Reliability of dynamometry to quantify isometric strength following traumatic brain injury

The quality of measurement properties of neurocognitive assessment in brain tumor clinical trials over the last 30 years: a COSMIN checklist-based approach

PURPOSE

To provide an exhaustive review of the neuropsychological examination as conducted in brain tumor clinical trials over the last 30 years and to provide objective ratings about the reliability and suitability of such tests in neurooncological research and clinical practice.

METHODS

Methodologies and tools provided by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) were exploited in order to assess the measurement properties of questionnaires and performance-based instruments used to evaluate cognitive functioning in brain tumor clinical trials from 1997 to 2017.

RESULTS

Twenty-six brain tumor clinical trials were analyzed and an overall set of 10 neuropsychological tests was identified. A list of 24 studies concerning the reliability of such tests was analyzed. Reliability and level of evidence scores for each study and for each test were obtained. The results revealed relevant faults about the quality of measurements and the suitability of the neurocognitive assessment batteries most commonly used in brain tumor clinical trials.

CONCLUSION

Our findings suggest that the cognitive assessment in brain tumor clinical trials should be implemented according to specific endpoints and should be addressed to investigate all the cognitive domains known to be affected by brain tumor and treatment.

Pediatric Traumatic Brain Injury and Exercise Medicine: A Narrative Review

The multidisciplinary field of pediatric traumatic brain injury (TBI) and exercise medicine is of growing importance. There is active study into the diagnostic and therapeutic potential of exercise in pediatric TBI as well as the effects of TBI on postinjury fitness. With the evidence-based growing, a literature review can help establish the state of the science and inform future research. Therefore, the authors performed a narrative review (based on a search of 6 health sciences databases) to summarize evidence on pediatric TBI and cardiorespiratory fitness, muscular fitness and neuromotor control, and obesity. To date, studies related to cardiorespiratory fitness have centered on exercise tolerance and readiness to return to play, and indicate that protracted rest may not facilitate symptom recovery; this suggests a role for exercise in concussion management. Furthermore, strength and gait may be impaired following pediatric brain injury, and interventions designed to train these impairments may lead to their improvement. Pediatric brain injury can also lead to changes in body composition (which may be related to poorer cognitive recovery), but additional research is required to better understand such associations. This narrative review of pediatric TBI and exercise medicine can serve as a reference for researchers and clinicians alike.

Comparison of isometric triceps brachii force measurement in different elbow positions

PURPOSE

Objective and reliable force measurement is necessary to monitor the rehabilitation after triceps brachii pathology, injuries, and posterior approach-based surgery. It is unclear at which amount of extension the triceps is best tested and if comparison to the uninjured sided is reliable. This study aims to identify the most reliable elbow position at which elbow extension force is measured using a dynamometer. Furthermore, it aims to compare the extension strength of the dominant arm with that of the nondominant arm.

METHODS

Isometric elbow extension force of the dominant and nondominant arms of healthy subjects was measured. The measurements were taken in three sequences per arm in 0, 30, 60, 90, and 120 degrees of flexion. A subgroup repeated the measurements to analyze test-retest reliability using intraclass correlation.

RESULTS

We included a total of 176 volunteers. The repeated measures analysis of variance for within-subject effect showed the lowest variation coefficient at 30 degrees of flexion. Extension forces showed a mean difference of 3.2-6.9 N in advantage of the dominant arm, resulting in ratios from 1.05 to 1.09. Learning curve analysis showed that during the first session in dominant and nondominant arms, less forces were exerted.

CONCLUSION

The most reliable isometric triceps brachii muscle strength measurement was at 30 degrees of flexion of the elbow. Considering the learning curve, a first tryout session for both arms is indicated. Then, a second measurement suffices as no further learning curve is observed.

Within-session reliability and smallest real difference of muscle strength following nerve transfers in patients with brachial plexus injuries

PURPOSE

To quantify the smallest real difference (SRD) of muscle strength in patients with brachial plexus injuries (BPI) after nerve transfer.

METHODS

This study enrolled 16 patients with BPI who had C5-C6 and C5-C7 root injuries and who received nerve transfer of the spinal accessory nerve to the suprascapular nerve and fascicles of the ulnar nerve to the branch of the musculocutaneous nerve that innervates the biceps muscle. The quantitative peak strength of the shoulder abductor, external rotator, and elbow flexor in both arms were measured by the hand-held dynamometer. The SRD of each muscle was determined from the values of the intraclass correlation coefficient and standard error of measurement.

RESULTS

In the involved arm, peak strength ranged from 18% of the noninvolved (shoulder external rotator) to 40% of the noninvolved (shoulder abductor). The intraclass coefficient for within-session reliability revealed good to excellent reliability for muscles, ranging from 0.86 to 0.99 and 0.87 to 0.91 in the involved and noninvolved arms, respectively. The SRD values were low for the shoulder external rotator (2.6 kg) and high for the elbow flexor (3.3 kg).

CONCLUSIONS

The hand-held dynamometer is a device with good to excellent reliability for measuring the objective strength of patients with BPI in a single session. The SRD values established in the current study are more applicable for patients achieving a Medical Research Council grading of 3 or higher and can be used to detect real changes occurring after intervention, which can thereby differentiate real changes from changes that could be attributed to random variation in the measurements.

