Reliability Of Hand-held Dynamometry Research Articles

Assessing the Reliability of Handheld Dynamometry and Ultrasonography to Measure Quadriceps Strength and Muscle Thickness in Children, Adolescents, and Young Adults

Aims: Muscle strength testing is a core aspect in the pediatric physical and occupational therapy clinical examination and evaluation, and quadriceps muscle strength is associated with the ability to perform gross motor skills. The aim of this study was to assess the reliability of handheld dyamometry (HHD) and ultrasonography to measure quadriceps muscle strength and thickness in children, adolescents, and young adults. Methods : In 30 participants (6–26 years), without motor impairment, quadriceps strength was measured with HHD in seated and supine with the knee flexed to 90° and 35°. Rectus femoris (RF) and vastus lateralis (VL) muscle thickness was measured using ultrasonography. Typical error of measurement (TEM), coefficient of variation (CV%), and intra-class correlation coefficient (ICC) were used to assess the error and reliability of measures. Results : The average CV% among three trials of strength testing was 7.07%–9.94% and improved when using the top two trials (4.49%–5.61%). The average TEM was 2.21 Nm for strength and 0.03 cm for muscle thickness. Intra-rater and inter-rater reliability of muscle thickness was good to excellent (0.91–1.00). Conclusions: The results of this study suggest quadriceps muscle strength and thickness measurements using HHD and ultrasonography are reliable in children, adolescents, and young adults.

Measurement properties of handheld dynamometry for assessment of shoulder muscle strength: A systematic review.

Like any assessment tool, handheld dynamometry (HHD) must be valid and reliable in order to be meaningful in clinical practice and research. To summarize the evidence of measurement properties of HHD for the assessment of shoulder muscle strength. Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, and PEDro were searched up to February 2020. Inclusion criteria were studies (a) evaluating HHD used on the glenohumeral joint, (b) evaluating measurement properties, and (c) included individuals≥18years old with or without shoulder symptoms. Exclusion criteria were studies (a) including patients with neurologic, neuromuscular, systemic diseases, or critical illness or bed-side patients and (b) that did not report the results separately for each movement. In total, 28 studies with 963 participants were included. The reliability results showed that 98% of the intraclass correlation coefficient (ICC) values were ≥0.70. The measurement error showed that the minimal detectable change in percent varied from 0% to 51.0%. The quality of evidence was high or moderate for the majority of movements and type of reliability examined. Based on the evidence of low or very low quality of evidence, the convergent validity and discriminative validity of HHD were either sufficient, indeterminate, or insufficient. The reliability of HHD was overall sufficient, and HHD can be used to distinguish between individuals on the group level. The measurement error was not sufficient, and evaluation of treatment effect on the individual level should be interpreted with caution.

Validity and Reliability of Hand-Held Dynamometry for Abdominal Flexion Muscular Assessment.

Abdominal musculature underpins core stability, which can allow for optimal performance in many activities of daily living (eg,walking and rising from a chair). Therefore, assessment of the abdominal muscles poses as an important consideration for clinicians in order to identify people at risk of injury or functional decline. This study aimed to build on the limited amount of knowledge surrounding abdominal muscle strength assessments by investigating the validity and reliability of hand-held dynamometry (HHD) for the assessment of isometric abdominal flexion strength. Comparative analysis for validity and test-retest reliability was employed on a cohort of apparently healthy individuals. HHD was compared with the criterion, isokinetic dynamometry, through an isometric contraction of trunk flexion on both instruments. Hand-held dynamometry assessments only were performed on a subsequent day for reliability analysis. The peak values for all assessments were recorded. A total of 35 participants were recruited from the University of South Australia and the general public. Comparative analysis between the HHD and isokinetic dynamometer showed good agreement (intraclass correlation coefficients = .82), with the Bland-Altman plots confirming no proportional bias. Reliability analysis for the HHD reported good consistency (intraclass correlation coefficients = .87). HHD together with the participant setup (supine, trunk flexed, and supported at 25° with the legs horizontal and remaining unfixed) is a valid and reliable tool to assess isometric abdominal flexion strength.

