BACKGROUND: 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. OBJECTIVE: This cross-sectional observational study aimed to determine the reliability and validity of the EPGT in individuals post-stroke. METHODS: 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. RESULTS: 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). CONCLUSION: 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. TRIAL REGISTRATION: ClinicalTrials.gov (NCT07181005). The Enhanced Paper Grip Test (EPGT) is a reliable and valid tool for assessing side-specific ankle muscle strength in patients post-stroke, enabling clinicians to quickly quantify hemiparetic lower limb weakness in routine practice.EPGT scores show significant correlations with balance performance (modified mini-BESTest) and ankle muscle strength, particularly on the affected side, providing clinicians with a practical, objective measure to guide individualized rehabilitation and fall-risk management.The test is simple, low-cost, and requires minimal training, allowing for safe, rapid assessments in clinical settings, supporting both initial evaluation and ongoing monitoring of recovery in post-stroke rehabilitation.
Polat et al. (Sat,) studied this question.