Hand-held Dynamometry Research Articles

Gait Velocity and Joint Power Generation After Stroke: Contribution of Strength and Balance.

The aim of the study was to assess the degree to which isometric strength of multiple lower limb muscle groups and balance is associated with gait velocity and joint power generation during gait after stroke. Sixty-three participants in a multisite, multinational, cross-sectional, observational study underwent assessment of gait velocity (10-m walk test), standing balance (computerized posturography), and isometric strength (hand-held dynamometry). Twenty-seven participants had joint power generation assessed (three-dimensional gait analysis). Bivariate associations were examined using Spearman's correlations. Regression models with partial F tests were used to compare the contribution to gait between measures. Although all muscle groups demonstrated significant associations with gait velocity (ρ = 0.40-0.72), partial F tests identified that ankle plantar flexor and hip flexor strength made the largest contribution to gait velocity. Ankle plantar flexor strength also had strong associations with habitual and fast-paced ankle power generation (ρ = 0.65 and 0.75). Balance had significant associations with habitual and fast gait velocity (ρ = -0.57 and -0.53), with partial F tests showing that the contribution was independent of strength. Ankle plantar flexor and hip flexor strength had the largest contribution to gait velocity. Future research may wish to refocus strength assessment and treatment to target the ankle plantar flexors and hip flexors. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Differentiate the contribution that lower limb strength of each muscle group has on gait velocity after stroke; (2) Appraise the relationship between isometric strength and joint power generation during gait; and (3) Interpret the contribution of both strength and balance to gait after stroke. Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s). Physicians should only claim credit commensurate with the extent of their participation in the activity.

Magnetic resonance imaging of the anterior compartment of the lower leg is a biomarker for weakness, disability, and impaired gait in childhood Charcot-Marie-Tooth disease.

Biomarkers of disease severity in Charcot-Marie-Tooth disease (CMT) are required to evaluate early responses to treatment. In this study we used magnetic resonance imaging (MRI) to evaluate the relationship between muscle volume and intramuscular fat accumulation with weakness, disability, and impaired gait in affected children and adolescents. Fifty-five participants underwent MRI of the anterior compartment of the lower leg. Muscle and fat volumes were calculated. Strength was measured using hand-held dynamometry, disability using the CMT Pediatric Scale, and 3-dimensional gait analysis using an 8-camera Vicon Nexus motion capture system. Lower muscle volume was significantly associated with reduced dorsiflexion strength, increased disability, impaired gait profile score, and foot drop. Intramuscular fat accumulation was associated with reduced dorsiflexion strength and impaired gait profile score. The MRI protocol described was feasible, reliable, and sensitive to the magnitude of weakness, disability, and walking difficulties in children with CMT. Muscle Nerve 59:213-217, 2019.

Quantitative assessment of elbow flexion by handheld dynamometry in brachial plexus palsy.

The purpose of this study was to assess the relative and absolute reliability of a handheld dynamometer when used for examining elbow flexion power in patients with brachial plexus palsy. The assessment of the intra-rater and inter-rater reliability coefficients for the handheld dynamometer was done using the stationary Kin-Com® dynamometer as the reference standard. We determined the measurement errors and checked the systematic biases of the handheld dynamometer. The inter-rater and intra-rater reliabilities of the handheld dynamometer had a very high intraclass correlation coefficient. The values of handheld dynamometer readings had a high correlation to Kin-Com® readings. The Medical Research Council grading was a comparatively inaccurate method for quantitative assessment of motor power. We conclude that a handheld dynamometer measurement is more precise and reliable than the Medical Research Council grading for measuring recovery of elbow flexion in patients with brachial plexus palsy. Level of evidence: III.

