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Assessment of Physical Activity and Muscle Function in Adult Inflammatory Myopathies

  • Inflammatory Muscle Disease (L Diederichsen and H Chinoy, Section Editors)
  • Published:
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Abstract

Purpose of Review

The aim is to summarize the outcome measures used in the assessment and monitoring of muscle function and physical activity in the management idiopathic inflammatory myopathy.

Recent Findings

Assessment techniques have progressed and matured over the past decade, and new options are now available to clinicians working in this field. Newer outcome measures, including the Functional Index-3 and wearable motion sensors are reviewed, as well as the current application of more established measures.

Summary

The available outcome measures for use in clinical practice in idiopathic inflammatory myopathies with regard to muscle function and physical activity have expanded over the past 15 years. There are valid and reliable options for several domains and methods for assessing these factors. In a busy clinical setting, efficiency is important, but there also needs to be considered the choosing of tools that work together to give the fullest picture of the status of the patient.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Khan S, Christopher-Stine L. Polymyositis, dermatomyositis, and autoimmune necrotizing myopathy: clinical features. Rheum Dis Clin North Am. 2011;37(2):143–58, https://doi.org/10.1016/j.rdc.2011.01.001.

  2. Regardt M, Welin Henriksson E, Alexanderson H, Lundberg IE. Patients with polymyositis or dermatomyositis have reduced grip force and health-related quality of life in comparison with reference values: an observational study. Rheumatology (Oxford). 2011;50(3):578–85. https://doi.org/10.1093/rheumatology/keq356.

    Article  Google Scholar 

  3. Miller FW, Rider LG, Chung YL, Cooper R, Danko K, Farewell V, et al. Proposed preliminary core set measures for disease outcome assessment in adult and juvenile idiopathic inflammatory myopathies. Rheumatology (Oxford). 2001;40(11):1262–73. https://doi.org/10.1093/rheumatology/40.11.1262.

    Article  CAS  Google Scholar 

  4. Aggarwal R, Rider LG, Ruperto N, Bayat N, Erman B, Feldman BM, et al. 2016 American College of Rheumatology/European League Against Rheumatism criteria for minimal, moderate, and major clinical response in adult dermatomyositis and polymyositis: an International Myositis Assessment and Clinical Studies Group/Paediatric Rheumatology International Trials Organisation Collaborative Initiative. Arthritis Rheumatol. 2017;69(5):898–910. https://doi.org/10.1002/art.40064.

    Article  PubMed  PubMed Central  Google Scholar 

  5. • Esfandiary T, Park JK, Alexanderson H, Regardt M, Needham M, de Groot I, et al. Assessing the content validity of patient-reported outcome measures in adult myositis: a report from the OMERACT myositis working group. Semin Arthritis Rheum. 2020;50(5):943–8. https://doi.org/10.1016/j.semarthrit.2020.06.006. Updated evidence to support adequate content validity for several PROMs.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Rider LG, Werth VP, Huber AM, Alexanderson H, Rao AP, Ruperto N, et al. Measures of adult and juvenile dermatomyositis, polymyositis, and inclusion body myositis: physician and patient/parent global activity, manual muscle testing (MMT), Health Assessment Questionnaire (HAQ)/Childhood Health Assessment Questionnaire (C-HAQ), Childhood Myositis Assessment Scale (CMAS), Myositis Disease Activity Assessment Tool (MDAAT), Disease Activity Score (DAS), Short Form 36 (SF-36), Child Health Questionnaire (CHQ), physician global damage, Myositis Damage Index (MDI), Quantitative Muscle Testing (QMT), Myositis Functional Index-2 (FI-2), Myositis Activities Profile (MAP), Inclusion Body Myositis Functional Rating Scale (IBMFRS), Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI), Cutaneous Assessment Tool (CAT), Dermatomyositis Skin Severity Index (DSSI), Skindex, and Dermatology Life Quality Index (DLQI). Arthritis Care Res (Hoboken). 2011;63(Suppl 11):S118–57. https://doi.org/10.1002/acr.20532.

    Article  Google Scholar 

  7. Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334–59. https://doi.org/10.1249/MSS.0b013e318213fefb.

  8. Wilder RP, Greene JA, Winters KL, Long WB 3rd, Gubler K, Edlich RF. Physical fitness assessment: an update. J Long Term Eff Med Implants. 2006;16(2):193–204. https://doi.org/10.1615/jlongtermeffmedimplants.v16.i2.90.

