The psychometric properties of the toe tap test in people with stroke

Objectives: To investigate the: (i) inter-rater and test-retest reliability of the toe tap test for people with stroke, (ii) the convergent validity of toe tap test counts with stroke-specific impairments, (iii) minimum detectable change in toe tap test counts, (iv) toe tap test cutoff counts which best discriminating the performance between stroke survivors and healthy controls. Design: Cross-sectional study. Setting: University-based rehabilitation center. Participants: Thirty-seven people with stroke and 35 healthy controls. Main Outcome Measures: The toe tap test was administered along with the Fugl–Meyer lower extremity assessment, muscle strength of ankle dorsiflexors and plantarflexors, five times sit-to-stand test, Berg Balance Scale, limit of stability test, timed up and go test, and Community Integration Measures questionnaire. Results: Excellent inter-rater and test-retest reliabilities (intraclass correlation coefficient = 0.868–0.995 on the affected side) were found. A minimal detectable change of 8.7 counts and a cutoff score of 21 counts was found on the affected side, while 12.6 counts and 25 counts were found on the unaffected side, respectively. Toe tap test counts on the affected side were significantly associated with Fugl–Meyer lower extremity assessment scores, ankle muscle strength, Berg Balance Scale scores and timed up and go test times. Conclusions: Toe tap test count on the affected side is a simple and reliable tool for assessing ankle control in people with stroke.Implications for rehabilitation Toe Tap Test counts have excellent intra-rater, inter-rater, and test-retest reliabilities in people with stroke. Toe Tap Test counts on the affected side were significantly associated with Fugl–Meyer Assessment of Lower Extremity scores, ankle muscle strength, Berg Balance Scale scores, and timed Up and Go test completion times. The 95% Minimal Detectable Change for the Toe Tap Test counts was 8.7 counts of the affected side and 12.6 of the unaffected side. Toe Tap Test counts of 21 on the affected side and 25 on the unaffected side (sensitivity 70.3–83.3%; specificity 71.4–85.7%) was found to be the most representative for discriminating performance of Toe Tap Test in chronic stroke survivors and healthy older adults. Toe Tap Test is a simple and reliable tool for assessing ankle control in people with stroke.