Schrama Patrick P M, Stenneberg Martijn S, Lucas Cees, van Trijffel Emiel
private practice Leidsevaart, Haarlem, The Netherlands; Stichting Opleidingen Musculoskeletale Therapie, Institute for Master Education in Musculoskeletal Therapy, Amersfoort, The Netherlands.
Stichting Opleidingen Musculoskeletale Therapie, Institute for Master Education in Musculoskeletal Therapy, Amersfoort, The Netherlands.
Arch Phys Med Rehabil. 2014 Dec;95(12):2444-69. doi: 10.1016/j.apmr.2014.05.019. Epub 2014 Jun 5.
To summarize and appraise the literature on the intraexaminer reliability of hand-held dynamometry (HHD) in the upper extremity.
MEDLINE, CINAHL, and EMBASE were searched for relevant studies published up to December 2011. In addition, experts were contacted, and journals and reference lists were hand searched.
To be included in the review, articles needed to (1) use a repeated-measures, within-examiner(s) design; (2) include symptomatic or asymptomatic individuals, or both; (3) use HHD to measure muscle strength in any of the joints of the shoulder, elbow, or wrist with the "make" or the "break" technique; (4) report measurements in kilogram, pound, or torque; (5) use a device that is placed between the examiner's hand and the subject's body; and (6) present estimates of intraexaminer reliability.
Quality assessment and data extraction were performed by 2 reviewers independently.
Fifty-four studies were included, of which 26 (48%) demonstrated acceptable intraexaminer reliability. Seven high-quality studies showed acceptable reliability for flexion and extension of the elbow in healthy subjects. Conflicting results were found for shoulder external rotation and abduction. Reliability for all other movements was unacceptable. Higher estimates were reached for within-sessions reliability and if means of trials were used.
Intraexaminer reliability of HHD in upper extremity muscle strength was acceptable only for elbow measurements in healthy subjects. We provide specific recommendations for future research. Physical therapists should not rely on HHD measurements for evaluation of treatment effects in patients with upper extremity disorders.
总结并评价有关上肢手持式测力计（HHD）检查者内信度的文献。
检索MEDLINE、CINAHL和EMBASE数据库，查找截至2011年12月发表的相关研究。此外，还联系了专家，并手工检索了期刊和参考文献列表。
纳入综述的文章需满足以下条件：（1）采用重复测量、检查者内设计；（2）纳入有症状或无症状个体，或两者皆有；（3）使用HHD通过“对抗”或“制动”技术测量肩部、肘部或腕部任一关节的肌肉力量；（4）报告以千克、磅或扭矩为单位的测量值；（5）使用放置在检查者手部与受试者身体之间的设备；（6）给出检查者内信度的估计值。
由2名评价者独立进行质量评估和数据提取。
共纳入54项研究，其中26项（48%）显示出可接受的检查者内信度。7项高质量研究表明，健康受试者肘部屈伸的信度可接受。肩部外旋和外展的结果存在冲突。所有其他运动的信度均不可接受。同一检查期间的信度估计值更高，且使用试验均值时也是如此。
仅在健康受试者肘部测量中，HHD在上肢肌肉力量检查者内信度是可接受的。我们为未来研究提供了具体建议。物理治疗师不应依赖HHD测量来评估上肢疾病患者的治疗效果。
