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RehabMeasures Instrument

Hand Held Myometry / Dynamometry

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Purpose

A quantitative and objective method for assessment of muscular strength using a portable handheld dynamometer.

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instrument details

Area of Assessment

Strength

Assessment Type

Performance Measure

Administration Mode

Computer

Cost

Not Free

Diagnosis/Conditions

  • Arthritis + Joint Conditions
  • Cerebral Palsy
  • Parkinson's Disease + Neurologic Rehabilitation
  • Pediatric + Adolescent Rehabilitation
  • Spinal Cord Injury

Key Descriptions

  • Assessment is scored using force production in:
    A) kilograms
    B) Newtons or
    C) pounds
  • Results are compared with unaffected muscle or age-matched norms.
  • The muscle tested must have ability to move against gravity.
  • “Make test:” A person holds an isometric contraction for 3-5 seconds.
  • “Break Test:” An assessor applies a force to just overcome the strength of the person being tested, producing an eccentric muscular contraction.
  • Myometer is held perpendicular to the muscle being tested at a set distance from the joint.
  • 2-3 maximum voluntary isometric or eccentric contractions are completed and scores summed.
  • Procedural instructions reported in several publications (Van der Ploeg, 1984, 1991; Bohannon, 1986; Andrews 1996).
  • See user manual for specific instruction on use of dynamometer.

Number of Items

Number of muscles tested

Equipment Required

  • Requires purchase of a hand held dynamometer

Time to Administer

Time is determined by the number of muscles being tested 

Required Training

Reading an Article/Manual

Age Ranges

Adult

18 - 64

years

Instrument Reviewers

Intially reviewed by Wendy Romney, PT, DPT, NCS, Cara Weisbach, PT, DPT, and the SCI EDGE task force of the Neurology Section of the APTA in 07/2012

Reviewed by Heather Anderson and Rie Yoshida 4/28/2016

Body Part

Upper Extremity
Lower Extremity

ICF Domain

Body Structure
Body Function

Measurement Domain

Motor

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

Abbreviations:

 

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group / Unable to Recommend

NR

Not Recommended

Recommendations based on SCI AIS Classification: 

 

AIS A/B

AIS C/D

SCI EDGE

HR

HR

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

SCI EDGE

Yes

Yes

Yes

Not reported

 

Recommendations for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

Subacute

(CVA 2 to 6 months)

Chronic

(> 6 months)

StrokEDGE

R

R

R

 

Recommendations based on level of care in which the assessment is taken:

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

StrokEDGE

NR

R

NR

R

NR

 

 

 

 

 

 

 

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

StrokEDGE

No

Yes

Yes

Yes

 

Considerations

  • This document reflects hand-held dynamometry not grip strength testing
  • Proper stabilization must occur to improve reliability (Compton et al, 2007)
  • Gender, body weight and grip strength can affect a rater’s ability to stabilize a hand-held dynamometer and can influence reliability when “smaller” testers are testing stronger muscle groups (Wadsworth et al, 1992)
  • Dynamometers are expensive and not always available depending on the setting
  • Client must be able to follow instructions to complete
  • Examiner strength must be strong enough to hold against isometric contraction or overcome for eccentric contraction for subject being tested. 
  • Herbison et al 1996 found significant differences in strength change over time using myometry that were not detected with manual muscle testing with strength grades greater than 3.5.  
  • Myometry is more sensitive in detecting change in muscle strength for MMT grades 3.5 and above than MMT
  • Limitation in SCI due to inability to use with muscle grades < 3/5 

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Non-Specific Patient Population

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Normative Data

Healthy Population: 

  • Break Test:
    • Ages 20-60 years (Van der Ploeg, 1991)
    • Ages 20-69 years (Phillips, 2000)
  • Make Test:
    • Ages 50-79 years (Andrews, 1996) 
    • Ages 20-79 years (Bohannon RW, 1986)

Test/Retest Reliability

Patients with neurological dysfunction:

(Bohannon, 1986, n = 30; stroke n = 16, TBI n = 4, incomplete SCI n = 2, peripheral neuropathy n = 2, other neurological dysfunction n = 6, 18 muscle groups tested, make contractions 4-5 seconds)

