Fiona Keogan - Academia.edu (original) (raw)
Papers by Fiona Keogan
Age and Ageing
Background Frailty predisposes older people to adverse outcomes following hospitalisation. Physio... more Background Frailty predisposes older people to adverse outcomes following hospitalisation. Physiotherapy can reduce the risk of adverse frailty-related outcomes including functional decline. Research examining frailty and physiotherapy referral in Acute Medical Units is limited. The objective of this study was to estimate the prevalence of frailty in older adults admitted to an Acute Medical Admissions Unit (AMAU), and to explore factors associated with early physiotherapy referral in the frail group. Methods A prospective cohort study was conducted in the AMAU of a large acute hospital in Ireland. Participants were those over 65 years who were admitted to the AMAU. All participants underwent frailty screening on admission using both the Clinical Frailty Scale and Program of Research to Integrate Services for the Maintenance of Autonomy-7 questionnaire. They were defined as frail if positive on at least one of the tools. Referral to physiotherapy and time to referral during hospital...
Musculoskeletal Care, Jan 15, 2010
Measuring patient satisfaction with exercise therapy for knee osteoarthritis (OA) and its relatio... more Measuring patient satisfaction with exercise therapy for knee osteoarthritis (OA) and its relationship with clinical outcomes.
Irish Journal of Medical Science, Jan 7, 2010
Background Osteoarthritis (OA) of the knee is a common disorder with significant social and finan... more Background Osteoarthritis (OA) of the knee is a common disorder with significant social and financial implications. Obesity is the strongest modifiable risk factor of knee OA. There is little data on obesity in Irish knee OA populations and its relationship to other measures of disease severity. Aims In Beaumont Hospital, we have been collecting data on patients presenting with knee OA as part of a screening process for potential candidates for therapeutic exercise intervention studies. Here, we present data on the first 96 candidates screened during this process. Results The mean body mass index (BMI) of the group fell within the obese range (31); indeed, only 21% had a normal BMI. The vast majority of our patients had severe self-reported disability. In contrast, the distribution of radiographic severity of knee OA was more even. There was no significant relationship between radiographic severity and disability. BMI did predict disability but had a weak correlation. Radiographic severity did not correlate with BMI. Conclusion Irish patients with knee OA referred for physiotherapy were very disabled, significantly obese and represent a challenging cohort of patients to treat.
International journal of therapy and rehabilitation, Oct 1, 2013
Background: Falls continue to be the most common cause of injury for those aged over 65 years of ... more Background: Falls continue to be the most common cause of injury for those aged over 65 years of age. The aim of this study was to characterise multifactorial falls risk factors in participants who had sustained a low-trauma wrist fracture and identify their healthcare use. Methods: This was a case-control, observational study, incorporating a comprehensive multifactorial falls assessment on 41 consecutive adults between 55 and 80 years who sustained a low-trauma wrist fracture and were compared to 41 age-matched healthy controls. The assessments included falls history, balance, footwear, vision, lower-limb strength, cognition, self-efficacy and environmental hazards. Results: The mean age of the wrist fracture group was 67.3 (SD ± 7.0) and that of the age-matched controls was 68.5 (SD ± 5.7). There were statistically significant differences between the wrist fracture participants and the control participants in: the Timed Up and Go test (TUG) (P<0.002); the Modified Clinical Test of Sensory Integration and balance (M-CTSIB) (P<0.001); knee flexor strength (right: p<0.006, left: P<0.019); and cognition (P<0.009). There were higher levels of healthcare demands and medical interventions (referral to GP P<0.001; geriatrician P<0.04) and for further physiotherapy (P<0.001) for the participants following a low-trauma wrist fracture. Conclusions: The findings of this study highlight the need for a targeted falls prevention screening tool and intervention programmes for patients over 55 years of age who sustain a low-trauma wrist fracture.
International Examples of Lean in Healthcare
International Journal of Therapy and Rehabilitation, 2013
Background: Falls continue to be the most common cause of injury for those aged over 65 years of ... more Background: Falls continue to be the most common cause of injury for those aged over 65 years of age. The aim of this study was to characterise multifactorial falls risk factors in participants who had sustained a low-trauma wrist fracture and identify their healthcare use. Methods: This was a case-control, observational study, incorporating a comprehensive multifactorial falls assessment on 41 consecutive adults between 55 and 80 years who sustained a low-trauma wrist fracture and were compared to 41 age-matched healthy controls. The assessments included falls history, balance, footwear, vision, lower-limb strength, cognition, self-efficacy and environmental hazards. Results: The mean age of the wrist fracture group was 67.3 (SD ± 7.0) and that of the age-matched controls was 68.5 (SD ± 5.7). There were statistically significant differences between the wrist fracture participants and the control participants in: the Timed Up and Go test (TUG) (P<0.002); the Modified Clinical Tes...