Shoulder internal and external rotation strength and prediction of subsequent injury in water-polo players.

Water-polo players have greater isokinetic shoulder strength than age-matched controls. Due to the repetitive demands of throwing, however, water-polo players demonstrate an altered strength ratio, with greater internal rotation (IR) strength relative to external rotation (ER). The relationship between shoulder strength and risk of shoulder injury is unknown. In addition, the effect on test position for strength testing on the reliability of handheld dynamometry (HHD) in this population is not known. The aims were to determine the: (a) Inter-rater reliability of HHD testing of IR and ER strength in two positions: neutral and 90°abduction-90°ER (90-90) and (b) relationship between preseason shoulder strength and occurrence of future injury in sub-elite water-polo players. Two assessors measured shoulder IR and ER strength using HHD in 15 water-polo players across two testing days. Athletes were followed over a 6-month period, and injury was assessed and recorded by the team physiotherapist. Measurement of water-polo players' isometric IR and ER strength in the clinical setting had good to excellent inter-rater reliability; however, systematic error was observed in the neutral position but not the 90-90 position. Irrespective of testing position, the neutral and 90-90 test position showed a significant difference (P=0.01) in absolute preseason IR and ER mean strength between prospectively injured and non-injured players. There was no significant difference in strength ratio or strength normalized for body mass index. These results suggest that preseason strength testing may help identify players at risk of in-season shoulder injury.

Intrarater reliability of hand held dynamometry in measuring lower extremity isometric strength using a portable stabilization device

Hand held dynamometry (HHD) is a more objective way to quantify muscle force production (MP) compared to traditional manual muscle testing. HHD reliability can be negatively impacted by both the strength of the tester and the subject particularly in the lower extremities due to larger muscle groups. The primary aim of this investigation was to assess intrarater reliability of HHD with use of a portable stabilization device for lower extremity MP in an athletic population. Isometric lower extremity strength was measured for bilateral lower extremities including hip abductors, external rotators, adductors, knee extensors, and ankle plantar flexors was measured in a sample of healthy recreational runners (8 male, 7 females, = 30 limbs) training for a marathon. These measurements were assessed using an intrasession intrarater reliability design. Intraclass correlation coefficients (ICC) were calculated using 3,1 model based on the single rater design. The standard error of measurement (SEM) for each muscle group was also calculated. ICC were excellent ranging from ICC (3,1) = 0.93–0.98 with standard error of measurements ranging from 0.58 to 17.2 N. This study establishes the use of a HHD with a portable stabilization device as demonstrating good reliability within testers for measuring lower extremity muscle performance in an active healthy population.

Strength Measurements in Acute Hamstring Injuries: Intertester Reliability and Prognostic Value of Handheld Dynamometry.

Study Design Cohort study, repeated measures. Background Although hamstring strength measurements are used for assessing prognosis and monitoring recovery after hamstring injury, their actual clinical relevance has not been established. Handheld dynamometry (HHD) is a commonly used method of measuring muscle strength. The reliability of HHD has not been determined in athletes with acute hamstring injuries. Objectives To determine the intertester reliability and the prognostic value of hamstring HHD strength measurement in acute hamstring injuries. Methods We measured knee flexion strength with HHD in 75 athletes at 2 visits, at baseline (within 5 days of hamstring injury) and follow-up (5 to 7 days after the baseline measurement). We assessed isometric hamstring strength in 15° and 90° of knee flexion. Reliability analysis testing was performed by 2 testers independently at the follow-up visit. We recorded the time needed to return to play (RTP) up to 6 months following baseline. Results The intraclass correlation coefficients of the strength measurements in injured hamstrings were between 0.75 and 0.83. There was a statistically significant but weak correlation between the time to RTP and the strength deficit at 15° of knee flexion measured at baseline (Spearman r = 0.25, P = .045) and at the follow-up visit (Spearman r = 0.26, P = .034). Up to 7% of the variance in time to RTP is explained by this strength deficit. None of the other strength variables were significantly correlated with time to RTP. Conclusion Hamstring strength can be reliably measured with HHD in athletes with acute hamstring injuries. The prognostic value of strength measurements is limited, as there is only a weak association between the time to RTP and hamstring strength deficit after acute injury. Level of Evidence Prognosis, level 4. J Orthop Sports Phys Ther 2016;46(8):689-696. Epub 12 May 2016. doi:10.2519/jospt.2016.6363.

