Assessment of muscular strength with the modified sphygmomanometer test: what is the best method and source of outcome values?

Effectiveness of a sensorimotor exercise program on proprioception, balance, muscle strength, functional mobility and risk of falls in older people

Introduction

Sensory systems provide the necessary information for a motor response to be provided. In this sense, the objective of this study is to evaluate the effectiveness of a sensorimotor exercise program on proprioceptive acuity, balance, muscle strength, functional mobility and risk of falls in institutionalized elderly.

Methodology

56 participants (84.6 ± 8.4 years) were randomly distributed between the control (CG, n = 28) and intervention groups (IG, n = 28). The CG performed a protocol based on warm-up, muscle strengthening and warm down and the IG performed the same intervention, with the addition of sensorimotor exercises. Joint Position Sensation (JPS) was evaluated in both limbs at angles of 20° and 45°, balance, functional mobility, fear of falling in the elderly and muscle strength of quadriceps, hamstrings, adductors and abductors in both limbs, before and after the 12 weeks of intervention.

Results

Both groups showed gains in muscle strength. When analyzing functionality through Timed Up and Go (TUG), before and after for each group separately, both showed a significant difference (CG p = 0.002; IG p < 0.001). For the Short Physical Performance Battery (SPPB) variable, there were significant differences in IG in balance (p < 0.001), gait speed time (s) (p = 0.004) and sit-to-stand (p = 0.002). In JPS, significant differences were recorded for Absolute Error 45° Non-Dominant (p = 0.045) and Relative Error 45° Non-Dominant (p = 0.045) in the CG and Relative Error 45° Non-Dominant for IG (p = 0.018). In the Falls Efficacy Scale International (FES-I) variable there were significant improvements in the CG (p = 0.006) and in the GI (p = 0.002). However, only IG showed significant improvements (p = 0.013) for Activities-Specific Balance Confident (ABC) in a comparison between before and after the 12-week research period. When comparing the differences verified with the intervention between CG and IG, only balance SPPB (p < 0.001) and sit-to-stand SPPB (p = 0.022) showed significant values.

Conclusion

He effectiveness of sensorimotor exercises provides balance gain in the elderly (p < 0.001) and positively impacts their confidence (p = 0.013) when performing their duties. It is concluded that the protocol presented in its different levels of difficulty is effective and important for the quality of life of the institutionalized sedentary elderly.

Predictors of muscle strength assessed with the modified sphygmomanometer test

OBJECTIVES

To investigate the best predictor of muscle strength assessed with both Modified Sphygmomanometer Test (MST) methods (bag adaptation and non-adapted) and to provide normative values for these two MST methods for the strength assessment of the trunk, upper, and lower limb muscles.

DESIGN

Cross-sectional study.

METHODS

The strength of 42 muscle groups were assessed with the MST in the bag adaptation and non-adapted methods in 120 healthy individuals, 50 % males, divided into three age groups (20-39, 40-59, 60-79) with 40 subjects per group. Stepwise multiple regression analysis was performed to investigate which independent variables (sex, age, and limb dominance) is the best predictor of muscle strength (α = 5 %).

RESULTS

Sex was the best independent predictor for all muscle groups for both MST methods (8.8 % < R2<57.8 %, p < 0.0001), except for the ankle plantar flexors assed with the non-adapted sphygmomanometer, in which age was the best independent predictor (R2 = 25.6 %; p < 0.0001). The normative values of muscle strength were reported for both MST methods considering the subgroups (sex, age, and limb dominance). Ceiling effect was observed when the MST bag adaptation was used to assess some muscles (8.8 %).

CONCLUSION

Sex was the best predictor of muscle strength, as commonly found for muscle strength assessment with the dynamometer. The normative values provided have high clinical utility and can be used to interpret results of muscle strength assessment using both MST methods. For the MST in the bag adaptation method, caution is advised for the assessment of some muscles.

Alternative instrument for the evaluation of handgrip strength in Duchenne muscular dystrophy

Background

The commonly used dynamometers can be ineffective in evaluating handgrip in patients with Duchenne muscular dystrophy (DMD), especially children with generalized muscle weakness. The aim of this study was to analyze whether the modified sphygmomanometer is an effective instrument for handgrip strength evaluation in patients with DMD, during different stages of the disease.

Method

The handgrip strength of 33 patients was evaluated by the Jamar dynamometer and the modified sphygmomanometer. Motor function was evaluated by the Motor Function Measurement (MFM) scale. Four evaluations, with a six-month interval between each, were performed: Evaluation 1 (N = 33), Evaluation 2 (N = 24), Evaluation 3 (N = 15), and Evaluation 4 (N = 8). A linear regression model with mixed effects was used for the longitudinal data and descriptive analysis of strength for all four evaluations.