Evaluation of a method to scale muscle strength for gait simulations of children with cerebral palsy

Cerebral palsy (CP) is a neurological disorder that results in life-long mobility impairments. Musculoskeletal models used to investigate mobility deficits for children with CP often lack subject-specific characteristics such as altered muscle strength, despite a high prevalence of muscle weakness in this population. We hypothesized that incorporating subject-specific strength scaling within musculoskeletal models of children with CP would improve accuracy of muscle excitation predictions in walking simulations. Ten children (13.5 ± 3.3 years; GMFCS level II) with spastic CP participated in a gait analysis session where lower-limb kinematics, ground reaction forces, and bilateral electromyography (EMG) of five lower-limb muscles were collected. Isometric strength was measured for each child using handheld dynamometry. Three musculoskeletal models were generated for each child including a ‘Default’ model with the generic musculoskeletal model’s muscle strength, a ‘Uniform’ model with muscle strength scaled allometrically, and a ‘Custom’ model with muscle strength scaled based on handheld dynamometry strength measures. Muscle-driven gait simulations were generated using each model for each child. Simulation accuracy was evaluated by comparing predicted muscle excitations and measured EMG signals, both in the duration of muscle activity and the root-mean-square difference (RMSD) between signals. Improved agreement with EMG were found in both the ‘Custom’ and ‘Uniform’ models compared to the ‘Default’ model indicated by improvement in RMSD summed across all muscles, as well as RMSD and duration of activity for individual muscles. Incorporating strength scaling into musculoskeletal models can improve the accuracy of walking simulations for children with CP.

Hip muscle weakness and reduced joint range of motion in patients with femoroacetabular impingement syndrome: a case-control study

BackgroundFemoroacetabular impingement (FAI) syndrome is a hip joint motion-related clinical disorder characterized by abnormal contact between the hip joint structures. Abnormal hip morphology and joint pain may impair the hip joint range of motion (ROM) and muscle function. However, FAI effects on hip joint ROM and muscle strength remain controversial. ObjectivesThe purpose of this study was to compare hip joint ROM and muscle strength between FAI syndrome patients and healthy controls. MethodsTwenty FAI syndrome male patients and 20 healthy male controls (CG) matched for age (FAI=28±6 years; CG=27±5 years), body mass (FAI=81±12kg; CG=80±13kg) and height (FAI=177±6cm; CG=178±6cm), participated in the study. Hip joint ROM for flexion, internal rotation and external rotation were assessed through goniometry. Maximal isometric strength for hip flexion, extension, abduction and adduction were evaluated through hand-held dynamometry. ResultsHip joint ROM was significantly lower in FAI syndrome patients compared with CG for passive flexion (−4%; effect size – ES=0.65), active internal rotation (−42%; ES=1.60), active external rotation (−28%; ES=1.46) and passive external rotation (−23%; ES=1.63). FAI patients’ hip extensors (−34%; ES=1.46), hip adductors (−33%; ES=1.32), and hip flexors (−25%; ES=1.17) were weaker compared to the CG subjects. ConclusionsFAI syndrome patients presented both hip muscle weakness and reduced joint ROM compared to match CG.

A novel device to assess hip strength: Concurrent validity and normative values in male athletes

Objectives To assess concurrent validity of the new, novel externally-fixed dynamometer (GroinBar) with hand-held dynamometry (HHD); to provide normative GroinBar scores for elite Australian rules football (AFL) and football (Soccer) players; and to evaluate preliminary predictive validity of the GroinBar and HHD in this population by comparing strength results with patient-reported outcome scores. Design Cross-sectional and reliability study Participants Total of 67 athletes, 36 AFL players and 31 football (Soccer) players Setting Elite AFL and football (Soccer) teams Main Outcome Measures The GroinBar system, HHD, The Copenhagen Hip and Groin Outcome Score (HAGOS) Questionnaire. Results Moderate to good correlations were identified between the GroinBar and HHD strength tests for hip adduction and abduction in the long lever position (rs 0.53 – 0.71). Normative values of the GroinBar and HHD for both AFL and football (Soccer) players were obtained. Neither the GroinBar or HHD strength measures differed between players with groin problems and those without. Conclusion This externally fixed strength testing device, the GroinBar, may provide a robust method of athlete monitoring and screening that does not rely on tester experience and strength. Normative values are documented for hip adduction and abduction strength in elite male athletes.

