Manual muscle testing (MMT) and hand-held dynamometry (HHD) are commonly used in people with inflammatory myopathy (IM), but their clinimetric properties have not yet been sufficiently studied. To evaluate the reliability and validity of MMT and HHD, maximum isometric strength was measured in eight muscle groups across three measurement events. To evaluate reliability of HHD, intra-class correlation coefficients (ICC), the standard error of measurements (SEM) and smallest detectable changes (SDC) were calculated. To measure reliability of MMT linear Cohen`s Kappa was computed for single muscle groups and ICC for total score. Additionally, correlations between MMT8 and HHD were evaluated with Spearman Correlation Coefficients. Fifty people with myositis (56±14 years, 76% female) were included in the study. Intra-and interrater reliability of HHD yielded excellent ICCs (0.75–0.97) for all muscle groups, except for interrater reliability of ankle extension (0.61). The corresponding SEMs% ranged from 8 to 28% and the SDCs% from 23 to 65%. MMT8 total score revealed excellent intra-and interrater reliability (ICC>0.9). Intrarater reliability of single muscle groups was substantial for shoulder and hip abduction, elbow and neck flexion, and hip extension (0.64–0.69); moderate for wrist (0.53) and knee extension (0.49) and fair for ankle extension (0.35). Interrater reliability was moderate for neck flexion (0.54) and hip abduction (0.44); fair for shoulder abduction, elbow flexion, wrist and ankle extension (0.20–0.33); and slight for knee extension (0.08). Correlations between the two tests were low for wrist, knee, ankle, and hip extension; moderate for elbow flexion, neck flexion and hip abduction; and good for shoulder abduction. In conclusion, the MMT8 total score is a reliable assessment to consider general muscle weakness in people with myositis but not for single muscle groups. In contrast, our results confirm that HHD can be recommended to evaluate strength of single muscle groups.
Zusammenfassung Hintergrund Inflammatorische Myopathien (IM) sind eine Gruppe seltener entzündlicher Muskelerkrankungen. Verminderte Kraft und Ausdauerfähigkeit stellen die Hauptsymptome dar. Diverse Studien konnten positive Effekte einer Trainingstherapie nachweisen, es existieren jedoch keine krankheitsspezifischen Trainingsrichtlinien. Ziel Erstellung einer Übersicht der vorhandenen Trainingsstudien mit Fokus auf erwachsene Patienten mit IM, um daraus einen evidenzbasierten, krankheitsspezifischen Trainingsleitfaden abzuleiten. Methode In einem ersten Schritt erfolgte eine systematische Literaturübersicht. Sie diente als Basis, um den Trainingsleitfaden zu entwickeln. Die langjährige klinische Erfahrung spezialisierter Physiotherapeuten sowie die Trainingsrichtlinien des American College of Sports Medicine fanden ebenfalls Berücksichtigung. Ergebnisse In die systematische Übersicht wurden 24 Studien mit insgesamt 151 Patienten mit IM eingeschlossen. Alle Studien zeigten positive Effekte eines Kraft- und/oder Ausdauertrainings auf. Unerwünschte Ereignisse traten nicht ein. Der Trainingsleitfaden besteht aus einem Einführungsteil zu allgemeinen Trainingsprinzipien sowie zwei weiteren Teilen über Kraft- und Ausdauertraining für jede Krankheitsaktivität (früh-aktiv, aktiv, stabil). Schlussfolgerungen Obwohl die Trainingsprotokolle im Bereich der Myositis unterschiedlich sind, weisen alle Studien konsistent darauf hin, dass das Training sicher und effektiv ist. Der Trainingsleitfaden ermöglicht Therapeuten einen raschen Überblick über evidenzbasierte Trainingsrichtlinien. Die Richtlinien sollten in weiteren Studien angewendet, überprüft und anschließend verfeinert werden.