  • Excellent test-retest reliability (ICC= 0.84-0.99)

 

Community Dwelling Older Adults: (Abizanda, et al., 2012, n=281; mean age = 74.3 (4.9) years, healthy older adults)

  • Excellent test-retest reliability (ICC = 0.9766-0.9874)

 

Interrater/Intrarater Reliability

Healthy Subjects: (Sullivan et al 1988 healthy subjects; shoulder)

  • Excellent intra-rater reliability (r=0.986)

Responsiveness

(Nitschke et al, 1999; n = 42; mean age 32.3 (7.3) healthy female subjects & 42.6 (11.8) nonspecific regional pain in upper arm female subjects; Jamar dynamometer)

  • A change of more than 6 kg (13.2 lb) is necessary to detect a genuine change in grip strength 95% of the time.

(Reddon et al., 1985 n=12, healthy subjects, right-handed)

  • Small change: effect size 0.01 for men’s non-preferred and women’s preferred hand and 0.13 for men’s preferred and 0.14 for women’s non-preferred hands over 10 week trial

Spinal Injuries

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Interrater/Intrarater Reliability

Spinal Cord Injury:

(Burns, 2005, n = 19, mean age 53.5 years, < 6 month post injury to > 1 year post injury, C4-C6 AIS A, B and D) 

Reliability of strength measurements

 

 

Intrarater reliability

ICC

95% Confidence Interval

Examiner 1 make

0.91

0.79-0.97

Examiner 2 make

0.94

0.86-0.98

Examiner 1 break

0.94

0.86-0.98

Examiner 2 break

0.93

0.82-0.97

Interrater reliability

 

 

Examiner 1 make

0.94

0.86-0.98

Examiner 2 make

0.97

0.93-0.99

Examiner 1 break

0.95

0.87-0.98

Examiner 2 break

0.94

0.86-0.98

Excellent reliability > 0.75

 

 

 

Spinal Cord Injury:

(May, 1997, n=25, level of injury C3-L3, time since injury 9 months to 25 years, break test)

SCI IIC's

 

Shoulder Movement

Interrater Reliability ICC (95% CI)

External rotation all subjects

0.94 (.91-.96)

Internal rotation all subjects

0.96 (.94-.98)

External rotation (paraplegic)

0.89 (.80-.94)

External rotation (tetraplegia)

0.93 (.87-.96)

Internal rotation (paraplegia)

0.92 (.86-.96)

Internal rotation (tetraplegic)

0.89 (.81-.91)

Excellent reliability ICC ≥ 0.75

 

 

  • Excellent intrarater reliability (ICC=0.89-0.96) (May, 1997)

 

Spinal Cord Injury:

(Herbison et al, 1996, n = 88, C4-C8 AIS A-D, 0-2 years post injury, measured make test for C5 elbow flexor strength)

 

  • Excellent inter rater reliability (ICC=0.82)

 

Spinal Cord Injury:

(Schwartz, 1992, n = 122 AIS A-D level C4-C6, measured Bilateral Bicep and Exensor Carpi Radialis at 72 hours to 12 months post injury)

 

  • Excellent inter rater reliability (ICC=0.85-0.95)

 

SCI: (May et al, 1997; isokinetic measures of shoulder IR/ER rotator strength in persons with SCI

  • Excellent intra-rater reliability (ICC= 0.89-0.96)

(Larson et al, 2010; assessment of postural muscle strength in sitting for persons with SCI

  • Excellent intra-rater reliability (0.79-0.99) supported upper extremity

  • Excellent intra-rater reliability (0.80-.99) unsupported upper extremity

  • Excellent inter-rater reliability (0.96-0.99) supported upper extremity

  • Excellent inter-rater reliability (0.97-0.99) supported upper extremity

Construct Validity

Spinal Cord Injury:

(May, 1997) 

  • Excellent convergent validity of myometry and isokinetic testing in paraplegia (r = 0.86-0.88)
  • Adequate convergent validity of myometry and isokinetic testing in tetraplegia (r = 0.52-0.56)

 

