Dynamometry for the measurement of grip, pinch, and trunk muscles strength in subjects with subacute stroke: reliability and different number of trials

Aguiar, Larissa T.; Martins, Júlia C.; Lara, Eliza M.; Albuquerque, Julianna A.; Teixeira-Salmela, Luci F.; Faria, Christina D. C. M.

doi:10.1590/bjpt-rbf.2014.0173

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Brazilian Journal of Physical Therapy

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Original Articles • Braz. J. Phys. Ther. 20 (05) • Oct 2016 • https://doi.org/10.1590/bjpt-rbf.2014.0173 copy

Dynamometry for the measurement of grip, pinch, and trunk muscles strength in subjects with subacute stroke: reliability and different number of trials

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Background

Muscle strength is usually measured in individuals with stroke with Portable dynamometers (gold standard). However, no studies have investigated the reliability, the standard error of measurement (SEM) and the minimal detectable difference (MDD_95%) of the dynamometry for the measurement of hand grip, pinch grip and trunk strength in subjects with subacute stroke.

Objective

1) To investigate the intra and inter-rater reliability, the SEM and the MDD_95% of the portable dynamometers for the measurement of grip, pinch and trunk strength in subjects with subacute stroke, and 2) to verify whether the use of different number of trials (first trial and the average of the first two and three trials) affected the results.

Method

32 subjects with subacute stroke (time since stroke onset: 3.6 months, SD=0.66 months) were evaluated. Hand grip, 3 pinch grips (i.e. pulp-to-pulp/palmar/lateral) and 4 trunk muscles (i.e. flexors, extensors, lateral flexors and rotators) strength were bilaterally assessed (except trunk flexors/extensors) with portable dynamometry by two independent examiners over two sessions (1-2 weeks apart). One-way ANOVAs and intraclass correlation coefficients (ICC_2,k) were used for analysis (α=0.05). SEM and MDD_95% were also calculated.

Results

For all muscular groups and sources of outcome values, including one trial, after familiarization, similar results were found (0.01≤F≤0.08; 0.92≤p≤0.99) with significant and adequate values of intra-rater (0.64≤ICC≤0.99; 0.23≤95%CI≤0.99) and inter-rater (0.66≤ICC≤0.99; 0.25≤95%CI≤0.99) reliability. SEM and MDD_95% were considered low (0.39≤EPM≤2.21 Kg; 0.96≤MMD_95%≤6.12 Kg) for all outcome scores.

Conclusion

Only one trial, following familiarization, demonstrated adequate intra-rater and inter-rater reliability of the portable dynamometers for the measurement of hand grip, pinch grip and trunk strength in subjects with subacute stroke.

Keywords:
physical therapy; muscle strength dynamometer; reproducibility of results; stroke

Characteristics	n=32
Age (years): mean (SD); range [min-max]	63 (12); [35-85]
Time since the onset of stroke (months): mean; range [min-max]	3.6 (0.66); [3-5]
Body mass index (Kg/m²): mean (SD); range [min-max]	25 (4.3); [15-37]
Gender
Men: number (percentage)	18 (56%)
Paretic Side
Right: number (percentage)	17 (53%)
Type of stroke
Ischaemic: number (percentage)	30 (94%)
Haemorrhagic: number (percentage)	1 (3%)
Ischaemic and Haemorrhagic: number (percentage)	1 (3%)
Upper Limb Motor Impairment (Fugl-Meyer Scale). score (0-66)
Mild motor impairments: number (percentage)	24 (75%)
Moderate: number (percentage)	1 (3%)
Severe: number (percentage)	7 (22%)
Trunk Performance scale: median (IQR). score (0-23)	16 (6)

Muscular groups (n)	First trial	Mean of two first trials	Mean of three trials		ANOVA (F; p)
Non-paretic upper extremity
Hand grip (25)	28.12±10.48	27.76±10.45	27.41±10.29		0.03; 0.98
Pulp-to-pulp pinch (23)	4.25±1.63	4.22±1.55	4.20±1.51		0.02; 0.98
Tripod pinch (23)	5.63±2.31	5.58±2.03	5.56±1.92		0.01; 0.99
Lateral pinch (23)	7.09±2.10	7.27±2.01	7.22±1.97		0.02; 0.98
Paretic upper extremity
Hand grip (18)	26.31±9.86	25.62±9.97	25.54±10.06		0.01; 0.99
Pulp-to-pulp pinch (17)	4.08±1.44	3.88±1.54	3.89±1.56		0.01; 0.99
Tripod pinch (17)	4.88±2.29	5.02±2.22	4.94±2.09		0.04; 0.97
Lateral pinch (19)	6.32±2.84	6.16±2.77	6.11±2.72		0.01; 0.99
Trunk
Anterior trunk flexors (20)	9.39±3.48	9.28±3.56	9.25±3.48	0.01; 0.99
Trunk extensors (20)	10.26±3.23	10.16±3.12	9.87±3.25	0.08; 0.92
Right lateral trunk flexors (20)	8.32±2.85	8.35±2.96	8.51±2.99	0.03; 0.98
Left lateral trunk flexors (20)	8.43±2.76	8.64±2.73	8.62±2.74	0.04; 0.97
Right trunk rotators (20)	7.71±2.58	7.46±2.51	7.44±2.56	0.07; 0.93
Left trunk flexors (20)	7.46±2.69	7.34±2.65	7.22±2.58	0.04; 0.96

