Abstract
Background: Proprioception encompasses position sense, posture and body movements, providing essential sensory information for learning and controlling movements, which is critical for children’s motor development, coordination and school readiness. Existing proprioceptive tests are primarily clinical, costly and difficult to apply in resource-limited settings, thus creating a need for feasible and reliable tasks to evaluate proprioception.
Aim: This study aimed to establish inter-rater and test-retest reliability of existing proprioceptive tasks.
Setting: This study was conducted in the Mangaung area of South Africa, involving participants from a Quintile 3 school.
Methods: Twenty-four participants (50% males and 50% females) between the ages of 6 and 9 years completed six proprioceptive tasks on two occasions, 5 days apart. The performances were video recorded and rated by three reviewers. Test-retest and inter-rater reliability of each task item was calculated using the intraclass correlation coefficient for a single rater and for absolute agreement across multiple raters.
Results: Three of the tests exhibited moderate test-retest reliability (shoulder-level-arm-raise both arms, finger-to-nose total and shoulder-level-arm-raise total), and one showed good reliability (Finger-to-nose eyes closed). Inter-rater reliability showed greater consistency; excellent reliability was shown for two task items (Rhomberg and force perception), and three showed moderate reliability (shoulder-level-arm-raise, both arms, and preferred arm, angels-in-the-snow and reciprocal imitations).
Conclusion: The proprioceptive task items were deemed reliable to use in a field-based setting for children.
Contribution: This study provides the first evidence of reliability for field-based proprioceptive tasks for South African children, identifying several tasks that can be confidently applied in school and community settings.
Keywords: test-retest; inter-rater reliability; proprioception; children; field-based.
Introduction
Children with proprioceptive difficulties are often labelled as clumsy, uncoordinated and sensory seeking (Chu 2017; Kaviraja 2017). These proprioceptive difficulties can manifest as poor postural control, an inability to maintain an upright body position, uncoordinated movements, poor motor control, poor body awareness and behaviours such as biting, chewing and pushing peers (Cheatum & Hammond 2000; Kaviraja 2021; Laukkanen et al. 2019; Veldman et al. 2020). Proprioception, which encompasses position sense, posture and body movements, provides essential sensory information for learning and controlling movements. Several researchers have highlighted the need to evaluate the developing proprioceptive system in young children (Chu 2017; Hillier, Immink & Thewlis 2015; Holst-Wolf, Yeh & Konczak 2016; Tahir et al. 2019; Tarakci & Tarakci 2016; Valori et al. 2020). Targeted evaluations can therefore help identify potential developmental lags in the proprioceptive system, which can be addressed to maximise performance-based outcomes as maturation continues.
The proprioceptive abilities of children can be evaluated through the implementation of clinical and field-based testing. Clinical testing mainly utilises equipment in a specific location (e.g. practitioner practice) and is often costly, whereas field-based testing uses low-cost equipment and is typically conducted in an individual’s natural environment (e.g. home or school), which may enhance comfort and ecological validity (Han et al. 2016; Munóz-Jiménez, Rojas-Valverde & Leon 2021; Sayar & Ünübol 2017; Takahashi, Kawana & Furukawa 2024). Although assessments do exist for evaluating the proprioceptive system, especially in the clinical field (e.g. lumbar proprioceptive equipment, spinal motion apparatus, shuttle MiniClinic constant resistance device, active movement extent discrimination apparatus [AMEDA] and Manipulandum), these are not easily accessible or cost-effective for use in the typical South African setting, which is often resource and funding restrained (Blanche et al. 2012; Han et al. 2016; Holst-Wolf et al. 2016; Statistics South Africa 2023; Visser, Hannan & Juan 2019).