Zusammenfassung Hintergrund Messungen bilden die Grundlage des wissenschaftsbasierten therapeutischen Vorgehens. Messfehler sind jedoch ein verbreitetes Problem. Um Fehlerquellen zu ermitteln, sind erweiterte statistische Modelle notwendig. Im Gegensatz zur klassischen Testtheorie ermöglicht die Generalisierbarkeitstheorie, mehrere Fehlerquellen gleichzeitig zu untersuchen. Ziel Vergleich der klassischen Testtheorie und der Generalisierbarkeitstheorie anhand eines physiotherapeutischen Beispiels zur Reliabilitätsermittlung und deren Ergebnisse. Methode Die Messeigenschaft „Reliabilität“ wurde anhand von Daten einer vorangegangenen Reliabilitätsstudie, in der die klassische Testtheorie zum Einsatz kam, untersucht. Dazu wurde exemplarisch eine Generalisierbarkeitsstudie durchgeführt. Ergebnisse Die Variabilität ging hauptsächlich von den Probanden und der Probanden-Untersucher-Interaktion aus. Unabhängig von fixen oder zufälligen Facetten waren die Generalisierbarkeitskoeffizienten für alle Bedingungen (overall, inter-rater, intra-Messzeitpunkte) exzellent. Schlussfolgerung Die Ergebnisse deuten darauf hin, dass die Generalisierbarkeitstheorie gegenüber der klassischen Testtheorie Vorteile hat. Diese ermöglicht es, einen wirkungsvollen und effizienten Einsatz von Messinstrumenten im klinischen Alltag zu ermitteln.
BackgroundInflammatory myopathies (IMs) are systemic autoimmune diseases, characterized by reduced muscle strength and endurance. Although IMs are relatively rare, patients' disabilities in daily life are substantial. Thus, there is a need for appropriate and reliable assessments to quantify muscle weakness. Although the manual muscle test (MMT) and the quantitative muscle test (QMT), which employs a dynamometer, are commonly used tests to evaluate muscle strength, their psychometric properties (e.g. reliability) have not yet been sufficiently studied1.ObjectivesTo determine the reliability of the MMT8 and the QMT in patients with IM.MethodsTwenty-four adult, German speaking patients with established diagnosis of IM were included. The majority of patients was female (83%), 57±12 years old with a mean disease duration of 28±29 months. The maximum isometric strength of eight muscle groups, which are most often affected, was evaluated with the MMT8 using the 10 point Kendall scale and the QMT indicating strength in Newton (N). For intra-rater reliability, one tester performed the MMT8 and the QMT twice and for inter-rater reliability, they were tested by a second independent tester. The Intraclass Correlation Coefficient (ICC) and the Standard Error of Measurement (SEM) were evaluated.ResultsThe intra-rater reliability of the MMT8 yielded moderate to good ICCs (0.63–0.89) for all muscle groups and an excellent ICC (0.92) for the total score. Inter-rater reliability yielded moderate to good ICCs (0.54–0.84) for shoulder abductors, wrist and hip extensors, hip abductors, neck flexors and the total score, and low ICCs (0.08–0.34) for the remaining muscle groups (elbow flexors, knee and foot extensors). The SEM was smaller for the intra-rater (SEM 0.5/10 point of Kendall scale for muscle groups and 2/10 points for the total score) than for inter-rater reliability (SEM 0.5–1/10 point for muscle groups and 3/10 points for the total score). QMT presented moderate to excellent intra- and inter-rater reliability (ICCs 0.52–0.92) for all muscle groups. The intra-rater comparison for shoulder abductors was 10N, inter-rater comparison 13N and the intra-rater and inter-rater comparisons for the knee extensors were 28N and 35N, respectively. In contrast to the QMT, the MMT8 showed high ceiling effects between 18% and 77% for all but one muscle group (hip extensors).ConclusionsIn this study, the QMT showed a better reliability than the MMT8 because of missing ceiling effects and due to the good to excellent intra- and inter-rater reliability. Notably, the QMT seems to be more accurate to measure single muscle groups especially in patients with mild weakness as for example in early disease. If no hand-held dynamometer is available, the total score of MMT8 represents an appropriate alternative.ReferencesRider LG, Werth VP, Huber AM, Alexanderson H, Rao AP, Ruperto N, Herbelin L, Barohn R, Isenberg D, Miller FW: Measures of adult and juvenile dermatomyositis, polymyositis, and inclusion body myositisArthritis Care Res (Hoboken) 2011Di...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.