Progressive resistance training in cachectic head and neck cancer patients undergoing radiotherapy: a randomized controlled pilot feasibility trial

BackgroundCancer cachexia is a prevalent symptom of head and neck neoplasms. The reduction in skeletal muscle mass is one of the main characteristics which can lead to poor physical functioning. The purposes of this pilot randomized controlled trial were to determine the feasibility of progressive resistance training in cachectic head and neck cancer patients during radiotherapy and to explore possible risks and benefits.MethodsTwenty cachectic participants with head and neck cancer receiving radiation were randomized to obtain either a machine supported progressive resistance training (n = 10) or usual care (n = 10). The training took place 3 times weekly for 30 min. Intervention included 3 exercises for major muscle groups with 8–12 repetition maximum for 3 sets each. Bioelectrical impedance analysis, hand-held dynamometry, Six-Minute Walk Test and standardized questionnaires for fatigue and quality of life were used for evaluating outcomes at baseline before radiotherapy (t1), after 7 weeks of radiotherapy (t2) and 8 weeks after the end of radiotherapy (t3).ResultsAll participants (n = 20) completed the trial. No serious adverse events occurred. At the initial assessment the cachectic patients had already lost 7.1 ± 5.2% of their body weight. General fatigue (score 10.7 ± 3.3) and reduced quality of life (score 71.3 ± 20.6) were prevalent in cachectic head and neck cancer patients even before radiotherapy. An average improvement of weight loading for leg press (+ 19.0%), chest press (+ 29.8%) and latissimus pull-down (+ 22.8%) was possible in the intervention group. Participants had at least 13 training sessions. The outcome measures showed nonsignificant changes at t2 and t3, but a trend for a better course of general fatigue and quality of life at t2 in the intervention group.ConclusionsDespite advanced tumor stage and burdensome treatment the intervention adherence is excellent. Progressive resistance training in cachectic head and neck cancer patients during radiotherapy seems to be safe and feasible and may have beneficial effects of general fatigue and quality of life.Trial registrationClinicalTrials.gov, NCT03524755. Registered 15 May 2018 - Retrospectively registered.

Reliability and validity of trunk flexor and trunk extensor strength measurements using handheld dynamometry in a healthy athletic population

ObjectivesTo investigate reliability and validity of handheld dynamometry (HHD) strength tests to accurately measure isometric trunk flexion and extension strength. DesignTest-retest design and comparative analysis to investigate reliability and validity respectively. SettingIsometric trunk flexion and extension strength, measured with a handheld dynamometer, was compared to isometric strength testing on a stationary isokinetic dynamometer. Different test positions were examined for the HHD measurements for trunk flexion and extension strength. Main outcome measuresTrunk muscle strength was calculated in newton metres (Nm) for both devices. Results of both devices were compared with Pearson correlations and agreement between both methods was explored with Bland-Altman plots. ICC values were calculated to assess HHD intra- and inter-tester reliability. ResultsReliability was good to excellent for all HHD tests (ICC = 0.67–0.93). High correlations were found between the HHD tests and stationary dynamometer tests (r = 0.65–0.86). Bland-Altman plots showed agreement between both methods for the trunk flexion test, supported in 30° trunk flexion and for the trunk extension test in a prone position in 0° trunk flexion. ConclusionHandheld dynamometry is reliable and a clinically applicable valid method to evaluate isometric trunk flexion and extension strength.

Association of Muscle Strength and Walking Performance in Adult Patients With Pompe Disease.

