Background Shoulder range of motion (ROM) and strength measurements are imperative in the clinical assessment of the patient's status and progression over time. The method and type of assessment ...varies among clinicians and institutions. No comprehensive study to date has examined the reliability of a variety of procedures based on different testing equipment and specific patient or shoulder position. The purpose of this study was to establish absolute and relative reliability for several procedures measuring the rotational shoulder ROM and strength into internal (IR) and external (ER) rotation strength. Methods Thirty healthy individuals (15 male, 15 female), with a mean age of 22.1 ± 1.4 years, were examined by 2 examiners who measured ROM with a goniometer and inclinometer and isometric strength with a hand-held dynamometer (HHD) in different patient and shoulder positions. Relative reliability was determined by intraclass correlation coefficients (ICC). Absolute reliability was quantified by standard error of measurement (SEM) and minimal detectable change (MDC). Systematic differences across trials or between testers, as well as differences among similar measurements under different testing circumstances, were analyzed with dependent t tests or repeated-measures analysis of variance in case of 2 or more than 2 conditions, respectively. Results Reliability was good to excellent for IR and ER ROM and isometric strength measurements, regardless of patient or shoulder position or equipment used (ICC, 0.85-0.99). For some of the measurements, systematic differences were found across trials or between testers. The patient's position and the equipment used resulted in different outcome measures. Conclusions All procedures examined showed acceptable reliability for clinical use. However, patient position and equipment might influence the results.
Wstęp Ciężkie zwężenie zastawki aortalnej to istotny problem kliniczny w starzejących się społeczeństwach. Jedną z opcji terapeutycznych dla pacjentów z taką diagnozą jest przezcewnikowe wszczepienie ...zastawki aortalnej (transcatheter aortic valve implantation – TAVI). Materiał i metody W grupie pacjentów (n = 92) leczonych z powodu zwężenia zastawki aortalnej w Górnośląskim Centrum Medycznym im. prof. Leszka Gieca SUM w Katowicach w latach 2018–2020, kwalifikowanych przez heart team do leczenia metodą TAVI, dokonano oceny siły mięśniowej oraz oceny prawdopodobieństwa występowania zespołu kruchości. Dodatkowo grupę badaną podzielono ze względu na płeć, aby porównać częstość występowania zespołu kruchości i rozkład wartości referencyjnych pomiarów siły mięśniowej w zależności od tego czynnika. Wyniki Mediana siły mięśniowej zmierzonej testem Grip wyniosła 26,8 kg. Wartości te, w połączeniu z danymi z Tilburg Frailty Indicator (TFI), wskazywały na istotną kruchość u badanej próby. Mediana wyników testu TFI wynosiła 8 pkt, co wskazywało na wysoki poziom kruchości. Funkcja serca, mierzona za pomocą frakcji wyrzutowej (ejection fraction – EF), wynosiła 55% – wartość ta była w granicach normy, co sugerowało umiarkowane funkcjonowanie serca. Wartość mediany przepływu kłębuszkowego (glomerular filtration rate – GFR) wynosiła 62,5 ml/min/1,73 m2, co również sugerowało umiarkowane funkcjonowanie nerek. Wnioski W odniesieniu do zespołu kruchości, określonego za pomocą testu TFI, prezentowane w pracy wyniki pokazują, że zdecydowana większość badanych (94,6%) ma symptomy zespołu kruchości. Głębsza analiza wyników TFI pokazała, że prawie 60% badanych uzyskało do 5 pkt (łagodny stopień kruchości), podczas gdy 27,5% powyżej 10 pkt (ciężki stopień kruchości).
