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Coordination Tests in Persons With Acute Central Nervous System Pathology: Assessment of Interrater Reliability and Known-Group Validity

Lanzino, Desiree J. PT, PhD; Rabinstein, Alejandro MD; Kinlaw, Denise PT; Hepburn, Stephanie B. SPT; Ness, Brandon M. SPT; Olson, Karen J. SPT; Sobie, Sarah M. SPT; Hollman, John H. PT, PhD

Journal of Neurologic Physical Therapy: September 2012 - Volume 36 - Issue 3 - p 122–130
doi: 10.1097/NPT.0b013e3182641d36
Research Articles

Background and Purpose: Coordination testing is a standard part of the neurologic examination, yet the psychometric properties of many tests used by practitioners are unknown. This study investigated the interrater reliability and known-group validity of limb coordination tests in participants with acute central nervous system (CNS) pathology.

Methods: Twenty-five participants with CNS pathology completed 20 different limb coordination tests administered at bedside by a physical therapist. Examinations were videotaped and independently rated by a neurologist, a physical therapist, and a student physical therapist using a 5-point ordinal scale. Nine tests were also timed. Results were analyzed for interrater reliability and the degree to which they differed between groups categorized as having or not having coordination deficits.

Results: Participants were individuals who had been diagnosed with either a CNS vascular lesion or intracranial tumor. Timed test scores had higher levels of agreement (mean intraclass correlation coefficient [ICC], 0.69–0.97) than ordinal scores (mean κfree 0.56–0.91). Scores from 5 of the 9 timed measures and 8 of the 20 ordinal measures differed between groups.

Discussion and Conclusions: Eleven tests were scored reliably between raters (κ > 0.60 or ICC > 0.75) and were performed differently between groups with and without coordination deficits (P ≤ 0.05). These tests are recommended for use when examining patients with acute neurologic pathology from a vascular lesion or tumor. They are simple to perform and require only a stopwatch to complete. Future studies should explore the sensitivity and specificity of these tests in disease states and their correlation with functional measures.

Mayo School of Health Sciences (D.J.L., D.K., S.B.H., B.M.N., K.J.O., S.M.S., J.H.H.) and College of Medicine, Mayo Clinic (A.R.), Rochester, Minnesota.

Correspondence: Desiree J. Lanzino, PT, PhD, Mayo School of Health Sciences, College of Medicine, Mayo Clinic, Siebens 11-06, 200 First St SW, Rochester, MN 55905 (

This study, in part, was presented as a Platform Presentation by Ms Hepburn and Ms Olson at the APTA Minnesota Chapter 2010 Spring Conference.

The authors declare no conflict of interest.

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© 2012 Neurology Section, APTA