Reliability of position sense testing assessed with a fully automated system.

Position sense testing has increased as a tool for augmenting evaluation of joint injury. In the present study, we investigated the inter-day reliability for four different types of position sense tests using a fully automated system. The tests included (1) passive presentation/active replication, (2) passive presentation/passive replication, (3) semi-passive presentation/semi-passive replication (where semi-passive denotes passive movement during antagonist muscle contraction), and (4) active presentation/active replication. The absolute difference between presented target and replicated position was used as a measure of position sense accuracy. Ten healthy subjects who were blindfolded and seated with the arm in a moveable rig performed the tests on two occasions, separated by 3-4 days. For each type of position sense test, horizontal abduction from a starting position of 0 degrees (relative to the sagittal plane) to target positions of 32 degrees and 64 degrees, and horizontal adduction from a starting position of 80 degrees to 48 degrees and 16 degrees were conducted. A two-way ANOVA revealed no differences in absolute error between days or between testing procedures. However, intra-class correlations (ICC), which are most often used to express test-retest reliability, were moderate at best, ranging from 0.40 to 0.61 for the four types of position sense tests. Hence, the present study indicates that the ability of repositioning tests to detect alterations in proprioceptive function is limited, suggesting that their use in clinical evaluation be approached with prudence.