BackgroundThe loss of the ability to walk is among the most prominent signs of Pompe disease. The associations with muscle strength have not been described.ObjectiveThe objective of this study was to estimate the associations of walking performance with muscle strength in 4 specific lower extremity muscle groups along with other factors in adult patients with Pompe disease.DesignThis was a single-center, cross-sectional study.MethodsMuscle strength (hand-held dynamometry of hip flexion and abduction and knee extension and flexion) and walking performance (unable to walk, able with aids, walking without aids but with a waddling gait, or walking without aids and with a normal gait) were assessed in 107 patients at their first visit. Relationships between walking performance and muscle strength were studied through multivariate analyses and regression modeling. Age, sex, body mass index (BMI), disease duration, and use of ventilator support were taken into account as potential confounders. The results were transformed into a nomogram to allow the probability of a patient having a certain level of walking performance to be calculated based on the values of the independent variables.ResultsWalking performance declined significantly with decreasing muscle strength of hip flexion and abduction and knee extension and flexion. The final selected model, including strength of the hip abductor and knee extensor, BMI, age, sex, and use of ventilation, predicted 66% of the cases accurately.LimitationsThese results are based on cross-sectional data and do not predict future changes.ConclusionsIn adult people with Pompe disease, walking performance can be explained by muscle strength, BMI, age, sex, and ventilation use. The proposed model gives insight into how an individual is expected to walk based on his or her risk factors and serves as a starting point to unraveling factors associated with walking performance and ultimately to developing a prognostic model.

LIMB-GIRDLE MUSCULAR DYSTROPHY I: P.9A comparison of the utility between three muscle strength assessment methods in dysferlinopathy

This study compared results between 3 methods of muscle strength testing used in the jain clinical outcome study (COS) for dysferlinopathy performed at baseline and year 1 visits. The COS is an international natural history study of patients with dysferlinopathy with the intent of improving trial readiness. Dysferlinopathy presents with heterogeneity in muscle weakness, including both distal and proximal phenotypes which poses significant challenges for developing appropriate clinical trial outcome measures. Two hundred and three patients, at 15 sites in 8 countries were evaluated using three methods to measure strength on a variety of upper and lower limb muscle groups. Manual muscle testing (MMT) uses the medical research council scoring system to subjectively grade the amount of resistance the subject can withstand as the evaluator pushes against the extremity. Hand held dynamometry (HHD) uses a force transducer in a small device held against the extremity by the clinical evaluator. Quantitative muscle testing (QMT) uses a force transducer secured to a wall mounted fixed frame. Although MMT is quick, simple and does not require specific equipment, it produces ordinal level data, which can be difficult for statistical analysis. Both HHD and QMT provide objective and quantitative measures of muscle strength but require specific equipment to perform. Cost and the size are significant limitations of QMT. All sites completed MMT and HHD, while only 7 of the 15 sites had the QMT equipment available. Muscle strength changes over 1 year will be presented for each of the three assessment methods. Although HHD, QMT and MMT detected change in many of the same muscles, differences in the responsiveness will be highlighted. Both HHD and QMT options offer linear, objective and quantitative data. HHD is an inexpensive, more accessible and simple option compared to QMT muscle testing. All three methods were able to detect change in this heterogeneous cohort over one year.

LIMB-GIRDLE MUSCULAR DYSTROPHY I: P.11Clinical outcome study in dysferlinopathy: random forest approach to assess the relationship between baseline muscle MRI and longitudinal functional outcome measures

The Jain clinical outcome study (COS) is an international study of 203 adults with dysferlinopathy in 8 countries. Patients undergo six visits over three years, during which physiotherapy and medical assessments as well as muscle MRI were performed. Our aim is to analyse baseline muscle pathology by MRI in a large cohort of dysferlinopathy patients and to examine the relationship between baseline muscle MRI findings and the results of longitudinal functional outcome measures over one year. We aim to identify which muscles may predict a rapid decline over one year. Lower limb muscle MRI has been performed in 182 patients with a confirmed diagnosis of dysferlinopathy in 14 different centres, using 1.5T or 3T scanners from different manufacturers (Philips, General Electrics, Siemens). 74 patients also underwent upper limb muscle MRI at baseline. Muscles were scored on axial T1-weighted sequences with the semi quantitative Mercuri visual scale modified by fisher. Physiotherapy assessments included muscle strength (manual muscle testing; hand held dynamometry) and functional ability evaluations (adapted north star, brooke test, timed tests) and patient reported outcome measure (ACTIVLIM). We will present the outcome of the analysis between semi-quantitative MRI at baseline and disease progression over one year as measured by the north star assessment for dysferlinopathy, the 10 metre walk and the ACTIVLIM using the Random Forest approach (package ``random forest SRC'' in R). Random-forest studies will be used to identify whether combinations of muscle involvement at baseline can predict a change of more than 10% in muscle function tests at a one year visit. Muscle MRI is useful for the diagnosis of patients with muscle disorders, but also to identify patients at risk of having a quick progression of their symptoms.

