Leijendekkers Ruud A, Hinte Gerben van, Sman Amy D, Staal J Bart, Nijhuis-van der Sanden Maria W G, Hoogeboom Thomas J
Department of Orthopaedics, Physical Therapy, Radboud University Medical Centre, Nijmegen, the Netherlands.
Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Centre, Nijmegen, the Netherlands.
PLoS One. 2017 Jun 22;12(6):e0179887. doi: 10.1371/journal.pone.0179887. eCollection 2017.
Suitable handheld dynamometer (HHD)-techniques to test hip abduction strength in individuals with a lower extremity amputation, irrespective of their amputation level are absent. The aim of this study was to optimise a HHD-technique and to test its reproducibility and validity.
This study involved three phases, in which two techniques were evaluated. Both HHD-techniques used a lever-arm of 22 centimetre. HHD-technique 1 used a break-technique. After obtaining within-session test-retest reproducibility (phase 1) we optimised the HHD-technique by adding a fixation-belt and using a make-technique (HHD-technique 2). We tested the within-session test-retest and inter-rater reproducibility (phase 2) and the validity (phase 3) of HHD-technique 2 using an isokinetic dynamometer. New cohorts of participants were recruited for each phase.
Phase 1: we tested HHD-technique 1 in 26 participants with a lower extremity amputation. It was test-retest reproducible (ICC3.1agreement: 0.80-0.92, standard error of measurement (SEM): 3.1-4.4 Nm and smallest detectable change (SDC): 8.6-12.3 Nm). There were questions regarding the validity of the measurement, because the mean muscle torque of the residual limb and sound limb were similar, which is uncommon. Phase 2: reproducibility of HHD-technique 2 was tested in 44 participants with a lower extremity amputation. It was test-retest reproducible (ICC3.1agreement: 0.96-0.97, SEM: 3.9-4.7 Nm and SDC: 10.9-12.9 Nm) but not inter-rater reproducible despite having good reliability (ICC3.1agreement: 0.92, SEM: 6.9-7.6 Nm and SDC: 19.2-21.2 Nm). Systematic bias and bias related to the magnitude of the muscle torque was suspected. Phase 3: the concurrent validity was established in 30 healthy participants (r = 0.84). Systematic bias in measurement error was present, including a consistent overestimation of the muscle torque of 28% using the HHD.
HHD-technique 2 is a test-retest reproducible and valid measuring technique The technique may be further optimised by the use of an external device to stabilise the HHD.
目前尚无适用于测试下肢截肢者髋关节外展力量的手持式测力计（HHD）技术，无论其截肢水平如何。本研究的目的是优化一种HHD技术，并测试其重现性和有效性。
本研究包括三个阶段，对两种技术进行了评估。两种HHD技术均使用22厘米的力臂。HHD技术1采用制动技术。在获得组内重测重现性（第一阶段）后，我们通过添加固定带并采用推动技术（HHD技术2）对HHD技术进行了优化。我们使用等速测力计测试了HHD技术2的组内重测和评分者间重现性（第二阶段）以及有效性（第三阶段）。每个阶段招募了新的参与者队列。
第一阶段：我们对26名下肢截肢参与者测试了HHD技术1。它具有重测重现性（组内相关系数（ICC3.1一致性）：0.80 - 0.92，测量标准误差（SEM）：3.1 - 4.4牛米，最小可检测变化（SDC）：8.6 - 12.3牛米）。关于测量的有效性存在疑问，因为残肢和健侧肢体的平均肌肉扭矩相似，这并不常见。第二阶段：对44名下肢截肢参与者测试了HHD技术2的重现性。它具有重测重现性（ICC3.1一致性：0.96 - 0.97，SEM：3.9 - 4.7牛米，SDC：10.9 - 12.9牛米），但尽管可靠性良好（ICC3.1一致性：0.92，SEM：6.9 - 7.6牛米，SDC：19.2 - 21.2牛米），评分者间却没有重现性。怀疑存在系统偏差以及与肌肉扭矩大小相关的偏差。第三阶段：在30名健康参与者中建立了同时效度（r = 0.84）。测量误差中存在系统偏差，包括使用HHD时肌肉扭矩持续高估28%。
HHD技术2是一种重测重现性良好且有效的测量技术。该技术可通过使用外部设备稳定HHD进一步优化。