Introduction Severe aortic stenosis has become one of those diseases that pose a significant clinical problem in aging societies in recent years. One of the therapeutic options for patients with such a diagnosis has become the transcatheter aortic valve implantation (TAVI). Material and methods In the group of patients (n = 92) treated for aortic stenosis in Leszek Giec Upper-Silesian Medical Centre of the Medical University of Silesia in Katowice, qualified by the heart team for TAVI treatment, muscle strength was assessed and the probability of frailty syndrome in the study group was assessed. The study group was further divided by gender to compare the incidence of frailty syndrome and the distribution of reference values of muscle strength measurements depending on this factor. Results The median muscle strength measured by the Grip Test was 26.8 kg. These values, combined with data from the Tilburg Frailty Indicator (TFI) test, indicated significant fragility among the sample. The median TFI score was 8 pts, indicating a high level of fragility. Cardiac function, as measured by ejection fraction (EF), was 55%, which was within normal limits, suggesting moderate heart function among the subjects. The median glomerular filtration rate (GFR) was 62.5 ml/min/1.73 m2, which also suggested moderate renal function among the participants. Conclusions The results presented in the paper in relation to frailty syndrome determined by the TFI test showed that the vast majority of the subjects (94.6%) exhibited frailty syndrome. A deeper analysis of the TFI results showed that almost 60% of the subjects had up to 5 pts (mild degree of fragility), while 27.5% had a score above 10 pts (severe degree of fragility).
The objective of this study was to assess the reliability of a hand-held dynamometer for isometric strength measurements among nursing home residents.
The isometric muscle strength of nursing home ...residents was assessed for eight different muscle groups, using a hand-held dynamometer, the MicroFET2 device. Strength measurements were performed at baseline and after 4 days by the same operator and after 8 days by a second operator. Intraclass coefficients (ICC) were computed to assess the relative reliability, whereas the minimal detectable change (MDC%) was calculated to assess the absolute reliability of the test-retest of the MicroFET2 used by one single operator or by two different ones.
Thirty nursing home residents (75·0 ± 11·2 years, 50% of women) were enrolled in this study. ICC of the test-retest with one single operator ranged from 0·60 (0·37-0·83) for the ankle extensors to 0·85 (0·74-0·95) for the elbow flexors. When considering the test-retest with two different operators, the ICC values ranged from 0·62 (0·41-0·84) for the ankle extensors to 0·87 (0·79-0·96) for the elbow extensors. For the absolute reliability, MDC% varies from 27·64 (elbow flexors) to 81·97 (ankle extensors) when performed in intra-observer. In interobserver condition, MDC%, respectively, varies from 24·38 (elbow extensors) 67·59 (ankle extensors).
Using standardized protocol and standardized instructions to patients, a high relative and moderate absolute reliability was observed for all but ankle muscle groups, making this hand-held dynamometer a potential tool for research in the elderly population.
Introduction and Aim: The objective of the study is to improve upper limb function in patients with acute stroke using graded repetitive arm supplementary program (GRASP) and virtual reality. Stroke ...is described as an sudden neurological outburst brought on by impeded blood flow via the brain’s blood vessels. Stroke has an annual mortality rate of 5.5 million which is the 2nd leading cause of mortality.
Materials and Methods: Fourteen patients were randomly split into two groups, Group A and Group B in A.C.S Medical College and Hospital. Inclusion criteria were persons with first ever acute stroke confirmed by CT or MRI, modified Ashworth scale less than 2, Fugl- Meyer score between 10 to 57, age > 18, both genders, eager participants who are willing volunteers for the study. Exclusion criteria were who were mentally unstable, other neurological conditions, any orthopaedic conditions, modified Ashworth scale more than 2, Fugl Meyer score less than 10 or more than 57, age group < 18, patients with TIA were excluded. Group A trained with GRASP program. Group B trained with virtual reality. Both groups consist of 7 patients and training given for 8 weeks, 60 minutes per day for 6 days a week.
Results: This study demonstrates a statistically significant difference between group A and group B in the hand-held dynamometer, Fugl-Meyer evaluation upper extremity, action research arm test, and EMG with a p value of 0.001. However, when compared to group B, group A exhibits greater relevance across the board.
Conclusion: The study concludes that graded repetitive arm supplementary programme in acute stroke patients demonstrates good recovery in upper limb function.
Muscle strength measurements using hand-held dynamometry (HHD) can be affected by the inadequate strength of the tester and lack of stabilization of the participants and the device. A portable HHD ...anchoring system was designed that enabled the measurement of isometric knee extensor muscle strength in a supine position. This can be used with individuals who are unable to assume the sitting position required for the measurement of knee extensor strength in conventional isokinetic dynamometry (IKD). The aim of this study was to evaluate the reliability and validity of knee extensor strength measurements using this device.