Physical Therapy Reviews, 2008
... on their experiences of recovery of upper limb activity; the therapy they received, and their... more ... on their experiences of recovery of upper limb activity; the therapy they received, and their views on the prospect of engaging with such technologies as part of a rehabilitation programme. Methods: Ethical approval was obtained from the University of Ulster Research Ethics ...
Irish Journal of Medical Science, 2010
Background Osteoarthritis (OA) of the knee is a common disorder with significant social and finan... more Background Osteoarthritis (OA) of the knee is a common disorder with significant social and financial implications. Obesity is the strongest modifiable risk factor of knee OA. There is little data on obesity in Irish knee OA populations and its relationship to other measures of disease severity. Aims In Beaumont Hospital, we have been collecting data on patients presenting with knee OA as part of a screening process for potential candidates for therapeutic exercise intervention studies. Here, we present data on the first 96 candidates screened during this process. Results The mean body mass index (BMI) of the group fell within the obese range (31); indeed, only 21% had a normal BMI. The vast majority of our patients had severe self-reported disability. In contrast, the distribution of radiographic severity of knee OA was more even. There was no significant relationship between radiographic severity and disability. BMI did predict disability but had a weak correlation. Radiographic severity did not correlate with BMI. Conclusion Irish patients with knee OA referred for physiotherapy were very disabled, significantly obese and represent a challenging cohort of patients to treat.
Amyotrophic Lateral Sclerosis, 2003
Maximum Voluntary Isometric Contraction (MVIC) is a standardised, objective and sensitive tool fo... more Maximum Voluntary Isometric Contraction (MVIC) is a standardised, objective and sensitive tool for the measurement of muscle strength. The purpose of this study was to investigate different aspects of reliability of MVIC and to determine if a learning effect existed in a relatively new user of the system. Two clinical investigators participated in the study. The inter- and intra-rater reliability of MVIC of 11 muscle groups was tested on healthy subjects (n=35). Intra-class correlation co-efficients (ICCs) were calculated and the statistical methods described by Bland and Altman were applied to the data. ICCs were higher for the more experienced investigator and a learning effect was demonstrated in a relatively new user of the system. Inter-rater reliability was acceptable but lower than intra-rater reliability. Upper limb tests generally yielded higher ICCs and lower ranges of error. The ICC was similar regardless of whether the maximum or average of the two values was taken in a single session. Utilising the statistical methods proposed by Bland and Altman allows estimation of the magnitude of error of MVIC and gives additional information to the ICC. These methods may be useful in the training of investigators and in clinical interpretation of MVIC values.
Musculoskeletal Care, 2010
Objectives: To assess patient satisfaction with exercise for knee osteoarthritis (OA) and to comp... more Objectives: To assess patient satisfaction with exercise for knee osteoarthritis (OA) and to compare the relationship between patient satisfaction and clinical outcomes. Methods: A convenience sample of 27 patients recruited to a randomised controlled trial (RCT) comparing open kinetic-chain (OKC) and closed kinetic-chain (CKC) exercises for knee OA were reassessed at 9 months post-randomisation. Clinical outcomes included self-report and physical performance measures of function and pain severity. They also completed the Physiotherapy Outpatient Survey (POPS) which is a multidimensional measure of patient satisfaction with physiotherapy. Results: There was no significant difference in satisfaction between the two intervention groups. Overall mean satisfaction for the entire cohort was 4.07 of a maximum score of 5 (standard deviation (SD) =0.52). Lower levels of satisfaction with outcome (mean =3.56, SD=0.8) were reported compared with other domains of expectations, communication, organisation and the therapist (mean=3.79-4.49; SDs=0.42-0.92). Changes in pain and function were also more strongly correlated with satisfaction with outcome (r=0.38-0.48) than other satisfaction subscales (r=0.004-0.33). Both intervention groups improved from baseline on clinical outcomes, with no significant differences between the two groups. Conclusion: High levels of satisfaction were reported in this subsample of knee OA patients participating in an RCT evaluating the effects of different exercise approaches for knee OA. Satisfaction varied depending on the satisfaction domain, with lower satisfaction with outcome compared to other aspects of care. A stronger relationship between satisfaction with outcome and clinical outcomes compared to other features of satisfaction was also found. The POPS is a useful questionnaire to evaluate the multidimensional aspects of satisfaction with physiotherapy for OA.
