Comparison of Common Methodologies for the Determination of Knee Flexor Muscle Strength (original) (raw)
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Physiotherapy Theory and Practice, 2013
Background: Muscular strength is a key parameter of rehabilitation programs and a strong predictor of functional capacity. Traditional methods to measure strength, such as manual muscle testing (MMT) and hand-held dynamometry (HHD), are limited by the strength and experience of the tester. The Performance Recorder 1 (PR1) is a strength assessment tool attached to resistance training equipment and may be a time-and cost-effective tool to measure strength in clinical practice that overcomes some limitations of MMT and HHD. However, reliability and validity of the PR1 have not been reported. Methods: Test-retest and inter-rater reliability was assessed using the PR1 in healthy adults (n = 15) during isometric knee flexion and extension. Criterion-related validity was assessed through comparison of values obtained from the PR1 and Biodex® isokinetic dynamometer. Results: Test-retest reliability was excellent for peak knee flexion (intra-class correlation coefficient [ICC] of 0.96, 95% CI: 0.85, 0.99) and knee extension (ICC = 0.96, 95% CI: 0.87, 0.99). Inter-rater reliability was also excellent for peak knee flexion (ICC = 0.95, 95% CI: 0.85, 0.99) and peak knee extension (ICC = 0.97, 95% CI: 0.91, 0.99). Validity was moderate for peak knee flexion (ICC = 0.75, 95% CI: 0.38, 0.92) but poor for peak knee extension (ICC = 0.37, 95% CI: 0, 0.73). Conclusions: The PR1 provides a reliable measure of isometric knee flexor and extensor strength in healthy adults that could be used in the clinical setting, but absolute values may not be comparable to strength assessment by gold-standard measures.
Test-retest reliability of reciprocal isokinetic knee extension and flexion peak torque measurements
Journal of athletic training, 1992
Our purpose in conducting this study was to estimate the reliability of reciprocal concentric knee extension and flexion peak torque obtained in uninjured male athletes using the Biodex isokinetic dynamometer. Twenty-six male intercollegiate athletes (age=19.5+/-4.1 yr; ht=70.3+/-14.9 in; wt=212.9+/-48.5 lb) participated in this study. We used the Biodex to measure peak torque occurring during right knee extension and flexion over 3 consecutive days. Means and standard deviations were calculated for both extension and flexion on each of the 3 days. We observed a significant main effect for days for both extension and flexion. Mean peak torque for the first day was significantly higher (Turkey, p<.05) than the means for the other 2 days, which were not significantly different from each other (Turkey, p>0.05). Intraclass correlation coefficients (ICCs) were estimated for each of the six trials on each of the 3 days. Intraclass correlation coefficients (ICCs) ranged from .88 on t...
BMC Musculoskeletal Disorders, 2011
Background: Patients undergoing total knee arthroplasty (TKA) often experience strength deficits both pre-and post-operatively. As these deficits may have a direct impact on functional recovery, strength assessment should be performed in this patient population. For these assessments, reliable measurements should be used. This study aimed to determine the inter-and intrarater reliability of hand-held dynamometry (HHD) in measuring isometric knee strength in patients awaiting TKA. Methods: To determine interrater reliability, 32 patients (81.3% female) were assessed by two examiners. Patients were assessed consecutively by both examiners on the same individual test dates. To determine intrarater reliability, a subgroup (n = 13) was again assessed by the examiners within four weeks of the initial testing procedure. Maximal isometric knee flexor and extensor strength were tested using a modified Citec hand-held dynamometer. Both the affected and unaffected knee were tested. Reliability was assessed using the Intraclass Correlation Coefficient (ICC). In addition, the Standard Error of Measurement (SEM) and the Smallest Detectable Difference (SDD) were used to determine reliability.
BMC Musculoskeletal Disorders, 2019
Background: Muscle strength measurements using hand-held dynamometry (HHD) can be affected by the inadequate strength of the tester and lack of stabilization of the participants and the device. A portable HHD anchoring system was designed that enabled the measurement of isometric knee extensor muscle strength in a supine position. This can be used with individuals who are unable to assume the sitting position required for the measurement of knee extensor strength in conventional isokinetic dynamometry (IKD). The aim of this study was to evaluate the reliability and validity of knee extensor strength measurements using this device. Methods: The maximal knee extensor isometric strength of the dominant leg in healthy adults aged 20 to 40 years was tested. Three trials of three contractions were assessed by two raters using the portable dynamometer anchoring system whilst the participant was in the supine position. After the three measurement trials, peak knee extensor torque was evaluated using IKD. The intraclass correlation coefficient (ICC) and 95% limits of agreement (LOA) for intra-and inter-rater reliability were obtained. Results: Thirty-nine participants (19 male and 20 female, aged 30.08 ± 4.16 y), completed the three measurement trials. The ICC for intra-rater reliability was 0.98 for the maximum measurements of knee extensor strength (95% confidence interval [CI]: 0.96-0.98) and 0.98 (95% CI: 0.96-0.99) for inter-rater reliability. The mean difference (%) between the maximum knee extensor strength measurements of each trial was 1.02% (LOA range: − 11.13 to 13.16%) for intra-rater and − 1.44% (LOA range: − 13.98 to 11.08%) for inter-rater measurements. The Pearson correlation coefficient of the maximum voluntary peak torque measurements with the portable dynamometer anchoring system and IKD was 0.927. Conclusions: The portable dynamometer anchoring system is a reliable and valid tool for measuring isometric knee extensor strength in a supine position. Future clinical feasibility studies are needed to determine if this equipment can be applied to people with severe illness or disabilities. Trial registration: KCT0003041.
Frontiers in Physiology, 2018
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.