The maximal knee extensor isometric strength of the dominant leg in healthy adults aged 20 to 40 years was tested. Three trials of three contractions were assessed by two raters using the portable dynamometer anchoring system whilst the participant was in the supine position. After the three measurement trials, peak knee extensor torque was evaluated using IKD. The intraclass correlation coefficient (ICC) and 95% limits of agreement (LOA) for intra- and inter-rater reliability were obtained.
Thirty-nine participants (19 male and 20 female, aged 30.08 ± 4.16 y), completed the three measurement trials. The ICC for intra-rater reliability was 0.98 for the maximum measurements of knee extensor strength (95% confidence interval CI: 0.96-0.98) and 0.98 (95% CI: 0.96-0.99) for inter-rater reliability. The mean difference (%) between the maximum knee extensor strength measurements of each trial was 1.02% (LOA range: - 11.13 to 13.16%) for intra-rater and - 1.44% (LOA range: - 13.98 to 11.08%) for inter-rater measurements. The Pearson correlation coefficient of the maximum voluntary peak torque measurements with the portable dynamometer anchoring system and IKD was 0.927.
The portable dynamometer anchoring system is a reliable and valid tool for measuring isometric knee extensor strength in a supine position. Future clinical feasibility studies are needed to determine if this equipment can be applied to people with severe illness or disabilities.
KCT0003041 .
Objective: To develop a feasible protocol for testing maximum shoulder rotation strength in tetraplegic wheelchair athletes, and investigate concurrent validity of maximum isometric handheld ...dynamometer (HHD) towards maximum isokinetic dynamometer (ID) strength measurements; secondly, to study shoulder muscle activation during maximum shoulder rotation measurements, and the association between shoulder strength and shoulder pain.
Design: Descriptive methodological.
Setting: Danish Wheelchair Rugby (WCR) association for WCR tetraplegic athletes from local WCR-clubs.
Participants: Twelve adult tetraplegics.
Interventions: N/A.
Outcome measures: Wheelchair User's Shoulder Pain Index (WUSPI) and Visual Analog Scale (VAS) measured shoulder pain, isometric HHD and ID (60°/s) measured maximum internal (IR) and external (ER) shoulder rotation strength. Surface Electromyography normalized to maximum EMG measured muscle activity (mm Infraspinatus and Latissimus Dorsi) during maximum shoulder rotation strength.
Results: Concurrent validity of isometric HHD towards ID showed Concordance Correlation Coefficients of left and right arms 0.90 and 0.86 (IR), and 0.89 and 0.91 (ER), with no difference in muscle activity between isometric HHD and ID, but larger co-activation during ER. There was no association between shoulder strength and pain, except for significantly weak negative associations between ID and pain during ER for left and right arms (P = 0.03; P = 0.04).
Conclusion: Standardized feasible protocol for tetraplegic wheelchair athletes for measuring maximum shoulder rotation strength was established. Isometric HHD is comparable with ID on normalized peak torques and muscle activity, but with larger co-activation. Strength was not clearly associated with shoulder pain.
During maximal contractions, the sum of forces exerted by homonymous muscles unilaterally is typically higher than the sum of forces exerted by the same muscles bilaterally. However, the underlying ...mechanism(s) of this phenomenon, which is known as the bilateral strength deficit, remain equivocal. One potential factor that has received minimal attention is the contribution of body adjustments to bilateral and unilateral force production. The purpose of this study was to evaluate the plantar-flexors in an innovative dynamometer that permitted the influence of torque from body adjustments to be adapted. Participants were identically positioned between two setup configurations where torques generated from body adjustments were included within the net ankle torque (locked-unit) or independent of the ankle (open-unit). Twenty healthy adult males performed unilateral and bilateral maximal voluntary isometric plantar-flexion contractions using the dynamometer in the open and locked-unit mechanical configurations. While there was a significant bilateral strength deficit in the locked-unit (p = 0.01), it was not evident in the open-unit (p = 0.07). In the locked-unit, unilateral torque was greater than in the open-unit (p<0.001) and this was due to an additional torque from the body since the electromyographic activity of the agonist muscles did not differ between the two setups (p>0.05). This study revealed that the mechanical configuration of the dynamometer and then the body adjustments caused the observation of a bilateral strength deficit.
