Journal of Orthopaedic and Sports Physical Therapy

239th ENMC International Workshop: Classification of dermatomyositis, Amsterdam, the Netherlands, 14-16 December 2018.

Muscle strength impairments are related to mobility limitations and other untoward outcomes. This narrative review, therefore, describes considerations relative to the definition and measurement of muscle strength. Thereafter, practical options for measuring muscle strength are described and their clinimetric properties are delineated. Information provided herein may help students, clinicians, and researchers select the strength tests best suited to their research needs and limitations.

/pdf/considerations-and-practical-options-for-measuring-muscle-35iqps0op5.pdf

Considerations and Practical Options for Measuring Muscle Strength: A Narrative Review

Association of Body Fat With Health-Related Quality of Life and Depression in Nonagenarians: The Mugello Study.

Objectives We explored efficacy and safety of IVIg as first-line treatment in patients with an idiopathic inflammatory myopathy. Methods In this investigator-initiated phase 2 open-label study, we included 20 adults with a newly diagnosed, biopsy-proven idiopathic inflammatory myopathy, and a disease duration of less than 9 months. Patients with IBM and prior use of immunosuppressants were excluded. The standard treatment regimen consisted of IVIg (Privigen) monotherapy for 9 weeks: a loading dose (2 g/kg body weight) and two subsequent maintenance doses (1 g/kg body weight) with a 3-week interval. The primary outcome was the number of patients with at least moderate improvement on the 2016 ACR/EULAR Total Improvement Score. Secondary outcomes included time to improvement, the number of patients requiring rescue medication and serious adverse events. Results We included patients with DM (n = 9), immune-mediated necrotizing myopathy (n = 6), non-specific myositis/overlap myositis (n = 4) and anti-synthetase syndrome (n = 1). One patient was excluded from analyses because of minimal weakness resulting in a ceiling effect. Eight patients (8/19 = 42.0%; Clopper-Pearson 95% CI: 19.6, 64.6) had at least moderate improvement by 9 weeks. Of these, six reached improvement by 3 weeks. Seven patients required rescue medication due to insufficient efficacy and prematurely ended the study. Three serious adverse events occurred, of which one was pulmonary embolism. Conclusion First-line IVIg monotherapy led to at least moderate improvement in nearly half of patients with a fast clinical response in the majority of responders. Trial registration Netherlands Trial Register identifier, NTR6160.

Intravenous immunoglobulins as first-line treatment in idiopathic inflammatory myopathies: a pilot study.

Manual muscle testing (MMT) and hand-held dynamometry (HHD) are commonly used in people with inflammatory myopathy (IM), but their clinimetric properties have not yet been sufficiently studied. To evaluate the reliability and validity of MMT and HHD, maximum isometric strength was measured in eight muscle groups across three measurement events. To evaluate reliability of HHD, intra-class correlation coefficients (ICC), the standard error of measurements (SEM) and smallest detectable changes (SDC) were calculated. To measure reliability of MMT linear Cohen`s Kappa was computed for single muscle groups and ICC for total score. Additionally, correlations between MMT8 and HHD were evaluated with Spearman Correlation Coefficients. Fifty people with myositis (56±14 years, 76% female) were included in the study. Intra-and interrater reliability of HHD yielded excellent ICCs (0.75-0.97) for all muscle groups, except for interrater reliability of ankle extension (0.61). The corresponding SEMs% ranged from 8 to 28% and the SDCs% from 23 to 65%. MMT8 total score revealed excellent intra-and interrater reliability (ICC>0.9). Intrarater reliability of single muscle groups was substantial for shoulder and hip abduction, elbow and neck flexion, and hip extension (0.64-0.69); moderate for wrist (0.53) and knee extension (0.49) and fair for ankle extension (0.35). Interrater reliability was moderate for neck flexion (0.54) and hip abduction (0.44); fair for shoulder abduction, elbow flexion, wrist and ankle extension (0.20-0.33); and slight for knee extension (0.08). Correlations between the two tests were low for wrist, knee, ankle, and hip extension; moderate for elbow flexion, neck flexion and hip abduction; and good for shoulder abduction. In conclusion, the MMT8 total score is a reliable assessment to consider general muscle weakness in people with myositis but not for single muscle groups. In contrast, our results confirm that HHD can be recommended to evaluate strength of single muscle groups.

