of altered scapular characteristics, which will enhance treatment planning for PAF post-stroke.