Purpose
In football, ice-hockey, and track and field, injuries have been predicted, and hip- and knee-strength deficits quantified using hand-held dynamometry (HHD). However, systematic bias exists ...when testers of different sex and strength perform the measurements. Belt-fixation of the dynamometer may resolve this. The aim of the present study was therefore to examine the inter-tester reliability concerning strength assessments of isometric hip abduction, adduction, flexion, extension and knee-flexion strength, using HHD with external belt-fixation.
Methods
Twenty-one healthy athletes (6 women), 30 (8.6) (mean (SD)) years of age, were included. Two physiotherapy students (1 female and 1 male) performed all the measurements after careful instruction and procedure training. Isometric hip abduction, adduction, flexion, extension, and knee-flexion strength were tested. The tester-order and hip-action order were randomised.
Results
No systematic between-tester differences (bias) were observed for any of the hip or knee actions. The intra-class correlation coefficients (ICC 2.1) ranged from 0.76 to 0.95. Furthermore, standard errors of measurement in per cent (SEM %) ranged from 5 to 11 %, and minimal detectable change in per cent (MDC %) from 14 to 29 % for the different hip and knee actions.
Conclusion
The present study shows that isometric hip- and knee-strength measurements have acceptable inter-tester reliability at the group level, when testing strong individuals, using HHD with belt-fixation. This procedure is therefore perfectly suited for the evaluation and monitoring of strong athletes with hip, groin and hamstring injuries, some of the most common and troublesome injuries in sports.
Levels of evidence
Diagnostic, Level III.
Reduced calf muscle pump function (CPF) is an independent risk factor for venous thromboembolism and mortality. We aimed to evaluate the relationship between handgrip strength (HGS) and CPF.
Patients ...referred to the Gonda Vascular Laboratory for noninvasive venous studies were identified and consented. Patients underwent standard venous air plethysmography protocol. CPF (ejection fraction) was measured in each lower extremity of ambulatory patients by comparing refill volume after ankle flexes and passive refill volumes. The cutoff for reduced CPF (rCPF) was defined as an ejection fraction of <45%. Maximum HGS bilaterally was obtained (three trials per hand) using a dynamometer. HGS and CPF were compared (right hand to calf, left hand to calf) and the correlation between the measures was evaluated.
115 patients (mean age, 59.2 ± 17.4 years; 67 females, mean body mass index, 30.83 ± 6.46) were consented and assessed for HGS and CPF. rCPF was observed in 53 right legs (46%) and 67 left legs (58%). CPF was reduced bilaterally in 45 (39%) and unilaterally in 30 (26%) patients. HGS was reduced bilaterally in 74 (64.3%), unilaterally in 23 (20%), and normal in 18 (15.7%) patients. Comparing each hand/calf pair, no significant correlations were seen between HGS and CPF. The Spearman's rank correlation coefficients test yielded values of 0.16 for the right side and 0.10 for the left side.
There is no significant correlation between HGS and CPF, demonstrating that HGS measurements are not an acceptable surrogate for rCPF, indicating different pathophysiological mechanisms for each process.
This study sought to assess the reliability and comparability of two custom-built isokinetic dynamometers (Model A and Model B) with the gold-standard (Humac Norm). The two custom-built dynamometers ...consisted of commercially available leg extension machines attached to a robotically controlled resistance device (1080 Quantum), able to measure power, force and velocity outputs. Twenty subjects (14m/6f, 26±4.8yr, 176±7cm, 74.4±12.4kg) performed concentric leg extensions on the custom-built dynamometers and the Humac Norm. Fifteen maximal leg extensions were performed with each leg at 180° s-1, or the linear equivalent (~0.5m s-1). Peak power (W), mean power (W), and fatigue indexes (%) achieved on all three devices were compared. Both custom-built dynamometers revealed high reliability for peak and mean power on repeated tests (ICC>0.88). Coefficient of variation (CV) and standard error of measurement (SEM) were small when comparing power outputs obtained using Model A and the Humac Norm (Formula: see text CV = 9.0%, Formula: see text SEM = 49W; peak CV = 8.4%, peak SEM = 49W). Whereas, Model B had greater variance (Formula: see text CV = 13.3% Formula: see text SEM = 120W; peak CV = 14.7%, peak SEM = 146W). The custom-built dynamometers are capable of highly reliable measures, but absolute power outputs varied depending on the leg extension model. Consistent use of a single model offers reliable results for tracking muscular performance over time or testing an intervention.
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