    Article  PubMed  Google Scholar 

  9. Loell I, Lundberg IE. Can muscle regeneration fail in chronic inflammation: a weakness in inflammatory myopathies? J Intern Med. 2011;269(3):243–57. https://doi.org/10.1111/j.1365-2796.2010.02334.x.

    Article  CAS  PubMed  Google Scholar 

  10. • Ernste FC, Chong C, Crowson CS, Kermani TA, Mhuircheartaigh ON, Alexanderson H. Functional Index-3: a valid and reliable functional outcome assessment measure in patients with dermatomyositis and polymyositis. J Rheumatol. 2021;48(1):94–100. https://doi.org/10.3899/jrheum.191374. A further modification of the Functional Index, the FI-3 significantly shortens the time of application when compared to FI-2. Greater applicability to the busy clinical setting. Validity and reliability proven.

    Article  PubMed  Google Scholar 

  11. Harris-Love MO, Shrader JA, Koziol D, Pahlajani N, Jain M, Smith M, et al. Distribution and severity of weakness among patients with polymyositis, dermatomyositis and juvenile dermatomyositis. Rheumatology (Oxford). 2009;48(2):134–9. https://doi.org/10.1093/rheumatology/ken441.

    Article  CAS  Google Scholar 

  12. Lovett RWM, E. G. Certain aspects of infantile paralysis: with a description of a method of muscle testing. Journal of the American Medical Association. 1916;LXVI(10):729–33.

  13. Rider LG, Koziol D, Giannini EH, Jain MS, Smith MR, Whitney-Mahoney K, et al. Validation of manual muscle testing and a subset of eight muscles for adult and juvenile idiopathic inflammatory myopathies. Arthritis Care Res (Hoboken). 2010;62(4):465–72. https://doi.org/10.1002/acr.20035.

    Article  Google Scholar 

  14. Knepler C, Bohannon RW. Subjectivity of forces associated with manual-muscle test grades of 3+, 4-, and 4. Percept Mot Skills. 1998;87(3 Pt 2):1123–8. https://doi.org/10.2466/pms.1998.87.3f.1123.

    Article  CAS  PubMed  Google Scholar 

  15. Mulroy SJ, Lassen KD, Chambers SH, Perry J. The ability of male and female clinicians to effectively test knee extension strength using manual muscle testing. J Orthop Sports Phys Ther. 1997;26(4):192–9. https://doi.org/10.2519/jospt.1997.26.4.192.

    Article  CAS  PubMed  Google Scholar 

  16. • Saygin D, Oddis CV, Moghadam-Kia S, Rockette-Wagner B, Neiman N, Koontz D, et al. Hand-held dynamometry for assessment of muscle strength in patients with inflammatory myopathies. Rheumatology (Oxford). 2021;60(5):2146–56. https://doi.org/10.1093/rheumatology/keaa419. Assessment of a quantitaive, portable devise demonstrated strong reliability, construct validity and responsiveness in myositis patients.

    Article  CAS  Google Scholar 

  17. • Baschung Pfister P, de Bruin ED, Sterkele I, Maurer B, de Bie RA, Knols RH. Manual muscle testing and hand-held dynamometry in people with inflammatory myopathy: an intra- and interrater reliability and validity study. PLoS ONE. 2018;13(3):e0194531. https://doi.org/10.1371/journal.pone.0194531. Found that, while the MMT8 total score is a reliable assessment to consider general muscle weakness, HHD can be recommended to evaluate strength of single muscle groups.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Bohannon RW. Considerations and practical options for measuring muscle strength: a narrative review. Biomed Res Int. 2019;2019:8194537. https://doi.org/10.1155/2019/8194537.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Laing BAM, F. L.; Lo, S. K.; Zilko, P. Comparative assessment of knee strength using hand-held myometry and isometric dynamometry in patients with inflammatory myopathy. Physiother Theory Pract. 1995;11(3):151–6.

  20. Stoll T, Bruhlmann P, Stucki G, Seifert B, Michel BA. Muscle strength assessment in polymyositis and dermatomyositis evaluation of the reliability and clinical use of a new, quantitative, easily applicable method. J Rheumatol. 1995;22(3):473–7.

    CAS  PubMed  Google Scholar 

  21. Henriksson KG. Assessment of muscle strength and endurance in patients with neuromuscular diseases. Recent achievements in restoration neurology 2:progressive neuromuscular diseases. Basel: Karger; 1986.

  22. • Gregory WJ, Oldroyd A, Chinoy H. Hand-held dynamometry may provide a valid and objective method of muscle strength quantification in adult inflammatory myopathy: results from clinical practice in a tertiary centre. Rheumatology (Oxford). 2021;60 (suppl 1). 23. Josefson A, Romanus E, Carlsson J. A functional index in myositis. J Rheumatol. 1996;23(8):1380–4. Further support of the use of HHD for muscle assessment in the clinic setting abstract only.