South Africa is classified as an upper-middle-income country; however, this masks substantial socio-economic inequality, with a large proportion of the population living in low- and lower-middle-income conditions (Mangaung Metro Statistics 2019; Marais 2021; Statistics South Africa 2023). Within the Mangaung Metropolitan Municipality, average household earnings were reported to be approximately R29 400 per month, while only 39.21% of the population was employed (Mangaung Metro Statistics 2019; Marais 2021; Statistics South Africa 2023). These socio-economic constraints may limit access to specialised proprioceptive assessments, particularly when testing relies on costly equipment available mainly through privately funded healthcare or educational services (Mangaung Metro Statistics 2019; Marais 2021; Statistics South Africa 2023). Furthermore, the South African schooling system remains influenced by socio-economic disparities through the Quintile ranking system, where schools in lower Quintiles often experience limited access to healthcare services, specialised assessments and therapeutic resources (Maistry & Africa 2020; Ogbonnaya & Awuah 2019; White & Van Dyk 2019). Consequently, there is a need for feasible and cost-effective proprioception assessments, supported by standardised and norm-referenced values, to facilitate the evaluation and contextualisation of children’s proprioception in field-based settings (Bonafede & Van der Merwe 2024; Chu 2017; Hillier et al. 2015).
Several field-based proprioceptive tasks have therefore been proposed as practical alternatives for use in paediatric populations (Cheatum & Hammond 2000; Chu 2017; Sciutti et al. 2019). These tasks (angels-in-the-snow, Rhomberg, reciprocal imitations, finger-to-nose, shoulder-level-arm-raise and force perception) evaluate proprioception, balance, coordination, joint position awareness, imitation of movement patterns and force perception. Each task follows specific administration and scoring procedures and contributes information regarding children’s proprioceptive and motor abilities. The mentioned tasks are easily accessible, easy to conduct and require minimal equipment, thereby making them cost-effective. However, most of these tasks have not yet been evaluated in terms of reliability, except for the Rhomberg (intraclass correlation coefficient [ICC] = 0.84 and 0.86) (Murray et al. 2014) and finger-to-nose (ICC = 0.74 – 0.79) (Alouche et al. 2021) tests, which have established reliability for adolescents and adults. Norms have been established for the mentioned proprioceptive tasks, specifically for 6-year-olds in South Africa (Bonafede & Van der Merwe 2024), although reliability has not been determined. These tasks are already established and described in the literature; therefore, the current study does not aim to validate the tasks themselves but rather to determine whether their findings are repeatable when applied in a field-based South African context.
Reliability is particularly important as assessment findings are often used to guide intervention planning and referral decisions (Koo & Li 2016; Mokkink et al. 2016). Test-retest reliability refers to the consistency of performance across repeated testing occasions, while inter-rater reliability describes the extent to which independent raters provide consistent assessments of the same phenomenon beyond what would be expected by chance (Berchtold 2016; Gwet 2014; McDonald, Schoenebeck & Forte 2019). Importantly, several variables may influence the interpretation of test-retest and inter-rater reliability outcomes in children. These variables include floor and ceiling effects, task complexity, developmental variability, boredom and confidence, attention, motivation, environmental distractions and activity type (Danckert et al. 2022; French et al. 2018; Raffaelli, Mills & Christoff 2018; Rossi et al. 2024; Schmidt, Egger & Benzing 2021; Vega-Fernández, Rodríguez & García 2014; Westgate & Wilson 2023). For example, tasks that are too easy may produce ceiling effects, whereas tasks that are too difficult may result in floor effects, both of which can reduce the sensitivity and repeatability of assessments (Rossi et al. 2024; Salman et al. 2020). In paediatric populations specifically, temporary factors such as fatigue, sleep quality, engagement, confidence, emotional state and familiarity with the task may also contribute to inconsistent performance across testing sessions (Hadjisavvas et al. 2025; Sun et al. 2025).
