Intra- and inter-rater reliability of the ActivForce digital dynamometer for the isometric strength of the neck muscles in patients with chronic neck pain

Interrater and Intrarater Reliability and Minimum Detectable Change of Ultrasound for Active Myofascial Trigger Points in Upper Trapezius Muscle in Individuals With Shoulder Pain

Intrarater and Inter-rater Reliability of Maximal Voluntary Neck Muscle Strength Assessment Using a Handheld Dynamometer in Women With Headache and Healthy Women

Methodology: We enrolled 30 patients (14 males and 16 females) with chronic neck pain and respiratory dysfunction fulfilling inclusion criteria. Two trials of CAROM measurement for flexion, extension, left and right lateral flexion and left and right rotation were performed, with a gap of one week to measure test retest reliability of CROM device. Intraclass correlation coefficient (ICC), standard errors of measurement (SEM) and minimal detectable change (MDC) were calculated to test the intrarater reliability.
 Results: Intrarater reliability of repeated measurements of CAROM using the CROM device was found to be good. The ICC values ranged between 0.88-0.97 for flexion, 0.93-0.98 for extension, 0.92-0.98 for right lateral flexion,0.93-0.98 for left lateral flexion. For right rotation it was 0.88-0.97, for left lateral rotation it was 0.95-0.99. The standard error of measurement for these movements ranged from 1.5° to 2.9°. Minimal detectable change ranged from 3.5°for extension to 6.8°for left lateral flexion.
 Conclusion: Cervical range of motion device is a reliable tool for measuring cervical active range of motion in patients simultaneously suffering from chronic neck pain and respiratory dysfunction.
 Abbreviations: CAROM - cervical active range of motion; CROM - cervical range of motion; ICC - Intraclass correlation coefficient; SEM - standard errors of measurement; MDC - minimal detectable change
 Key words: Adult; Exercise Therapy / methods; Female; Humans; Male; Neck Pain / physiopathology; Neck Pain / therapy; Pain Measurement; Pulmonary function; Range of Motion, Articular; Reliability
 Citation: Anwar S, Arsalan SA, Zafar H, Ahmad A, Gillani SA, Hanif A. Intrarater reliability of cervical range of motion device in measuring cervical active range of motion in patients with chronic neck pain and respiratory dysfunction. Anaesth. pain intensive care 2022;26(4):503-509; DOI: 10.35975/apic.v26i4.1957
 Received: September 29, 2021; Reviewed: April 21, 2022; Accepted: May 10, 2022

VP.28 Psychometric properties of muscle strength assessment by hand-held dynamometry in healthy adults: A reliability study

Association of neck pain, disability and neck pain during maximal effort with neck muscle strength and range of movement in women with chronic non-specific neck pain

The objectives of this study were to estimate the intra-rater and inter-rater reliability of the Pressure Pain Threshold (PPT) and Conditioned Pain Modulation (CPM) in healthy participants and patients with chronic shoulder pain. Additionally, the Standard Error of Measurement (SEM) and Smallest Detectable Change (SDC) were calculated. Thirty-one healthy volunteers and twenty patients with chronic shoulder pain were assessed using the PPT and CPM by two raters, with a 24 h interval between sessions. Excellent intra-rater reliability was demonstrated for PPT, with similar SEM and SDC when assessed by the same rater. The inter-rater reliability for PPTs in patients was moderate to good (ICC = 0.59-0.89) with higher SEM (73.83-121.98 kPa) and SDC (61.58-97.59) values than the asymptomatic group (ICC = 0.92-0.96, SEM = 49.61-103.12 kPa, SDC = 42.01-56.30) respectively. CPM's intra-rater reliability was good (ICC = 0.82) in the patients and moderate (ICC = 0.67) in the asymptomatic group, while inter-rater reliability was low for the asymptomatic group (ICC = 0.37) and extremely low (ICC = 0.074) for the patients, with comparable SEM and SDC outcomes in both groups. PPT and CPM measurements are highly reliable when conducted by the same rater on the same day. Patients had lower inter-rater PPT reliability but better intra-rater CPM reliability. Clinicians need to be mindful of potential variability when interpreting these test results.

Intra- and inter-rater reliability, standard error of measurement, and minimal detectable change of the cranio-cervical flexion test in individuals with non-specific chronic neck pain.

“Agent of Empire: Gaming with Imperialism in No Man’s Sky” (Hello Games, 2016): Review of No Man’s Sky. By Sean Murray, Grant Duncan, Ryan Doyle, and David Ream. Video Game. Guildford, UK: Hello Games, 2016.

