Reliability and agreement between 2 strength devices used in the newly modified and standardized Constant score

Comparison of two electronic dynamometers for measuring handgrip strength

INTRODUCTION

Handgrip strength (HGS) is a strong predictor and easily applicable assessment, indicating a person's physical condition and health. However, many dynamometers are available; therefore, it is essential to ensure that the results of HGS testing using different dynamometers can be used interchangeably. The primary purpose of this study was to investigate the inter-instrument agreement and criterion validity of the Baseline BIMS Digital Grip Dynamometer in comparison with the Jamar electronic dynamometer (Jamar+).

METHODS

Seventy participants, aged between 23-88 (five men and five women in each decade from 20 to 80+), performed three attempts with each dynamometer (30-sec break between attempts) in a randomized order and separated with a 5-minute break between dynamometers. Intraclass correlation coefficient (3.1), standard error of measurement and minimal detectable change were used for comparison of the strongest and average strength measured with dynamometers. Jamar+ and Baseline BIMS Digital Grip Dynamometer were new dynamometers and considered calibrated by the manufacturer.

RESULTS

The overall Intraclass correlation coefficient was excellent (0.98). An average (SD) difference of 0.68 (2.2) kg (p = 0.04) was seen for the comparison of the strongest attempt for Baseline BIMS minus Jamar+, Correspondingly, for the average of three attempts, it was 0.37 (2.29, p = 0.2) kg. The standard error of measurement (%) and minimal detectable change (%) of the strongest attempt was 1.64 kg (4.2%) and 3.55 kg (9.0%), respectively.

CONCLUSIONS

Findings indicate low measurement error with high agreement and criterion validity for the comparison of Baseline BIMS Digital Grip Dynamometer and Jamar+ and that results of the two dynamometers can be used interchangeably.

Evaluation of the Multiple Assessment Subjective Shoulder Score (MASSS). A pilot study

INTRODUCTION

This study compares an entirely patient reported modification of the Constant-Murley Score (CS) (the Multiple Assessment Subjective Shoulder Score [MASSS]), with the CS in symptomatic patients with non-instability shoulder pathology.

HYPOTHESIS

The hypothesis is that the sub scores and overall score of the MASSS will be well correlated and in high agreement to the corresponding scores of the CS.

MATERIALS AND METHODS

The MASSS, the CS and adjusted-CS (a-CS) were administered to 74 patients. The MASSS replaced the strength and ROM domains of the CS with SANE scores. Correlations, differences, agreement, test-retest reliability, and internal consistency were assessed using Pearson's R test, paired t-test, Bland-Altman method, intraclass correlations (ICC) and Cronbach's alpha.

RESULTS

Correlation between MASSS and CS (0.834) and a-CS (0.824) were excellent. Total MASSS (54.0) was higher than CS (41.8) (p<0.001) and a-CS (47.8) (p<0.05). MASSS strength and ROM domains were higher than those of the CS (Strength: 13.4 v 5.3 [p<0.001], ROM: 24.8 v 20.8 [p<0.001]. There was a floor effect for the strength domain of the CS (46.7% minimum score), but not the MASSS (0% minimum score). MASSS internal consistency (0.626-0.734) was better than the CS (0.401-0.643). Test re-test reliability of the total MASSS (ICC 0.93) and the strength (ICC 0.90) and ROM (ICC 0.86) domains was excellent.

DISCUSSION

The MASSS has several advantages over the CS. Although the correlation of the total MASSS with the CS and a-CS was high, there was poor agreement in the strength and the ROM domains and therefore the MASSS value is not interchangeable with the CS, but rather should be considered as an alternative.

LEVEL OF EVIDENCE

II; Prospective cohort study.

Normal Baseline Values for Isometric Shoulder Strength in Scaption for Healthy Filipino Individuals in the 20-30 year Age Group

Introduction:

Isometric shoulder strength is vital in the management of individuals suffering from shoulder diseases such as rotator cuff tears. Normal values for the working Filipino population who are at risk of developing shoulder problems are lacking. The objective of this study was to determine the isometric baseline isometric shoulder strengths in scaption of healthy Filipino individuals aged 20-30 years old without a history of a shoulder injury.

Material and Methods:

This is a cross-sectional descriptive study measuring the isometric strength values using the handheld IDO isometer of dominant and non-dominant shoulder of healthy Filipino individuals aged 20 to 30 years old.

Results:

There is no significant difference in the mean isometric shoulder strength between the dominant and non-dominant arm for both sexes. The male gender scored higher values compared to the female gender and is statistically significant.

