Júlia Caetano Martins

Dynamometry for the Assessment of Grip, Pinch, and Trunk Strength in Subjects with Chronic Stroke: Reliability and Various Sources of Outcome Values

Background: Muscular weakness, commonly observed in individuals with stroke, is usually assessed with portable dynamometers. However, no studies were found which investigated the reliability of the dynamometry for the assessment of grip, pinch, and trunk strength in subjects with chronic stroke, nor which evaluated the best source of outcome values. Objectives: To investigate the test-retest and inter-rater reliabilities of the portable dynamometer for the assessment of grip, pinch, and trunk strength in subjects with chronic stroke and to verify whether the use of various sources of outcomes (first trial, the means of two and three trials) affected the obtained values, as well as their reliabilities. Methods: A methodological study with 47 (58.67 ± 14.79 years) and 38 (57.05 ± 16.23 years) subjects with chronic stroke was carried out to investigate test-retest and inter-rater reliabilities, respectively. Grip and pinch (pulp-to-pulp, palmar, and lateral) strength were bilaterally assessed, as well as the strength of the trunk flexors/extensors, lateral flexors, and rotators, with portable dynamometry by two independent examiners over two sessions, 1-4 weeks apart. One-way ANOVAs were employed to compare the values between the various sources of outcome values. Intra-class correlation coefficients (ICCs) were calculated to investigate the test-retest and inter-rater reliabilities for all sources of outcome values (α=0.05). Results: For all muscular groups, similar results were found for all sources of outcome values (0.01

Assessment of grip strength with the modified sphygmomanometer test: association between upper limb global strength and motor function

ABSTRACT Background: Grip strength, commonly evaluated with the handgrip dynamometer, is a good indicator of upper limb (UL) function in stroke subjects and may reflect the global strength deficits of the whole paretic UL. The Modified Sphygmomanometer Test (MST) also provides objective and adequate measures at low-cost. Objective: To assess whether grip strength values obtained by using the MST and those obtained by using a handgrip dynamometer would present similar correlations with the global strength and motor function of the paretic UL in subjects with stroke, both in the subacute and chronic phases. Method: Measures of grip strength (MST and handgrip dynamometer), UL global strength (MST and hand-held dynamometer), and UL motor function (Fugl-Meyer motor assessment scale) were obtained with 33 subacute and 44 chronic stroke subjects. Pearson and Spearman correlation coefficients were calculated and Stepwise multiple regression analyses were performed to investigate predictor variables of grip strength (α=0.05). Results: Significant correlations of similar magnitude were found between measures of global strength of the paretic UL and grip strength assessed with both the MST (0.66≤r≤0.78) and handgrip dynamometer (0.66≤r≤0.78) and between UL motor function and grip strength assessed with both the MST (0.50≤rs≤0.51) and hand-held dynamometer (0.50≤rs≤0.63) in subacute and chronic stroke subjects. Only global strength remained as a significant predictor variable of grip strength for the MST (0.43≤R2≤0.61) and for the handgrip dynamometer (0.44≤R2≤0.61) for both stroke subgroups. Conclusion: Grip strength assessed with the MST could be used to report paretic UL global strength.

Assessment of the strength of the trunk and upper limb muscles in stroke subjects with portable dynamometry: a literature review

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.

Assessment of the strength of the lower limb muscles in subjects with stroke with portable dynamometry: a literature review

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.

Dynamometry for the measurement of grip, pinch, and trunk muscles strength in subjects with subacute stroke: reliability and different number of trials