Hallux plantar flexor strength in people with diabetic neuropathy: Validation of a simple clinical test

AimTo validate the paper grip test for assessing plantar flexion strength of the hallux. MethodsPlantar flexor strength for 69 people with diabetic neuropathy was assessed: (a) using the paper grip test while simultaneously a plantar pressure platform quantified the force under the hallux, and (b) using a hand-held dynamometer. Following testing, participants were divided into groups: (1) passed vs. failed paper grip test (2) males vs. females. Statistical analyses determined if differences were evident between the groups and assessed the relationship between the paper grip test and the hand-held dynamometer. The discrimination ability, sensitivity, specificity, and reproducibility of the paper grip test was established. ResultsParticipants who passed the paper grip test demonstrated greater grip force at the hallux than those who failed, and they also exhibited greater isometric maximum force during the hand-held dynamometry test (p ≤ 0.05). Grip force for males was significantly higher than for females. A moderate positive correlation between the paper grip test and the hand-held dynamometer was evident. ConclusionsIn the population examined the paper grip test was found to be a valid clinical tool; it offers a non-invasive, inexpensive, and quick method to assess plantar flexion strength of the hallux.

Acute skeletal muscle wasting and relation to physical function in patients requiring extracorporeal membrane oxygenation (ECMO)

PurposeMuscle weakness is common in patients requiring extracorporeal membrane oxygenation (ECMO), but early identification is challenging. This study aimed to 1) quantify the change in quadriceps size and quality (echogenicity) from baseline to day 10 using ultrasound in patients requiring ECMO, 2) determine the relationship between ultrasound measures, muscle strength and highest mobility level. Materials and methodsProspective cohort study involving ultrasound measurement of quadriceps at baseline, days 10 and 20. Muscle strength and highest mobility level were assessed at days 10 and 20 using the Medical Research Council sum-score (MRC), hand-held dynamometry (HHD) and the ICU mobility scale (IMS). Results25 patients (age 49 ± 14 years, 44% male) received ECMO. There was a significant reduction (−19%, p < .001) in rectus femoris cross-sectional area by day 10. Echogenicity did not change over time. There was a negative correlation between echogenicity and MRC at day 10 (r = −0.66) and HHD at day 20 (r = −0.81). At day 20, there was a moderate correlation between total muscle thickness and IMS (rho = 0.59) and MRC (rho = 0.56). ConclusionsIn patients requiring ECMO there was marked wasting of the quadriceps over the first 10 days. Ultrasound measures were related to muscle strength and highest mobility level.

A cross-sectional analysis of clinical evaluation in 35 individuals with mutations of the valosin-containing protein gene

Inclusion body myopathy (IBM) associated with Paget disease of the bone and frontotemporal dementia or IBMPFD is an autosomal dominant degenerative disorder caused by mutations in the valosin-containing protein (VCP) gene. We aim to establish a detailed clinical phenotype of VCP disease amongst 35 (28 affected individuals, 7 presymptomatic gene carriers) individuals versus 14 unaffected first-degree relatives in 14 families to establish useful biomarkers for IBMPFD and identify the most meaningful tests for monitoring disease progression in future clinical trials. Comprehensive studies included the Inclusion Body Myositis Functional Rating Scale (IBMFRS) and fatigue severity scale questionairres, strength measurements using the Manual Muscle Test with Medical Research Council (MRC) scales, hand-held dynamometry using the microFET and Biodex dynamometers, 6 minute walk test (6MWT), and pulmonary function studies. Strong correlation was observed between the IBMFRS and measurements of muscle strength with dynamometry and the other functional tests, indicating that it may be utilized in long-term follow-up assessments due to its relative simplicity. This cross-section study represents the most comprehensive evaluation of individuals with VCP disease to date and provides a useful guide for evaluating and possible monitoring of muscle weakness and pulmonary function progression in this unique cohort of individuals.

