Development and Content Validity of the Movement Compensatory Screening (MoCS): A Structured Framework for Identifying Compensatory Strategies After Stroke

BACKGROUND: Compensatory movement strategies are common after stroke and vary across individuals and tasks. However, the lack of a structured framework to guide movement analysis during mobility and postural control tasks may limit consistent identification of these strategies across clinicians in clinical practice. OBJECTIVE: To develop and examine the content validity of the Movement Compensatory Screening (MoCS) to identify compensatory movement strategies during mobility and postural control tasks after stroke. METHODS: Following the Delphi method and COSMIN guidelines, the MoCS was developed through a multi-phase process. Item generation was based on a literature review, exploratory video analysis of individuals after stroke, and expert input. Item-level content validity was evaluated in 2 Delphi rounds using relevance and clarity ratings (Content Validity Coefficient ≥ 0.80). Instrument-level content comprehensiveness was subsequently assessed through a Delphi-based global evaluation by physiotherapists. RESULTS: The final MoCS comprised 65 items across 7 domains: sit-to-stand and stand-to-sit transfer, gait, turn, climb up/down stairs, and dynamic standing balance. Initial mean CVC values were 0.89 for relevance and 0.86 for clarity, leading to item exclusion or refinement. Revised items achieved mean CVC values of 0.93 and 0.88 and were retained. An instrument-level evaluation indicated adequate content comprehensiveness, with expert agreement that the final item set sufficiently covered compensatory movement domains. A compensatory index (CI) was used to describe compensatory strategies by domain and anatomical plane. CONCLUSION: The MoCS demonstrated content validity as an observational framework for identifying compensatory movement strategies during mobility and postural control tasks after stroke.