scholarly journals P150 Hand-held dynamometry may provide a valid and objective method of muscle strength quantification in adult inflammatory myopathy: results from clinical practice in a tertiary centre

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
William J Gregory ◽  
Alexander Oldroyd ◽  
Hector Chinoy
Keyword(s):  
Muscle Strength ◽  
Inflammatory Myopathy ◽  
Health Assessment ◽  
Manual Muscle Testing ◽  
Shoulder Abduction ◽  
P Value ◽  
Strength Assessment ◽  
Tertiary Centre ◽  
Muscle Testing ◽  
Global Activity

Abstract Background/Aims  Accurate methods of muscle strength assessment are vital in the care of patients with idiopathic inflammatory myopathy (IIM). Manual muscle testing (MMT) is limited in quantification of strength and has a demonstrated 'ceiling effect'. Recent research has indicated that hand-held dynamometry (HHD) may provide a user-friendly and patient-acceptable method to quantify muscle strength without a ceiling effect. This study aims to demonstrate routine clinical application of HHD and explore the ability to predict physical function and patient-rated impact in a tertiary IIM cohort. Methods  Data was collected from adult IIM patients attending a UK tertiary centre between 2016 and 2019. Bilateral HHD of knee extension, shoulder abduction and grip strength were measured by a single specialist physiotherapist. Data was also collected on function (Health Assessment Questionnaire [HAQ]), muscle strength (MMT-8) and global activity (patient global visual analogue scale [VAS]). Generalised linear modelling, adjusted for age and sex was used to quantify associations between HHD values of each movement and HAQ score, MMT-8 score and patient global activity VAS. Results  Data was collected on 57 patients (60% female) with a mean age of 56 years (SD 13), mean HAQ of 1 (SD 0.85), and mean MMT-8 of 75 (SD 6) out of a maximum score of 80. Summary values of each collected measurement and modelling results are displayed in Table 1. All HHD measurements significantly correlated with HAQ, MMT-8 and patient global VAS scores. The greatest magnitude of association was seen with shoulder abduction. The collection of strength measures by the HHD method was tolerable and time-efficient for patient and clinician. Patient feedback on being able to see their objective strength measures on the HHD was also encouragingly positive, boosting their intrinsic motivation to take part in rehabilitation. P150 Table 1:Summary HHD strength values and modelling resultsMeasurement using HHDMean (SD) (kg)Association with HAQ - Coef (p-value)Association with MMT-8 - Coef (p-value)Association with patient global VAS - Coef (p-value)Grip strength22.98 (12.41)-0.04 (<0.01)0.26 (<0.01)-1.53 (<0.01)Shoulder abduction10.39 (5.51)-0.11 (<0.01)0.60 (<0.01)-2.74 (<0.01)Knee extension13.03 (7.17)-0.06 (<0.01)0.51 (<0.01)-1.53 (<0.01)SD = standard deviation, HAQ = Health Assessment Questionnaire, MMT-8 = manual muscle testing, VAS = visual analogue scale, Coef = coefficient, HHD = hand held dynamometry. Conclusion  This study indicates that HHD may provide an inexpensive, user-friendly method of strength assessment in IIM patients, providing accurate insights into function, strength and global activity. Undertaking HHD in clinic and by a specialist physiotherapist allows for stratified, personalised rehabilitation intervention. Following future validation, HHD could form a method of objective muscle strength assessment, thus focusing IIM clinical care and research. Disclosure  W.J. Gregory: Honoraria; W.G. has received honoraria from Abbvie, Pfizer and UCB. A. Oldroyd: None. H. Chinoy: None.

scholarly journals P.007 Onset of facial weakness correlated with muscle strength in infantile facioscapulohumeral dystrophy (FSHD)

2016 ◽  
Vol 43 (S2) ◽  
pp. S23-S23
Author(s):  
JK Mah ◽  
J Feng ◽  
C Carty ◽  
Y Chen ◽  
T Duong ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Disease Severity ◽  
Age At Onset ◽  
Clinical Severity ◽  
Manual Muscle Testing ◽  
Shoulder Abduction ◽  
Facial Weakness ◽  
Muscle Involvement ◽  
Muscle Testing ◽  
Severity Scores