Another important consideration is the evaluator’s experience and training. The repeatability of field-based assessments may depend in part on the reviewer’s clinical experience, interpretation of scoring criteria, familiarity with movement assessment and use of standardised procedures (Eckes 2009; Heidari, Ghanbari & Abbasi 2022; Khabbazbashi & Galaczi 2020; Neittaanmäki & Lamprianou 2024; Weigle 2002). This issue is particularly relevant if these assessments are to be implemented more broadly within under-resourced communities, where highly specialised practitioners may not always be available. Establishing repeatability under controlled conditions with trained evaluators may therefore provide an important first step before investigating the feasibility of implementation by less specialised personnel in under-resourced settings. The use of manuals, standardised scoring criteria and video demonstrations may help improve consistency between reviewers; however, the extent to which these factors influence repeatability in field-based proprioceptive assessments remains unclear (Carballo-Fazanes et al. 2021, 2023; Franki et al. 2015).
The current study forms part of a broader investigation into proprioceptive task performance among South African children and was conducted at a Quintile 3 primary school in the Mangaung district. In South Africa, Quintile 1–3 schools are classified as lower-income schools and do not charge school fees, making them representative of the population most likely to benefit from low-cost field-based screening tools (Maistry & Africa 2020; Ogbonnaya & Awuah 2019; White & van Dyk, 2019). The selected school was chosen because it was representative of the Mangaung Metro population and had adequate space, sufficient learner numbers and availability to support the study (Statistics South Africa 2016; Visser et al. 2019). Therefore, this study aimed to determine the test-retest and inter-rater reliability of selected field-based proprioceptive task items in 6-to-9-year-old children from the Mangaung district of South Africa.
Research methods and design
Study design
This study followed a quantitative cross-sectional descriptive design involving children between the ages of 6 years and 9 years and was conducted in the Mangaung, Motheo district of the Free State province in South Africa during May of 2024. The primary researcher collected the data assisted by a pre-trained interpreter. Collected data were reviewed by three reviewers to determine test-retest and inter-rater reliability.
Study sampling
Test-retest and inter-rater reliability were determined by using 24 participants, of whom 12 were males (50%) and 12 were females (50%), between the ages of six and nine, from one identified Quintile 3 school in Mangaung. The Quintile 3 school was selected based on its location and resources (adequate space, adequate and/or sufficient number of children and availability of the school). The school is representative of the Mangaung Metro population (Statistics South Africa 2016; Visser et al. 2019). For adequate statistical power, a sample size of 24 participants was calculated a priori based on the following input parameters: (1) expected reliability = 0.80; (2) precision = 0.05; (3) confidence level = 0.95; and (4) two repetitions per participant = 2 (Arifin 2018). Participants were included in the study if they were between the ages of 6 years and 9 years old. Additionally, children were included only if their parents provided consent and the children themselves provided assent. Children were excluded from the study if the above-mentioned inclusion criteria were not adhered to or if they had any other additional delays, such as vestibular (hearing) problems, autism and/or Down syndrome.
Measurement instruments
Data were collected to evaluate the proprioceptive abilities of children using six task items, including the angels-in-the-snow, Rhomberg, reciprocal imitations, finger-to-nose and shoulder-level-arm-raise, as well as force perception tasks (Cheatum & Hammond 2000; Chu 2017; Sciutti et al. 2019).
A structured test form developed in previous research was used to record scores for each task item (Bonafede 2021; Cheatum & Hammond 2000; Chu 2017; Sciutti et al. 2016). Administration of the six tasks took approximately 10–15 min per child, and video recordings were obtained (with parental consent and child assent) to support later scoring by reviewers.
The angels-in-the-snow task evaluated proprioception and progression to complex cross-lateral movement skills. The Rhomberg task assessed proprioception, standing balance and vestibular function. Reciprocal imitations evaluated proprioception, laterality and directionality. The finger-to-nose task assessed proprioception and coordination, while the shoulder-level arm raise task evaluated proprioception, vestibular function and body schema. The force perception task assessed proprioception and force discrimination abilities.
Refer to Online Appendix 1 for a detailed explanation of the setup, instructions, equipment used, scoring and observations noted for each of the proprioceptive task items.