TYPE OF STUDY/LEVEL OF EVIDENCE

Diagnosis II.

Clinical tests of ankle plantarflexor strength do not predict ankle power generation during walking

OBJECTIVE

The aim of this study was to investigate the relationship between a clinical test of ankle plantarflexor strength and ankle power generation (APG) at push-off during walking.

DESIGN

This is a prospective cross-sectional study of 102 patients with traumatic brain injury.

OUTCOME MEASURES

Handheld dynamometry was used to measure ankle plantarflexor strength. Three-dimensional gait analysis was performed to quantify ankle power generation at push-off during walking.

RESULTS

Ankle plantarflexor strength was only moderately correlated with ankle power generation at push-off (r = 0.43, P < 0.001; 95% confidence interval, 0.26-0.58). There was also a moderate correlation between ankle plantarflexor strength and self-selected walking velocity (r = 0.32, P = 0.002; 95% confidence interval, 0.13-0.48).

CONCLUSIONS

Handheld dynamometry measures of ankle plantarflexor strength are only moderately correlated with ankle power generation during walking. This clinical test of ankle plantarflexor strength is a poor predictor of calf muscle function during gait in people with traumatic brain injury.

Assessment of the strength of the trunk and upper limb muscles in stroke subjects with portable dynamometry: a literature review

Introduction Clinical measurements of strength in stroke subjects are usually performed and portable dynamometers are one of the most employed instruments. Objective To verify the standardization procedures of the methods used to assess the strength of the trunk and upper limb muscles with portable dynamometers in stroke subjects, as well as to assess the psychometric properties which were already investigated. Materials and methods An extensive search was performed on the MEDLINE, SciELO, LILACS, and PEDro databases, by combining specific key words, followed by active manual searches by two independent researchers. Results and discussion Fifty-eight studies were included: three related to the trunk and 55 to the upper limb muscles, including handgrip and pinch strength assessments. The most investigated muscular groups were handgrip, elbow flexors/extensors, wrist extensors, and lateral pinch. Nine studies reported adequate reliability levels and the seated position was employed in the majority of the studies which assessed trunk, handgrip, and pinch strength, while the supine position was used for the other muscular groups. The number of trials most used was three, while the reported contractions and rest times were variable. Final considerations Most studies reported the positioning and/or the data collection protocols; however, there was no consensus on the standardization procedures. The only investigated psychometric property was reliability. Few studies evaluated the trunk muscles and other psychometric properties.

[Early rehabilitation for neurologic patients]

Rehabilitation improves the functional prognosis of patients after a neurologic lesion, and tendency is to begin rehabilitation as soon as possible. This review focuses on the interest and the feasibility of very early rehabilitation, initiated from critical care units. It is necessary to precisely assess patients' impairments and disabilities in order to define rehabilitation objectives. Valid and simple tools must support this evaluation. Rehabilitation will be directed to preventing decubitus complications and active rehabilitation. The sooner rehabilitation is started; the better functional prognosis seems to be.

A systematic review of dynamometry and its role in hand trauma assessment

The dynamometer was developed by American neurologists and came into general use in the late 19th century. It is still used in various ways as a diagnostic and prognostic tool in clinical settings. In this systematic review we assessed in detail the different uses of dynamometry, its reliability, different dynamometers used and the influence of rater experience by bringing together and evaluating all published literature in this field. It was found that dynamometry is applied in a wide range of medical conditions. Furthermore, the great majority of studies reported acceptable to high reliability of dynamometry. Jamar mechanical dynamometer was used most often in the studies reviewed. There were mixed results concerning the effect of rater experience. The factors influencing the results of dynamometry were identified as age, gender, body weight, grip strength, BMI, non/dominant hand, assessing upper/lower limbs, rater and patient’s strength and the distance from the joint where the dynamometer is placed. This review provides an understanding of the relevance and significance of dynamometry which should serve as a starting point to guide its use in hand trauma assessment. On the basis of our findings, we suggest that hand dynamometry has a great potential, and could be used more often in clinical practice.

Test–retest reliability of hand-held dynamometry and functional tests in systemic lupus erythematosus

The aim of this study was to evaluate the test–retest reliability and determine the degree of measurement error of tests of isometric muscle strength and upper and lower limb function in women with systemic lupus erythematosus (SLE). Twelve women with SLE (age 39.8 ± 10 years) were assessed on two occasions separated by a 7–10-day interval. Strength of six muscle groups was measured using a hand-held dynamometer; function was measured by the 30-s sit to stand test and the 30-s 1 kg arm lift. Relative reliability was estimated using the intraclass correlation coefficient (ICC), model 2,1 (ICC2,1). Absolute reliability was estimated using standard error measurement and the minimal detectable difference was calculated. All ICCs were greater than 0.87. Muscle strength would need to increase by between 18% and 39% in women with SLE to be 95% confident of detecting real changes. The functional tests demonstrated a systematic bias between trials. This study demonstrates that hand-held dynamometry in SLE can be performed with excellent reliability. Further work needs to be completed to determine the number of trials necessary for both the 30-s sit to stand and 30-s 1 kg arm lift to decrease the systematic bias.