BackgroundPatients 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.MethodsTo 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.ResultsIn both the affected and unaffected knee, the inter- and intrarater reliability were good for knee flexors (ICC range 0.76-0.94) and excellent for knee extensors (ICC range 0.92-0.97). However, measurement error was high, displaying SDD ranges between 21.7% and 36.2% for interrater reliability and between 19.0% and 57.5% for intrarater reliability. Overall, measurement error was higher for the knee flexors than for the knee extensors.ConclusionsModified HHD appears to be a reliable strength measure, producing good to excellent ICC values for both inter- and intrarater reliability in a group of TKA patients. High SEM and SDD values, however, indicate high measurement error for individual measures. This study demonstrates that a modified HHD is appropriate to evaluate knee strength changes in TKA patient groups. However, it also demonstrates that modified HHD is not suitable to measure individual strength changes. The use of modified HHD is, therefore, not advised for use in a clinical setting.
MULTIFILE
Objectives: To develop an instrument to measure adherence to frequency, intensity, and quality of performance of home-based exercise (HBE) programs recommended by a physical therapist and to evaluate its construct validity and reliability in patients with low back pain. Methods: The Exercise Adherence Scale (EXAS) was developed following a literature search, an expert panel review, and a pilot test. The construct validity of the EXAS was determined based on data from 27 participants through an investigation of the convergent validity between adherence, lack of time to exercise, and lack of motivation to exercise. Associations between adherence, pain, and disability were determined to test divergent validity. The reliability of the EXAS quality of performance score was assessed using video recordings from 50 participants performing four exercises. Results: Correlations between the EXAS and lack of time to exercise, lack of motivation to exercise, pain, and disability were rho = 0.47, rho = 0.48, rho = 0.005, and rho = 0.24, respectively. The intrarater reliability of the quality of performance score was Kappa quadratic weights (Kqw) = 0.87 (95%-CI 0.83–0.92). The interrater reliability was Kqw = 0.36 (95%-CI 0.27–0.45). Conclusions: The EXAS demonstrates acceptable construct validity for the measurement of adherence to HBE programs. Additionally, the EXAS shows excellent intrarater reliability and poor interrater reliability for the quality of performance score and is the first instrument to measure adherence to frequency, intensity, and quality of performance of HBE programs. The EXAS allows researchers and clinicians to better investigate the effects of adherence to HBE programs on the outcomes of interventions and treatments.
LINK
OBJECTIVES: Amplitude-mode (A-mode) ultrasonography is a promising technique to monitor loss and recovery of skeletal muscle in patients with burns. However, its clinimetric properties are unknown. Therefore, we determined its feasibility, interrater, and intrarater reliability, and clinical utility.METHODS: Skeletal muscle thickness of upper arms and legs was assessed longitudinally in hospitalized adult patients with ≥ 5 % total body surface area (TBSA) burns, by pairs of two out of five raters. Feasibility was evaluated by % successful assessments, reliability by intra-class correlation coefficients (ICCs), and clinical utility by smallest detectable change (SDC).RESULTS: Thirty-four patients participated (77 % male; mean age 48 ± 17 y, median TBSA burned 12 % [IQR 7-19]). Images were acquired on 69 % of planned occasions, and 89 % of images could be analyzed. Overall interrater ICCs were ≥ 0.84 (for pairs: 0.63-0.99) and intrarater ICCs were ≥ 0.95 (for pairs: 0.45-0.99). The overall interrater SDC was ≤ 33 % of the measured mean (for pairs: 3-52 %), while intrarater SDC was ≤ 20 % (for pairs: 3-48 %). All five raters could measure legs with moderate to excellent reliability, whereas for arms some demonstrated poor reliability.CONCLUSION: A-mode ultrasonography assessment of skeletal muscle in patients with burns is feasible. However, reliability and clinical utility are rater-dependent; therefore we recommend assessments by the same rater.
DOCUMENT
