Souweine Jean-Sébastien, Boudet Agathe, Chenine Leila, Leray Helene, Rodriguez Annie, Mourad Georges, Mercier Jacques, Cristol Jean-Paul, Hayot Maurice, Gouzi Fares
Department of Biochemistry, University Hospital of Montpellier, University of Montpellier, Montpellier, France; Department of Nephrology, University Hospital of Montpellier, University of Montpellier, Montpellier, France; PhyMedExp, UMR CNRS 9214, Inserm U1046, University of Montpellier, Montpellier, France.
Department of Biochemistry, University Hospital of Montpellier, University of Montpellier, Montpellier, France.
J Ren Nutr. 2017 May;27(3):194-200. doi: 10.1053/j.jrn.2017.01.017. Epub 2017 Mar 17.
In hemodialysis, diminution of muscle strength constitutes a major prognostic factor of mortality. Currently, measurement of quadriceps isometric maximal voluntary force (MVF) represents the reference method to investigate muscle strength. However, reduction of MVF is rarely detected in these patients due to the absence of portative bedside tools in clinical practice. The purposes of this study were therefore to assess the agreement of a belt-stabilized handheld dynamometer (HHD) with the dynamometer chair (reference method) and to determine intratester and intertester reliability of the quadriceps MVF measurements using belt-stabilized HHD in healthy subjects and in hemodialysis patients.
Repeated-measures cross-sectional study.
Clinical and academic hospital.
Fifty-three healthy adult subjects (23 males, 36.5 + 12.5 y.o.) and 21 hemodialysis patients (14 males, 72.4 + 13.3 y.o., dialysis vintage 30 + 75.1 months).
Not applicable.
MVF measurements were assessed with belt-stabilized HHD and dynamometer chair, by two independent investigators. The agreement between the two devices would be quantified using the Bland-Altman 95% limits of agreement (LOA) method and the Spearman correlation.
For healthy subjects and hemodialysis patients, Spearman coefficients between belt-stabilized HHD and dynamometer chair were 0.63 and 0.75, respectively (P < .05). In hemodialysis group, reliability was excellent for both the intratester and intertester reliability R = 0.85 (P < .01) and R = 0.90 (P < .01), respectively. In all individuals, the mean difference between the dynamometer chair and the belt-stabilized HHD was -13.07 ± 21.77 N.m. (P < .001). The LOA for the upper and the lower was 29.59 and -55.73 N.m., respectively.
In healthy subjects and in hemodialysis patients, the belt-stabilized HHD dynamometer appears as a valid and reliable method to measure in clinical practice isometric MVF of quadriceps in hemodialysis patients. Therefore, the belt-stabilized HHD appears as a suitable and a relevant diagnostic tool for the identification of muscle dysfunction in hemodialysis patients.
在血液透析中，肌肉力量减弱是死亡率的一个主要预后因素。目前，股四头肌等长最大自主收缩力（MVF）的测量是研究肌肉力量的参考方法。然而，由于临床实践中缺乏便携式床边工具，这些患者中MVF的降低很少被检测到。因此，本研究的目的是评估带稳定手持式测力计（HHD）与测力计椅（参考方法）的一致性，并确定在健康受试者和血液透析患者中使用带稳定HHD测量股四头肌MVF时测试者内部和测试者之间的可靠性。
重复测量横断面研究。
临床和学术医院。
53名健康成年受试者（23名男性，36.5±12.5岁）和21名血液透析患者（14名男性，72.4±13.3岁，透析龄30±75.1个月）。
不适用。
由两名独立研究人员使用带稳定HHD和测力计椅评估MVF测量值。将使用Bland-Altman 95%一致性界限（LOA）方法和Spearman相关性对两种设备之间的一致性进行量化。
对于健康受试者和血液透析患者，带稳定HHD与测力计椅之间的Spearman系数分别为0.63和0.75（P<.05）。在血液透析组中，测试者内部和测试者之间的可靠性均极佳，R分别为0.85（P<.01）和0.90（P<.01）。在所有个体中，测力计椅与带稳定HHD之间的平均差异为-13.07±21.77N·m（P<.001）。上下限的LOA分别为29.59和-55.73N·m。
在健康受试者和血液透析患者中，带稳定HHD测力计似乎是临床实践中测量血液透析患者股四头肌等长MVF的一种有效且可靠的方法。因此，带稳定HHD似乎是识别血液透析患者肌肉功能障碍的一种合适且相关的诊断工具。