  23. Alexanderson H, Broman L, Tollback A, Josefson A, Lundberg IE, Stenstrom CH. Functional Index-2: validity and reliability of a disease-specific measure of impairment in patients with polymyositis and dermatomyositis. Arthritis Rheum. 2006;55(1):114–22. https://doi.org/10.1002/art.21715.

    Article  PubMed  Google Scholar 

  24. Agarwal S, Kiely PD. Two simple, reliable and valid tests of proximal muscle function, and their application to the management of idiopathic inflammatory myositis. Rheumatology (Oxford). 2006;45(7):874–9. https://doi.org/10.1093/rheumatology/kel017.

    Article  CAS  Google Scholar 

  25. van der Stap DK, Rider LG, Alexanderson H, Huber AM, Gualano B, Gordon P, et al. Proposal for a candidate core set of fitness and strength tests for patients with childhood or adult idiopathic inflammatory myopathies. J Rheumatol. 2016;43(1):169–76. https://doi.org/10.3899/jrheum.150270.

    Article  PubMed  Google Scholar 

  26. Opinc AH, Brzezinska OE, Makowska JS. Disability in idiopathic inflammatory myopathies: questionnaire-based study. Rheumatol Int. 2019;39(7):1213–20. https://doi.org/10.1007/s00296-019-04302-y.

    Article  PubMed  Google Scholar 

  27. Bruce B, Fries JF. The Stanford Health Assessment Questionnaire: a review of its history, issues, progress, and documentation. J Rheumatol. 2003;30(1):167–78.

    PubMed  Google Scholar 

  28. • Saygin D, Oddis CV, Dzanko S, Koontz D, Moghadam-Kia S, Ardalan K, et al. Utility of patient-reported outcomes measurement information system (PROMIS) physical function form in inflammatory myopathy. Semin Arthritis Rheum. 2021;51(3):539–46. https://doi.org/10.1016/j.semarthrit.2021.03.018. First study in adult IIM of these outcome measures, demonstrates favorable psychometric properties in a large cohort of myositis patients and offers distinct advantages.

    Article  CAS  PubMed  Google Scholar 

  29. Ware JE, Jr., Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473–83.

  30. Ponyi A, Borgulya G, Constantin T, Vancsa A, Gergely L, Danko K. Functional outcome and quality of life in adult patients with idiopathic inflammatory myositis. Rheumatology (Oxford). 2005;44(1):83–8. https://doi.org/10.1093/rheumatology/keh404.

    Article  CAS  Google Scholar 

  31. Poulsen KB, Alexanderson H, Dalgard C, Jacobsen S, Weile L, Diederichsen LP. Quality of life correlates with muscle strength in patients with dermato- or polymyositis. Clin Rheumatol. 2017;36(10):2289–95. https://doi.org/10.1007/s10067-017-3706-6.

    Article  PubMed  Google Scholar 

  32. Cleary LC, Crofford LJ, Long D, Charnigo R, Clasey J, Beaman F, et al. Does computed tomography-based muscle density predict muscle function and health-related quality of life in patients with idiopathic inflammatory myopathies? Arthritis Care Res (Hoboken). 2015;67(7):1031–40. https://doi.org/10.1002/acr.22557.

    Article  Google Scholar 

  33. • Landon-Cardinal O, Bachasson D, Guillaume-Jugnot P, Vautier M, Champtiaux N, Hervier B, et al. Relationship between change in physical activity and in clinical status in patients with idiopathic inflammatory myopathy: a prospective cohort study. Semin Arthritis Rheum. 2020;50(5):1140–9. https://doi.org/10.1016/j.semarthrit.2020.06.014. Showed correlation between accelerometer-measured physical activity levels and measures of muscle strength and function in those with IIM.

    Article  CAS  PubMed  Google Scholar 

  34. • DiRenzo DdG, I; Alexanderson, H; Bingham, C; Lundberg, I; Needham, M; Park, J; Regardt, M; Sarver, C; Saygin, D; Song, Y; Maxwell, L; Beaton, D; Christopher-Stine, L; Mecoli, C. . Pain interference, fatigue, physical function as outcome measures in adult myositis: updates on the validation process by the OMERACT Myositis Working Group. Arthritis Rheum. 2021;73(supply 10). Showed high construct validity and test-retest reliability for the measurement properties of the Patient Reported Outcome Information System (PROMIS) Pain Interference 6a v1.0, Fatigue 7a v1.0, and Physical Function 8b v2.0 instruments abstract only.

