Use of myometry in the assessment of neuropathic weakness: testing for reliability in clinical practice

Abstract

The myometer has been recommended as a quantitative method of measuring muscle strength in clinical practice. The reliability of the myometer was tested in a clinical environment by physiotherapists and a form incorporating the testing positions was designed. An intensive training programme for examiners was instigated and piloted on normal subjects. The study tested the reliability of paired examiners in recording the muscle strength of 20 Guillain-Barre syndrome patients at different stages in their recovery. Ten patients were tested in the first experiment. The error rate between observers was large and unacceptable. Procedures for improving reliability were implemented. Testing was repeated on 10 more patients but no improvement in reliability was observed. The implications for clinical practice are discussed.

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References

Medical Research Council. Aids to examination of the peripheral nervous system. Memorandum no. 45, London: HMSO, 1976.

Daniels L. , Worthington C. Muscle testing techniques of manual examination, third edition. Philadelphia: WB Saunders , 1972.

Hyde SA , Goddard CM , Scott OM The myometer: the development of a clinical tool. Physiotherapy 1983;69:424-27.

Hyde SA , Maskill D. , Scott OM , McDonnell M. Assessment of muscle function: a clinical application. Physiotherapy 1983; 69: 420-23.

Hoskings GP , Bhat US , Dubowitz V. , Edwards Rht. Measurements of muscle strength and performance in children with normal and diseased muscle. Arch Dis Childhood 1976; 51: 957-63.

Wiles CM , Karni Y. The measurement of muscle strength in patients with peripheral neuromuscular disorders. J Neurol Neurosurg Psychiatry 1983 ; 46: 1006-13.

Wiles CM , Karni Y. , Nicklin J. Laboratory testing of muscle function in the management of neuromuscular disease . J Neurol Neurosurg Psychiatry 1990; 53: 384-87.

Bohannon RW , Andrews W. Interrater reliability of hand-held dynamometry. Phys Ther Rev 1987; 67:931-33.

Wadsworth CT , Krishnan R. , Sear M. , Harrold J. , Nielson DH Intra-rater reliability of manual muscle testing and hand-held dynamometric testing. Phys Ther Rev 1987; 67: 1342-47.

10.

Bohannon RW , Endemann N. Magnitude and reliability of hand-held dynamometer measurements within and between days. Physiother Pract 1989; 5: 177-81.

11.

Iddings DM , Smith LK , Spencer WA Muscle testing: part 2. Reliability in clinical use. Phys Ther Rev 1961; 41:249-56.

12.

Lilenfeld AB , Jacobs M. , Willis M. A study of the reproducibility of muscle testing and certain other aspects of muscle scoring. Phys Ther Rev 1954; 34: 279-89.

13.

Beasley WC Influence of method on estimates of normal knee extensor force among normal and postpolio children. Phys Ther Rev 1956 ; 42: 21-41.

14.

Van der Ploeg Rjo , Fidler V. , Osterhuis HJGH. Hand-held myometry: reference values. J Neurol Neurosurg Psychiatry 1991; 54: 244-47.

15.

Edwards Rht , McDonnell M. Hand-held dynamometer for evaluating voluntary muscle function. Lancet 1974; ii: 757-58.

16.

Wikholm JB , Bohannon RW Hand-held dynamometer measurements: tester strength makes a difference. J Orthop Sports Phys Ther 1991; 13: 191-98.

17.

Smidt GL , Rogers MW Factors contributing to the regulation and clinical assessment of muscular strength. Phys Ther 1982; 62: 1283-90.

18.

Bohannon RW The clinical measurement of strength. Clin Rehabil 1987;1: 5-16.