ABSTRACT Background Muscle strength is usually measured in individuals with stroke with Portable dynamometers (gold standard). However, no studies have investigated the reliability, the standard error of measurement (SEM) and the minimal detectable difference (MDD95%) of the dynamometry for the measurement of hand grip, pinch grip and trunk strength in subjects with subacute stroke. Objective 1) To investigate the intra and inter-rater reliability, the SEM and the MDD95% of the portable dynamometers for the measurement of grip, pinch and trunk strength in subjects with subacute stroke, and 2) to verify whether the use of different number of trials (first trial and the average of the first two and three trials) affected the results. Method 32 subjects with subacute stroke (time since stroke onset: 3.6 months, SD=0.66 months) were evaluated. Hand grip, 3 pinch grips (i.e. pulp-to-pulp/palmar/lateral) and 4 trunk muscles (i.e. flexors, extensors, lateral flexors and rotators) strength were bilaterally assessed (except trunk flexors/extensors) with portable dynamometry by two independent examiners over two sessions (1-2 weeks apart). One-way ANOVAs and intraclass correlation coefficients (ICC2,k) were used for analysis (α=0.05). SEM and MDD95% were also calculated. Results For all muscular groups and sources of outcome values, including one trial, after familiarization, similar results were found (0.01≤F≤0.08; 0.92≤p≤0.99) with significant and adequate values of intra-rater (0.64≤ICC≤0.99; 0.23≤95%CI≤0.99) and inter-rater (0.66≤ICC≤0.99; 0.25≤95%CI≤0.99) reliability. SEM and MDD95% were considered low (0.39≤EPM≤2.21 Kg; 0.96≤MMD95%≤6.12 Kg) for all outcome scores. Conclusion Only one trial, following familiarization, demonstrated adequate intra-rater and inter-rater reliability of the portable dynamometers for the measurement of hand grip, pinch grip and trunk strength in subjects with subacute stroke.

Assessment of muscular strength with the modified sphygmomanometer test: what is the best method and source of outcome values?

Background Tests that are usually employed for the clinical assessment of muscular strength have notable disadvantages. The Modified Sphygmomanometer Test (MST) is a promising method because it is low-cost and provides objective measures. Objectives To investigate the most adequate method and sources of outcome values for the assessment of strength with the MST. Method Methodological study with 40 healthy adults (22.98±2.26 years), who did not practice physical activity regularly. The strength of the flexors and extensors of the elbow and knee, the handgrip of the dominant side and anterior trunk flexors were randomly assessed with portable dynamometers and the MST (bag and cuff adaptations, and sphygmomanometer without adaptation) by a single examiner. An independent examiner read and recorded the values. The sources of the investigated outcome values were the first trial and the means of two and three trials. One-way ANOVAs and Pearson Correlation Coefficients were used for the analyses (α=0.05). Results For the MST methods applied to assess all muscular groups, similar values were found for all sources of outcome values (0.01<F<0.26; 0.77<p<1.00) with significant and positive correlations between the measures obtained with the dynamometers (0.51<r<0.94; p<0.003). Conclusions All MST methods showed adequate results for the assessment of strength in healthy individuals, and after familiarization, only one trial was sufficient to provide reliable measures. The sphygmomanometer without adaptation is not time consuming, compared to the other adaptations, and showed the capability of measuring higher values of strength. The bag method was easily trained to be used and stabilized.

Measurement properties of self-report physical activity assessment tools in stroke: a protocol for a systematic review

Introduction Self-report physical activity assessment tools are commonly used for the evaluation of physical activity levels in individuals with stroke. A great variety of these tools have been developed and widely used in recent years, which justify the need to examine their measurement properties and clinical utility. Therefore, the main objectives of this systematic review are to examine the measurement properties and clinical utility of self-report measures of physical activity and discuss the strengths and limitations of the identified tools. Methods and analysis A systematic review of studies that investigated the measurement properties and/or clinical utility of self-report physical activity assessment tools in stroke will be conducted. Electronic searches will be performed in five databases: Medical Literature Analysis and Retrieval System Online (MEDLINE) (PubMed), Excerpta Medica Database (EMBASE), Physiotherapy Evidence Database (PEDro), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and Scientific Electronic Library Online (SciELO), followed by hand searches of the reference lists of the included studies. Two independent reviewers will screen all retrieve titles, abstracts, and full texts, according to the inclusion criteria and will also extract the data. A third reviewer will be referred to solve any disagreement. A descriptive summary of the included studies will contain the design, participants, as well as the characteristics, measurement properties, and clinical utility of the self-report tools. The methodological quality of the studies will be evaluated using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist and the clinical utility of the identified tools will be assessed considering predefined criteria. This systematic review will follow the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. Discussion This systematic review will provide an extensive review of the measurement properties and clinical utility of self-report physical activity assessment tools used in individuals with stroke, which would benefit clinicians and researchers. Trial registration number PROSPERO CRD42016037146.

