Diagnostic Accuracy of Handheld Dynamometry and 1-Repetition-Maximum Tests for Identifying Meaningful Quadriceps Strength Asymmetries

作者：Sinacore J Anthony; Evans Andrew M; Lynch Brittany N; Joreitz Richard E; Irrgang James J; Lynch Andrew D^*

来源：Journal of Orthopaedic & Sports Physical Therapy, 2017, 47(2): 97-107.

DOI：10.2519/jospt.2017.6651

• knee joint
• leg extension
• leg press
• muscle strength dynamometer
• quadriceps index

STUDY DESIGN: Clinical measurement, cross-sectional.
BACKGROUND: Quadriceps deficits are common in individuals with knee joint impairments and impact functional and quality-of-life outcomes. Quadriceps strength symmetry influences clinical decisions after knee injury. Isometric electromechanical dynamometry (ISO-ED) is the gold standard for measuring symmetry, but is not available in all clinical settings.
OBJECTIVES: To compare concurrent validity of handheld dynamometry and 1-repetition-maximum leg press, knee extension from 90 degrees to 0 degrees, and knee extension from 90 degrees to 45 degrees to that of ISO-ED in identifying meaningful quadriceps strength deficits.
METHODS: Fifty-six participants with knee joint impairments completed ISO-ED and 4 alternative measures of quadriceps strength symmetry in a single session. Absolute agreement of alternative measures with ISO-ED was calculated with intraclass correlation coefficients (ICCs). Clinical agreement values at thresholds of 80% and 90% symmetry were compared between the alternatives and ISO-ED.
RESULTS: Knee extension from 90 degrees to 45 degrees (ICC = 0.67) and handheld dynamometry (ICC = 0.70) had the greatest ICCs. Clinical agreement was also best for these measures for 80% symmetry (kappa = 0.56 and 0.55, respectively) and 90% symmetry (kappa = 0.19 and 0.33, respectively).
CONCLUSION: Handheld dynamometry and 1-repetition-maximum testing of knee extension from 90 to 45 are fair alternatives, although symmetry is typically overestimated. Receiver operating characteristic analysis identified alternative measure thresholds that correlated with the 80% and 90% symmetry thresholds on the ISO-ED. Clinicians should use more stringent symmetry values for these alternative tests to increase the probability that individuals have a minimum ISO-ED symmetry of 80% or 90%.

• 出版日期2017-2