/pdf/manual-muscle-testing-and-hand-held-dynamometry-in-people-2t655t746h.pdf

Manual muscle testing and hand-held dynamometry in people with inflammatory myopathy: An intra- and interrater reliability and validity study.

Hintergrund Inflammatorische Myopathien (IM) sind eine Gruppe seltener entzundlicher Muskelerkrankungen. Verminderte Kraft und Ausdauerfahigkeit stellen die Hauptsymptome dar. Diverse Studien konnten positive Effekte einer Trainingstherapie nachweisen, es existieren jedoch keine krankheitsspezifischen Trainingsrichtlinien. Ziel Erstellung einer Ubersicht der vorhandenen Trainingsstudien mit Fokus auf erwachsene Patienten mit IM, um daraus einen evidenzbasierten, krankheitsspezifischen Trainingsleitfaden abzuleiten. Methode In einem ersten Schritt erfolgte eine systematische Literaturubersicht. Sie diente als Basis, um den Trainingsleitfaden zu entwickeln. Die langjahrige klinische Erfahrung spezialisierter Physiotherapeuten sowie die Trainingsrichtlinien des American College of Sports Medicine fanden ebenfalls Berucksichtigung. Ergebnisse In die systematische Ubersicht wurden 24 Studien mit insgesamt 151 Patienten mit IM eingeschlossen. Alle Studien zeigten positive Effekte eines Kraft- und/oder Ausdauertrainings auf. Unerwunschte Ereignisse traten nicht ein. Der Trainingsleitfaden besteht aus einem Einfuhrungsteil zu allgemeinen Trainingsprinzipien sowie zwei weiteren Teilen uber Kraft- und Ausdauertraining fur jede Krankheitsaktivitat (fruh-aktiv, aktiv, stabil). Schlussfolgerungen Obwohl die Trainingsprotokolle im Bereich der Myositis unterschiedlich sind, weisen alle Studien konsistent darauf hin, dass das Training sicher und effektiv ist. Der Trainingsleitfaden ermoglicht Therapeuten einen raschen Uberblick uber evidenzbasierte Trainingsrichtlinien. Die Richtlinien sollten in weiteren Studien angewendet, uberpruft und anschliesend verfeinert werden.

Entwicklung eines Trainingsleitfadens für Patienten mit entzündlicher Muskelerkrankung

Hintergrund Messungen bilden die Grundlage des wissenschaftsbasierten therapeutischen Vorgehens. Messfehler sind jedoch ein verbreitetes Problem. Um Fehlerquellen zu ermitteln, sind erweiterte statistische Modelle notwendig. Im Gegensatz zur klassischen Testtheorie ermoglicht die Generalisierbarkeitstheorie, mehrere Fehlerquellen gleichzeitig zu untersuchen. Ziel Vergleich der klassischen Testtheorie und der Generalisierbarkeitstheorie anhand eines physiotherapeutischen Beispiels zur Reliabilitatsermittlung und deren Ergebnisse. Methode Die Messeigenschaft „Reliabilitat“ wurde anhand von Daten einer vorangegangenen Reliabilitatsstudie, in der die klassische Testtheorie zum Einsatz kam, untersucht. Dazu wurde exemplarisch eine Generalisierbarkeitsstudie durchgefuhrt. Ergebnisse Die Variabilitat ging hauptsachlich von den Probanden und der Probanden-Untersucher-Interaktion aus. Unabhangig von fixen oder zufalligen Facetten waren die Generalisierbarkeitskoeffizienten fur alle Bedingungen (overall, inter-rater, intra-Messzeitpunkte) exzellent. Schlussfolgerung Die Ergebnisse deuten darauf hin, dass die Generalisierbarkeitstheorie gegenuber der klassischen Testtheorie Vorteile hat. Diese ermoglicht es, einen wirkungsvollen und effizienten Einsatz von Messinstrumenten im klinischen Alltag zu ermitteln.