Reliability of hand held dynamometry compared to externally fixed dynamometry for shoulder internal and external rotation strength ratios

Reliability of hand held dynamometry compared to externally fixed dynamometry for shoulder internal and external rotation strength ratios

Intra-Tester Reliability of Hand-Held Dynamometry and Strap-Mounted Dynamometry for Assessment of Ankle Strength

Context:Measurement of ankle evertor and invertor strength is important for assessment of ankle sprain risk and assessment of restoration of normal function after an ankle sprain.Objective:To compare the intra-tester reliability of ankle evertor and invertor strength measurements derived from hand-held dynamometry (HHD) and strap-mounted dynamometry (SMD) for both make-test and break-test techniques.Participants:25 healthy individuals.Main Outcome Measure:Repeated measurements of isometric evertor and invertor strength derived from both HHD and SMD devices using both make-test and break-test techniques.Results:High make-test reliability values were found for both inversion and eversion force measured by both the HHD and SMD devices (ICC = 0.80 to ICC = 0.88). The correlation coeffcients between HHD and SMD measurements for the inversion make-test, the inversion break-test, and the eversion make-test ranged from r = 0.74 to r = 0.87, but the correlation between HHD and SMD measurements for the eversion break-test was poor.Conclusion:The fndings suggest that testers with limited experience can obtain reliable measurements of ankle evertor and invertor strength using either HHD or SMD.

Between-Rater Reliability of the 6-Minute Walk Test, Berg Balance Scale, and Handheld Dynamometry in People with Multiple Sclerosis

This study investigated the between-rater reliability of the Berg Balance Scale (BBS), 6-Minute Walk test (6MW), and handheld dynamometry (HHD) in people with multiple sclerosis (MS). Previous studies that examined BBS and 6MW reliability in people with MS have not used more than two raters, or analyzed different mobility levels separately. The reliability of HHD has not been previously reported for people with MS. In this study, five physical therapists assessed eight people with MS using the BBS, 6MW, and HHD, resulting in 12 pairs of data. Data were analyzed using intraclass correlation coefficients (ICCs), Spearman correlation coefficients (SCCs), and Bland and Altman methods. The results suggest excellent agreement for the BBS (SCC = 0.95, mean difference between raters [d̄] = 2.08, standard error of measurement [SEM] = 1.77) and 6MW (ICC = 0.98, d̄ = 5.22 m, SEM = 24.76 m) when all mobility levels are analyzed together. Reliability is lower in less mobile people with MS (BBS SCC = 0.6, d̄ = -1.83; 6MW ICC = 0.95, d̄ = 20.04 m). Although the ICC and SCC results for HHD suggest good-to-excellent reliability (0.65-0.85), d̄ ranges up to 17.83 N, with SEM values as high as 40.95 N. While the small sample size is a limitation of this study, the preliminary evidence suggests strong agreement between raters for the BBS and 6MW and decreased agreement between raters for people with greater mobility problems. The mean differences between raters for HHD are probably too high for it to be applied in clinical practice.

Test–retest reliability of hand-held dynamometry and functional tests in systemic lupus erythematosus

The aim of this study was to evaluate the test-retest reliability and determine the degree of measurement error of tests of isometric muscle strength and upper and lower limb function in women with systemic lupus erythematosus (SLE). Twelve women with SLE (age 39.8 ± 10 years) were assessed on two occasions separated by a 7-10-day interval. Strength of six muscle groups was measured using a hand-held dynamometer; function was measured by the 30-s sit to stand test and the 30-s 1 kg arm lift. Relative reliability was estimated using the intraclass correlation coefficient (ICC), model 2,1 (ICC2,1). Absolute reliability was estimated using standard error measurement and the minimal detectable difference was calculated. All ICCs were greater than 0.87. Muscle strength would need to increase by between 18% and 39% in women with SLE to be 95% confident of detecting real changes. The functional tests demonstrated a systematic bias between trials. This study demonstrates that hand-held dynamometry in SLE can be performed with excellent reliability. Further work needs to be completed to determine the number of trials necessary for both the 30-s sit to stand and 30-s 1 kg arm lift to decrease the systematic bias.