Result

The first evaluation data presented very high correlations between the dynamometer and the modified sphygmomanometer (r = 0.977; p < 0.001). The longitudinal analysis showed a significant difference between Evaluation 1 and the other handgrip strength evaluations obtained using the dynamometer (p < 0.05) but not the modified sphygmomanometer (p > 0.05). Null values were obtained only when using the dynamometer device.

Conclusion

The modified sphygmomanometer seems to be more suitable than the dynamometer for measuring handgrip strength in all stages of DMD.

Validity of the modified sphygmomanometer test for the assessment of tip pinch strength in Parkinson's disease

BACKGROUND

The tip pinch is one of the most delicate and precise movement of the hand, and it is used to manipulate small objects, commonly observed in the activities of daily living of any individuals. Individuals with Parkinson Disease (PD) with impaired manual dexterity, manipulative skills, and hand weakness have an important barrier for activities of daily life. However, the dynamometer usually used for measuring the tip pinch have a high cost, so, validate a sphygmomanometer can make this assessment more accessible.

OBJECTIVE

To investigate the validity of the modified sphygmomanometer test in the evaluation of tip pinch strength when compared to the gold standard.

METHODS

50 individuals with idiopathic PD took part in the study. The muscle strength of tip pinch on the dominant and non-dominant side was measured by the modified sphygmomanometer test and the gold standard, the dynamometer. Concurrent validity was analyzed using Pearson's correlation coefficient.

RESULTS

50 individuals diagnosed with idiopathic PD, mean age of 67 ± 8.0 years, 68% male, mean time of diagnosis in months of 84 ± 66 and Hoehn and Yahr mean of 2.5 ± 0.6. There was a significant correlation of moderate magnitude between the modified sphygmomanometer test and the dynamometer in dominant side (r = 0.44; p < 0.01) and non-dominant side (r = 0.48; p < 0.01).

CONCLUSION

The modified sphygmomanometer test showed adequate validity for assessing the muscle strength of the tip pinch in individuals with PD.

The modified sphygmomanometer test for assessment of muscle strength of community-dwelling older adults in clinical practice: reliability and validity

Purpose: (a) to investigate the test-retest and inter-rater reliabilities and the criterion-related validity of the modified sphygmomanometer test (MST) for the assessment of muscle strength in community-dwelling older adults, (b) to calculate the standard error of measurement (SEM) and the smallest real difference (SRD); (c) to verify whether the number of trials affect the results.Methods: Bilateral strength of lower limbs (LL) and grip muscles were evaluated with the MST and with portable dynamometers in 50 older adults (69.92 ± 5.52 years). Intra-class Correlation Coefficients (ICC) was used to evaluate the inter-rater and test-retest reliabilities and Pearson Correlations was used to investigate the criterion-related validity of the MST. SEM and SRD were also calculated. Analysis of variance was used to investigate whether the number of trials affects the results.Results: Significant correlations with high to very high magnitude were found for all muscle groups evaluated for test-retest and inter-rater reliabilities (0.80 ≤ ICC ≤ 0.99; p < 0.001) and validity (0.80 ≤ r ≤ 0.91; p < 0.001). Moreover, the values provided by different numbers of trials were similar. The SEM (3.66 ≤ SEM ≤ 20.46) and the SRD (10.15 ≤ SRD95% ≤ 56.70) were considered low for all outcome measures.Conclusion: The MST showed adequate results for all the measurement properties evaluated for the assessment of the muscle strength of older adults.Implications for rehabilitationOlder adults often develop sarcopenia and dynapenia that are associated with an increased number of falls and fractures and loss of independence.Portable dynamometer is the standard instrument to evaluate isometric muscle strength, however this instrument is expensive and it is not readily available in the underdeveloped or in developed countries.The Modified Sphygmomanometer Test is an alternative method for the clinical measurement of muscle strength, is portable, has a low-cost and provides an objective measurement.In this study the Modified Sphygmomanometer Test showed adequate results for all the measurement properties evaluated for the assessment of the muscle strength in community-dwelling older adults and a single trial after test familiarization can be used to measure the muscle strength in this population.

Validity and reliability of the Modified Sphygmomanometer Test with fixed stabilization for clinical measurement of muscle strength

OBJECTIVE

To investigate the concurrent validity of the Modified Sphygmomanometer Test (MST) with fixed stabilization, compared to the portable dynamometer, and to verify its test-retest and inter-raterreliability.

METHODS

Methodological study. The muscle strength of the following groups was measured: flexors and extensors of the wrist, of the hip, and of the knee and plantar flexors. The Tycos® aneroid sphygmomanometer and the Microfet 2® dynamometer were used. Stabilization was performed using the Mullingan® belt. Descriptive statistics were performed for characterization of the sample. To determine the validity of the MST with fixed stabilization, comparing it with the portable dynamometer, we investigated the correlation between the measurements obtained with the two instruments using the Pearson correlation coefficient. Intraclass Correlation Coefficient (ICC) was used to investigate inter-examiner and test-retest reliability (α = 0.05).

