Grip and Muscle Strength Dynamometry in Acute Burn Injury: Evaluation of an Updated Assessment Protocol

Abstract

External stabilization is reported to improve reliability of hand-held dynamometry, yet this has not been tested in burns. We aimed to assess the reliability of dynamometry using an external system of stabilization in people with moderate burn injury and explore construct validity of strength assessment using dynamometry. Participants were assessed on muscle and grip strength three times on each side. Assessment occurred three times per week for up to 4 weeks. Within-session reliability was assessed using intraclass correlations calculated for within-session data grouped before surgery, immediately after surgery and in the subacute phase of injury. Minimum detectable differences were also calculated. In the same timeframe categories, construct validity was explored using regression analysis incorporating burn severity and demographic characteristics. Thirty-eight participants with total burn surface area 5% to 40% were recruited. Reliability was determined to be clinically applicable for the assessment method (intraclass correlation coefficient >0.75) at all phases after injury. Muscle strength was associated with sex and burn location during injury and wound healing. Burn size in the immediate period after surgery and age in the subacute phase of injury were also associated with muscle strength assessment results. Hand-held dynamometry is a reliable assessment tool for evaluating within-session muscle strength in the acute and subacute phase of injury in burns up to 40% total burn surface area. External stabilization may assist to eliminate reliability issues related to patient and assessor strength.

Acometimento do sistema musculoesquelético por queimaduras de terceiro grau em pacientes ambulatoriais: Série de casos

“…No teste de Thomas a média foi de 32,64° Todos os participantes demonstraram média de redução da força de preensão palmar segundo os dados da literatura 10,11 (Tabela 3). Apenas o paciente dois (28kgf) demonstrou força de preensão preservada.…”

“…A força de preensão manual apresentou média inferior à de uma população jovem saudável e próxima aos valores esperados para idosos 11 . Os dados do estudo também foram inferiores a um estudo realizado na Austrália Ocidental com 38 pacientes queimados, cuja SCQ era de no máximo 40%, porém os participantes não tinham lesões nas mãos 10 .…”

“…A força muscular dos MMII apresentou valores inferiores à normalidade em todos os movimentos testados 12,13 . A média de força para a extensão de joelho foi um pouco maior em comparação a um estudo longitudinal prospectivo com 38 pacientes com SCQ entre 6 e 40%, porém com queimaduras recentes ainda não cicatrizadas 10 .…”

“…A força de preensão manual adotou o protocolo utilizado por Gittins et al 10 e o dinamômetro Jamar ® , realizando a preensão por três vezes e considerando para análise a medida de maior valor 10,11 .…”

Effects of early exercise training following severe burn injury: a randomized controlled trial

“…This muscle force measure is not a direct measure of quadriceps muscle force alone, but a compound measure of hip flexor and knee extensor muscles. A fixation band, fixed around the bed frame, provided the necessary counter-resistance to ensure isometric contraction during the test [ 63 ]. This test position was chosen to make muscle force assessment possible for bed-bound participants whose joint range of motion is too limited to reach traditional positions of muscle force assessment (e.g.…”