Muscular groups (n)	Intra-rater reliability
	First trial	Mean of two first trials	Mean of three trials
	ICC_2.1 [95% CI]	ICC_2.2 [95% CI]	ICC_2.3 [95% CI]
Non-paretic upper extremity
Hand grip (17)	0.95^* * p≤0.001. [0.87-0.98]	0.98^* * p≤0.001. [0.94-0.99]	0.99^* * p≤0.001. [0.96-0.99]
Pulp-to-pulp pinch (16)	0.64^ p=0.003. [0.23-0.86]	0.83^* * p≤0.001. [0.50-0.94]	0.85^* * p≤0.001. [0.57-0.95]
Tripod pinch (16)	0.84^* * p≤0.001. [0.60-0.94]	0.93^* * p≤0.001. [0.80-0.98]	0.95^* * p≤0.001. [0.85-0.98]
Lateral pinch (16)	0.84^* * p≤0.001. [0.60-0.94]	0.93^* * p≤0.001. [0.79-0.98]	0.94^* * p≤0.001. [0.84-0.98]
Paretic upper extremity
Hand grip (13)	0.97^* * p≤0.001. [0.90-0.99]	0.99^* * p≤0.001. [0.96-0.99]	0.98^* * p≤0.001. [0.95-0.99]
Pulp-to-pulp pinch (12)	0.82^* * p≤0.001. [0.51-0.95]	0.89^* * p≤0.001. [0.63-0.97]	0.90^* * p≤0.001. [0.67-0.97]
Tripod pinch (12)	0.85^* * p≤0.001. [0.57-0.91]	0.95^* * p≤0.001. [0.81-0.98]	0.95^* * p≤0.001. [0.81-0.98]
Lateral pinch (14)	0.91^* * p≤0.001. [0.74-0.97]	0.95^* * p≤0.001. [0.85-0.99]	0.96^* * p≤0.001. [0.88-0.99]
Trunk
Anterior trunk flexors (20)	0.87^* * p≤0.001. [0.71-0.95]	0.94^* * p≤0.001. [0.85-0.98]	0.94^* * p≤0.001. [0.85-0.98]
Trunk extensors (20)	0.79^* * p≤0.001. [0.55-0.91]	0.89^* * p≤0.001. [0.70-0.96]	0.90^* * p≤0.001. [0.71-0.96]
Right lateral trunk flexors (20)	0.84^* * p≤0.001. [0.51-0.94]	0.94^* * p≤0.001. [0.84-0.98]	0.96^* * p≤0.001. [0.89-0.98]
Left lateral trunk flexors (20)	0.88^* * p≤0.001. [0.72-0.95]	0.96^* * p≤0.001. [0.90-0.98]	0.96^* * p≤0.001. [0.90-0.98]
Right trunk rotators (20)	0.77^* * p≤0.001. [0.39-0.91]	0.89^* * p≤0.001. [0.69-0.96]	0.89^* * p≤0.001. [0.72-0.96]
Left trunk rotators (20)	0.74^* * p≤0.001. [0.46-0.89]	0.92^* * p≤0.001. [0.79-0.97]	0.94^* * p≤0.001. [0.84-0.98]

