RESUMO
Abstract Introduction: Weakness of the lower limb muscles, which are the main impairments after stroke, is associated with reduced mobility and decreased performance in functional tasks. Therefore, the assessment of strength of these muscles is necessary, which is commonly assessed with portable dynamometry. Aims: To perform a literature review regarding the methods used to assess lower limb strength with portable dynamometry in subjects with stroke and to describe its investigated measurement properties with this population. Materials and Methods: An extensive search was performed on the MEDLINE, SCIELO, LILACS, and PEDro databases, by combining specific key words, followed by active manual search by two independent researchers. Results and Discussion: Thirty studies were included, and the muscular groups of the knee (90%) were the most assessed, followed by the ankle (66.7%) and hip (63.3%) joints. In 5% of the studies, there were not reported any descriptions related to the positioning of the subjects and the equipment, neither regarding the stabilization procedures. Only 50% provided information regarding the number of trials and only 46.7% regarding the contraction times, being three trials and 5s the most commonly applied. Only 10% provided feedback and 23.3% demonstrations, prior to data collection. Only seven studies (23.3%) investigated the measurement properties of portable dynamometry and reported moderate to high reliability levels. Final Considerations: The protocols used for the assessment of the strength of the lower limb muscles with portable dynamometry in subjects with stroke were not standardized. Moreover, only one measurement property was investigated: the reliability, which was considered adequate.
Resumo Introdução: A fraqueza muscular de membros inferiores (MMII) é uma das principais deficiências do Acidente Vascular Encefálico (AVE), associada à redução da mobilidade e da execução de tarefas funcionais. Portanto, é necessária a avaliação da força muscular desses segmentos, o que é comumente realizado com a dinamometria portátil. Objetivos: Verificar os protocolos utilizados para a avaliação da força muscular de MMII com o dinamômetro portátil em indivíduos pós-AVE e as propriedades de medida investigadas. Métodos: Foram realizadas buscas nas bases de dados MEDLINE/SCIELO/LILACS/PEDro com combinação de termos específicos, seguida de busca manual ativa. Dois examinadores independentes analisaram os estudos e extraíram as informações. Resultados: Foram incluídos 30 estudos, sendo os grupos musculares do joelho os mais comumente avaliados (90%), seguido do tornozelo (66,7%) e quadril (63,3%). Em 5% dos estudos, não houve qualquer descrição do posicionamento dos indivíduos, do equipamento e nem da estabilização adotada. Apenas 50% relatou o número de repetições e apenas 46,7% o tempo da contração muscular, sendo três repetições e cinco segundos de contração os mais utilizados. Poucos relataram uso de feedback imediato e verbal (10%) e demonstração (23,3%) antes da coleta dos dados. Apenas sete estudos (23,3%) investigaram as propriedades de medida do dinamômetro portátil, sendo investigada a confiabilidade com resultados significativos, de moderada a elevada magnitude. Considerações finais: Não houve uma padronização clara dos protocolos utilizados na avaliação da força muscular de MMII com o dinamômetro portátil em indivíduos pós-AVE e apenas uma propriedade de medida foi investigada: a confiabilidade, com resultados adequados.
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OBJECTIVE: To investigate the reliability (test-retest and inter-rater) and criterion-related validity of the modified sphygmomanometer test (MST) for the assessment of upper limb muscle strength in subjects with chronic stroke, and to determine whether the results are affected by the number of trials. PATIENTS AND METHODS: The strength of 11 upper limb muscle groups of 57 subjects with stroke was bilaterally assessed with portable dynamometers and the MST (measured in mmHg). To investigate whether the number of trials would affect the results, 1-way analysis of variance was applied. For the test-retest/inter-rater reliabilities and criterion-related validity of the MST, intra-class correlation coefficients (ICCs), Pearson's correlation coefficients, and coefficients of determination were calculated. RESULTS: Different numbers of trials provided similar values for all assessed muscles (0.01 ≤ F ≤ 0.18; 0.83 ≤ p ≤ 0.99) with adequate test-retest (0.83 ≤ ICC ≤ 0.97; p < 0.0001) and inter-rater reliabilities (0.79 ≤ ICC ≤ 0.97; p < 0.0001) and validity (0.61 ≤ r ≤ 0.95; p < 0.0001). The values obtained with the MST were good predictors of those obtained with portable dynamometers (0.60 ≤ r2 ≤ 0.86), except for pinch strength (0.39 ≤ r2 ≤ 0.54). CONCLUSION: The MST showed adequate measurement properties for the assessment of the strength of the upper limb muscles of subjects with chronic stroke. After familiarization a single trial provided adequate strength values.