Background: We investigated motor function associations with age, gender, and D4Z4 fragment size among participants with infantile FSHD. Methods: We collected standardized motor assessments including goniometry, manual muscle testing (MMT), quantitative muscle testing (QMT), and FSHD clinical severity scores (CSS) at 12 CINRG sites. To measure associations, we used linear regression models adjusted for age at enrollment, onset of weakness, gender, and D4Z4 repeats. Results: 53 participants (59% female, mean age 23.1±14.6 years) were enrolled. Weakness was most pronounced at the shoulder girdle and rectus abdominis (median MMT 30-38% of normal). Older enrollment age was associated with greater CSS (p=0.005) and reduced range of motion in shoulder abduction, shoulder flexion, elbow flexion, and ankle dorsiflexion (all p<0.01). Females and participants with larger D4Z4 repeats had milder shoulder/arm weakness and lesser disease severity (all p<0.05). Increased age at onset of facial weakness was significantly associated with greater total muscle strength, as measured by QMT and MMT (both p=0.002). Conclusions: We confirm the descending pattern of muscle involvement and milder disease severity in females or those with larger D4Z4 repeats. Furthermore, earlier age at onset of facial weakness was associated with greater muscle weakness. Future longitudinal assessments will describe rates of disease progression in this population.

scholarly journals Pengaruh Latihan Range Of Motion (ROM) Menggenggam Bola Terhadap Kekuatan Otot Ekstremitas Atas Pasien Stroke Iskemik

2019 ◽  
Vol 14 (2) ◽  
pp. 79-86
Author(s):  
Hendri Budi ◽  
Netti Netti ◽  
Yossi Suryarinilsih
Keyword(s):  
Ischemic Stroke ◽  
Muscle Strength ◽  
Range Of Motion ◽  
Design Research ◽  
Nursing Intervention ◽  
Wilcoxon Test ◽  
Manual Muscle Testing ◽  
P Value ◽  
Stroke Patients ◽  
Muscle Testing

Stroke causes motor hemiparise disorders or weakness. Nursing intervention to overcome this is by doing range of motion (ROM) exercises grasping the ball. The purpose of the study was to identify the effect of ROM-grasping ball exercises on the strength of limb muscles for ischemic stroke patients. Quasi-experimental research type, one group pre-post test design. Research in the Neuro Ward Dr. M. Djamil Padang Hospital. The time of the research is October to December 2017. The intervention is ROM gripping ball exercises, namely rubber balls for 3 days followed by tennis balls for 2 days. Hold the ball firmly for 5 seconds then relax 10 seconds, practice repeated 10 times, frequency 3 times a day. The study population were all stroke patients in the Neuro Ward Dr. M. Djamil Padang Hospital. A sample of 10 people was obtained by purposive sampling that met the inclusion criteria. Data collection by measurement of muscle strength using Manual Muscle Testing (MMT). Data were computerized, analyzed by descriptive statistics and Wilcoxon test. The results of the study showed differences in upper limb muscle strength before and after the ROM exercise held the ball on the patient's shoulder (p value = 0.004), on the elbow of the patient (p value = 0.000), on the patient's hand (p value = 0.000), and on the patient's finger (p value = 0.000). It is recommended to nurses to implement the practice of grasping the ball to increase muscle strength of ischemic stroke patients and make it as a procedure for nursing intervention to patients to muscle strength.      

scholarly journals Importance of aggressive treatment in juvenile dermatomyositis

2005 ◽  
Vol 133 (Suppl. 2) ◽  
pp. 118-123 ◽  
Author(s):  
Jelena Vojinovic ◽  
Phill Riley ◽  
Sue Maillard ◽  
Clarissa Pilkington
Keyword(s):  
Juvenile Dermatomyositis ◽  
Inflammatory Myopathy ◽  
Laboratory Data ◽  
Health Assessment ◽  
Idiopathic Inflammatory Myopathy ◽  
Manual Muscle Testing ◽  
Aggressive Treatment ◽  
Predictive Parameters ◽  
Muscle Testing ◽  
One Year

Juvenile dermatomyositis (JDM) is the most common idiopathic inflammatory myopathy in children. Its outcome depends on the precocity of the diagnosis and of the treatment, but predictive parameters for guiding the correct therapeutic and prognostic approaches to JDM are still lacking. We analysed the one-year-old outcomes of 20 JDM patients treated with methylprednisolone boluses, methotrexate, and cyclophosphamide, through a longitudinal retrospective study. The outcome variables included: the Childhood Myositis Assessment Score (CMAS); Manual Muscle Testing (MMT); the Childhood Health Assessment Questionnaire (CHAQ); the Child Health Questionnaire (CHQ: physical score CHQ PhS and psycho-social score CHQ PsS), patient and parent Visual Analogue Scale (VAS), as well as laboratory data: ESR, LDH, CK, and ALT. Within all JDM patient groups, we discovered significant improvement in all disease activity parameters CMAS (p<0.001) and MMT (p<0.001), followed by a significant decrease in CHAQ (p<0.001), as well as parent VAS (p<0.001) and physician VAS (p<0.001). With regard to laboratory parameters, only CK (p=0.001) and LDH (p=0.013) levels were found to be significantly decreased, while there were no significant changes in ESR and ALT. The results of our study support the findings that the aggressive treatment of JDM patients improves their shortterm outlook.