Skin impedance is a biological signal that has been employed in the measurement of pain. However, there are few scientific data on skin impedance, with a great variety of assessment methods and controversial results. To examine the intra- and inter-rater reliability of skin impedance measurement in individuals with chronic neck pain. This is a blind cross-sectional study. Thirty individuals of both genders, aged between 18 and 45 years and with chronic neck pain were included in the study. Two examiners assessed skin impedance of the upper and lower limbs and torso at two intervals separated by one week. For statistical analysis, we used the intraclass correlation coefficient (ICC2,3) to determine the intra- and inter-rater reliability of skin impedance, with its respective confidence interval of 95%, standard error of measurement (SEM) and minimum detectable change (MDC). The intra-rater reliability was considered substantial to excellent, with ICC values ranging between 0.843 and 0.978, SEM between 0.58 and 15.26 Ω, and MDC between 1.61 and 42.31 Ω. The inter-rater reliability was moderate to excellent, with ICC values ranging between 0.761 and 0.997, SEM ranging between 0.22 and 16.72 Ω, and MDC ranging between 0.63 and 46.35 Ω. The measurement of skin impedance of the upper and lower limbs and torso in individuals with chronic neck pain has acceptable reliability values when considered at different times and by different examiners.

Background Chronic neck pain associated with reduced cervical range of motion, necessitating accurate and reliable assessment for effective rehabilitation. The ActivForce 2 electronic goniometer is a user-friendly tool with potential applicability in both clinical and research settings. Objective This study evaluated the intra- and inter-rater reliability of the ActivForce 2 electronic goniometer in measuring cervical range of motion in patients with chronic neck pain. Methods Thirty-one patients (21 women, 10 men; mean age ± standard deviation: 38.74 ± 11.08 years) were assessed over two sessions, one week apart. Two data collectors measured cervical movements, with three repetitions per movement. Intra-rater reliability was evaluated by having each collector assess participants in both sessions, while inter-rater reliability was tested by comparing measurements between collectors. Reliability was evaluated using the Intraclass Correlation Coefficient, Standard Error of Measurement, Minimum Detectable Change, Bland-Altman plots and linear regression. Results The electronic goniometer demonstrated excellent reliability, with ICC values ranging from 0.980-0.999 (intra-rater) and 0.954-1.00 (inter-rater). Low SEM and narrow Bland-Altman limits supported the precision of measurements. Conclusion The ActivForce 2 electronic goniometer is a reliable tool for assessing cervical spine movements in chronic neck pain patients.

PurposeTo assess the test–retest and inter-rater reliability of goniometry and fleximetry in measuring cervical range of motion in individuals with chronic neck pain.MethodsA reliability study. Thirty individuals with chronic neck pain were selected. Cervical range of motion was measured by goniometry and fleximetry at two time points 7 days apart. To characterize the sample, we used the numerical pain rating scale, Pain-Related Catastrophizing Thoughts Scale, and Neck Disability Index. Intraclass correlation coefficient (ICC), standard error of measurement (SEM) and minimum detectable change (MDC) were calculated. Correlations between goniometry and fleximetry measurements were performed using Spearman’s correlation coefficient (rho).ResultsFor goniometry, we found excellent test–retest reliability (ICC ≥ 0.986, SEM ≤ 1.89%, MDC ≤ 5.23%) and inter-rater reliability (ICC ≥ 0.947, SEM ≤ 3.91%, MDC ≤ 10.84%). Similarly, we found excellent test–retest reliability (ICC ≥ 0.969, SEM ≤ 2.71%, MDC ≤ 7.52%) and inter-rater reliability (ICC ≥ 0.981, SEM ≤ 1.88%, MDC ≤ 5.20%) for fleximetry. Finally, we observed a strong correlation between the goniometry and the fleximetry for all cervical movements (rho ≥ 0.993).ConclusionGoniometry and fleximetry measurements are reliable for assessing cervical range of motion in individuals with chronic neck pain.

