Reliability and validity of hand-held dynamometry for assessing lower limb muscle strength

BACKGROUND: Hand-held dynamometry (HHD) is used to assess muscle strength in various patient populations, but many variations in protocols exist. OBJECTIVE: First, to systematically develop a protocol of HHD for all lower limb muscle groups and evaluate intra-rater reliability; second, to validate HHD with fixed dynamometry for the knee flexor and extensor muscles. METHODS: Thirty healthy young adults (women: men – 15:15) participated in two testing sessions. HHD of 12 lower limb muscle groups was performed in both sessions, while fixed dynamometry of knee muscle groups was performed only in the second session. RESULTS: The intra-rater reliability of HHD was good for five muscle groups and excellent for seven muscle groups (ICC3, k= 0.80–0.96). The criterion validity of HHD ranged from very good to excellent for the knee flexors (r= 0.77–0.89) and from good to very good for the knee extensors (r= 0.65–0.78). However, peak moment values for the knee extensor muscles were underestimated by 32% (p< 0.001). CONCLUSIONS: The proposed HHD protocol provides reliable and valid measurements of lower limb muscle isometric strength in healthy adults, which may also be used to test patients with mild muscle strength deficits. However, possible underestimation of absolute strength must be considered when interpreting the results of knee extensors or other large muscles.

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Assessment of Lower Limb Muscle Strength and Power Using Hand-Held and Fixed Dynamometry: A Reliability and Validity Study

PLoS ONE ◽

10.1371/journal.pone.0140822 ◽

2015 ◽

Vol 10 (10) ◽

pp. e0140822 ◽

Cited By ~ 105

Author(s):

Benjamin F. Mentiplay ◽

Luke G. Perraton ◽

Kelly J. Bower ◽

Brooke Adair ◽

Yong-Hao Pua ◽

...

Keyword(s):

Muscle Strength ◽

Lower Limb ◽

Reliability And Validity ◽

Validity Study ◽

Lower Limb Muscle ◽

Limb Muscle

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RELATIONSHIP BETWEEN ISOMETRIC STRENGTH OF SIX LOWER LIMB MUSCLE GROUPS AND MOTOR SKILLS AMONG NURSING HOME RESIDENTS

Journal of Frailty & Aging ◽

10.14283/jfa.2015.70 ◽

2015 ◽

pp. 1-4

Author(s):

F. BUCKINX ◽

J.L. CROISIER ◽

J.Y. REGINSTER ◽

J. PETERMANS ◽

E. GOFFART ◽

...

Keyword(s):

Nursing Home ◽

Muscle Strength ◽

Motor Skills ◽

Lower Limb ◽

Nursing Home Residents ◽

Lower Limb Muscle ◽

Limb Muscle ◽

Muscle Groups ◽

The Relationship ◽

Isometric Muscle

This research aimed to assess the correlation between isometric muscle strength of the lower limb and motor skills. This is a cross sectional study performed among volunteer nursing home residents included in the SENIOR (Sample of Elderly Nursing home Individuals: an Observational Research) cohort. The present analysis focused on isometric muscle strength of 6 lower limb muscle groups (i.e. knee extensors, knee flexors, hip abductors, hip extensors, ankle flexors and ankle extensors), assessed using a validated hand-held dynamometer (i.e. the MicroFET2 device), and motor skills evaluated using the Tinetti test, the Timed Up and Go test, the Short Physical Performance Battery test (SPPB) and the walking speed. The relationship between all these parameters was tested by means of a multiple correlation, adjusted on age, sex and body mass index. 450 nursing home residents (69.8% of women) with a mean age of 83.1±9.4 years were included in this study. Our results showed a significant inverse correlation between lower limb muscle strength and the time required to perform the TUG test or gait speed, except for ankle flexors and ankle extensors. The relationship between the Tinetti test or the SPPB score, and lower limb muscle strength was significant, except for ankle flexors and ankle extensors. In conclusion, a positive association between lower limb muscle strength of the four main muscle groups and motor skills of the elderly nursing residents was found in this research. Therefore, special attention should be given to these muscle groups during rehabilitation programs.