Lower Cognitive Function in Older Patients with Lower Muscle Strength and Muscle Mass

Background: Low muscle strength and muscle mass are associated with adverse outcomes in older hospitalized patients. The aim of this study was to assess the association between cognitive functioning and muscle strength and muscle mass in hospitalized older patients. Methods: This prospective inception cohort included 378 patients aged 70 years or older. At admission patients were assessed for cognitive functioning by use of the Six-Item Cognitive Impairment Test (6-CIT). Muscle strength and muscle mass were assessed using handheld dynamometry and segmental multifrequency bioelectrical impedance analysis, within 48 h after admission and on day 7, or earlier on the day of discharge. Results: The data of 371 patients (mean age ± standard deviation 80.1 ± 6.4 years, 49.3% female) were available for analyses. The median (interquartile range) 6-CIT score was 4 (0–8) points. At admission, lower cognitive functioning was associated with lower muscle strength, lower skeletal muscle mass (SMM), lower appendicular lean mass, and lower SMM index. Cognitive functioning was not associated with change in muscle strength and muscle mass during hospitalization. Conclusion: This study further strengthens evidence for an association between lower cognitive functioning and lower muscle strength and muscle mass, but without a further decline during hospitalization.

The validity and reliability of the Functional Strength Measurement (FSM) in children with intellectual disabilities.

There is lack of valid and reliable field-based tests for assessing functional strength in young children with mild intellectual disabilities (IDs). The aim of this study was to investigate the test-retest reliability and construct validity of the Functional Strength Measurement in children with ID (FSM-ID). Fifty-two children with mild ID (40 boys and 12 girls, mean age 8.48years, SD=1.48) were tested with the FSM. Test-retest reliability (n=32) was examined by a two-way interclass correlation coefficient for agreement (ICC 2.1A). Standard error of measurement and smallest detectable change were calculated. Construct validity was determined by calculating correlations between the FSM-ID and handheld dynamometry (HHD) (convergent validity), FSM-ID, FSM-ID and subtest strength of the Bruininks-Oseretsky test of motor proficiency - second edition (BOT-2) (convergent validity) and the FSM-ID and balance subtest of the BOT-2 (discriminant validity). Test-retest reliability ICC ranged 0.89-0.98. Correlation between the items of the FSM-ID and HHD ranged 0.39-0.79 and between FSM-ID and BOT-2 (strength items) 0.41-0.80. Correlation between items of the FSM-ID and BOT-2 (balance items) ranged 0.41-0.70. The FSM-ID showed good test-retest reliability and good convergent validity with the HHD and BOT-2 subtest strength. The correlations assessing discriminant validity were higher than expected. Poor levels of postural control and core stability in children with mild IDs may be the underlying factor of those higher correlations.

Subtyping children with developmental coordination disorder based on physical fitness outcomes

PurposeChildren with Developmental Coordination Disorder (DCD) are known to have poor physical fitness. However, differentiating homogenous subgroups of DCD using fitness performance has not yet been established. Therefore the purpose of this study was to identify subtypes in children with and without DCD using measures of physical fitness. MethodChildren (aged 6–10 years, n = 217) constituted the sample for this study. They were assessed on 1) aerobic fitness (20m Shuttle Run test), 2) anaerobic fitness (Muscle Power Sprint Test), 3) isometric muscle strength (handheld dynamometry) 4) functional upper and lower body strength (Functional Strength Measurement) and 5) motor coordination [Movement Assessment Battery for Children-2nd edition (MABC-2) test]. The Ward method was used to identify the various clusters. ResultsFive subtypes emerged in the entire sample. In the typically developing (TD) children mainly 2 subtypes (number 5 and 2) were found containing 89% of the TD children (n = 55), with the largest group demonstrating above average performance on all measures (cluster 5). Children in subtype 2 had just above average motor coordination and good aerobic fitness but lower muscle strength. Subtypes 1, 3 and 4 were clearly “DCD” clusters, however they showed difference in fitness performance. Subtype 1 contained children with DCD who showed poor performance on all fitness outcomes (n = 45). Children with DCD in subtype 3 had poor aerobic but average strength and anaerobic fitness (n = 48). Subtype 4 contained children with DCD (n = 45) who had good muscle strength and anaerobic fitness. Of these, 36% were at risk of DCD while 24% had definite motor coordination problems. ConclusionOur findings indicate that children with and without DCD demonstrate heterogeneous physical fitness profiles. The majority of the children (66%) with DCD belonged to subtypes with lower fitness performance. Further studies are needed to confirm these findings in other samples of DCD children.

