Therapy Services, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, United Kingdom.
Birmingham Hand and Peripheral Nerve Centre, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, United Kingdom.
Hand Surg Rehabil. 2023 Sep;42(4):332-336. doi: 10.1016/j.hansur.2023.05.005. Epub 2023 May 22.
Motor outcome following a brachial plexus injury is frequently measured to evaluate the success of surgical interventions. We aimed to identify whether the manual muscle testing using the Medical Research Council (MRC) method in adults with C5/6/7 motor weakness was reliable and whether its results correlated with functional recovery.
Two experienced clinicians examined 30 adults with C5/6/7 weakness following proximal nerve injury. The examination included using the modified MRC to assess motor outcome in the upper limb. Kappa statistics were calculated to evaluate inter-tester reliability. Correlation coefficients was calculated to explore the correlation between the MRC and the Disabilities of the Arm Shoulder and Hand (DASH) score and each EQ5D domain.
We found that grades 3-5 of the modified and unmodified MRC motor rating scales have poor inter-rater reliability when assessing C5/6/7 innervated muscles in adults with a proximal nerve injury. The Deltoid Posterior and the Extensor Carpi Radialis Longus were the only muscles (using the modified MRC) to achieve a Kappa over 0.6 indicating substantial reliability. Higher combined MRC scores correlated significantly with a lower DASH and vice versa. Similarly, higher combined scores of MRC correlated significantly with a higher rating of overall health on the EQ5D VAS.
This study demonstrates that the MRC motor rating scale has poor inter-rater reliability when assessing C5/C6/C7 innervated muscles in adults following proximal nerve injury. Other methods of assessing motor outcome following proximal nerve injury need to be considered.
臂丛神经损伤后的运动功能结果常被用于评估手术干预的效果。我们旨在明确成人 C5/6/7 运动神经弱点中，使用肌力量评估的 MRC 方法是否可靠，以及其结果是否与功能恢复相关。
两位经验丰富的临床医生对 30 名近端神经损伤后 C5/6/7 无力的成年人进行了检查。检查包括使用改良的 MRC 评估上肢的运动结果。通过 Kappa 统计评估测试者间的可靠性。通过计算相关系数来探讨 MRC 与 DASH 评分和 EQ5D 每个领域之间的相关性。
我们发现，对于近端神经损伤的成年人，评估 C5/6/7 神经支配肌肉的改良和未改良 MRC 运动评分量表，等级 3-5 的测试者间可靠性较差。三角肌后和桡侧伸腕长肌是唯一（使用改良 MRC）达到 Kappa 值大于 0.6 的肌肉，具有显著可靠性。更高的 MRC 综合评分与较低的 DASH 评分显著相关，反之亦然。同样，MRC 综合评分越高，在 EQ5D VAS 上的总体健康评分也越高。
本研究表明，在评估近端神经损伤后成人 C5/C6/C7 神经支配肌肉的 MRC 运动评分量表时，测试者间可靠性较差。需要考虑其他评估近端神经损伤后运动结果的方法。
