Ann Rehabil Med.  2020 Dec;44(6):502-509. 10.5535/arm.20056.

Knee Extensor Strength Measurement in Patients With Limited Physical Activity Using a Supine Dynamometer Anchoring Frame

• Lee MY
• Sung KS
• Ham H
• Yi YG
• Shin HI

• KMID: 2510817
• DOI: http://doi.org/10.5535/arm.20056

Abstract

Objective
To investigate the reliability of knee extensor strength measurements using a supine hand-held dynamometer (HHD) anchoring frame in patients with limited physical activity. Although an HHD is suitable for bedside use, its inter-rater reliability is low because measurements can be influenced by tester strength.
Methods
Maximal knee extensor isometric strength was measured using an HHD anchored to the supine frame. Three trials of three maximal contractions were assessed by two raters.
Results
A total of 33 inpatients who were non-ambulatory due to acute illness participated in the study. The intraclass correlation coefficients were 0.974 (inter-rater) and 0.959 (intra-rater). The minimal detectable changes in intra- and inter-observer measurements were 29.46 N (24.10%) and 36.73 N (29.26%), respectively. The limits of agreement ranged from -19.79% to 24.81% for intra-rater agreement and from -21.45% to 37.07% for inter-rater agreement.
Conclusion
The portable dynamometer anchoring system can measure the isometric strength of the knee extensor reliably in the supine position, and could be used for measurements in patients who have difficulty visiting the laboratory and maintaining a seated posture.

Keyword

Muscle strength; Dynamometer; Isometric contraction; Supine position; Reliability

Figure

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  Fig. 1. Portable dynamometer anchoring system in a supine position. A, the frame can be moved to adjust the hand-held dynamometer (HHD) depending on leg thickness; B, the frame can be moved to adjust the HHD depending on leg length; C, belts that fix the frame to the bed; D, Velcro strap to fix the patient’s thigh to minimize hip flexion movement; and E, the frame was designed at an angle of 145° to flex the knee to 35°.

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  Fig. 2. Procedure of measuring the strength of the knee extensor.

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  Fig. 3. Distribution from Bland-Altman plots for the mean difference and limits-of-agreement of (A) intra-rater measurements and (B) inter-rater measurements.

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