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CORP: Measurement of upper and lower limb muscle strength and voluntary activation

Journal of Applied Physiology ◽

10.1152/japplphysiol.00569.2018 ◽

2019 ◽

Vol 126 (3) ◽

pp. 513-543 ◽

Cited By ~ 10

Author(s):

James L. Nuzzo ◽

Janet L. Taylor ◽

Simon C. Gandevia

Keyword(s):

Muscle Strength ◽

Lower Limb ◽

Correlation Coefficients ◽

Attentional Focus ◽

Time Of Day ◽

Voluntary Activation ◽

Lower Limb Muscle ◽

Limb Muscle ◽

Rater Reliability ◽

Maximal Force

Muscle strength, the maximal force-generating capacity of a muscle or group of muscles, is regularly assessed in physiological experiments and clinical trials. An understanding of the expected variation in strength and the factors that contribute to this variation is important when designing experiments, describing methodologies, interpreting results, and attempting to replicate methods of others and reproduce their findings. In this review (Cores of Reproducibility in Physiology), we report on the intra- and inter-rater reliability of tests of upper and lower limb muscle strength and voluntary activation in humans. Isometric, isokinetic, and isoinertial strength exhibit good intra-rater reliability in most samples (correlation coefficients ≥0.90). However, some tests of isoinertial strength exhibit systematic bias that is not resolved by familiarization. With the exception of grip strength, few attempts have been made to examine inter-rater reliability of tests of muscle strength. The acute factors most likely to affect muscle strength and serve as a source of its variation from trial-to-trial or day-to-day include attentional focus, breathing technique, remote muscle contractions, rest periods, temperature (core, muscle), time of day, visual feedback, body and limb posture, body stabilization, acute caffeine consumption, dehydration, pain, fatigue from preceding exercise, and static stretching >60 s. Voluntary activation, the nervous system’s ability to drive a muscle to create its maximal force, exhibits good intra-rater reliability when examined with twitch interpolation (correlation coefficients >0.80). However, inter-rater reliability has not been formally examined. The methodological factors most likely to influence voluntary activation are myograph compliance and sensitivity; stimulation location, intensity, and inadvertent stimulation of antagonists; joint angle (muscle length); and the resting twitch.

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A Study of Inter-rater Reliability of Lower Limb Muscle Strength Measurements Using a Hand-held Dynamometer in Patients with Hip Fracture

JOURNAL OF THE JAPANESE ASSOCIATION OF RURAL MEDICINE ◽

10.2185/jjrm.65.196 ◽

2016 ◽

Vol 65 (2) ◽

pp. 196-201

Author(s):

Yuji KAWABATA ◽

Yasuhiro SUMIKAWA ◽

Mami YOSHINAKA ◽

Satoshi TAKECHI ◽

Keita GOTO ◽

...

Keyword(s):

Hip Fracture ◽

Muscle Strength ◽

Lower Limb ◽

Lower Limb Muscle ◽

Limb Muscle ◽

Rater Reliability

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Is maximal muscle strength and fatigability of three lower limb muscle groups associated with walking capacity and fatigability in multiple sclerosis? An exploratory study

Multiple Sclerosis and Related Disorders ◽

10.1016/j.msard.2021.102841 ◽

2021 ◽

Vol 50 ◽

pp. 102841

Author(s):

Fanny Van Geel ◽

Lars G Hvid ◽

Pieter Van Noten ◽

Bert O. Eijnde ◽

Ulrik Dalgas ◽

...

Keyword(s):

Multiple Sclerosis ◽

Muscle Strength ◽

Lower Limb ◽

Exploratory Study ◽

Lower Limb Muscle ◽

Limb Muscle ◽

Walking Capacity ◽

Muscle Groups ◽

Maximal Muscle Strength

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Correlation between static postural balance, falls and pick torque isokinetic of extensors and flexors of the knee in elderly

Manual Therapy Posturology & Rehabilitation Journal ◽

10.17784/mtprehabjournal.2017.15.469 ◽

2020 ◽

pp. 1-6

Author(s):

Marieli Ramos Stocco ◽

Deise Aparecida de Almeida Pires-Oliveira ◽

Laís Campus de Oliveira ◽

Raphael Gonçalves de Oliveira ◽

Fábio Antônio Néia Martini ◽

...

