A systematic review to determine the reliability of knee joint position sense assessment measures

Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK.
The Knee (Impact Factor: 1.94). 07/2012; 20(3). DOI: 10.1016/j.knee.2012.06.010
Source: PubMed


The assessment of joint position sense (JPS) is the most widely used measurement of knee proprioceptive capability within the literature. However, it remains unclear what the most reliable method is to assess this. The purpose of this study was to determine the intra- and inter-rater reliability of the various methods used to assess knee JPS.

A systematic review of published and unpublished literature sources was conducted up to June 2012. All studies principally assessing the reliability (intra- or inter-rater) or reproducibility of a JPS of the knee were included. The methodological quality of each study was reviewed using the Critical Appraisal Skills Programme tool.

A total of 18 studies were eligible, assessing the reliability of JPS with 456 knees. The reliability of four methods of JPS has been recorded: position replication using a model, image recorded angulation, electrogoniometry and dynamometry/angular motion chair. Intra-rater reliability was good for the assessment of JPS using photographs and digital images, and replicating knee position using a paper model, this was good but variable when electrogoniometry was used, and moderate but variable when assessed using dynamometry/angle motion chairs. The assessment of JPS by image recorded angulation, electrogoniometry and dynamometry/angular motion chair has demonstrated good inter-rater reliability.

Whilst JPS methods appear to have variable reliability, the four assessment methods should be further assessed with pathological populations such as those following patellar dislocation or anterior cruciate ligament rupture. This will better facilitate the generalisability of JPS assessment methods to inform clinical practice.

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    • "JPS refers to the awareness of the location of the joint in space, whilst kinesthesia is defined as the perception of active and passive joint movement. Objective quantification of JPS is possible through technology such as goniometers, electrogoniometers, isokinetic dynamometers , electromagnetic tracking devices, custom-made jigs and inclinometers [5], [7], [8]. Although JPS is one of the most widely used indices for the evaluation of proprioception , the paradigm of difference threshold or just noticeable difference (JND) seems to provide a more accurate and least variable quantification of proprioceptive acuity [9]. "
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    • "Movable ultrasonic waves (Mysono U5, Medison Korea, 2009) were used to measure the muscle thicknesses of the rectus femoris and gastrocnemius. Subjects were made comfortable in the prone position with knee extension, and the distance between the superior aponeurosis and the inferior aponerosis of the gastrocnemius was measured as the thickness of the gastrocnemius13). An intra-rater reliability of r = 0.98:1.0, "
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    • "Movable ultrasound wave measurement (Mysono U5, Medison Korea, 2009) was performed for measurement and examination of the internal structure of the rectus femoris and gastrocnemius. The method for examination was to make sure that subjects were in a comfortable prone position, with the knee extended, the muscle thickness of gastrocnemius was determined by measuring the distance between superior aponeurosis and inferior aponeurosis of gastrocnemius (Smith et al., 2013). High intrarater (ICC=0.98- "
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