FRI0627-HPR In Patients with Inflammatory Myopathy Quantitative Muscle Testing Has A Higher Reliability than Manual Muscle Testing

2016 ◽  
Vol 75 (Suppl 2) ◽  
pp. 1281.1-1281
Author(s):  
I. Sterkele ◽  
P. Baschung Pfister ◽  
E.D. de Bruin ◽  
B. Maurer ◽  
R.H. Knols
Keyword(s):  
Inflammatory Myopathy ◽  
Manual Muscle Testing ◽  
Muscle Testing

scholarly journals Effect of Isometric and Isotonic Exercise Program on Increased Strength of Quardriceps Muscles in Osteoarthritis Patients in Singgasana Rama Physiotherapy Clinic Blitar

2021 ◽  
Vol 5 (1) ◽  
pp. 42-48
Author(s):  
Irwan Syahputra ◽  
Nurwijayanti Nurwijayanti
Keyword(s):  
Muscle Strength ◽  
Exercise Program ◽  
Quadriceps Strength ◽  
Manual Muscle Testing ◽  
Moderate Intensity ◽  
Rank Test ◽  
Control Group ◽  
Isometric Training ◽  
Muscle Testing ◽  
Isotonic Exercise

Background: Osteoarthritis is a disease of the joints that can cause disability and is progressive in the joints which cause changes in the water content, proteoglycin content, and collagen in the joints. One of the ways to improve functional ability in osteoarthritis cases is to use isotonic and isometric training exercise. Pain is a clinical symptom of knee osteoarthritis, limiting movement due to pain over time will cause rehabilitation problems such as impaired flexibility and stability, reduction of muscle mass (atrophy). Mild and moderate intensity quadriceps strength training is effective at achieving optimal muscle strength and function without causing significant muscle damage. Destination: The purpose of this study was to analyze the effect of isotonic and isometric exercises on muscle strength. Research methods: This study uses a pre-experimental research type using "One Group Pre - test and Post - Test". This research has carried out the first observation (pretest) so that researchers can test the changes that occur after the treatment, and the control group. Result: with the Wilcoxon signed rank test test the isometric and isotonic groups had p = 0.000 while the control group had a significance value of p = 1,000; and the 3 groups test has different values, namely: isotonic exercise has a value of 27.67; isometric; 28.60; and control 12.73. The conclusion that can be concluded that the value of isometric training has the highest value, namely 28.60 which means it is the most effective exercise to increase the value of Manual Muscle Testing. Conclusion: There is an effect of giving isometric and isotonic exercises in strengthening the quadriceps muscles.

Plasma exchange therapy in refractory inflammatory myopathy with anti-signal recognition particle antibody: a case series

Rheumatology ◽  
2021 ◽  
Author(s):  
Hao Zhang ◽  
Yue Sun ◽  
Honglei Liu ◽  
Xiaobing Cheng ◽  
Junna Ye ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Plasma Exchange ◽  
Immunosuppressive Agents ◽  
Inflammatory Myopathy ◽  
Signal Recognition Particle ◽  
Case Series ◽  
Chest Ct ◽  
Signal Recognition ◽  
Muscle Testing ◽  
Global Activity

Abstract Objectives To explore the efficacy of plasma exchange (PE) therapy in refractory idiopathic inflammatory myopathy (IIM) patients with positive anti-signal recognition particle (SRP) antibody. Methods Nine refractory IIM patients with positive anti-SRP antibody were enrolled, who received PE therapy at Ruijin Hospital from Octobor 2017 to December 2020. The clinical manifestations, laboratory tests, chest CT and lower extremity MRI images before and after PE therapy were compared. The treatment response was evaluated by the 2016 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) myositis response criteria. Results 88.9% (8/9) subjects had achieved improvement by 3 weeks after PE therapy, with 55.6% (5/9) minimal improvement and 33.3% (3/9) moderate improvement. There were statistically significant improvements between baseline and after PE therapy at 3 weeks on the core set measures: physician global activity, patient global activity, Health Assessment Questionnaire (HAQ), manual muscle testing (MMT), extramuscular disease activity, and muscle enzymes activity including creatine kinase (CK), lactate dehydrogenase (LDH), aspartate transaminase (AST), except for alanine transaminase (ALT). Moreover, the chest CT showed regression of ground glass opacities and irregular linear opacities after PE therapy in four patients with interstitial lung disease. The MRI images of lower extremity in four patients showed reduction of muscle oedema after the therapy. Conclusion PE therapy is effective for refractory IIM patients with positive anti-SRP antibody. It should be considered as an alternative treatment for those patients who are resistant to the combined therapy of glucocorticoids and immunosuppressive agents.