Muscular groups (n)	Inter-rater reliability
	First trial	Mean of two first trials	Mean of three trials
	ICC_2.1 [95% CI]	ICC_2.2 [95% CI]	ICC_2.3 [95% CI]
Non-paretic upper extremity
Hand grip (24)	0.95^* * p≤0.001. [0.89-0.98]	0.98^* * p≤0.001. [0.95-0.99]	0.98^* * p≤0.001. [0.96-0.99]
Pulp-to-pulp pinch (22)	0.70^* * p≤0.001. [0.41-0.87]	0.84^* * p≤0.001. [0.61-0.93]	0.85^* * p≤0.001. [0.64-0.94]
Tripod pinch (22)	0.86^* * p≤0.001. [0.69-0.94]	0.94^* * p≤0.001. [0.85-0.97]	0.95^* * p≤0.001. [0.88-0.98]
Lateral pinch (22)	0.91^* * p≤0.001. [0.80-0.96]	0.93^* * p≤0.001. [0.84-0.97]	0.95^* * p≤0.001. [0.88-0.98]
Paretic upper extremity
Hand grip (18)	0.95^* * p≤0.001. [0.88-0.98]	0.98^* * p≤0.001. [0.95-0.99]	0.99^* * p≤0.001. [0.96-0.99]
Pulp-to-pulp pinch (17)	0.70^* * p≤0.001. [0.34-0.88]	0.92^* * p≤0.001. [0.78-0.97]	0.94^* * p≤0.001. [0.83-0.98]
Tripod pinch (17)	0.88^* * p≤0.001. [0.69-0.95]	0.94^* * p≤0.001. [0.84-0.98]	0.94^* * p≤0.001. [0.84-0.98]
Lateral pinch (18)	0.88^* * p≤0.001. [0.72-0.96]	0.93^* * p≤0.001. [0.80-0.97]	0.95^* * p≤0.001. [0.85-0.98]
Trunk
Anterior trunk flexors (26)	0.76^* * p≤0.001. [0.37-0.90]	0.90^* * p≤0.001. [0.59-0.96]	0.91^* * p≤0.001. [0.52-0.97]
Trunk extensors (26)	0.66^* * p≤0.001. [0.14-0.86]	0.84^* * p≤0.001. [0.25-0.95]	0.84^* * p≤0.001. [0.21-0.95]
Right lateral trunk flexors (25)	0.87^* * p≤0.001. [0.74-0.94]	0.92^* * p≤0.001. [0.79-0.97]	0.87^* * p≤0.001. [0.64-0.95]
Left lateral trunk flexors (25)	0.70^* * p≤0.001. [0.33-0.87]	0.85^* * p≤0.001. [0.61-0.94]	0.85^* * p≤0.001. [0.59-0.94]
Right trunk rotators (25)	0.73^* * p≤0.001. [0.22-0.90]	0.83^* * p≤0.001. [0.41-0.94]	0.85^* * p≤0.001. [0.49-0.94]
Left trunk rotators (25)	0.78^* * p≤0.001. [0.52-0.90]	0.87^* * p≤0.001. [0.70-0.95]	0.89^* * p≤0.001. [0.76-0.95]

	Intra-rater reliability (n=24)							Inter-rater reliability (n=32)
Muscular groups	First trial		Mean of first two trials		Mean of three trials			First trial		Mean of first two trials		Mean of three trials
Muscular groups	SEM	MMD_95%	SEM	MMD_95%	SEM	MMD_95%		SEM	MMD_95%	SEM	MMD_95%	SEM	MMD_95%
Non-paretic upper extremity
Hand grip	2.21	6.12	1.38	3.84	0.99		2.74	2.07	5.74	1.27	3.51	1.29	3.57
Pulp-to-pulp pinch	0.79	2.20	0.54	1.51	0.50		1.38	0.80	2.21	0.58	1.62	0.56	1.56
Tripod pinch	0.84	2.33	0.50	1.39	0.41		1.15	0.73	2.01	0.45	1.23	0.41	1.12
Lateral pinch	0.82	2.27	0.54	1.48	0.50		1.38	0.60	1.68	0.52	1.44	0.44	1.22
Paretic upper extremity
Hand grip	1.68	4.64	0.95	2.63	1.33		3.69	2.18	6.03	1.33	3.69	0.93	2.58
Pulp-to-pulp pinch	0.62	1.73	0.52	1.43	0.49		1.36	0.73	2.01	0.39	1.07	0.35	0.96
Tripod pinch	0.87	2.39	0.51	1.41	0.50		1.39	0.79	2.19	0.53	1.47	0.54	1.49
Lateral pinch	0.81	2.26	0.60	1.66	0.52		1.45	0.70	1.95	0.55	1.53	0.46	1.26
Trunk
Anterior trunk flexors	1.23	3.42	0.84	2.33	0.83		2.31	1.78	4.94	1.18	3.28	1.13	3.13
Trunk extensors	1.56	4.31	1.12	3.10	1.06		2.94	2.17	6.00	1.47	4.09	1.45	4.02
Right lateral trunk flexors	1.16	3.20	0.71	1.98	0.59		1.62	1.05	2.91	0.84	2.34	1.07	2.97
Left lateral trunk flexors	0.96	2.66	0.55	1.51	0.54		1.51	1.67	4.63	1.15	3.20	1.19	3.29
Right trunk rotators	1.15	3.19	0.77	2.15	0.80		2.21	1.29	3.57	1.04	2.89	0.99	2.73
Left trunk rotators	1.30	3.61	0.69	1.90	0.59		1.63	1.41	3.91	1.06	2.93	0.96	2.65

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[1] *Correspondence Christina Danielli Coelho de Morais Faria Universidade Federal de Minas Gerais Departamento de Fisioterapia Avenida Antonio Carlos, 6627, Campus Pampulha CEP 31270-901, Belo Horizonte, MG, Brazil e-mail: cdcmf@ufmg.br, chrismoraisf@yahoo.com