Assuntos
Esfigmomanômetros/estatística & dados numéricos , Acidente Vascular Cerebral/complicações , Extremidade Superior/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Reabilitação do Acidente Vascular Cerebral , Extremidade Superior/patologiaRESUMO
Introduction Clinical measurements of strength in stroke subjects are usually performed and portable dynamometers are one of the most employed instruments. Objective To verify the standardization procedures of the methods used to assess the strength of the trunk and upper limb muscles with portable dynamometers in stroke subjects, as well as to assess the psychometric properties which were already investigated. Materials and methods An extensive search was performed on the MEDLINE, SciELO, LILACS, and PEDro databases, by combining specific key words, followed by active manual searches by two independent researchers. Results and discussion Fifty-eight studies were included: three related to the trunk and 55 to the upper limb muscles, including handgrip and pinch strength assessments. The most investigated muscular groups were handgrip, elbow flexors/extensors, wrist extensors, and lateral pinch. Nine studies reported adequate reliability levels and the seated position was employed in the majority of the studies which assessed trunk, handgrip, and pinch strength, while the supine position was used for the other muscular groups. The number of trials most used was three, while the reported contractions and rest times were variable. Final considerations Most studies reported the positioning and/or the data collection protocols; however, there was no consensus on the standardization procedures. The only investigated psychometric property was reliability. Few studies evaluated the trunk muscles and other psychometric properties. .
Introdução A mensuração da força muscular em indivíduos acometidos pelo Acidente Vascular Encefálico (AVE) é comumente realizada na clínica, sendo os dinamômetros portáteis os instrumentos mais utilizados para tanto. Objetivo Verificar se há uma padronização dos métodos utilizados para avaliação da força muscular de tronco e membros superiores (MMSS) com o uso de dinamômetros portáteis em indivíduos pós-AVE, bem como verificar quais propriedades de medida já foram investigadas. Materiais e métodos As buscas foram realizadas nas bases de dados MEDLINE, SciELO, LILACS e PEDro com combinação de termos específicos, seguidas de busca manual ativa. A seleção dos estudos e a extração das informações foram realizadas por dois examinadores independentes. Resultados e discussão Foram incluídos 58 estudos (três de tronco e 55 de MMSS, incluindo preensão manual e pinça). Os grupos musculares mais avaliados foram preensão manual, flexores de cotovelo, extensores de punho, extensores de cotovelo e pinça lateral. Nove estudos reportaram confiabilidade adequada do método. A maioria dos estudos que avaliaram os músculos de tronco, de preensão manual e de pinça utilizou a postura sentada, enquanto o decúbito dorsal foi mais utilizado na avaliação dos demais músculos. O número de repetições mais utilizado foi três, já o tempo de contração e o período de repouso variaram entre os estudos. Considerações finais A maioria dos estudos relatou o posicionamento e/ou o protocolo de coleta, porém não houve uma padronização. A única propriedade de medida investigada foi a confiabilidade. Poucos estudos avaliaram os músculos de tronco e as outras propriedades de medida. .
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OBJECTIVES: To investigate the criterion-related validity, test-retest and inter-rater reliabilities of the modified sphygmomanometer test (MST) for assessment of the strength of the trunk and lower limb muscles in subjects with chronic stroke, and to verify whether the number of trials affected the results. PATIENTS AND METHODS: Fifty-nine subjects with stroke (mean age 57.80 years; standard deviation 13.79 years) were included in the study. Maximum isometric strength was assessed with a hand-held dynamometer and the MST. To investigate whether the number of trials affected the results, one-way analysis of variance was applied. For the criterion-related validity, test-retest and inter-rater reliabilities of the MST, Pearson correlation coefficients, coefficients of determination, and intra-class correlation coefficient (ICC) were calculated. RESULTS: Different numbers of trials provided similar values for all assessed muscles (0.003 ≤ F ≤ 0.08; 0.92 ≤ p ≤ 1.00) with adequate validity (0.79 ≤ r ≤ 0.90; p ≤ 0.001), test-retest (0.57 ≤ ICC ≤ 0.98; p ≤ 0.001), and inter-rater reliabilities (0.53 ≤ ICC ≤ 0.97; p ≤ 0.001), except for the inter-rater reliability of the non-paretic ankle plantar flexors. The values obtained with the MST were good predictors of those obtained with the hand-held dynamometer (0.57 ≤ r2 ≤ 0.79). CONCLUSION: In general, the MST showed adequate criterion-related validity, test-retest and inter-rater reliabilities for the assessment of strength of the lower limb and trunk muscles in subjects with chronic stroke. For the majority of the assessed muscles, only one trial, after familiarization, provided adequate strength values.