Procedure
Following ethical clearance, a pilot study was conducted to refine the testing procedures, instructions, scoring criteria and equipment setup for the proprioceptive task items prior to the main study. Adjustments made after the pilot included the use of a trained interpreter to address the language barrier, the development of a detailed instruction and scoring manual and the use of a larger tripod stand to improve the quality and accuracy of video recordings.
Thereafter, 40 consent forms were distributed at the identified Quintile 3 school, and 24 participants (n = 11 boys and n = 13 girls, aged 6 years to 9 years) after inclusion and exclusion criteria were applied were included in the study. The 24 participants were tested with the six proprioceptive task items and then re-tested 5 days later with the same task items to determine the reliability of these items. Video footage was recorded during data collection for each round, providing all three reviewers with the same opportunity to score the execution of task items for each child. The same reviewer (reviewer one) conducted both rounds of testing, at the same location, with the same 24 participants, while using the same interpreter for consistency. After testing, the first and second reviewers used video footage to score the first round of participants on 1 day and the second round of participants 5 days later. Data analysis was received for both reviewers one and two. Hereafter, the biostatistician advised that a third reviewer should be added for more consistency and to compare reliability values of the task items (Koo & Li 2016). To ensure consistency, the third reviewer followed the same protocol as the first and second reviewers. All reviewers received the manual prior to the data collection, and they were able to go through the manual, which also served as their training.
Data analysis
Descriptive statistics are presented as mean, median, standard deviation and interquartile range. For the primary objective, the reliability of each test item (i.e. intra-rater) was evaluated by calculating the ICC using the two-way mixed effects model for a single rater (ICC3,1) (Koo & Li 2016). Additional measures of reliability included the typical error of measurement (TE) and the minimal detectable change (MDC), which evaluates the smallest detectable difference that would need to be overcome to conclude that a true change has occurred. The inter-rater reliability was evaluated by calculating the ICC using a two-way mixed effects model for absolute agreement across multiple (n = 3) raters (ICC2,k) (Koo & Li 2016). For all ICC calculations, the psych package (version 2.3.9) was used, and the absolute magnitude of the ICC was qualitatively interpreted as follows: poor: < 0.50, moderate: 0.50–0.74, good: 0.75–0.90 and excellent: > 0.90 (Koo & Li 2016). All analyses were conducted in R (RStudio, version 2023.06.01, Build 524, Posit Software, PBC), and statistical significance was accepted when p < α where α = 0.05.
Ethical considerations
Ethical clearance to conduct this study was obtained from the North-West University Health Research Ethics Committee (No. NWU-00208-22-A1). Furthermore, permission was obtained from the Department of Basic Education (DoBE) in the Free State province before the commencement of data collection. The principals of each of the identified schools also granted permission for their school to take part in the study. Informed consent was obtained from the parents or legal guardians of the children involved. The execution of each task item was recorded and explained in the informed consent documentation. The children whose parents provided consent were called to the identified area on the school’s premises on the day of testing, and an information session was provided, explaining the study to the children. The participants were then provided with an assent form to sign (a written name acted as a signature of consent) if they wanted to participate in the study. In order to minimise participant discomfort, the children were offered a rest and water break during the testing. To ensure the confidentiality of all participants, each participant was assigned a unique participant number, which was visible on all consent, assent and test forms. Data were inserted into an Excel password-protected file that also only included participant numbers, and only the main researcher and biostatistician had access to this file. The procedures used in this study adhered to the principles outlined in the Declaration of Helsinki (1964).
Results
The age distributions of all the participants included in this study are presented in Figure 1, which indicates the number of participants (boys and girls), including their age ranges, separately by gender.
