How many body locations need to be tested when assessing sensation after stroke? An investigation of redundancy in the Rivermead assessment of somato-sensory perception

Objective: Assessing sensation after stroke is time consuming. This study aimed toidentify how many body locations need to be tested to establish whether sensation is‘intact’, ‘impaired’ or ‘absent’ and to assess validity of that classification.Design: Participants’ sensation was tested in a single assessment session.Agreement between the scores for individual anatomical sites and those for thewhole limb was calculated using a weighted kappa and percentage agreement foreach modality. High agreement between tests indicated redundancy, suggesting thatthe number of anatomical sites tested could be reduced. The Kruskal–Wallis testassessed the validity of classification by comparing a range of measures of functionalability in people with intact, impaired and absent sensation.Setting: Hospital-based stroke care.Subjects: One hundred and two patients tested 2–4 weeks after stroke.Main measures: Four proprioceptive and tactile modalities were measured using theRivermead Assessment of Somatosensory Performance.Results: Agreement between the total limb score and individual anatomical sites wassubstantial to excellent for all modalities and anatomical sites. Agreement wasgreater than 90% when sensation was intact or absent. The comparison betweenpatients with intact, impaired and absent sensation showed significant differences infunctional mobility, independence in the activities of daily living, balance and weaknessin people with stroke.Conclusions: Sensory impairment can be classified as ‘intact’, ‘impaired’ or ‘absent’.There is a high redundancy between anatomical sites when the patient’s sensation is‘intact’ or ‘absent’ and not all sites need to be tested. Reducing the number of sitestested will improve usability of the Rivermead Assessment of SomatosensoryPerformance in day-to-day clinical practice