Conclusion:

There is no difference in isometric shoulder strength between the dominant and non-dominant shoulder. Strength differences favour the male gender.

Neither operative nor nonoperative approach is superior for treating displaced midshaft clavicle fractures: a partially blinded randomized controlled clinical trial

AIMS

To compare the functionality of adults with displaced mid-shaft clavicular fractures treated either operatively or nonoperatively and to compare the relative risk of nonunion and reoperation between the two groups.

METHODS

Based on specific eligibility criteria, 120 adults (median age 37.5 years (interquartile range (18 to 61)) and 84% males (n = 101)) diagnosed with an acute displaced mid-shaft fracture were recruited, and randomized to either the operative (n = 60) or nonoperative (n = 60) treatment group. This randomized controlled, partially blinded trial followed patients for 12 months following initial treatment. Functionality was assessed by the Constant score (CS) (assessor blinded to treatment) and Disability of the Arm, Shoulder and Hand (DASH) score. Clinical and radiological evaluation, and review of patient files for complications and reoperations, were added as secondary outcomes.

RESULTS

At 12 months, 87.5% of patients (n = 105) were available for analysis. The two groups were well balanced based on demographic and fracture-related characteristics. At six weeks of follow-up a significant difference in DASH score (p < 0.001) was found in favour of operative treatment. The functionality at 12 months of follow-up based on CS and DASH was excellent in both groups (CS > 90 points and DASH < 10 points) with no significant difference (p = 0.277 for DASH and p = 0.184 for CS) between the two groups. The risk of symptomatic nonunion was significantly higher in the nonoperative group (p = 0.014), with a relative risk of 9.47 (95% confidence interval (CI) 1.26 to 71.53) in this group compared to the operative group. The number-needed-to-treat to avoid one symptomatic nonunion was 6.2. Initial treatment and age were factors significantly associated with nonunion in a logistic analysis. There were 26% in both groups (n = 14 in operative group and n = 15 in nonoperative group) who required secondary surgery, with most indications in the nonoperative group mandatory due to nonunion compared to most relative indications in the operative group requiring intervention due to implant irritation.

CONCLUSION

Superiority was not identified with either an all-operative or all-nonoperative approach. The functionality at short term (within six weeks) seems igreater following operative treatment but was not found at one year. The risk of nonunion is significantly higher with nonoperative treatment. However, an all-operative approach to lower the nonunion risk may result in unnecessary surgery and is not recommended. Cite this article: Bone Joint J 2021;103-B(4):762-768.

Evaluation of the Constant score: which is the method to assess the objective strength?

BACKGROUND

The Constant score (CS) is one of the most frequently applied tools for the assessment of the shoulder joint. However, evaluation of strength is not standardized leading to potential bias when comparing different studies.

METHODS

Seventy-six patients with fractures of the proximal humerus undergoing open reduction and internal fixation (ORIF) were assessed using standardized CS strength measurements at the deltoid muscle insertion and at the wrist in three different arm positions. Variation coefficients were evaluated for each patient and position.

RESULTS

Forty women (57%) and 36 men (43%) were examined 96 months in mean after ORIF. We could state a maximum of 105.3 N difference if measurements were performed at the wrist or the insertion of the deltoid muscle in 90° forward flexion on the injured arm (167.9 ± 83.1 N; 62.6 ± 29.4 N). The lowest variation coefficient of the three performed measurements could be stated at the deltoid muscle insertion in a 90° abduction position in the scapula plane (6.94 ± 5.5).

CONCLUSION

Following our study results, different positions of force measurement can change the total CS by a whole category (e.g. "very good" to "good"). We recommend performing the measurement at the insertion of the deltoid muscle in a 90° abduction position in the scapula plane. Otherwise, even in the non-injured, it is hard to reach a "normal" shoulder function, based on the CS. When using the CS as outcome parameter, authors must give detailed information about the force measuring and use an exact measuring device.

A prospective study of coracoclavicular ligament reconstruction with autogenous peroneus longus tendon for acromioclavicular joint dislocations

BACKGROUND

Anatomic coracoclavicular (CC) ligament reconstruction (ACCR) provides good outcomes for Rockwood type III and VI acromioclavicular (AC) joint dislocations. Various grafts have been used, but complications from graft harvesting are not uncommon. This study examined the clinical and radiographic outcomes of patients with AC joint dislocations repaired with the autogenous anterior half of the peroneus longus tendon (AHPLT) to achieve ACCR.

