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.

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.

Furthermore, the descriptive statistics of the task items per age are presented in Table 1.

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.

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.

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.

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.