Dose-response relation between plasma-insulin and blood-glucose levels during oral glucose loads ... more Dose-response relation between plasma-insulin and blood-glucose levels during oral glucose loads in prediabetic and diabetic subjects. Lancet 1973; 1: 794-7.
International Journal of Integrated Care, Oct 17, 2017
International journal of environmental research and public health, Jan 25, 2018
We addressed the research question "what factors enable the successful development and imple... more We addressed the research question "what factors enable the successful development and implementation of a frail older person's pathway within the acute setting". A rapid realist review (RRR) was conducted by adopting the RAMESES standards. We began with a sample of 232 articles via database searches supplemented with 94 additional records including inputs from a twitter chat and a hospital site visit. Our final sample consisted of 18 documents. Following review and consensus by an expert panel we identified a conceptual model of context-mechanism-(resources)-outcomes. There was overall agreement frailty should be identified at the front door of the acute hospital. Significant challenges identified related to organisational boundaries both within the acute setting and externally, the need to shift outcomes to patient orientated ones, to support staff to sustain the pathway by providing ongoing education and by providing role clarity. RRRs can support research such as t...
Age and Ageing, Sep 1, 2017
Annals of the Rheumatic Diseases, 2004
Objective: To describe the characteristics of rheumatoid arthritis in patients managed by hospita... more Objective: To describe the characteristics of rheumatoid arthritis in patients managed by hospital based rheumatologists in France. Methods: All public and non-profit private hospitals in France were invited to participate in a cross sectional study. Clinical data on the day of inclusion and health resources used for rheumatoid arthritis over the previous 12 months (treatments, medical devices, physician visits, examinations, hospital admissions, and other health professional care) were recorded. Results: 1109 patients from 75 centres located throughout the country were included (846 female; mean disease duration, 10.6 years; mean age, 56.7 years). Active disease (swollen joint count >6, tender joint count >6, and two of: morning stiffness >45 min, C reactive protein >20 mg/l, erythrocyte sedimentation rate .28 mm/h) was observed in 146 patients (13.2%). Mean (SD) DAS 28 was 4.51 (1.55). Severe extraarticular manifestations were reported in 8.4%. ACR functional status was: class I, 19%; class II, 28%; class III, 31%; class IV, 22%. Comorbidity was observed in 44.9% of cases, particularly chronic pulmonary disease and coronary or peripheral vascular disease. Average AIMS2-SF dimension scores were between 4.56 and 6.18, and mean HAQ was 1.32 (0.77). Disease modifying antirheumatic drugs (DMARDs) were prescribed for 82.1% of the patients. During the previous four weeks, one DMARD was used in 62.5%, and two or more in 19.5%. Corticosteroids were prescribed in 72%. Conclusions: In a rheumatoid arthritis population managed by hospital based rheumatologists, the disease was active in 13% and severe in more than one third of cases. 1235 www.annrheumdis.com on May 25, 2020 by guest. Protected by copyright.
Amyotrophic lateral sclerosis and other motor neuron disorders : official publication of the World Federation of Neurology, Research Group on Motor Neuron Diseases, 2003
Maximum Voluntary Isometric Contraction (MVIC) is a standardised, objective and sensitive tool fo... more Maximum Voluntary Isometric Contraction (MVIC) is a standardised, objective and sensitive tool for the measurement of muscle strength. The purpose of this study was to investigate different aspects of reliability of MVIC and to determine if a learning effect existed in a relatively new user of the system. Two clinical investigators participated in the study. The inter- and intra-rater reliability of MVIC of 11 muscle groups was tested on healthy subjects (n=35). Intra-class correlation co-efficients (ICCs) were calculated and the statistical methods described by Bland and Altman were applied to the data. ICCs were higher for the more experienced investigator and a learning effect was demonstrated in a relatively new user of the system. Inter-rater reliability was acceptable but lower than intra-rater reliability. Upper limb tests generally yielded higher ICCs and lower ranges of error. The ICC was similar regardless of whether the maximum or average of the two values was taken in a ...