RESULTS

59 individuals were included (1176 evaluations). A statistically significant correlation of moderate to high magnitude (0.58 ≤ r ≤ 0.81) was observed for concurrent validity of the MST with fixed stabilization versus the portable dynamometer for all muscle groups. Regarding inter-rater reliability, it was observed statistically significant ICC considered excellent to good (0.72 ≤ r ≤ 0.94) for all muscle groups. Regarding test-retest reliability, first evaluator presented good to excellent ICC (0.64 ≤ r ≤ 0.94), while second evaluator presented good to excellent ICC (0.74 ≤ r ≤ 0.96) for all muscle groups.

CONCLUSION

The MST with fixed stabilization is valid and reliable for clinical measurement of muscle strength and can overcome previous limitations reported in the literature.

Força muscular e habilidade de locomoção em indivíduos pós-acidente vascular encefálico crônico

RESUMO O objetivo do estudo foi verificar se existem diferenças na força muscular dos membros inferiores (MMII) e na habilidade de locomoção de indivíduos pós-acidente vascular encefálico (AVE) crônico, classificados como deambuladores comunitários ou não comunitários. Foi realizado um estudo transversal em 60 indivíduos pós-AVE crônico, divididos em deambuladores comunitários (n=33) e não comunitários (n=27) pela velocidade de marcha. A força muscular de sete grupos musculares bilaterais de MMII foi avaliada por meio do teste do esfigmomanômetro modificado e habilidade de locomoção pelo ABILOCO. Estatísticas descritivas foram utilizadas para caracterizar a amostra, e o teste t de Student para amostras independentes, a fim de comparar os dois grupos de indivíduos pós-AVE. Observou-se que os deambuladores comunitários apresentaram maiores valores de força muscular para a maioria dos grupos musculares de MMII (−0,973≥t≥−3,189; p≤0,04), e na habilidade de locomoção (t=−2,841; p=0,006). Os indivíduos pós-AVE crônico deambuladores comunitários possuem maior força muscular de MMII e mais habilidade de locomoção em comparação aos deambuladores não comunitários. Sugere-se que a avaliação fisioterapêutica de indivíduos pós-AVE inclua, além da mensuração da força muscular de MMII e seu tratamento, a mensuração da percepção da habilidade de locomoção, para análises da evolução do paciente e da eficácia da conduta terapêutica.

Validity and Reliability of a Non-invasive Test to Assess Quadriceps and Hamstrings Strength in Athletes

Modifiable risk factors for hamstring injury include lack of strength, fatigue and muscle strength asymmetry. Assessing lower body strength in the field is problematic as “gold standard assessment” are expensive, non-portable and assessment is time-consuming. Therefore, the objective of this study was to examine the validity and reliability of an adapted aneroid sphygmomanometer test of hamstring and quadricep strength. In 14 active males (age 23.1 ± 2.5 years; height 180.9 ± 8.2 cm; weight 88.4 ± 8.5 kg). concurrent validity was assessed by comparing the adapted sphygmomanometer assessment at 30 and 90° of knee flexion to isokinetic dynamometry using Pearson product-moment correlation. The reliability of the adapted sphygmomanometer was assessed in 10 professional rugby players (age 21.5 ± 2.6 years; height 177.2 ± 5.8 cm; weight 92.7 ± 5.8 kg ) across two visits. Sphygmomanometer strength assessments of hamstring and quadriceps were associated with isokinetic measures (Quadricep: right, r = 0.386, 95% CI = 0.136–0.866, p < 0.05; left, r = 0.431, 95% CI = 0.193–0.880, p < 0.05), hamstring strength at 90° of knee flexion (Hamstring: right, r = 0.545, 95% CI = 0.342–0.912, p < 0.01; left, r = 0.643, 95% CI = 0.473–0.935, p < 0.001) and hamstring strength at 30° of knee flexion (right, r = 0.329, 95% CI = 0.062–0.846, p < 0.05; left, r = 0.387, 95% CI = 0.138–0.867, p < 0.05). However, the adapted test was not able to identify bilateral or hamstring to quadricep asymmetry. Test–retest reliability was high for most assessments (ICC range: 0.64–0.92), and SEM measures ranged between 5 and 12%, with the smallest change representing a change in strength ranging between 3 and 4%. In conclusion, an adapted sphygmomanometer test for hamstring and quadricep strength assessment was valid and reliable in assessing hamstring and quadricep strength but not bilateral or hamstring and quadricep asymmetry.