A Single Trial May Be Used for Measuring Muscle Strength With Dynamometers in Individuals With Stroke: A Cross-Sectional Study

The mean of 3 trials is commonly employed to report measures of muscle strength after a stroke. However, consistent and reliable results have been found for single trial dynamometric measures of grip, pinch, and trunk strength in individuals with stroke. Nevertheless, no studies were found that investigated whether only a single trial could be used for the assessment of the strength of both the upper and lower limb muscles.

Nível de atividade física de usuários da atenção primária: comparação entre indivíduos saudáveis e pós acidente vascular cerebral

Subjects with stroke have a low physical activity level which may lead to recurrence of stroke events, occurrence of other cardiovascular diseases and increase of disabilities. The maintenance of an adequate physical activity level is associated with improvements on functionality and health of these subjects. Objective: To compare the physical activity levels of subjects with stroke and matched healthy subjects from a Primary Health Care unit. Method: Subjects with stroke (G1; n = 37) from a Primary Health Care unit, with clinical conditions to answer a questionnaire, and healthy matched subjects (G2; n = 37), from the same unit, were assessed for physical activity level by the Human Activity Profile (HAP) questionnaire. Descriptive statistics, t-test student, chi-square test and Mann-Whitney test were used for analysis (α = 0.05). Results: The groups were similar in age, sex and exercise level (p>0.05). There was a significant difference between groups on HAP (0.001≤p≤0.011). Conclusion: Individuals with stroke are worse classified and have worse scores on physical activities levels of the HAP, when compared to matched healthy individuals.56 ABSTRACT Subjects with stroke have a low physical activity level which may lead to recurrence of stroke events, occurrence of other cardiovascular diseases and increase of disabilities. The maintenance of an adequate physical activity level is associated with improvements on functionality and health of these subjects. Objective: To compare the physical activity levels of subjects with stroke and matched healthy subjects from a Primary Health Care unit. Method: Subjects with stroke (G1; n = 37) from a Primary Health Care unit, with clinical conditions to answer a questionnaire, and healthy matched subjects (G2; n = 37), from the same unit, were assessed for physical activity level by the Human Activity Profile (HAP) questionnaire. Descriptive statistics, t-test student, chi-square test and Mann-Whitney test were used for analysis (α = 0.05). Results: The groups were similar in age, sex and exercise level (p>0.05). There was a significant difference between groups on HAP (0.001≤p≤0.011). Conclusion: Individuals with stroke are worse classified and have worse scores on physical activities levels of the HAP, when compared to matched healthy individuals.

Efficacy of interventions to improve physical activity levels in individuals with stroke: a systematic review protocol

Introduction Stroke is a leading health problem worldwide and an important cause of disability. Stroke survivors show low levels of physical activity, and increases in physical activity levels may improve function and health status. Therefore, the aims are to identify which interventions that have been employed to increase physical activity levels with stroke survivors, to verify their efficacy and to identify the gaps in the literature. Methods and analysis A systematic review of randomised controlled trials that investigated the efficacy of interventions aiming at increasing physical activity levels of stroke survivors will be conducted. Electronic searches will be performed in the MEDLINE, Physiotherapy Evidence Database (PEDro), Excerpta Medica (EMBASE), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and Scientific Electronic Library Online (SCIELO) databases. Hand searches of the reference lists of the included studies or relevant reviews will also be employed. Two independent reviewers will screen all the retrieved titles, abstracts and full texts. A third reviewer will be referred to solve any disagreements. The quality of the included studies will be assessed by the PEDro Rating Scale. This systematic review will also include a qualitative synthesis. Meta-analyses will be performed, if the studies are sufficiently homogeneous. This review will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. The quality of the evidence regarding physical activity will be assessed, according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Discussion This systematic review will provide information on which interventions are effective for increasing physical activity levels of stroke survivors. This evidence may be important for clinical decision-making and will allow the identification of gaps in the literature that may be useful for the definition of future research goals and the planning of new trials. Trial registration number CRD42016037750.