Strength testing using hand-held dynamometry

Abstract

INTRODUCTIONAssessment of muscle strength is an integral component of the patient examination in physical therapy practice: 1-5 physical therapists are routinely faced with the task of identifying the presence and quantity of muscle weakness. 6,7 It is essential to use reliable and valid methods when quantifying strength; 8 such methods allow clinicians to assess the effectiveness of treatment and make necessary adjustments to their treatment plan. 9,10 Reliable data regarding a patient's muscle strength can assist the therapist in making a differential diagnosis, measuring improvement or deterioration, determining functional impairments, and planning therapeutic measures. The evaluation of muscle strength may be accomplished using a number of tests, ranging from manual muscle testing (MMT) to the use of isokinetic and hand-held dynamometry. 11 The method and type of strength assessment will vary among clinicians and institutions based on issues such as portability, time, cost, and space.First used by Lovett and Martin 12 in 1912, MMT has since been the most widely used method of examining strength. 2,13-16 MMT is based on an ordinal system of grading movement against gravity or examiner resistance. 2,17 MMT is based on the clinician's internal determination of normative strength values for gender, age and activity level. 13,17,18 Reports in the literature have found MMT to be an inadequately precise indication of strength. 2,13,17 Beasley 19 demonstrated in the 1950s that children who had received normal strength grades with MMT were actually at about 50% of normal strength when tested with dynamometry, implying a ceiling effect of MMT grading. In addition to this ceiling effect, 17,18 MMT is unable to detect small changes in strength, particularly with patients who are tested over a long course of treatment, or those who exhibit higher levels of strength such as athletes. 2,20 The relatively imprecise ability of MMT to distinguish between strength in the good-to-normal categories has been reported 13,18 In a study by Hayes et al., 13 the internal rotation strength of symptomatic shoulders were ABSTRACT The reliability of strength measurements obtained during clinical examination has been the subject of many investigations. The need for an accurate, quantitative method to determine strength in multiple settings and environments is important for both examination and treatment. The purpose of this paper is to provide a review of the existing literature investigating the reliability and concurrent validity of hand-held dynamometry. A thorough review of the literature revealed that held dynamometry is a suitable alternative to traditional manual muscle testing as it exhibits goodto-excellent reliability, provides objective ratio data, and has the portability to be used in multiple environments. Hand-held dynamometry is a reliable method to determine the strength status and change status provided testing protocols are consistent.

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“…8 ROM was measured using a double-armed, clear plastic goniometer (Stryker Physiotherapy Associates) and strength using a HHD (JTECH Medical), a portable 9 non-invasive, light-weight and efficient device that is capable of detecting minor increases or decreases in muscle strength. 10 Compared to Manual Muscle Testing (MMT) the HHD is better because it provides a more objective evaluation in determining muscle strength. 8 …”