Muscle strength assessment in critically ill patients with handheld dynamometry: an investigation of reliability, minimal detectable change, and time to peak force generation

Baldwin, Calire, Paratz, Jennifer D. and Bersten, Andrew (2013) Muscle strength assessment in critically ill patients with handheld dynamometry: an investigation of reliability, minimal detectable change, and time to peak force generation. Journal of Critical Care, 28 1: 77-86. doi:10.1016/j.jcrc.2012.03.001


Author Baldwin, Calire
Paratz, Jennifer D.
Bersten, Andrew
Title Muscle strength assessment in critically ill patients with handheld dynamometry: an investigation of reliability, minimal detectable change, and time to peak force generation
Journal name Journal of Critical Care   Check publisher's open access policy
ISSN 0883-9441
1557-8615
Publication date 2013-02-01
Sub-type Article (original research)
DOI 10.1016/j.jcrc.2012.03.001
Volume 28
Issue 1
Start page 77
End page 86
Total pages 10
Place of publication Maryland Heights, MO, United States
Publisher W.B. Saunders
Collection year 2014
Language eng
Formatted abstract
Purpose: Dynamometry is an objective tool for volitional strength evaluation that may overcome the limited sensitivity of the Medical Research Council scale for manual muscle tests, particularly at grades 4 and 5. The primary aims of this study were to investigate the reliability, minimal detectable change, and time to peak muscle force, measured with portable dynamometry, in critically ill patients.
Materials and methods: Isometric hand grip, elbow flexion, and knee extension were measured with portable dynamometry.
Results: Interrater consistency (intraclass correlation coefficient [95% confidence interval]) (0.782 [0.321-0.930] to 0.946 [0.840-0.982]) and test-retest agreement (0.819 [0.390-0.943] to 0.918 [0.779-0.970]) were acceptable for all dynamometry forces, with the exception of left elbow flexion. Despite generally good reliability, a mean change (upper 95% confidence interval) of 2.8 (7.8) kg, 1.9 (5.2) kg, and 2.6(7.1) kg may be required from a patient's baseline force measurement of right grip, elbow flexion, and knee extension to reflect real force changes. There was also a delay in the time for critically ill patients to generate peak muscle forces, compared with healthy controls (P ≤ .001).
Conclusions: Dynamometry can provide reliable measurements in alert critically ill patients, but moderate changes in strength may be required to overcome measurement error, during the acute recovery period. Deficits in force timing may reflect impaired neuromuscular control.
Keyword Intensive care
Skeletal muscle
Quadriceps muscle
Muscle strength dynamometer
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
School of Medicine Publications
 
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Created: Tue, 18 Dec 2012, 01:20:54 EST by Sia Athanasas on behalf of Anaesthesiology and Critical Care - RBWH