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Intensive Care Med (2010) 36:10381043DOI 10.1007/s00134-010-1796-6 BRIEF REPORT
Eddy FanNancy D. Ciesla Alex D. Truong Vinodh Bhoopathi Scott L. Zeger Dale M. Needham
Inter-rater reliability of manual muscle strength testing in ICU survivorsand simulated patients
S. L. ZegerDepartment of Biostatistics, Johns Hopkins University, Baltimore, MD, USA
N. D. CieslaDepartment of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, MD, USA
V. BhoopathiDivision of Dental Public Health, Boston University, Boston, MA, USA
Abstract Objective: The goal of the paper is to determine inter-rater reliability of trained examiners performing standardized strength assessments using manual muscle testing (MMT). Design, subjects, and setting: The authors report on 19 trainees undergoing quality assurance within a multi-site prospective cohort study. Intervention: Inter-rater reliability for specially trained evaluators (trainees) and a reference rater, performing MMT using both simulated and actual patients recovering from critical illness was evaluated. Measurements and results: Across
26 muscle groups tested by 19 trainee-reference rater pairs, the median (interquartile range) percent agreement and intraclass correlation coefcient (ICC; 95% CI) were: 96% (91, 98%) and 0.98 (0.95, 1.00), respectively. Across all 19 pairs, the ICC (95% CI) for the overall composite MMT score was 0.99 (0.981.00). When limited to actual patients, the ICC was 1.00 (95% CI0.991.00). The agreement (kappa; 95% CI) in detecting clinically signicant weakness was 0.88 (0.441.00). Conclusions: MMT has excellent inter-rater reliability in trained examiners and is a reliable method of comprehensively assessing muscle strength.
Keywords Diagnostic techniques and procedures Epidemiologic
research design Muscle strength
Muscle weakness Physical
examination Reproducibility
of results
Received: 11 June 2009Accepted: 30 November 2009Published online: 6 March 2010 Copyright jointly held by Springer and
ESICM 2010
Electronic supplementary materialThe online version of this article (doi:http://dx.doi.org/10.1007/s00134-010-1796-6
Web End =10.1007/s00134-010-1796-6 ) contains supplementary material, which is available to authorized users.
E. Fan ()) A. D. Truong
D. M. NeedhamDivision of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1830 East Monument Street, 5th Floor, Baltimore, MD 21205, USAe-mail: [email protected].: ?1-410-9553467Fax: ?1-410-9550036
D. M. NeedhamDepartment of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA
Introduction
There is growing awareness of persistent neuromuscular complications after critical illness [15]. In studies evaluating interventions for improving muscle weakness, the reliable assessment of strength is key [68]. Standardized physical examination using manual muscle testing
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