Knee extensor muscles strength indicates global lower-limb strength in individuals who have suffered a stroke: A cross-sectional study

OBJECTIVES

This study had three aims: (1) to evaluate the relationships between the paretic knee extensor muscle strength and global lower-limb strength in individuals who had suffered a sub-acute/chronic stroke, (2) to determine whether global lower-limb strength, sex, body mass index, or age could predict knee extensor muscle strength, and 3) to investigate whether the results obtained via a Modified Sphygmomanometer Test (MST) would be similar to those obtained using a hand-held dynamometer.

METHODS

This was a cross-sectional study, performed at a research laboratory, at participants' homes, or at outpatient clinics. Forty-two individuals with a sub-acute stroke and 45 individuals with a chronic stroke participated. Maximum isometric strength of the paretic lower-limb muscles (i.e. hip, knee, and ankle flexors/extensors, hip abductors) was measured using the MST and a hand-held dynamometer.

RESULTS

Significant and high correlation coefficients were found between knee extensor muscle strength and global lower-limb strength as measured by the combined strength values of 6 lower limb muscle groups in individuals with sub-acute (0.81≤r≤0.88; p<0.05) and chronic (0.82≤r≤0.85; p<0.05) stroke. Step-wise multiple regression analysis revealed that only global lower-limb strength was retained in the model and accounted for 66-78% and 67-72% (p<0.001) of the variance in knee extensor muscle strength at the sub-acute and chronic phases post-stroke, respectively. The results obtained via the MST were similar to those obtained using the hand-held dynamometer.

CONCLUSION

Paretic knee extensor muscles strength, assessed using a MST or a hand-held dynamometer, indicates global lower-limb strength in individuals with a sub-acute or chronic stroke.

Assessment of grip strength with the modified sphygmomanometer test: association between upper limb global strength and motor function

BACKGROUND

Grip strength, commonly evaluated with the handgrip dynamometer, is a good indicator of upper limb (UL) function in stroke subjects and may reflect the global strength deficits of the whole paretic UL. The Modified Sphygmomanometer Test (MST) also provides objective and adequate measures at low-cost.

OBJECTIVE

To assess whether grip strength values obtained by using the MST and those obtained by using a handgrip dynamometer would present similar correlations with the global strength and motor function of the paretic UL in subjects with stroke, both in the subacute and chronic phases.

METHOD

Measures of grip strength (MST and handgrip dynamometer), UL global strength (MST and hand-held dynamometer), and UL motor function (Fugl-Meyer motor assessment scale) were obtained with 33 subacute and 44 chronic stroke subjects. Pearson and Spearman correlation coefficients were calculated and Stepwise multiple regression analyses were performed to investigate predictor variables of grip strength (α=0.05).

RESULTS

Significant correlations of similar magnitude were found between measures of global strength of the paretic UL and grip strength assessed with both the MST (0.66≤r≤0.78) and handgrip dynamometer (0.66≤r≤0.78) and between UL motor function and grip strength assessed with both the MST (0.50≤rs≤0.51) and hand-held dynamometer (0.50≤rs≤0.63) in subacute and chronic stroke subjects. Only global strength remained as a significant predictor variable of grip strength for the MST (0.43≤R2≤0.61) and for the handgrip dynamometer (0.44≤R2≤0.61) for both stroke subgroups.

CONCLUSION

Grip strength assessed with the MST could be used to report paretic UL global strength.

Validation and reliability of a modified sphygmomanometer for the assessment of handgrip strength in Parkinson's disease

BACKGROUND:

Handgrip strength is currently considered a predictor of overall muscle strength and functional capacity. Therefore, it is important to find reliable and affordable instruments for this analysis, such as the modified sphygmomanometer test (MST).

OBJECTIVES:

To assess the concurrent criterion validity of the MST, to compare the MST with the Jamar dynamometer, and to analyze the reproducibility (i.e. reliability and agreement) of the MST in individuals with Parkinson's disease (PD).

METHOD:

The authors recruited 50 subjects, 24 with PD (65.5±6.2 years of age) and 26 healthy elderly subjects (63.4±7.2 years of age). The handgrip strength was measured using the Jamar dynamometer and modified sphygmomanometer. The concurrent criterion validity was analyzed using Pearson's correlation coefficient and a simple linear regression test. The reproducibility of the MST was evaluated with the coefficient of intra-class correlation (ICC_2,1), the standard error of measurement (SEM), the minimal detectable change (MDC), and the Bland-Altman plot. For all of the analyses, α≤0.05 was considered a risk.

RESULTS:

There was a significant correlation of moderate magnitude (r≥0.45) between the MST and the Jamar dynamometer. The MST had excellent reliability (ICC_2,1≥0.7). The SEM and the MDC were adequate; however, the Bland-Altman plot indicated an unsatisfactory interrater agreement.

CONCLUSIONS:

The MST exhibited adequate validity and excellent reliability and is, therefore, suitable for monitoring the handgrip strength in PD. However, if the goal is to compare the measurements between examiners, the authors recommend that the data be interpreted with caution.