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FIGURE 1: Age distributions across gender cohorts: (a) female (F) and (b) male (M). |
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Furthermore, the descriptive statistics of the task items per age are presented in Table 1.
| TABLE 1: Descriptive statistics across year cohort. |
The test-retest (i.e. intra-rater) reliability ICC scores for the different task items are shown in Figure 2a. In contrast, the reliability between the three reviewers (i.e. inter-rater reliability) is shown in Figure 2b. In each figure, task items appear in order of ICC size.
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FIGURE 2: Reliability scores with 95% confidence interval for each task item: (a) test-retest reliability and (b) inter-rater reliability. |
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Three of the tests (i.e. ~27%) exhibited moderate test-retest reliability (shoulder-level-arm-raise both arms, finger-to-nose total and shoulder-level-arm-raise total), while one test (i.e. ~9%) demonstrated good reliability (finger-to-nose eyes closed). From the test-retest reliability scores (Figure 2a), it is clear that the majority of the tests (i.e. ~64%) exhibit poor test-retest reliability in their present form (reciprocal imitations, Rhomberg, shoulder-level-arm-raise non-preferred and preferred arm, force perception, finger-to-nose eyes open and angels-in-the-snow). The inter-rater reliability scores (Figure 2b) showed greater consistency, whereby excellent reliability was evident for ~20% of the tests (Rhomberg and force perception), moderate reliability was demonstrated for ~45% of the tests (shoulder-level-arm-raise both arms and preferred arm, angels-in-the-snow and reciprocal imitations) and ~36% of the tests showed poor inter-rater reliability (finger-to-nose eyes closed and eyes open and shoulder-level-arm-raise non-preferred arm). It is worth noting that shoulder-level-arm-raise (non-preferred arm) is the only task that showed poor test-retest and inter-rater reliability.
Discussion
This study aimed to determine the test-retest and inter-rater reliability of proprioceptive tasks for 6-to-9-year-old children in the Mangaung, Motheo district of South Africa. Test-retest reliability will be discussed first in the discussion, whereafter a discussion on inter-rater reliability will follow.
Test-retest reliability
Test-retest reliability varied across different task items, and while several aspects (floor and ceiling effects, boredom, confidence, developmental components and activity type) may have attributed to the varying results.
Floor and ceiling effect
The poor test-retest reliability observed for angels-in-the-snow may partly be explained by floor and ceiling effects. The task begins with relatively simple unilateral and homolateral movements before progressing to more complex contralateral movements (Cheatum & Hammond 2000). Consequently, some children may have reached maximum scores during the simpler movements (ceiling effect), whereas others may have struggled with the more complex movements (floor effect). Similar concerns may apply to the reciprocal imitations and the Rhomberg task. These tasks might have been too easy to execute for some children and more challenging to execute for other children, potentially contributing to the variability in scores observed across testing sessions. French et al. (2018) have indicated that children who perform better might progress through the tasks faster than children who struggle with them. Completing a task too fast might create a ceiling effect, which aligns with our results and reasoning. French et al. (2018) also stated that the ceiling effect comes into play during motor assessment tasks of children and provides a few reasons for this. Similarly, Smits-Engelsman et al. (2021) reported comparable findings when the test-retest reliability of specific motor tasks was investigated. The reasons put forth by French et al. (2018) included: Firstly, that chance is an inherent factor in human performance. For example, chance may have influenced children’s performance during the first round of testing, leading to better scores, a finding supported by the force perception task in our study. However, during the second round of testing, the task may have been underestimated, resulting in lower scores. Secondly, the ‘stopping rule’ suggests that interrupting data collection and resuming it on a different day may contribute to ceiling effects, which was not applicable in our study, as testing for each round was complete on the same day. To potentially mitigate these floor and/or ceiling effects, it may be necessary to either expand the existing scoring criteria outlined for each test or to incorporate additional elements that enable practitioners to capture more nuanced elements observed during task completion.