Reliability of handheld dynamometry in assessment of hip strength in adult male football players

The aim of this study was to evaluate the intra- and interrater reliability of handheld dynamometry (HHD) for measuring hip muscle strength in a sample of 30 healthy semi-professional adult male football players. The reliability of HHD had not been assessed in athletes who were likely to be stronger than populations tested previously. Maximal isometric strength of resisted hip flexion and adduction were measured. Mean strength ranged from 51.5 kg for dominant hip flexion to 26.7 kg for hip adduction at 90° of hip flexion. Intrarater reliability intraclass correlation coefficients (ICCs) ranged from 0.70 to 0.89. ICCs for interrater reliability ranged from 0.66 to 0.87. As expected, muscle strength in this group of athletes was significantly higher than that of populations in which HHD reliability has been assessed. Despite this, muscle strength testing of hip flexor and adductor muscles can be performed with good to excellent intra- and interrater reliability in this population.

Reliability of hand-held dynamometry and functional strength tests for the lower extremity in children with Cerebral Palsy

Purpose. To evaluate the intertester reliability of two methods for measuring lower-limb strength in children with cerebral palsy (CP).Method. Twenty-five subjects with CP (7 – 17 years of age) participated in this study. Lower-limb muscle strength was measured on 2 occasions using a Hand-held Dynamometer (HHD; break-method and make-method) and a 30-sec Repetition Maximum (RM) during three functional strength tests for the lower extremities. Reliability was measured using the intraclass correlation coefficients (ICCs), the standard error of measurement (SEM) and the coefficient of variation (CV).Results. The intertester reliability of strength measurement using a HHD was questionable with ICC values ranging from 0.42 – 0.73 for the break-method, and from 0.49 – 0.82 for the make-method. The SEM and CV (%) values ranged from 27.9 – 58.9 and 22.2 – 35.3% for the break-method, and from 30.6 – 52.7 and 16.2 – 56.2% for make-method. The intertester reliability of strength measurement using the 30-sec RM was acceptable with ICC values ranging from 0.91 – 0.96, and SEM and CV (%) values ranging from 1.1 – 2.6 and 10.9 – 39.9% for the functional exercises.Conclusion. The intertester reliability of measuring muscle strength of the lower extremities using a hand-held dynamometer is questionable. The intertester reliability of the 30-sec RM for the lower extremity is acceptable.

Reliability of dynamometry to quantify isometric strength following traumatic brain injury

Objective: To investigate the within-session reliability and test–re-test reliability of hand-held dynamometry (HHD) to quantify strength in hip flexors, quadriceps, plantarflexors and triceps brachii following traumatic brain injury (TBI).Design: Within-session reliability was examined across six consecutive trials of HHD. Test–re-test reliability was examined between two sessions separated by 7 days.Setting: Private physical therapy practice, Melbourne, Australia.Participants: Ten adults with TBI with a mean age of 32.5 years (range = 19–63, SD = 12.8) and mean time after injury of 12.2 years (range = 2.3–26, SD = 8.6).Main outcome measures: Isometric strength measured by HHD.Results: Test–re-test reliability of HHD following TBI was good when repeated tests occurred within a single session. Within a session, the first trial was the most variable out of the six examined. Of the four muscles examined, re-test measures of strength for the quadriceps, plantarflexors and triceps were the most reliable. For the hip flexors an increase greater than 3.1 kg (28%) was needed before real change could be detected. Test–re-test reliability was higher for muscles tested on the more affected side (ICC(2,1)= 0.55–0.93) than muscles tested on the less affected side (ICC(2,1)= 0.09–0.86).Conclusions: To gain a representative measure of isometric strength using HHD in a single session, three trials are recommended. The first is for familiarization and trials 2 and 3 are averaged to provide a typical measure of isometric muscle strength. Further research needs to occur but alternative methods to quantify muscle strength might be needed if repeated measures are to be performed over a 7-day interval.