Age and Ageing
Background Frailty predisposes older people to adverse outcomes following hospitalisation. Physio... more Background Frailty predisposes older people to adverse outcomes following hospitalisation. Physiotherapy can reduce the risk of adverse frailty-related outcomes including functional decline. Research examining frailty and physiotherapy referral in Acute Medical Units is limited. The objective of this study was to estimate the prevalence of frailty in older adults admitted to an Acute Medical Admissions Unit (AMAU), and to explore factors associated with early physiotherapy referral in the frail group. Methods A prospective cohort study was conducted in the AMAU of a large acute hospital in Ireland. Participants were those over 65 years who were admitted to the AMAU. All participants underwent frailty screening on admission using both the Clinical Frailty Scale and Program of Research to Integrate Services for the Maintenance of Autonomy-7 questionnaire. They were defined as frail if positive on at least one of the tools. Referral to physiotherapy and time to referral during hospital...
Musculoskeletal Care, Jan 15, 2010
Measuring patient satisfaction with exercise therapy for knee osteoarthritis (OA) and its relatio... more Measuring patient satisfaction with exercise therapy for knee osteoarthritis (OA) and its relationship with clinical outcomes.
Irish Journal of Medical Science, Jan 7, 2010
Background Osteoarthritis (OA) of the knee is a common disorder with significant social and finan... more Background Osteoarthritis (OA) of the knee is a common disorder with significant social and financial implications. Obesity is the strongest modifiable risk factor of knee OA. There is little data on obesity in Irish knee OA populations and its relationship to other measures of disease severity. Aims In Beaumont Hospital, we have been collecting data on patients presenting with knee OA as part of a screening process for potential candidates for therapeutic exercise intervention studies. Here, we present data on the first 96 candidates screened during this process. Results The mean body mass index (BMI) of the group fell within the obese range (31); indeed, only 21% had a normal BMI. The vast majority of our patients had severe self-reported disability. In contrast, the distribution of radiographic severity of knee OA was more even. There was no significant relationship between radiographic severity and disability. BMI did predict disability but had a weak correlation. Radiographic severity did not correlate with BMI. Conclusion Irish patients with knee OA referred for physiotherapy were very disabled, significantly obese and represent a challenging cohort of patients to treat.
International journal of therapy and rehabilitation, Oct 1, 2013
Background: Falls continue to be the most common cause of injury for those aged over 65 years of ... more Background: Falls continue to be the most common cause of injury for those aged over 65 years of age. The aim of this study was to characterise multifactorial falls risk factors in participants who had sustained a low-trauma wrist fracture and identify their healthcare use. Methods: This was a case-control, observational study, incorporating a comprehensive multifactorial falls assessment on 41 consecutive adults between 55 and 80 years who sustained a low-trauma wrist fracture and were compared to 41 age-matched healthy controls. The assessments included falls history, balance, footwear, vision, lower-limb strength, cognition, self-efficacy and environmental hazards. Results: The mean age of the wrist fracture group was 67.3 (SD ± 7.0) and that of the age-matched controls was 68.5 (SD ± 5.7). There were statistically significant differences between the wrist fracture participants and the control participants in: the Timed Up and Go test (TUG) (P<0.002); the Modified Clinical Test of Sensory Integration and balance (M-CTSIB) (P<0.001); knee flexor strength (right: p<0.006, left: P<0.019); and cognition (P<0.009). There were higher levels of healthcare demands and medical interventions (referral to GP P<0.001; geriatrician P<0.04) and for further physiotherapy (P<0.001) for the participants following a low-trauma wrist fracture. Conclusions: The findings of this study highlight the need for a targeted falls prevention screening tool and intervention programmes for patients over 55 years of age who sustain a low-trauma wrist fracture.
International Examples of Lean in Healthcare
International Journal of Therapy and Rehabilitation, 2013
Background: Falls continue to be the most common cause of injury for those aged over 65 years of ... more Background: Falls continue to be the most common cause of injury for those aged over 65 years of age. The aim of this study was to characterise multifactorial falls risk factors in participants who had sustained a low-trauma wrist fracture and identify their healthcare use. Methods: This was a case-control, observational study, incorporating a comprehensive multifactorial falls assessment on 41 consecutive adults between 55 and 80 years who sustained a low-trauma wrist fracture and were compared to 41 age-matched healthy controls. The assessments included falls history, balance, footwear, vision, lower-limb strength, cognition, self-efficacy and environmental hazards. Results: The mean age of the wrist fracture group was 67.3 (SD ± 7.0) and that of the age-matched controls was 68.5 (SD ± 5.7). There were statistically significant differences between the wrist fracture participants and the control participants in: the Timed Up and Go test (TUG) (P<0.002); the Modified Clinical Tes...
