Department of Neurology, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.
J Neurol. 2021 May;268(5):1738-1746. doi: 10.1007/s00415-020-10366-9. Epub 2020 Dec 23.
We aimed to determine (1) the test-retest reliability of a newly developed portable fixed dynamometer (PFD) as compared to the hand-held dynamometer (HHD) in patients with motor neuron disease (MND) and (2) the PFD's ability to reduce possible examiner-induced ceiling effects.
Test-retest reliability of isometric muscle strength of the quadriceps was measured in patients with MND and non-neurological controls using the HHD and PFD. Reliability was estimated by the intraclass correlation coefficient (ICC) and standard error of measurement (SEM) using linear mixed effects models, and the Bland-Altman method of agreement.
In total, 45 patients with MND and 43 healthy controls were enrolled in this study. The ICC of the PFD was excellent and similar in both patients and controls (ICC 99.5% vs. ICC 98.6%) with a SEM of 6.2%. A strong examiner-induced ceiling effect in HHD was found when the participant's strength exceeded that of examiner. Employing the PFD increased the range of muscle strength measurements across individuals nearly twofold from 414 to 783 N.
Portable fixed dynamometry may significantly reduce examiner-induced ceiling effects, optimize the standardization of muscle strength testing, and maximize reliability. Ultimately, PFD may improve the delivery of care due to its potential for unsupervised, home-based assessments and reduce the burden to the patient of participating in clinical trials for MND or other neuromuscular diseases.
我们旨在确定（1）新开发的便携式固定测力计（PFD）与手持式测力计（HHD）在运动神经元病（MND）患者中的测试-再测试可靠性，以及（2）PFD 降低可能的检查者引起的天花板效应的能力。
使用 HHD 和 PFD 测量 MND 患者和非神经对照组的股四头肌等长肌肉力量的测试-再测试可靠性。使用线性混合效应模型和协议的 Bland-Altman 方法，通过组内相关系数（ICC）和测量标准误差（SEM）来估计可靠性。
本研究共纳入 45 例 MND 患者和 43 例健康对照者。PFD 的 ICC 在患者和对照组中均为优秀且相似（ICC 99.5% vs. ICC 98.6%），其 SEM 为 6.2%。当参与者的力量超过检查者的力量时，HHD 中发现了强烈的检查者引起的天花板效应。使用 PFD 使个体的肌肉力量测量范围几乎增加了两倍，从 414 到 783 N。
便携式固定测力计可显著降低检查者引起的天花板效应，优化肌肉力量测试的标准化，并最大限度地提高可靠性。最终，由于其可能进行非监督、家庭评估的潜力，以及减少患者参与 MND 或其他神经肌肉疾病临床试验的负担，PFD 可能会改善护理的提供。
