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

Intensive Care Medicine volume 36, pages 1038–1043 (2010)Cite this article

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 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).

Conclusions

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

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Acknowledgments

This research is supported by the National Institutes of Health (Acute Lung Injury SCCOR grant P050 HL 73994). EF is supported by a Fellowship Award from the Canadian Institutes of Health Research and a Detweiler Traveling Fellowship from the Royal College of Physicians and Surgeons of Canada. DMN is supported by a Clinician-Scientist Award from the Canadian Institutes of Health Research. The funding bodies had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

Conflicts of interest statement

No potential conflicts of interest to disclose.

Author information

Affiliations

  1. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1830 East Monument Street, 5th Floor, Baltimore, MD, 21205, USA

    Eddy Fan, Alex D. Truong & Dale M. Needham

  2. Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA

    Dale M. Needham

  3. Department of Biostatistics, Johns Hopkins University, Baltimore, MD, USA

    Scott L. Zeger

  4. Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, MD, USA

    Nancy D. Ciesla

  5. Division of Dental Public Health, Boston University, Boston, MA, USA

    Vinodh Bhoopathi

Authors
  1. Eddy Fan
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  2. Nancy D. Ciesla
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  3. Alex D. Truong
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  4. Vinodh Bhoopathi
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  5. Scott L. Zeger
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  6. Dale M. Needham
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Corresponding author

Correspondence to Eddy Fan.

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Fan, E., Ciesla, N.D., Truong, A.D. et al. Inter-rater reliability of manual muscle strength testing in ICU survivors and simulated patients. Intensive Care Med 36, 1038–1043 (2010). https://doi.org/10.1007/s00134-010-1796-6

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  • DOI: https://doi.org/10.1007/s00134-010-1796-6

Keywords

  • Diagnostic techniques and procedures
  • Epidemiologic research design
  • Muscle strength
  • Muscle weakness
  • Physical examination
  • Reproducibility of results