Intensive Care Medicine

, Volume 36, Issue 6, pp 1038–1043

Inter-rater reliability of manual muscle strength testing in ICU survivors and simulated patients

  • Eddy Fan
  • Nancy D. Ciesla
  • Alex D. Truong
  • Vinodh Bhoopathi
  • Scott L. Zeger
  • Dale M. Needham
Brief Report

DOI: 10.1007/s00134-010-1796-6

Cite this article as:
Fan, E., Ciesla, N.D., Truong, A.D. et al. Intensive Care Med (2010) 36: 1038. doi:10.1007/s00134-010-1796-6



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.


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 coefficient (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 (0.98–1.00). When limited to actual patients, the ICC was 1.00 (95% CI 0.99–1.00). The agreement (kappa; 95% CI) in detecting clinically significant weakness was 0.88 (0.44–1.00).


MMT has excellent inter-rater reliability in trained examiners and is a reliable method of comprehensively assessing muscle strength.


Diagnostic techniques and proceduresEpidemiologic research designMuscle strengthMuscle weaknessPhysical examinationReproducibility of results

Supplementary material

134_2010_1796_MOESM1_ESM.doc (188 kb)
Supplementary material 1 (DOC 188 kb)

Copyright information

© Copyright jointly held by Springer and ESICM 2010

Authors and Affiliations

  • Eddy Fan
    • 1
  • Nancy D. Ciesla
    • 4
  • Alex D. Truong
    • 1
  • Vinodh Bhoopathi
    • 5
  • Scott L. Zeger
    • 3
  • Dale M. Needham
    • 1
    • 2
  1. 1.Division of Pulmonary and Critical Care MedicineJohns Hopkins UniversityBaltimoreUSA
  2. 2.Department of Physical Medicine and RehabilitationJohns Hopkins UniversityBaltimoreUSA
  3. 3.Department of BiostatisticsJohns Hopkins UniversityBaltimoreUSA
  4. 4.Department of Physical Medicine and RehabilitationJohns Hopkins HospitalBaltimoreUSA
  5. 5.Division of Dental Public HealthBoston UniversityBostonUSA