Keyword(s):

Muscle Strength ◽

Lower Limb ◽

Postural Balance ◽

The Elderly ◽

Knee Extension ◽

Knee Extensors ◽

Strong Positive Correlation ◽

Lower Limb Muscle ◽

Limb Muscle ◽

Positive Correlation

Introduction: Declines of static postural balance and muscle strength, especially of lower limbs are strong predictors of falls in the elderly. Objective: The objective of this study was to identify the possible correlation between static postural balance, falls and isokinetic torque peak of knee extensors and flexors in the elderly. Methods: A cross-sectional study with anthropometric evaluation of static postural balance in unipodal limb support was performed using the force platform, flexural strength test and knee extension of the dominant limb using the isokinetic dynamometer and the application of a structured questionnaire on falls. They agreed to participate in the study 106 volunteers of both sexes through the signing of the free and informed consent. The data were treated in the Statistical Package for the Social Sciences program version 20.0. Results: There was a weak positive correlation between center of pressure (COP) area and peak flexion torque (r=0.204, p=0.041) and extension (r=0.228; p=0.022) of the knee, as well as peak extension (r=0.319, p=0.001) and lateral mean (r=0.324, p=0.001). A moderate positive correlation between COP area and anteroposterior velocity (r=0.694, p=0.000) and lateral mean (r = 0.646; p = 0.000) and strong positive correlation was found only between peak flexion torque and knee extension (r=0.719, p=0.000). Conclusion: There was a weak correlation between static postural balance and dominant lower limb muscle strength, and there was no correlation between falls and lower limb muscle strength, or between falls and static postural balance in the studied sample.

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Falls, muscle strength, and functional abilities in community-dwelling elderly women

Fisioterapia em Movimento ◽

10.1590/1980-5918.030.002.ao16 ◽

2017 ◽

Vol 30 (2) ◽

pp. 357-366

Author(s):

Viviane Santos Borges ◽

Nayara Santos Silva ◽

Ariana Cristina Malta ◽

Nathália Cristina Xavier ◽

Lorene Elka Santana Bernardes

Keyword(s):

Muscle Strength ◽

Lower Limb ◽

Elderly Women ◽

Fear Of Falling ◽

Community Dwelling ◽

Knee Extensors ◽

Functional Abilities ◽

Lower Limb Muscle ◽

Limb Muscle ◽

Plantar Flexors

Abstract Introduction: Falls are among the most common and serious problems facing elderly women. Falling is associated with increased mortality, morbidity, reduced functioning, loss of independence and hospitalization. Objective: The aim of this study was to investigate the association among fear of falling, muscle strength, and functional abilities in community-dwelling elderly women. Methods: Forty-nine elderly women (70.57 ± 5.59 years) participated in this study. Records of falls, self-efficacy associated with falls (FES-I Brazil), functional abilities (the Timed Up and Down Stairs test [TUDS] and the Timed Up and Go test [TUG]), lower limb muscle strength (knee extensors and ankle plantar flexors), and hand grip strength were investigated as variables of interest. Descriptive statistics, the one-way ANOVA, and linear regression tests were used to analyze the association between fear of falling and falls with other variables (α = 0.05). Results: Elderly women who presented records of falls within the last year had lesser strength of knee extensors and plantar flexors (p ≤. 05). Those who had low self-efficacy associated with falls presented lower strength of knee extensors (p ≤. 01). Variables associated with functional abilities (r = 0.70) and lower limb strength (r = 0.53) showed a positive correlation (p ≤. 01). Conclusion: The concern with the fear of falling and falls may be negative effects caused by lower limb muscle weakness.

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