Boredom and confidence
Participant engagement may also have influenced the reliability outcomes observed in this study. Children may experience boredom when tasks are repetitive, insufficiently challenging, overly difficult or uninteresting (Min & Kawabata 2022; Raffaelli et al. 2017). Reduced engagement may therefore have contributed to the poor-to-moderate reliability observed for some tasks. For example, the Figer-to-nose tasks required repeated performance using both preferred and non-preferred hands, which may have reduced children’s interest and attentiveness during repeated testing. Raffaelli et al. (2017) corroborate this statement, showing that children score lower in an activity when they are uninterested. Other research confirms the effect of boredom, stating that it can negatively influence motor performance (Danckert et al. 2022; Schmidt & Benzing 2021; Vega-Fernández et al. 2014; Westgate & Wilson 2023). In contrast, overconfidence may have also influenced task performance. Children who perceive tasks as easy or familiar may not attend carefully to instructions, potentially leading to misunderstandings and inconsistent execution (Xia, Poorthuis & Thomaes 2024). Reciprocal imitations may present an example of this, as each movement in this task is repetitively performed and involves both cognitive thinking and motor movements. Xia et al. (2024) reported that children tend to overestimate their abilities when performing certain tasks, especially those tasks involving motor and cognitive functions that the children feel comfortable performing. Subsequently, the results of the present study are meant to provide guidance to practitioners regarding the variability in task performances as well as reasonable MDC values that should be incorporated into the decision-making processes when evaluating children in the 6-to-9-year-old category.
Developmental and performance variables
While this study aimed to evaluate the stability of proprioceptive performances across two testing occasions, separated by 5 days, it is important to consider factors that may have influenced inconsistencies in individual performance. Short-term fluctuations in proprioceptive task performance are more likely to be influenced by temporary and situational factors including the child’s level of alertness or fatigue on the day of testing, the amount and quality of sleep prior to the session, mood and emotional state, the degree of motivation or engagement and even the presence of environmental distractions during testing (Brahms et al. 2022; Hadjisavvas et al. 2025; Sun et al. 2025). Additionally, task familiarity may play a role. In some cases, children may perform better during the second session due to increased understanding of the task, while others may lose interest or become less engaged, especially if they did not find the task stimulating (Min & Kawabata 2022; Raffaelli et al. 2017). Any of these factors could affect the child’s concentration or effort, thereby impacting performance consistency. Nonetheless, broader developmental factors may still play a background role by contributing to a child’s overall susceptibility to variability. For instance, a child with underlying motor coordination difficulties or reduced postural control, possibly linked to early developmental risk factors, may be more prone to inconsistent performance, even within a short timeframe (Houwen et al. 2016; Jeoung 2018; Ku 2020; Park 2015). This could help explain why tasks requiring static balance, such as the Rhomberg test, showed lower reliability in some children.
Inter-rater reliability
The inter-rater reliability scores for each task time, shown in Figure 2b, were derived from different reviewers who measured the same proprioceptive task items on the same participants, following the same procedures using a set manual. The Rhomberg test and the force perception task demonstrated excellent inter-rater reliability, whereas the other task items (finger-to-nose eyes closed, eyes open and total score; shoulder-level-arm-raise preferred, non-preferred arm and both arms; reciprocal imitations and angels-in-the-snow) demonstrated poor-to-good inter-rater reliability. Various factors may influence inter-rater reliability, including reviewer experience, the effect of the manual and video versus live performance. These factors are further elaborated on below.
Reviewer experience
Differences in reviewer experience may have contributed to variability in scoring and interpretation. Reviewer one has 7 years of practical experience in the field of Kinderkinetics, holding a master’s degree; reviewer two has 17 years of academic experience in neuro-developmental paediatric physiotherapy with a PhD degree. In comparison, reviewer three has 2 years of practical and 10 years of academic experience in the field of Kinderkinetics with a PhD degree. Previous studies have shown that reviewers with different professional backgrounds and levels of experience may apply scoring criteria differently (Eckes 2009; Khabbazbashi & Galaczi 2020; Weigle 2002). Neittaanmäki and Lamprianou (2024) further suggested that with greater practical experience may score more leniently than those with primarily academic experience. This trend was observed in the present study, where reviewer one tended to allocate more lenient scores than the other reviewers (Figure 2b).