Physical Therapy Reviews, 2008
... on their experiences of recovery of upper limb activity; the therapy they received, and their... more ... on their experiences of recovery of upper limb activity; the therapy they received, and their views on the prospect of engaging with such technologies as part of a rehabilitation programme. Methods: Ethical approval was obtained from the University of Ulster Research Ethics ...
Irish Journal of Medical Science, 2010
Background Osteoarthritis (OA) of the knee is a common disorder with significant social and finan... more Background Osteoarthritis (OA) of the knee is a common disorder with significant social and financial implications. Obesity is the strongest modifiable risk factor of knee OA. There is little data on obesity in Irish knee OA populations and its relationship to other measures of disease severity. Aims In Beaumont Hospital, we have been collecting data on patients presenting with knee OA as part of a screening process for potential candidates for therapeutic exercise intervention studies. Here, we present data on the first 96 candidates screened during this process. Results The mean body mass index (BMI) of the group fell within the obese range (31); indeed, only 21% had a normal BMI. The vast majority of our patients had severe self-reported disability. In contrast, the distribution of radiographic severity of knee OA was more even. There was no significant relationship between radiographic severity and disability. BMI did predict disability but had a weak correlation. Radiographic severity did not correlate with BMI. Conclusion Irish patients with knee OA referred for physiotherapy were very disabled, significantly obese and represent a challenging cohort of patients to treat.
Amyotrophic Lateral Sclerosis, 2003
Maximum Voluntary Isometric Contraction (MVIC) is a standardised, objective and sensitive tool fo... more Maximum Voluntary Isometric Contraction (MVIC) is a standardised, objective and sensitive tool for the measurement of muscle strength. The purpose of this study was to investigate different aspects of reliability of MVIC and to determine if a learning effect existed in a relatively new user of the system. Two clinical investigators participated in the study. The inter- and intra-rater reliability of MVIC of 11 muscle groups was tested on healthy subjects (n=35). Intra-class correlation co-efficients (ICCs) were calculated and the statistical methods described by Bland and Altman were applied to the data. ICCs were higher for the more experienced investigator and a learning effect was demonstrated in a relatively new user of the system. Inter-rater reliability was acceptable but lower than intra-rater reliability. Upper limb tests generally yielded higher ICCs and lower ranges of error. The ICC was similar regardless of whether the maximum or average of the two values was taken in a single session. Utilising the statistical methods proposed by Bland and Altman allows estimation of the magnitude of error of MVIC and gives additional information to the ICC. These methods may be useful in the training of investigators and in clinical interpretation of MVIC values.
Musculoskeletal Care, 2010
Objectives: To assess patient satisfaction with exercise for knee osteoarthritis (OA) and to comp... more Objectives: To assess patient satisfaction with exercise for knee osteoarthritis (OA) and to compare the relationship between patient satisfaction and clinical outcomes. Methods: A convenience sample of 27 patients recruited to a randomised controlled trial (RCT) comparing open kinetic-chain (OKC) and closed kinetic-chain (CKC) exercises for knee OA were reassessed at 9 months post-randomisation. Clinical outcomes included self-report and physical performance measures of function and pain severity. They also completed the Physiotherapy Outpatient Survey (POPS) which is a multidimensional measure of patient satisfaction with physiotherapy. Results: There was no significant difference in satisfaction between the two intervention groups. Overall mean satisfaction for the entire cohort was 4.07 of a maximum score of 5 (standard deviation (SD) =0.52). Lower levels of satisfaction with outcome (mean =3.56, SD=0.8) were reported compared with other domains of expectations, communication, organisation and the therapist (mean=3.79-4.49; SDs=0.42-0.92). Changes in pain and function were also more strongly correlated with satisfaction with outcome (r=0.38-0.48) than other satisfaction subscales (r=0.004-0.33). Both intervention groups improved from baseline on clinical outcomes, with no significant differences between the two groups. Conclusion: High levels of satisfaction were reported in this subsample of knee OA patients participating in an RCT evaluating the effects of different exercise approaches for knee OA. Satisfaction varied depending on the satisfaction domain, with lower satisfaction with outcome compared to other aspects of care. A stronger relationship between satisfaction with outcome and clinical outcomes compared to other features of satisfaction was also found. The POPS is a useful questionnaire to evaluate the multidimensional aspects of satisfaction with physiotherapy for OA.