The reliability of hand-held dynamometry in measuring isometric strength of the shoulder internal and external rotator musculature using a stabilization device

Although hand-held dynamometry is considered an objective method of measuring strength, the reliability of the procedure can be compromised by inadequate tester strength and insufficient stabilization of the dynamometer and subject. The purpose of this study was to investigate the test-retest reliability of a hand-held dynamometer with the use of a portable stabilization device while testing the shoulder internal and external rotator musculature. The isometric strength of the shoulder rotator musculature was tested twice in 30 asymptomatic adult volunteers (15 male and 15 female) between 18 and 63 years of age by using an intrasession design. Consistency of the testing protocol was maintained through the use of an arm stabilization apparatus, which fixed the arm in 30° of the scapular plane and a portable dynamometer stabilization device. Intraclass correlation coefficients (ICC's) were high, ranging from ICC (3,1) = 0.971–0.972 for the test-retest trials of internal and external rotation. There was no significant difference between sessions one and two for maximum internal rotation (p = 0.431) and maximum external rotation strength (p = 0.780). The results indicate that the testing protocol with stabilization device is a reliable method for measuring strength of the internal and external rotator shoulder musculature.

Reliability of Hand-Held Dynamometry and Its Relationship with Manual Muscle Testing in Patients with Osteoarthritis in the Knee

Support for this study was provided by the Arthritis Health Professions Association, Arthritis Foundation, National Office, and NIH (NIAMS) Multipurpose Arthritis Center Grant No. AM 30692. The reliability of data gathered with hand-held dynamometers (HHD) and the relationship between HHD measurements and manual muscle tests (MMT) have been assessed only with healthy subjects and patients with neuromuscular disorders, not with homogeneous groups of patients with orthopaedic problems. In this study, HHD and MMT were used to measure the strength of knee extensor muscles of 43 patients with osteoarthritis. Test-retest reliability of HHD was determined, and the two testing systems were compared. The HHD measurements indicated that the knee extensor muscles were weak; the MMT grades indicated good strength. The HHD intraclass correlation coefficient for knee extensor strength measurements was 0.92. The HHD measurements increased as the MMT grades increased. The Kendall tau correlation coefficient between HHD measurements and MMT grades for the knee extensor muscles was 0.24. Hand-held dynamometry is less subjective than MMT, especially at the stronger grades. For the purpose of documenting progress of patients, HHD provides a reliable, quantitative method. The use of HHD with weak examiners, weak patients, and inadequate trunk stabilization is questionable. Hand-held dynamometry is useful for clinical and research settings where isokinetic testing is either unfeasible (ie., home care) or cost-prohibitive. J Orthop Sports Phys Ther 1992;16(3):145-149.

Reliability of hand-held dynamometry ―with a use of Musculator GT-10―

Reliability of hand-held dynamometry ―with a use of Musculator GT-10―

The Validity and Reliability of Hand-Held Dynamometry in Assessing Isometric External Rotator Performance

The validity and reliability of hand-held dynamometry and Cybex dynamometry were investigated using maximal isometric contractions of the external rotators of the shoulder in 14 healthy male subjects. Three maximum voluntary contractions were recorded from each subject by a hand-held dynamometer and a Cybex isokinetic dynamometer at two testing sessions approximately 1 week apart. Analysis of variance did not reveal any significant differences between the mean peak torques obtained with either instrument or between days. The intrarater reliability was clearly established for both the hand-held dynamometer (r = 0.986) and Cybex dynamometer (r = 0.993). Within-day correlations between the two instruments accounted for 27% (day 1) and 60% (day 2) of the explainable variance. This suggests that although both techniques produced identical peak torque values and measured the same element of performance-strength, they did so in a slightly different manner. The possible nature of these differences is discussed.J Orthop Sports Phys Ther 1988;10(6):213-217.