Validity and reliability of the enhanced paper grip test in patients post-stroke

Assessing hallux (big toe) pulling force after stroke is important for rehabilitation. The Enhanced Paper Grip Test (EPGT) is a simple method to measure this force.

This cross-sectional observational study aimed to determine the reliability and validity of the EPGT in individuals post-stroke.

Forty-four patients with ischemic stroke, aged 18 to 65 years (mean time since stroke 11.94 ± 6.31 months), participated in this study. The EPGT was applied in two sessions one week apart by two physiotherapists. Intra-rater and inter-rater reliability were calculated using intraclass correlation coefficients [ICC (3,1)]. Convergent validity was assessed by correlating EPGT scores with the modified mini-BESTest and ankle muscle strength measurements.

The EPGT demonstrated excellent intra-rater reliability (ICC = 0.927-0.990) and inter-rater reliability (ICC = 0.953-0.992). EPGT scores were strongly correlated with the modified mini-BESTest scores, with higher correlations on the affected side (ρ = 0.927, p < 0.001) than the non-affected side (ρ = 0.639, p < 0.001). Significant positive correlations were also observed between EPGT scores and ankle muscle strength, particularly on the affected side (ankle plantar flexors: ρ = ;0.826, p < 0.001; ankle dorsiflexors: ρ = 0.846, p < 0.001), while moderate-to-weak correlations were found on the non-affected side (APF: ρ = 0.435, p = 0.01; ADF: ρ = 0.353, p = 0.04).

The EPGT is a valid and reliable tool for assessing hallux (big toe) pulling force post-stroke and can be quickly applied in clinical settings.

ClinicalTrials.gov (NCT07181005).