Dose-response relation between plasma-insulin and blood-glucose levels during oral glucose loads ... more Dose-response relation between plasma-insulin and blood-glucose levels during oral glucose loads in prediabetic and diabetic subjects. Lancet 1973; 1: 794-7.
International Journal of Integrated Care, Oct 17, 2017
International journal of environmental research and public health, Jan 25, 2018
We addressed the research question "what factors enable the successful development and imple... more We addressed the research question "what factors enable the successful development and implementation of a frail older person's pathway within the acute setting". A rapid realist review (RRR) was conducted by adopting the RAMESES standards. We began with a sample of 232 articles via database searches supplemented with 94 additional records including inputs from a twitter chat and a hospital site visit. Our final sample consisted of 18 documents. Following review and consensus by an expert panel we identified a conceptual model of context-mechanism-(resources)-outcomes. There was overall agreement frailty should be identified at the front door of the acute hospital. Significant challenges identified related to organisational boundaries both within the acute setting and externally, the need to shift outcomes to patient orientated ones, to support staff to sustain the pathway by providing ongoing education and by providing role clarity. RRRs can support research such as t...
Age and Ageing, Sep 1, 2017
Annals of the Rheumatic Diseases, 2004
Objective: To describe the characteristics of rheumatoid arthritis in patients managed by hospita... more Objective: To describe the characteristics of rheumatoid arthritis in patients managed by hospital based rheumatologists in France. Methods: All public and non-profit private hospitals in France were invited to participate in a cross sectional study. Clinical data on the day of inclusion and health resources used for rheumatoid arthritis over the previous 12 months (treatments, medical devices, physician visits, examinations, hospital admissions, and other health professional care) were recorded. Results: 1109 patients from 75 centres located throughout the country were included (846 female; mean disease duration, 10.6 years; mean age, 56.7 years). Active disease (swollen joint count >6, tender joint count >6, and two of: morning stiffness >45 min, C reactive protein >20 mg/l, erythrocyte sedimentation rate .28 mm/h) was observed in 146 patients (13.2%). Mean (SD) DAS 28 was 4.51 (1.55). Severe extraarticular manifestations were reported in 8.4%. ACR functional status was: class I, 19%; class II, 28%; class III, 31%; class IV, 22%. Comorbidity was observed in 44.9% of cases, particularly chronic pulmonary disease and coronary or peripheral vascular disease. Average AIMS2-SF dimension scores were between 4.56 and 6.18, and mean HAQ was 1.32 (0.77). Disease modifying antirheumatic drugs (DMARDs) were prescribed for 82.1% of the patients. During the previous four weeks, one DMARD was used in 62.5%, and two or more in 19.5%. Corticosteroids were prescribed in 72%. Conclusions: In a rheumatoid arthritis population managed by hospital based rheumatologists, the disease was active in 13% and severe in more than one third of cases. 1235 www.annrheumdis.com on May 25, 2020 by guest. Protected by copyright.
Amyotrophic lateral sclerosis and other motor neuron disorders : official publication of the World Federation of Neurology, Research Group on Motor Neuron Diseases, 2003
Maximum Voluntary Isometric Contraction (MVIC) is a standardised, objective and sensitive tool fo... more Maximum Voluntary Isometric Contraction (MVIC) is a standardised, objective and sensitive tool for the measurement of muscle strength. The purpose of this study was to investigate different aspects of reliability of MVIC and to determine if a learning effect existed in a relatively new user of the system. Two clinical investigators participated in the study. The inter- and intra-rater reliability of MVIC of 11 muscle groups was tested on healthy subjects (n=35). Intra-class correlation co-efficients (ICCs) were calculated and the statistical methods described by Bland and Altman were applied to the data. ICCs were higher for the more experienced investigator and a learning effect was demonstrated in a relatively new user of the system. Inter-rater reliability was acceptable but lower than intra-rater reliability. Upper limb tests generally yielded higher ICCs and lower ranges of error. The ICC was similar regardless of whether the maximum or average of the two values was taken in a ...