Clinical evaluator reliability for quantitative and manual muscle testing measures of strength in children

Abstract

Measurements of muscle strength in clinical trials of Duchenne muscular dystrophy have relied heavily on manual muscle testing (MMT). The high level of intra- and interrater variability of MMT compromises clinical study results. We compared the reliability of 12 clinical evaluators in performing MMT and quantitative muscle testing (QMT) on 12 children with muscular dystrophy. QMT was reliable, with an interclass correlation coefficient (ICC) of >0.9 for biceps and grip strength, and >0.8 for quadriceps strength. Training of both subjects and evaluators was easily accomplished. MMT was not as reliable, and required repeated training of evaluators to bring all groups to an ICC >0.75 for shoulder abduction, elbow and hip flexion, knee extension, and ankle dorsiflexion. We conclude that QMT shows greater reliability and is easier to implement than MMT. Consequently, QMT will be a superior measure of strength for use in pediatric, neuromuscular, multicenter clinical trials.

Is Tibialis Anterior Tendon Transfer Effective for Recurrent Clubfoot?

“…To our knowledge, our study is the first to quantify muscle strength balance using a hand-held dynamometer in patients with congenital talipes equinovarus. Hand-held dynamometry has superior reliability and accuracy compared with manual muscle testing [5], has proven validity in other pediatric populations [2], and can be used in children as young as 2 years [21]. We found that the significant imbalance of eversion-to-inversion strength at baseline in the tibialis anterior tendon transfer group was no longer present at 3 months after surgery.…”

Reliability of the Grading System for Fatty Degeneration of Rotator Cuff Muscles

“…The acceptable threshold of ICC values varies study by study or system by system. In the studies of Escolar et al [4] and Fleiss [5], 0.75 was established as a threshold value for reliability. The criteria of Cicchetti and Sparrow [1] were 0.00 to 0.39 as poor; 0.40 to 0.59 as fair; 0.60 to 0.74 as good; and 0.75 to 1.00 as excellent.…”

Age-related changes in physical functioning: correlates between objective and self-reported outcomes

“…A viable compromise may include quantifying muscle strength 338 manually given its widespread use within a clinical setting (49,50). Reliable, valid data may be 339 obtained from such measures (51,52) providing that recommendations such as those proposed by 340 the International College of Applied Kinesiology are adhered to(53). However, extra care must be 341 taken when constructing controlled testing conditions for use with large age ranges given that 342 some of the oldest individuals appear unable to perform at higher joint angular velocities.…”