Absolute Reliability and Concurrent Validity of Hand Held Dynamometry and Isokinetic Dynamometry in the Hip, Knee and Ankle Joint: Systematic Review and Meta-analysis.

Claudio Chamorro,Luis Javier Chirosa,Carlos De La Fuente,Susan Armijo-Olivo,Javiera Fuentes

doi:10.1515/med-2017-0052

Abstract

The purpose of the study is to establish absolute reliability and concurrent validity between hand-held dynamometers (HHDs) and isokinetic dynamometers (IDs) in lower extremity peak torque assessment. Medline, Embase, CINAHL databases were searched for studies related to psychometric properties in muscle dynamometry. Studies considering standard error of measurement SEM (%) or limit of agreement LOA (%) expressed as percentage of the mean, were considered to establish absolute reliability while studies using intra-class correlation coefficient (ICC) were considered to establish concurrent validity between dynamometers. In total, 17 studies were included in the meta-analysis. The COSMIN checklist classified them between fair and poor. Using HHDs, knee extension LOA (%) was 33.59%, 95% confidence interval (CI) 23.91 to 43.26 and ankle plantar flexion LOA (%) was 48.87%, CI 35.19 to 62.56. Using IDs, hip adduction and extension; knee flexion and extension; and ankle dorsiflexion showed LOA (%) under 15%. Lower hip, knee, and ankle LOA (%) were obtained using an ID compared to HHD. ICC between devices ranged between 0.62, CI (0.37 to 0.87) for ankle dorsiflexion to 0.94, IC (0.91to 0.98) for hip adduction. Very high correlation were found for hip adductors and hip flexors and moderate correlations for knee flexors/extensors and ankle plantar/dorsiflexors.

Highlights

Assessing muscle strength is an important clinical consideration for patients who may have a neurological, muscular, and/or skeletal illness [1,2]
Isokinetic dynamometry is the current gold standard for strength assessments [15], it was expected that the upper LOA limit of the assessed studies would fall much closer to 15%
Considering all hand-held dynamometry (HHD) assessments, the highest LOAs and, lower reliability scores were found for knee extension and ankle plantar flexion

Summary

Introduction

Assessing muscle strength is an important clinical consideration for patients who may have a neurological, muscular, and/or skeletal illness [1,2]. Muscle force assessments are commonly performed before and after interventions to quantify treatment effectiveness [3]. The psychometric properties of strength devices are important for research and for clinical practice. The ability to determine if a device is valid, reliable, and/or responsive in a determined context can help clinicians decide when and how to use it. While the psychometric properties of these devices have been investigated in different contexts using different models, joints and conditions, the resulting information is fragmented and difficult to comprehensively understand [4,5,6,7,8]

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