/pdf/eine-alternative-zur-klassischen-testtheorie-eine-1w5t5b9c2j.pdf

Eine Alternative zur klassischen Testtheorie? – Eine exemplarische Anwendung der Generalisierbarkeitstheorie auf der Basis von Sekundärdaten

Background Inflammatory myopathies (IMs) are systemic autoimmune diseases, characterized by reduced muscle strength and endurance. Although IMs are relatively rare, patients9 disabilities in daily life are substantial. Thus, there is a need for appropriate and reliable assessments to quantify muscle weakness. Although the manual muscle test (MMT) and the quantitative muscle test (QMT), which employs a dynamometer, are commonly used tests to evaluate muscle strength, their psychometric properties (e.g. reliability) have not yet been sufficiently studied1. Objectives To determine the reliability of the MMT8 and the QMT in patients with IM. Methods Twenty-four adult, German speaking patients with established diagnosis of IM were included. The majority of patients was female (83%), 57±12 years old with a mean disease duration of 28±29 months. The maximum isometric strength of eight muscle groups, which are most often affected, was evaluated with the MMT8 using the 10 point Kendall scale and the QMT indicating strength in Newton (N). For intra-rater reliability, one tester performed the MMT8 and the QMT twice and for inter-rater reliability, they were tested by a second independent tester. The Intraclass Correlation Coefficient (ICC) and the Standard Error of Measurement (SEM) were evaluated. Results The intra-rater reliability of the MMT8 yielded moderate to good ICCs (0.63–0.89) for all muscle groups and an excellent ICC (0.92) for the total score. Inter-rater reliability yielded moderate to good ICCs (0.54–0.84) for shoulder abductors, wrist and hip extensors, hip abductors, neck flexors and the total score, and low ICCs (0.08–0.34) for the remaining muscle groups (elbow flexors, knee and foot extensors). The SEM was smaller for the intra-rater (SEM 0.5/10 point of Kendall scale for muscle groups and 2/10 points for the total score) than for inter-rater reliability (SEM 0.5–1/10 point for muscle groups and 3/10 points for the total score). QMT presented moderate to excellent intra- and inter-rater reliability (ICCs 0.52–0.92) for all muscle groups. The intra-rater comparison for shoulder abductors was 10N, inter-rater comparison 13N and the intra-rater and inter-rater comparisons for the knee extensors were 28N and 35N, respectively. In contrast to the QMT, the MMT8 showed high ceiling effects between 18% and 77% for all but one muscle group (hip extensors). Conclusions In this study, the QMT showed a better reliability than the MMT8 because of missing ceiling effects and due to the good to excellent intra- and inter-rater reliability. Notably, the QMT seems to be more accurate to measure single muscle groups especially in patients with mild weakness as for example in early disease. If no hand-held dynamometer is available, the total score of MMT8 represents an appropriate alternative. References Rider LG, Werth VP, Huber AM, Alexanderson H, Rao AP, Ruperto N, Herbelin L, Barohn R, Isenberg D, Miller FW: Measures of adult and juvenile dermatomyositis, polymyositis, and inclusion body myositisArthritis Care Res (Hoboken) 2011 Disclosure of Interest None declared

https://ard.bmj.com/content/annrheumdis/75/Suppl_2/1281.1.full.pdf

FRI0627-HPR In Patients with Inflammatory Myopathy Quantitative Muscle Testing Has A Higher Reliability than Manual Muscle Testing

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Papers

Manual muscle testing and hand-held dynamometry in people with inflammatory myopathy: An intra- and interrater reliability and validity study.

Entwicklung eines Trainingsleitfadens für Patienten mit entzündlicher Muskelerkrankung

Eine Alternative zur klassischen Testtheorie? – Eine exemplarische Anwendung der Generalisierbarkeitstheorie auf der Basis von Sekundärdaten

FRI0627-HPR In Patients with Inflammatory Myopathy Quantitative Muscle Testing Has A Higher Reliability than Manual Muscle Testing