Life
Background: Assessing lower limb strength in the field is problematic, as the “gold standard assessment” with isokinetic strength is cumbersome, and the device is costly and not transportable and keeps the angle of the hip at around 90°. Methods: We evaluated isometric muscle strength in a standing position with the help of an exoskeleton that holds the subject and makes the test easily repeatable. Results: The optimal device angles for hip and knee were, respectively, 20° and 80° for flexor tests and 30° and 40° for extensor tests. Test–retest reliability was very high for the right knee extensor (ICC 0.96-0.98), left knee extensor (ICC 0.96–0.97), right knee flexor (ICC 0.91–0.96), and left knee flexor (ICC 0.96–0.97). Furthermore, the typical error in percent (T.E.%) ranged from 2.50 to 5.50%, and the change in the mean in percent ranged from 0.84 to 7.72%, making it possible to determine even a slight variation in force. Conclusions: this new method could represent a valid alter...
A purpose-built dynamometer to objectively measure static and dynamic knee torque
Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine, 2011
This paper reports the development of a purpose-built knee dynamometer (PBKD) to evaluate passive range of motion (ROM) and isometric muscle strength measurements of the knee. The PBKD uses a TorqSense rotary torque transducer and objectively measures isometric knee muscle strength in a valid and reliable manner and passive resistance to motion through range. The device and all associated instrumentation underwent dynamic and static calibration to ensure consistent and accurate measurements were obtained in terms of knee joint angular position, passive torque measures, and isometric torque measures. Eleven healthy male participants performed a knee flexion and extension task designed to evaluate knee function. The validation of the PBKD entailed measuring the consistency of measurement and accuracy of measurement. Accuracy of the PBKD was determined by comparing peak isometric muscle strength measurements against a KIN-COM machine. No significant differences were observed both passi...
The Reliability of Portable Fixed Dynamometry During Hip and Knee Strength Assessments
Journal of Athletic Training, 2010
Context: Insufficient lower extremity strength may be a risk factor for lower extremity injuries such as noncontact anterior cruciate ligament tears. Therefore, clinicians need reliable instruments to assess strength deficiencies. Objective: To assess the intrarater, interrater, intrasession, and intersession reliability of a portable fixed dynamometer in measuring the strength of the hip and knee musculature. Design: Crossover study. Setting: Sports medicine research laboratory. Patients or Other Participants: Three raters (A, B, C) participated in this 2-phase study. Raters A and B tested 11 healthy college graduate students (2 men, 9 women) in phase 1. Raters A and C tested 26 healthy college undergraduate students (7 men, 19 women) in phase 2. Main Outcome Measure(s): The dependent variables for the study were hip adductor, hip abductor, hip flexor, hip extensor, hip internal rotator, hip external rotator, knee flexor, and knee extensor peak force. Results: The phase 1 intrasess...
Open Journal of Internal Medicine, 2012
Background: Test-retest strength reliability of the Electronic Push/Pull Dynamometer (EPPD) in the measurement of the extensor and flexor muscles on a new constructed chair. The objective of the study was to assess reliability of Electronic Push/Pull Dynamometer in the measurement of the knee flexion and extension at 90˚ and 60˚ on a new constructed chair. The aims of the author: To assess reliability of Electronic Push/Pull Dynamometer in the measurement of the knee flexion and extension at 90˚ and 60˚ on a new constructed chair. Design: A test-retest reliability study. Subjects: One hundred healthy students male and female (mean age, 21 y). Methods: Maximum isometric strength of the quadriceps and hamstring muscle groups was measured using the EPPD were recorded at 60˚ and 90˚ for 3 trials on 2 occasions. Reliability was assessed with the Intraclass correlation coefficient (ICC), mean and standard deviation (SD) of measurements, and smallest real differences were calculated for the maximum and for the mean and work of the 3 repetitions. Results: Mean strength ranged from 50.44 kg for knee flexion to 55.76 kg for knee extension 50.44 kg to 61.98 kg at 90˚ hip flexion. Test-retest reliability Intraclass correlation coefficients (ICCs) ranged from 0.85 to 0.99. ICCs for test-retest reliability ranged from 0.780 to 0.998. Conclusions: The results of the reliability study indicate that the EPPD in reliable dynamometer to use in determining lower limb muscle force production. It can be used to measure disease progression and to evaluate changes in knee extension and flexion strength at the individual patient level.
BACKGROUND: Few studies have assessed the test-retest reliability of the isokinetic strength at 90 • /s and the isometric parameters for knee extensors. OBJECTIVES: To assess the reliability of isokinetic and isometric parameters of knee extensors, and to determine the smallest real difference between the test-retest measures. METHODS: Knee extensor strength was measured twice, 4 to 5 days apart, using a Biodex dynamometer in forty subjects (12 men, 28 women). The protocols consisted of 5 concentric contractions at 90 • /s and 5 isometric contractions. RESULTS: For women, test-retest reliability was very high for isometric and isokinetic peak-torque (ICCc,1 > 0.9 ), moderate for work (ICCc,1 = 0.82) and questionable for angle of peak torque (Angle-PT), mean Angle-PT and rate of torque development (RTD0−100 ms) (ICC < 0.67). The measurement errors were small for all variables, the SEM% ranged between 3.1% to 7.4%, and SRD% from 8.6% to 19.9%, except for RTD0−100 ms that was the most variable (SEM% = 16.4%; SRD = 47.5%). No differences were found in Angle-PT and RTD0−100 ms with regard to sex. CONCLUSIONS: The isokinetic values obtained at 90 • /s and isometric peak-torque for knee extensors are highly repeatable with a standardized test protocol and the SRD values can be used to detect real changes. Alternative strategies of analysis should be developed to improve reliability of Angle-PT and RTD0−100 ms. Angle-PT and RTD0−100 ms do not appear affected by gender