Hand-held dynamometry for assessment of muscle strength in patients with inflammatory myopathies

Rheumatology ◽  
2020 ◽  
Author(s):  
Didem Saygin ◽  
Chester V Oddis ◽  
Siamak Moghadam-Kia ◽  
Bonny Rockette-Wagner ◽  
Nicole Neiman ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Disease Activity ◽  
Neuromuscular Disorders ◽  
Strong Association ◽  
External Validation ◽  
Manual Muscle Testing ◽  
Inflammatory Myopathies ◽  
University Of Pittsburgh ◽  
Muscle Testing ◽  
The University

Abstract Objectives Muscle weakness in idiopathic inflammatory myopathies (IIMs) is conventionally assessed using manual muscle testing (MMT). However, more objective tools must be developed to accurately and reliably quantify muscle strength in myositis patients. Hand-held dynamometry (HHD) is a quantitative, portable device with reported reliability in neuromuscular disorders. Our aim was to assess the reliability, validity and responsiveness of HHD in myositis. Methods Myositis patients [DM, necrotizing myopathy (NM), PM and anti-synthetase syndrome] evaluated at the University of Pittsburgh myositis centre were prospectively enrolled. Each patient was assessed at 0, 3 and 6 months for validated outcome measures of myositis disease activity and physical function. At each visit, muscle strength was assessed using both MMT and HHD (Micro FET2, Hoggan Health Industries, Draper, UT, USA). The reliability, validity and responsiveness of the HHD was assessed using standard statistical methods. Results Fifty IIM patients (60% female; mean age 51.6 years; 6 PM, 9 NM, 24 DM and 11 anti-synthetase syndrome) were enrolled. HHD showed strong test–retest intrarater reliability (r = 0.96) and interrater reliability (r = 0.98). HHD correlated significantly with the MMT score (r = 0.48, P = 0.0006) and myositis disease activity and functional measures. Longitudinal analysis showed a significant and strong association between the HHD and MMT as well as 2016 ACR/EULAR myositis response criteria (r = 0.8, P &lt; 0.0001) demonstrating responsiveness. The mean effect size and standardized response mean of HHD was large: 0.95 and 1.03, respectively. MMT had a high ceiling effect compared with HHD. Conclusion HHD demonstrated strong reliability, construct validity and responsiveness in myositis patients. External validation studies are required to confirm these findings.

scholarly journals Large variation in effects during 10 years of enzyme therapy in adults with Pompe disease

Neurology ◽  
2019 ◽  
Vol 93 (19) ◽  
pp. e1756-e1767 ◽  
Author(s):  
Laurike Harlaar ◽  
Jean-Yves Hogrel ◽  
Barbara Perniconi ◽  
Michelle E. Kruijshaar ◽  
Dimitris Rizopoulos ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Pulmonary Function ◽  
Pompe Disease ◽  
Manual Muscle Testing ◽  
Controlled Clinical Trial ◽  
Walking Ability ◽  
Enzyme Replacement ◽  
Link Type ◽  
Muscle Testing

ObjectiveTo determine the effects of 10 years of enzyme replacement therapy (ERT) in adult patients with Pompe disease, focusing on individual variability in treatment response.MethodsIn this prospective, multicenter cohort study, we studied 30 patients from the Netherlands and France who had started ERT during the only randomized placebo-controlled clinical trial with ERT in late-onset Pompe disease (NCT00158600) or its extension (NCT00455195) in 2005 to 2008. Main outcomes were walking ability (6-minute walk test [6MWT]), muscle strength (manual muscle testing using Medical Research Council [MRC] grading), and pulmonary function (forced vital capacity [FVC] in the upright and supine positions), assessed at 3- to 6-month intervals before and after the start of ERT. Data were analyzed with linear mixed-effects models for repeated measurements.ResultsMedian follow-up duration on ERT was 9.8 years (interquartile range [IQR] 8.3–10.2 years). At the group level, baseline 6MWT was 49% of predicted (IQR 41%–60%) and had deteriorated by 22.2 percentage points (pp) at the 10-year treatment point (p < 0.001). Baseline FVC upright was 54% of predicted (IQR 47%–68%) and decreased by 11 pp over 10 years (p < 0.001). Effects of ERT on MRC sum score and FVC supine were similar. At the individual level, 93% of patients had initial benefit of ERT. Depending on the outcome measured, 35% to 63% of patients had a secondary decline after ≈3 to 5 years. Still, at 10 years of ERT, 52% had equal or better 6MWT and/or FVC upright compared to baseline.ConclusionsThe majority of patients with Pompe disease benefit from long-term ERT, but many patients experience some secondary decline after ≈3 to 5 years. Individual variation, however, is considerable.Classification of evidenceThis study provides Class IV evidence that for the majority of adults with Pompe disease, long-term ERT positively affects, or slows deterioration in, muscle strength, walking ability, and/or pulmonary function.

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