Manual muscle testing and hand-held dynamometry in people with inflammatory myopathy: An intra- and interrater reliability and validity study

Abstract Background: Manual Muscle Testing (MMT) is a useful tool to evaluate ventilatory mechanics in adults with asthma. However, in the reviewed literature, there are few studies that report psychometric features of this test. Therefore, the present study aimed to evaluate MMT reliability and validity in respiratory muscles in adults with asthma.Methods: It was a cross-sectional study. Muscle strength (MMT and static respiratory pressures), sociodemographic and anthropometric variables related to the disease were evaluated. Measurements were carried out by two independent evaluators The reliability of MMT was analyzed with the weighted kappa and the convergent validity was evaluated by comparing the MTT and the respiratory pressure measurements using Pearson's correlation coefficient. The level of significance was p <0.05. Results: Twenty-six adults with stable asthma participated in the study. The intrarater reliability for MMT was between moderate and substantial (kappa=0.45-0.88) for all evaluated muscles while the interrater reliability was slight and fair for intercostal muscles (kappa=0.07-0.24), and fair and substantial (kappa=0.36-0.75) for other muscles. The convergent validity of MMT and respiratory pressures was low (r=0.20-0.48).Conclusions: MMT is a reliable measurement that can be used to evaluate respiratory muscle strength in adults with asthma. This study support MMT application for respiratory muscles at clinical settings when more objective measures such as MIP and MEP are not available. Considering that the MMT is a useful, practical, low-cost tool commonly used by physiotherapists, future studies could evaluate the convergent validity compared with dynamometry or electromyography of the respiratory muscles.

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

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2016-eular.1387 ◽

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

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On the reliability and validity of manual muscle testing: a literature review

Chiropractic & Osteopathy ◽

10.1186/1746-1340-15-4 ◽

2007 ◽

Vol 15 (1) ◽

Cited By ~ 156

Author(s):

Scott C Cuthbert ◽

George J Goodheart

Keyword(s):

Literature Review ◽

Reliability And Validity ◽

Manual Muscle Testing ◽

Muscle Testing

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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 ◽

10.1093/rheumatology/keab247.146 ◽

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.

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The Association Between Muscular Ultrasonographic Alterations and Clinical Symptoms in Patients With Inflammatory Myopathy

Basic and Clinical Neuroscience Journal ◽

10.32598/bcn.2021.3567.1 ◽

2021 ◽

pp. 1-24

Author(s):

Farzad Fatehi ◽

◽

Parisa Khaghani ◽

Ali Asghar Okhovat ◽

Kamyar Moradi ◽

...

Keyword(s):

Clinical Symptoms ◽

Inflammatory Myopathy ◽

Manual Muscle Testing ◽

Inflammatory Myopathies ◽

Non Invasive ◽

Muscle Testing ◽

Healthy Control ◽

Muscle Groups ◽

And Gender ◽

Sum Scores

Purpose: We evaluated the ability of muscle ultrasound (MUS), a non-invasive and simple tool, to distinguish between healthy subjects and individuals with inflammatory myopathy. Methods: This study was conducted on 17 patients with recently diagnosed biopsy-proven inflammatory myopathies (12 dermatomyositis, five polymyositis) compared with 17 age- and gender-matched healthy control adults. All patients underwent clinical assessments, including manual muscle testing (MMT) and hand-held dynamometry, as well as MUS evaluations, including thickness and echointensity (EI) in predefined muscle groups. Results: The disease duration was seven months (interquartile range: 3-11). Except for biceps and gastrocnemius, the patients' muscles had significantly higher EI and lower thickness in comparison with the controls, The EI sum-score manifested the highest area under curve (AUC) in comparison with the sum-scores of other variables (EI vs. MMT: AUCs-difference = 0.18, p < 0.01; EI vs. dynamometry: AUCs-difference = 0.14, p = 0.02; EI vs. thickness: AUCs-difference = 0.25, p < 0.01). Conclusion: EI of muscles differed significantly between healthy individuals and those with inflammatory myopathies and may potentially serve as a useful diagnostic biomarker.

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Importance of aggressive treatment in juvenile dermatomyositis

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh05s2118v ◽

2005 ◽

Vol 133 (Suppl. 2) ◽

pp. 118-123 ◽

Cited By ~ 1

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.

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1040 RELIABILITY AND VALIDITY OF A HAND-HELD DYNAMOMETER FOR MANUAL MUSCLE TESTING

Medicine & Science in Sports & Exercise ◽

10.1249/00005768-199305001-01043 ◽

1993 ◽

Vol 25 (Supplement) ◽

pp. S185

Author(s):

A. Jackson ◽

E. T-Jackson ◽

N. Meske ◽

C. Frankowski ◽

K. Long

Keyword(s):

Reliability And Validity ◽

Manual Muscle Testing ◽

Muscle Testing

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Quick Reference: Chapter 3: The Musculoskeletal System and Chapter 4: The Nervous System

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2000.mayjun03 ◽

2000 ◽

Vol 5 (3) ◽

pp. 4-4

Keyword(s):

Nervous System ◽

Lower Extremity ◽

Musculoskeletal System ◽

Multistep Method ◽

Manual Muscle Testing ◽

Motor Deficits ◽

Lower Extremity Weakness ◽

Residual Symptoms ◽

Muscle Testing ◽

Almost All

Abstract Lesions of the peripheral nervous system (PNS), whether due to injury or illness, commonly result in residual symptoms and signs and, hence, permanent impairment. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition, divides PNS deficits into sensory and motor and includes pain in the former. This article, which regards rating sensory and motor deficits of the lower extremities, is continued from the March/April 2000 issue of The Guides Newsletter. Procedures for rating extremity neural deficits are described in Chapter 3, The Musculoskeletal System, section 3.1k for the upper extremity and sections 3.2k and 3.2l for the lower limb. Sensory deficits and dysesthesia are both disorders of sensation, but the former can be interpreted to mean diminished or absent sensation (hypesthesia or anesthesia) Dysesthesia implies abnormal sensation in the absence of a stimulus or unpleasant sensation elicited by normal touch. Sections 3.2k and 3.2d indicate that almost all partial motor loss in the lower extremity can be rated using Table 39. In addition, Section 4.4b and Table 21 indicate the multistep method used for spinal and some additional nerves and be used alternatively to rate lower extremity weakness in general. Partial motor loss in the lower extremity is rated by manual muscle testing, which is described in the AMA Guides in Section 3.2d.

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