These findings are particularly relevant given the intended field-based application of these proprioceptive tasks. One of the aims of developing simple proprioceptive screening tasks is to improve access to motor assessments in under-resourced settings where highly specialised clinicians may not be readily available. However, the present findings suggest that evaluator training and experience may substantially influence scoring consistency. This highlights the need for future research to determine whether acceptable reliability can be achieved by less experienced practitioners following structured training procedures.
Effect of the manual
The clarity of the scoring manual may also have influenced the reliability outcomes. Although all reviewers used the same manual during scoring, the criteria may not have been sufficiently explicit, potentially contributing to inconsistencies in interpretation and scoring. Heidari et al. (2022) similarly reported that unclear or ambiguous scoring criteria may reduce scoring consistency, while Khadka et al. (2012) emphasised the importance of clearly defined criteria for accurate and reliable data collection.
These findings suggest that refinement of the manual may improve reliability outcomes. More detailed scoring descriptors, clearer task instructions and additional examples of acceptable and unacceptable performances may reduce subjective interpretation and improve scoring consistency across reviewers. Furthermore, structured reviewer training on both task administration and scoring procedures may enhance standardisation, particularly if these assessments are to be used by practitioners with varying levels of expertise in field-based environments.
Video versus live performance
All reviewers scored performances using video recordings; however, reviewer one was also present during data collection and may therefore have been influenced by memory of the live performances. Previous research has shown that live and video-based assessments can yield different results (Carballo-Fazanes et al. 2021; Franki et al. 2015; McNulty et al. 2011; Nieder, Borges & Pearson 2011). Video recordings allow repeated viewing and playback at different speeds, whereas live assessments rely on a single observation opportunity (McNulty et al. 2011; Nieder et al. 2011).
Despite these differences, studies examining children’s gross motor skills using the Test of Gross Motor Development-Third Edition (TGMD-3) have reported minimal differences between live and video-based assessments (Carballo-Fazanes et al. 2021, 2023). Similar to the present findings, these studies reported higher intra-rater than inter-rater reliability and attributed lower inter-rater reliability to differences in interpretation of movement criteria between reviewers. This explanation may likewise account for the predominantly poor-to-moderate inter-rater reliability observed in the current study.
Collectively, these findings underscore the importance of considering assessor training, scoring clarity and assessment procedures when interpreting the reliability of field-based proprioceptive tasks. Although some of these factors extend beyond the primary aims of the study, they are important to acknowledge because the reliability of these field-based proprioceptive assessments has not previously been established. Understanding the factors that may influence reliability outcomes is therefore essential for informing future refinement and implementation of these assessments in clinical, school and community settings.
Conclusion
This study aimed to determine the reliability of selected field-based proprioceptive task items in 6-to-9-year-old children. Moderate to good test-retest reliability was found for selected finger-to-nose and shoulder-level arm raise scores, while moderate to excellent inter-rater reliability was observed for most tasks, including angels-in-the-snow, reciprocal imitations, Rhomberg, shoulder-level arm raise and force perception. Overall, the shoulder-level arm raise task demonstrated the most consistent reliability across both testing occasions and reviewers.
The practical value of these findings lies in the potential use of low-cost, field-based proprioceptive screening tasks in under-resourced South African settings, where access to specialised equipment and professionals is limited. However, the findings also suggest that reliability is influenced by evaluator experience and interpretation of scoring criteria. These tasks should therefore not yet be recommended for large-scale implementation or national screening policies without further research. Future studies should determine whether acceptable reliability can be achieved when the tasks are administered by less experienced evaluators, such as teachers or community healthcare workers, following appropriate training and the use of clearer scoring manuals. At present, these tasks may be most appropriately used as preliminary screening tools by practitioners with training in child movement and development, with abnormal findings indicating the need for referral for more comprehensive assessment.