METHODS

Patients with a Rockwood type III to V AC joint dislocation and magnetic resonance imaging of the disruption of the CC ligaments, as well as the AC capsule, were prospectively recruited. Patients received ACCR using an autogenous AHPLT graft and were evaluated clinically and radiographically preoperatively and at 1, 3, 6, and 12 months postoperatively.

RESULTS

A total of 18 patients (mean age, 51 years) were prospectively recruited and received an autogenous AHPLT graft ACCR. Fifteen patients completed clinical and radiographic follow-up examinations at 12 months. The mean Constant score (CS) was 51 preoperatively and 93 at 12 months (P <.005). No significant difference was noted at 12 months between the CS of the injured and contralateral shoulder. The mean American Orthopedic Foot and Ankle Society score at 12 months was 99, and this was not different from the value at any other time point. Loss of reduction occurred in 10 patients (56%), and tunnel widening was observed in 9 (50%), but neither was significantly correlated with functional outcome.

CONCLUSION

Autogenous AHPLT appears to be a reliable tendon graft source for CC ligament reconstruction.

High inter-rater reliability, agreement, and convergent validity of Constant score in patients with clavicle fractures

BACKGROUND

The Constant score (CS) has been the primary endpoint in most studies on clavicle fractures. However, the CS was not developed to assess patients with clavicle fractures. Our aim was to examine inter-rater reliability and agreement of the CS in patients with clavicle fractures. The secondary aim was to estimate the correlation between the CS and the Disabilities of the Arm, Shoulder and Hand score and the internal consistency of the 2 scores.

METHODS

On the basis of sample sizing, 36 patients (31 male and 5 female patients; mean age, 41.3 years) with clavicle fractures underwent standardized CS assessment at a mean of 6.8 weeks (SD, 1.0 weeks) after injury. Reliability and agreement of the CS were determined by 2 raters. The interclass correlation coefficient (ICC2,1), standard error of measurement, minimal detectable change, Cronbach α coefficient, and Pearson correlation coefficient were estimated.

RESULTS

Inter-rater reliability of the total CS was excellent (interclass correlation coefficient, 0.94; 95% confidence interval, 0.88-0.97), with no systematic difference between the 2 raters (P = .75). The standard error of measurement (measurement error at the group level) was 4.9, whereas the minimal detectable change (smallest change needed to indicate a real change for an individual) was 13.6 CS points. The internal consistency of the 10 CS items was good, with a Cronbach α of .85, and we found a strong correlation (r = -0.92) between the CS and Disabilities of the Arm, Shoulder and Hand score.

CONCLUSIONS

The CS was found to be reliable for assessing patients with clavicle fractures, especially at the group level. With high inter-rater reliability and agreement, in addition to good internal consistency, the standardized CS used in this study can be used for comparison of results from different settings.

Interrater Reliability of the 6-Minute Walk Test in Women With Hip Fracture

BACKGROUND AND PURPOSE

The 6-minute walk test (6MWT) is widely used as a clinical outcome measure. However, the reliability of the 6MWT is unknown in individuals who have recently experienced a hip fracture. The aim of this study was to evaluate the relative and absolute interrater reliability of the 6MWT in individuals with hip fracture.

METHODS

Two senior physical therapy students independently examined a convenience sample of 20 participants in a randomized order. Their assessments were separated by 2 days and followed the guidelines of the American Thoracic Society. Hip fracture-related pain was assessed with the Verbal Ranking Scale.

RESULTS

Participants (all women) with a mean (standard deviation) age of 78.1 (5.9) years performed the test at a mean of 31.5 (5.8) days postsurgery. Of the participants, 10 had a cervical fracture and 10 had a trochanteric fracture. Excellent interrater reliability (intraclass correlation coefficient [ICC2.1] = 0.92; 95% confidence interval, 0.81-0.97) was found, and the standard error of measurement and smallest real difference were calculated to be 21.4 and 59.4 m, respectively. Bland-Altman plots revealed no significant difference (mean of 3.2 [31.5] m, P = .83) between the 2 raters, and no heteroscedasticity was observed (r = -0.196, P = .41). By contrast, participants walked an average of 21.7 (22.5) m longer during the second trial (P = .002). Participants with moderate hip fracture-related pain walked a shorter distance than those with no or light pain during the first test (P = .04), but this was not the case during the second test (P = .25).

CONCLUSION

The interrater reliability of the 6MWT is excellent, and changes of more than 21.4 m (group level) and 59.4 m (individual participants with hip fracture) indicate a real change in the 6MWT. Measuring hip fracture-related pain during testing is recommended for individuals with hip fracture who undergo the 6MWT.