Development of a clinical scale to assess retropulsion in neurological disorders

Abstract

Summary Retropulsion represents a severe disorder of postural control in the sagittal plane. It is characterized by a posterior displacement of the center of mass with respect to the base of support and active resistance to passive correction of this posture.Although retropulsion seems quite frequent and relevant for neurorehabilitation, research on this postural behavior is limited. One major problem is that there is no established tool available to assess and quantify the behavior. Thus the objective of this Delphi study was to develop a clinical scale to assess retropulsion in neurological disorders. The Delphi method was applied to gather opinions from experts and build consensus on the validity of the content of theScale for Retropulsion. Twelve experts from different countries and disciplines participated in the Delphi study. The Delphi process comprised three rounds. All items of the scale reached consensus in the second round. The final version of the Scale for Retropulsion includes four subtests: A) static postural control, B) reactive postural control, C) resistance, and D) dynamic postural control which are tested in a sitting and a standing (initial) position. High level of international, multidisciplinary overall expert agreement was achieved for the scale (median 9, IQR 1). This bed side test will help clinicians, therapists and researchers to evaluate postural instability in the sagittal plane and to study the epidemiology, the etiology, and the rehabilitation process of patients with retropulsion. The next stage is to evaluate the clinimetric properties of the scale.