Muscle mass and muscle strength are associated with pre- and post-hospitalization falls in older male inpatients: a longitudinal cohort study

BackgroundLow muscle mass and strength are highly prevalent in inpatients. It is acknowledged that low muscle mass and strength are associated with falls in community-dwelling older adults, but it is unknown if these muscle measures are also associated with falls in a population of older inpatients. This study aimed to investigate the association between muscle measures and pre- and post-hospitalization falls in older inpatients.MethodsAn inception cohort of patients aged 70 years and older, admitted to an academic teaching hospital, was included in this study. Muscle mass and hand grip strength were measured at admission using bioelectrical impedance analysis and handheld dynamometry. Pre-hospitalization falls were dichotomized as having had at least one fall in the six months prior to admission. Post-hospitalization falls were dichotomized as having had at least one fall during the three months after discharge. Associations were analysed with logistic regression analysis.ResultsThe study cohort comprised 378 inpatients (mean age, SD: 79.7, 6.4 years). Fifty per cent of female and 41% of male patients reported at least one fall prior to hospitalization. Post-hospitalization, 18% of female and 23% of male patients reported at least one fall. Lower muscle mass was associated with post-hospitalization falls, and lower hand grip strength was associated with both pre- and post-hospitalization falls in male, but not in female, patients.ConclusionsThese findings confirm the likely involvement of muscle mass and strength in the occurrence of pre- and post-hospitalization falls in a population of older inpatients, but only in males.

Isometric muscle strength in children and adolescents using Handheld dynamometry: reliability and normative data for the Brazilian population

ObjectiveIsometric muscle strength measured by Handheld dynamometer indicates physical ability. There is no normative data for the Brazilian population. This study aims (a) to describe the development of isometric muscle strength in healthy children and adolescents 5–15 years of age; (b) to evaluate Handheld dynamometer inter and intra-rater reliability. MethodsIsometric muscle strength was obtained for shoulder abduction, elbow and knee flexion and extension, dorsiflexion and plantar flexion in 55 boys and 55 girls, aged between 5 and 15 years. Inter-rater reliability was determined based on the evaluation of 2 raters, with a 20-min interval between them. Intra-rater reliability was based on 2 evaluations from the same rater, one week apart. Interclass correlation coefficient (ICC2,1; 3,1), Bland Altman plots and linear regression models with mixed effects were used to quantify inter and intra-rater reliability, agreement and associations with physical activity level and maturational factors. ResultsA linear development of isometric muscular strength was observed for ages between 5 and 10. After age 10, boys showed a larger isometric muscular strength, when compared to girls. Both inter and intra-rater measurements of the Handheld dynamometer are reliable (ICC>0.63). ConclusionsThis study shows increase in isometric muscle strength starting at 10 years of age for boys, when compared to girls and inter and intra-rater reliability for the assessment of isometric strength, using the Handheld dynamometer for the muscle groups tested on the dominant and non-dominant side, for children between 5 and 15 years of age.

Comparison of Handheld and Human Norm Dynamometry for Lower Extremity Muscle Strength Measurements

Comparison of Handheld and Human Norm Dynamometry for Lower Extremity Muscle Strength Measurements