Objective: To compare the diagnostic accuracy of common bedside examination tests for upper limb ataxia.

Background: Although a number of ataxia scales have been validated, common bedside ataxia tests are used in routine practice without much knowledge of their diagnostic accuracy or reliability.

Methods: 27 healthcare individuals were recruited to blindly evaluate the presence or absence of ataxia in 36 videos. The participants included 6 medical students, 2 midlevel providers, 5 physicians in residency (3 neurology residents), 2 non-neurology specialists and 12 neurologists (4 movement disorders specialist). The videos depicted 6 common ataxia tests, in 6 people (4 patients with ataxia, 1 patient with dystonia without ataxia, and a healthy control). Ataxia severity ranged from mild-to-severe, based on BARS (Brief Ataxia Rating Scale) measures. Finger-to-nose (FNF), Finger tapping (FT), Sequential finger tapping (SFT), Thigh Alternating Patting (TAP), and Finger-Following-Finger (FFF) tests were included. FNF was performed allowing the patient’s arm full extension (FNF-E) or with restricted range of motion (FNF-R). Study data were collected and managed using REDCap electronic data capture tools hosted at the University of Nebraska Medical Center. The participants followed a web link to REDCap, where instructions on test interpretation were given, followed by a sequential listing of the cases. Each video showed a single test performed in a single patient, and was followed by the question: Is ataxia present? Sensitivity, Specificity and likelihood ratios were calculated for each test.

Results: The most sensitive test for upper appendicular ataxia was the FFF (Sensitivity = 90.74%, NLR=0.19). The most specific test was the TAP (Specificity = 90.74%, PLR=6.9). Sensitivity/Specificity for the other tests were as follows: FNF-E= 67.59%/81.48%; FNF-R=52.78%/87.04%; FT= 58.33%/77.78%; SFT= 69.44%/79.63%. When measured by neurologists, the FFF and the TAP test remained the top performers.

Conclusions: The Finger-Following-Finger test is the most sensitive test for upper appendicular ataxia. The diagnostic accuracy of bedside examination tests for ataxia does not seem to align well with current use and common teaching practices. Further studies are needed to measure reliability, and to ascertain the effects of level of training, experience, and specialty, in the diagnostic accuracy of ataxia tests.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/diagnostic-accuracy-of-common-bedside-ataxia-examination-tests/