  35. Alexanderson H, Lundberg IE, Stenstrom CH. Development of the myositis activities profile–validity and reliability of a self-administered questionnaire to assess activity limitations in patients with polymyositis/dermatomyositis. J Rheumatol. 2002;29(11):2386–92.

    PubMed  Google Scholar 

  36. Alexanderson H, Reed AM, Ytterberg SR. The Myositis Activities Profile – initial validation for assessment of polymyositis/dermatomyositis in the USA. J Rheumatol. 2012;39(11):2134–41. https://doi.org/10.3899/jrheum.120504.

    Article  PubMed  Google Scholar 

  37. Rider LG, Aggarwal R, Machado PM, Hogrel JY, Reed AM, Christopher-Stine L, et al. Update on outcome assessment in myositis. Nat Rev Rheumatol. 2018;14(5):303–18. https://doi.org/10.1038/nrrheum.2018.33.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Kocoloski AW, C; Koontz, D; Oddis, CV; Aggarwal R. Functional measures and patient home self-assessments in the idiopathic inflammatory myopathies. Arthritis Rheum. 2017;69(suppl 10).

  39. Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep. 1985;100(2):126–31.

    CAS  PubMed  PubMed Central  Google Scholar 

  40. Espinosa-Ortega HF, Moreno-Ramirez M, Alexanderson H. Novel insights of disability assessment in adult myositis. Curr Opin Rheumatol. 2017;29(6):591–7. https://doi.org/10.1097/BOR.0000000000000433.

    Article  PubMed  Google Scholar 

  41. Achtman J, Kling MA, Feng R, Okawa J, Werth VP. A cross-sectional study of untreated depression and anxiety in cutaneous lupus erythematosus and dermatomyositis. J Am Acad Dermatol. 2016;74(2):377–9. https://doi.org/10.1016/j.jaad.2015.09.016.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Dowd KP, Szeklicki R, Minetto MA, Murphy MH, Polito A, Ghigo E, et al. A systematic literature review of reviews on techniques for physical activity measurement in adults: a DEDIPAC study. Int J Behav Nutr Phys Act. 2018;15(1):15. https://doi.org/10.1186/s12966-017-0636-2.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Lee PH, Yu YY, McDowell I, Leung GM, Lam TH, Stewart SM. Performance of the international physical activity questionnaire (short form) in subgroups of the Hong Kong Chinese population. Int J Behav Nutr Phys Act. 2011;8:81. https://doi.org/10.1186/1479-5868-8-81.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Strath SJ, Kaminsky LA, Ainsworth BE, Ekelund U, Freedson PS, Gary RA, et al. Guide to the assessment of physical activity: Clinical and research applications: a scientific statement from the American Heart Association. Circulation. 2013;128(20):2259–79. https://doi.org/10.1161/01.cir.0000435708.67487.da.

    Article  PubMed  Google Scholar 

  45. • Rockette-Wagner B, Saygin D, Moghadam-Kia S, Oddis C, Landon-Cardinal O, Allenbach Y, et al. Reliability, validity and responsiveness of physical activity monitors in patients with inflammatory myopathy. rheumatology (Oxford). 2021. doi: https://doi.org/10.1093/rheumatology/keab236. Showed promising construct validity, reliability, and longitudinal responsiveness for physical activity monitors in IIM.

  46. Pinto AJ, Roschel H, Benatti FB, de Sa Pinto AL, Sallum AM, Silva CA, et al. Poor agreement of objectively measured and self-reported physical activity in juvenile dermatomyositis and juvenile systemic lupus erythematosus. Clin Rheumatol. 2016;35(6):1507–14. https://doi.org/10.1007/s10067-016-3234-9.

    Article  PubMed  Google Scholar 

  47. • Saygin D, Rockette-Wagner B, Oddis C, Neiman N, Koontz D, Moghadam-Kia S, et al. Consumer-based activity trackers in evaluation of physical activity in myositis patients. Rheumatology (Oxford). 2021. https://doi.org/10.1093/rheumatology/keab700. Daily step count is an accepted metric of physical activity; Fitbit daily steps and peak 1-min cadence are reliable and valid measures of physical activity in a cohort of myositis patients.

    Article  Google Scholar 

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Gregory, W.J., Saygin, D. Assessment of Physical Activity and Muscle Function in Adult Inflammatory Myopathies. Curr Rheumatol Rep 24, 54–63 (2022). https://doi.org/10.1007/s11926-022-01059-5

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