Limitations, contributions and recommendations
Several limitations were present in the current study. The instruction manual should provide clearer instructions on the scoring criteria. Reviewers should receive training on the manual and have similar backgrounds. Consistent methods for inter-rater reliability should be followed. Additionally, factors such as gender, weight, height and socio-economic status should be considered as possible influences on the reliability score. A larger sample size should be included to determine reliability, and lastly, although not affecting the study’s aim, the lack of 8-year-old males can also be seen as a limitation.
Despite the limitations, the study contributes to the knowledge of proprioceptive assessments of 6-to-9-year-old children in South Africa, where limited research has been conducted in the evaluation of these cohorts using reliable measures. Our findings have practical importance, which can assist movement specialists, especially those working with Kinderkinetici, in determining the proprioceptive abilities of 6-to-9-year-old children. This study sets the path for further research in developing reliable measures of proprioception.
It is recommended that further research should be conducted on the influencing factors of reliability as determined by the discussion above and to minimise the influence of these factors in future research. Further research should investigate the reliability of individual movements within each proprioceptive task item, particularly for more complex tasks such as angels-in-the-snow, which consists of 11 separate body movements, rather than evaluating each task only as a whole. A further recommendation can be made to evaluate the use of these proprioceptive task items by less experienced professionals like students, teachers, assistants and junior movement specialists.
Acknowledgements
This article is partially based on Carmen Bonafede’s doctoral thesis titled ‘Effect of a field-based proprioceptive intervention on proprioception and the relationship with motor abilities and academic performance of six-to-nine-year-old children’ towards the Doctor of Philosophy degree in Health Sciences with Human Movement Science in the Department of Physical Activity, Sport and Recreation, North-West University, South Africa in 2025. The thesis is currently unpublished and not publicly available. The thesis was supervised by Dr Alretha du Plessis, Dr Elna van der Merwe and Prof. Dane Coetzee. The thesis was reworked, revised, and adapted into a journal article for publication.
Gratitude is expressed to all the schools involved in this study, all the parents or guardians and all children involved. A special thank you is expressed to all three reviewers, especially Dr Robyn Smith and Dr Elna van der Merwe from the University of the Free State, for taking the time to assist and to the North-West University (NWU) for providing funding for the gift packets given to the students after their participation and funding for the printing of all consent, assent and test forms.
Competing interests
The authors reported that they received funding from the North-West University, which may be affected by the research reported in the enclosed publication. The authors have disclosed those interests fully and has implemented an approved plan for managing any potential conflicts arising from their involvement. The terms of these funding arrangements have been reviewed and approved by the affiliated university in accordance with its policy on objectivity in research.
CRediT authorship contribution
Carmen Bonafede: Conceptualisation, Data curation, Investigation, Methodology, Project administration, Visualisation, Writing – original draft, Writing – review & editing. Alretha M. du Plessis: Conceptualisation, Data curation, Investigation, Methodology, Supervision, Writing – review & editing. Elna van der Merwe: Conceptualisation, Data curation, Investigation, Methodology, Supervision, Writing – review & editing. Dané Coetzee: Methodology, Resources, Supervision, Writing – original draft. Mark Kramer: Formal analysis, Visualisation, Writing – review & editing. All authors reviewed the article, contributed to the discussion of results, approved the final version for submission and publication and take responsibility for the integrity of its findings.
Funding information
Funding was received from the North-West University for the gift packets and printing.
Data availability
The data that support the findings of this study are not openly available and are available from the corresponding author, Carmen Bonafede, upon reasonable request.
Disclaimer
The views and opinions expressed in this article are those of the authors and are the product of professional research. They do not necessarily reflect the official policy or position of any affiliated institution, funder, agency, or that of the publisher. The authors are responsible for this article’s results, findings, and content.
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