Directorate of Research and Education, Physiotherapy Occupational Therapy Research Center, University Hospital Zurich, Zurich, Switzerland.
Department of Health, Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland.
PLoS One. 2018 Mar 29;13(3):e0194531. doi: 10.1371/journal.pone.0194531. eCollection 2018.
Manual muscle testing (MMT) and hand-held dynamometry (HHD) are commonly used in people with inflammatory myopathy (IM), but their clinimetric properties have not yet been sufficiently studied. To evaluate the reliability and validity of MMT and HHD, maximum isometric strength was measured in eight muscle groups across three measurement events. To evaluate reliability of HHD, intra-class correlation coefficients (ICC), the standard error of measurements (SEM) and smallest detectable changes (SDC) were calculated. To measure reliability of MMT linear Cohen`s Kappa was computed for single muscle groups and ICC for total score. Additionally, correlations between MMT8 and HHD were evaluated with Spearman Correlation Coefficients. Fifty people with myositis (56±14 years, 76% female) were included in the study. Intra-and interrater reliability of HHD yielded excellent ICCs (0.75-0.97) for all muscle groups, except for interrater reliability of ankle extension (0.61). The corresponding SEMs% ranged from 8 to 28% and the SDCs% from 23 to 65%. MMT8 total score revealed excellent intra-and interrater reliability (ICC>0.9). Intrarater reliability of single muscle groups was substantial for shoulder and hip abduction, elbow and neck flexion, and hip extension (0.64-0.69); moderate for wrist (0.53) and knee extension (0.49) and fair for ankle extension (0.35). Interrater reliability was moderate for neck flexion (0.54) and hip abduction (0.44); fair for shoulder abduction, elbow flexion, wrist and ankle extension (0.20-0.33); and slight for knee extension (0.08). Correlations between the two tests were low for wrist, knee, ankle, and hip extension; moderate for elbow flexion, neck flexion and hip abduction; and good for shoulder abduction. In conclusion, the MMT8 total score is a reliable assessment to consider general muscle weakness in people with myositis but not for single muscle groups. In contrast, our results confirm that HHD can be recommended to evaluate strength of single muscle groups.
手动肌肉测试（MMT）和手持测力计（HHD）常用于炎性肌病（IM）患者，但它们的临床计量学特性尚未得到充分研究。为了评估 MMT 和 HHD 的可靠性和有效性，在三次测量事件中测量了八个肌肉群的最大等长力量。为了评估 HHD 的可靠性，计算了组内相关系数（ICC）、测量标准误差（SEM）和最小可检测变化（SDC）。为了评估 MMT 的可靠性，计算了单个肌肉群的线性 Cohen`s Kappa 和总评分的 ICC。此外，还使用 Spearman 相关系数评估了 MMT8 和 HHD 之间的相关性。研究纳入了 50 名肌炎患者（56±14 岁，76%为女性）。除了踝关节伸展的组间可靠性（0.61）外，所有肌肉群的 HHD 组内和组间可靠性均具有极好的 ICC（0.75-0.97）。相应的 SEM%范围为 8%至 28%，SDC%范围为 23%至 65%。MMT8 总评分显示出极好的组内和组间可靠性（ICC>0.9）。肩部和髋关节外展、肘部和颈部屈曲以及髋关节伸展的单个肌肉群的组内可靠性较高（0.64-0.69）；腕部（0.53）和膝关节伸展（0.49）中等，踝关节伸展（0.35）较低。颈部屈曲（0.54）和髋关节外展（0.44）的组间可靠性为中度；肩部外展、肘部屈曲、腕部和踝关节伸展的组间可靠性为轻度（0.20-0.33）；膝关节伸展的组间可靠性为轻度（0.08）。两个测试之间的相关性较低的是腕部、膝关节、踝关节和髋关节伸展；肘部屈曲、颈部屈曲和髋关节外展的相关性中等；肩部外展的相关性良好。总之，MMT8 总评分是评估肌炎患者整体肌肉无力的可靠方法，但不适用于单个肌肉群。相比之下，我们的结果证实 HHD 可用于评估单个肌肉群的力量。