Differences in Isometric Neck Muscle Strength Between Healthy Controls and Women With Chronic Neck Pain: The Use of a Reliable Measurement

Objective: The purpose of this study is to investigate the intrarater and interrater reliability of handheld dynamometer (HHD) measurements in assessing isometric muscle strength of the shoulder abductors and to compare these results with those obtained using a fixed dynamometer (FD).Methods: The study involved 25 voluntary participants, all over the age of 18, asymptomatic (with no injuries in the upper extremity), and not engaged in overhead sports. The participants were evaluated twice by 2 different testers who were experienced in orthopedic rehabilitation, at 90 degrees of shoulder abduction in the scapular plane. On the first measurement day, Tester 1 performed measurements using both HHD and FD, while on the second measurement day, both testers used only the HHD. A 3- to 7-day interval separated the 2 measurement sessions. Paired-samples t-tests were used to evaluate the systematic bias between the testers. Spearman’s rank correlation coefficient, intraclass correlation coefficient, standard error of measurement, and minimal detectable change were calculated. The statistical significance level was accepted as P < .05.Results: Data from 22 participants (15 women, 7 men; mean age: 23.00 ± 3.19 years) were analyzed, as 3 individuals did not attend the final assessment. A strong correlation (r = 0.772) was found between Tester 1’s HHD measurements and FD, while a similarly strong correlation (r = 0.748) was observed for Tester 2’s HHD measurements. Excellent intrarater reliability (intraclass correlation coefficient [ICC] = 0.941) was found between Tester 1’s measurements, and excellent interrater reliability (ICC = 0.889) was found between testers.Conclusion: Handheld dynamometer has demonstrated excellent interrater and intrarater reliability and high validity for assessing shoulder abductor muscle strength in research and clinical use. Since the muscle strength of testers using the HHD may influence the results, the FD may be a more appropriate option when the study population is stronger than the testers. Studies involving different clinical populations and testers with varying experience levels are needed to improve the relevance of the results.Level of Evidence:Level III, Diagnostic Study.

This study determined the intra- and inter-rater reliability of various shoulder testing methods to measure flexion range of motion (ROM), hand-behind-back (HBB), and external rotation (ER) strength. Twenty-four healthy adults (mean age of 31.2 and standard deviation (SD) of 10.9 years) without shoulder or neck pathology were assessed by two examiners using standardised testing protocols to measure shoulder flexion with still photography, HBB with tape measure, and isometric ER strength in two abduction positions with a hand-held dynamometer (HHD) and novel stabilisation device. Intraclass correlation coefficient (ICC) established relative reliability. Standard error of measurement (SEM) and minimum detectable change (MDC) established absolute reliability. Differences between raters were visualised with Bland–Altman plots. A paired t-test assessed for differences between dominant and non-dominant sides. Still photography demonstrated good intra- and inter-rater reliability (ICCs 0.75–0.86). HBB with tape measure demonstrated excellent inter- and intra-rater reliability (ICCs 0.94–0.98). Isometric ER strength with HHD and a stabilisation device demonstrated excellent intra-rater and inter-rater reliability in 30° and 45° abduction (ICCs 0.96–0.98). HBB and isometric ER at 45° abduction differed significantly between dominant and non-dominant sides. Standardised shoulder ROM and strength tests provide good to excellent reliability. HBB with tape measure and isometric strength testing with HHD stabilisation are clinically acceptable.

Objective There are limited reports about the reliability of measuring neck extensor muscle strength using a portable dynamometer in neck pain patients. The aims of the current study were 1) to investigate intra- and inter-rater reliability of neck extensor isometric strength measurement using a portable dynamometer in patients with chronic nonspecific neck pain (CNSNP) and 2) to compare neck extensor isometric strength in participants with and without CNSNP. Methods Guidelines for Reporting Reliability and Agreement Studies (GRRAS) were followed. Two examiners received a 15-minute training before enrollment. Inter-rater reliability was assessed with a 10-minute interval between measurements, and intra-rater reliability was assessed with a 10-day interval. Three trials were assessed and examiners were blind to the strength values (in Newtons) from other sessions of 20 individuals with CNSNP (mean±SD= 37.9 ± 9.8y; Neck Disability Index 29.2 ± 7.4%) and 20 individuals with other musculoskeletal disorders (mean ± SD = 32.8 ± 46.2y). Results Intra-rater reliability was excellent with intraclass correlation coefficient (ICC)(3,1) of 0.95 (CI:0.90–0.97) and inter-rater reliability was good to excellent with ICC(2,1) of 0.88 (CI:0.77–0.94) in CNSNP. No significant difference of neck extensor strength was found between CNSNP (93.27N±31.94) and Individuals without CNSNP (111.43N±40.11) (p > 0.05). Conclusion A portable dynamometer is a reliable tool for measuring maximal isometric neck extension strength in individuals with CNSNP. Slightly but no significant differences of neck extensor strength values between individuals with and without CNSNP. Future studies are needed to assess the generalizability of the findings in patients with other muscle deconditioning.