Assessment of the strength of the lower limb muscles in subjects with stroke with portable dynamometry: a literature review

Abstract

Introduction: Weakness of the lower limb muscles, which are the main impairments after stroke, is associated with reduced mobility and decreased performance in functional tasks. Therefore, the assessment of strength of these muscles is necessary, which is commonly assessed with portable dynamometry. Aims: To perform a literature review regarding the methods used to assess lower limb strength with portable dynamometry in subjects with stroke and to describe its investigated measurement properties with this population. Materials and Methods: An extensive search was performed on the MEDLINE, SCIELO, LILACS, and PEDro databases, by combining specific key words, followed by active manual search by two independent researchers. Results and Discussion: Thirty studies were included, and the muscular groups of the knee (90%) were the most assessed, followed by the ankle (66.7%) and hip (63.3%) joints. In 5% of the studies, there were not reported any descriptions related to the positioning of the subjects and the equipment, neither regarding the stabilization procedures. Only 50% provided information regarding the number of trials and only 46.7% regarding the contraction times, being three trials and 5s the most commonly applied. Only 10% provided feedback and 23.3% demonstrations, prior to data collection. Only seven studies (23.3%) investigated the measurement properties of portable dynamometry and reported moderate to high reliability levels. Final Considerations: The protocols used for the assessment of the strength of the lower limb muscles with portable dynamometry in subjects with stroke were not standardized. Moreover, only one measurement property was investigated: the reliability, which was considered adequate.

A Single Trial May Be Used for Measuring Muscle Strength With Dynamometers in Individuals With Stroke: A Cross‐Sectional Study

“…Consequently, there is less chance for the regression toward the mean phenomenon to occur . Because hand‐held dynamometers have shown to provide reliable measures of strength of the upper and lower limb muscles of individuals with stroke (0.58 ≤ correlation coefficient ≤ 0.99) , this may justify the findings; that is, similar values were provided by different scoring methods.…”

“…Consequently, there is less chance for the regression toward the mean phenomenon to occur [7]. Because hand-held dynamometers have shown to provide reliable measures of strength of the upper and lower limb muscles of individuals with stroke (0.58 ≤ correlation coefficient ≤ 0.99) [3][4][5][6], this may justify the findings; that is, similar values were provided by different scoring methods. Previous studies that investigated whether dynamometry strength measures based upon various numbers of trials were statistically different, found similar results for the following muscle groups: grip; pulp-to-pulp, palmar, and lateral pinch; and trunk flexors/extensors, lateral flexors, and rotators of individuals with sub-acute (.92 ≤ P ≤ .99) [5] and chronic (.85 ≤ P ≤ .99) [6] stroke.…”

“…For example, for the assessment of shoulder flexors, the examiner performed passive shoulder flexion. 3 One submaximal isometric contraction was performed, to ensure that the participants understood the correct muscle group to activate. not activate some muscle groups and, thus, could not perform all the strength assessments.…”

Does grip strength predict lower limb global strength in subjects with stroke?

“…All muscle groups were assessed alternately, with each muscle group of the non-paretic side evaluated first, followed by that of the paretic side. The participants and their body segments were standardized positioned, according to previous protocols [15,19,[29][30][31], as shown in Table 1. Immediately before the measurement of muscle strength, the procedures were performed for demonstration and familiarization [8].…”

“…During the tests, the individuals were instructed to perform a maximum isometric contraction for 5 seconds, and the peak value was recorded. A 20-second rest interval was allowed between the trials [19,29,31]. Participants received the following verbal encouragement: "Go, go, go, go…" [19,29].…”