Shoulder Movement

Convergent Validity Pearson product

External rotation all subjects

0.86a

Internal rotation all subjects

0.88a

External rotation (paraplegic)

0.83a

External rotation (tetraplegia)

0.56b

Internal rotation (paraplegia)

0.74a

Internal rotation (tetraplegic)

0.52b

a: Excellent correlation coefficient > 0.60
b: Adequate correlation coefficient 0.31-0.59

 

 

Spinal Cord Injury:

(Noreau, 1998, n = 38, level of injury C5-L3, AIS A-D)

Spearman correlation coefficients MMT and myometry

 

 

 

 

Muscles

Paraplegia (n = 23) Admittance

Paraplegia Discharge

Tetraplegia (n = 15) Admittance

Tetraplegia Discharge

Elbow flexor

0.48b

0.26

0.58b

0.48b

Elbow extensor

0.46b

0.55b

0.95a

0.88a

Shoulder flexors

0.63a

0.60b

0.83a

0.50b

Shoulder extensors

0.44b

0.49b

0.67a

0.57b

Shoulder abductors

0.64a

0.57*

0.55b

0.59b

Shoulder adductors

0.67a

0.34b

0.84a

0.73a

a: Excellent correlation coefficient > 0.60
b: Adequate correlation coefficient 0.31-0.59

 

 

 

 

 

Pearson correlation coefficients myometry and isokinetic testing n = 37

 

 

 

 

Muscles

Paraplegia (n = 23) Admittance

Paraplegia Discharge

Tetraplegia (n = 15) Admittance

Tetraplegia Discharge

Elbow flexor

0.76a

0.75a

0.81a

0.74a

Elbow extensor

0.70a

0.82a

0.92a

0.96a

Shoulder flexors

0.89a

0.89a

0.82a

0.78a

Shoulder extensors

0.85a

0.83a

0.59b

0.87a

Shoulder abductors

0.73a

0.82a

0.57b

0.76a

Shoulder adductors

0.81a

0.90a

0.91a

0.90a

a: Excellent correlation coefficient > 0.60
b: Adequate correlation coefficient 0.31-0.59

 

 

 

 

 

 

Spinal Cord Injury:

(Schwartz, 1992, n = 122)

Correlation between MMT and Myometry: Time post SCI

 

 

 

 

 

 

Muscle

72 hr

1 wk

1 month

3 month

6 month

12 month

L bicep

n

0.86a
31

0.84a
30

0.68a
37

0.82a
33

0.59b
24

0.42b
20

R bicep
n

0.80a

29

0.83a

29

0.79a

26

0.68a

34

0.59b

23

0.18
20

L ECR
n

0.92a

15

0.86a

22

0.81a

30

0.84a

21

0.84a

16

0.77a

18

R ECR
n

0.94a

18

0.78a

19

0.93a

26

0.79a

24

0.75a

17

0.71a

17

a: Excellent correlation coefficient > 0.60
b: Adequate correlation coefficient 0.31-0.59

 

 

 

 

 

 

Responsiveness

Tetraplegia:

(Herbison, 1996; n = 88, strength of elbow flexors at 72 hrs post injury up to 2 years)

  • Myometry detected changes in elbow muscle strength that MMT did not detect (between 16%, 40%, and 27% increase in myometry scores in individuals with initial MMT grades of 3.5, 4.0 and 4.5, respectively who did not show a change in MMT score)

Mixed Populations

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Test/Retest Reliability

Patients in rehabilitation with neuromuscular and muscular skeletal dysfunction:

(Wadsworth, 1987, n = 13 conditions not reported, mean age 70, tested 5 days apart)

  • Adequate to Excellent test-retest reliability (ICC = 0.69-0.90)

 

Stroke and TBI:

(Riddle et al 1989; measurements at wrist, elbow, shoulder, hip, knee and ankle)

  • Excellent test-retest reliability (ICC = 0.79-0.97)

 

Stroke, TBI, SCI and peripheral neuropathy (Mixed)

(Bohannon 1986; measurements at wrist, elbow, shoulder, hip, knee and ankle)

  • Excellent test-retest reliability (ICC = 0.97-0.98)

 

Interrater/Intrarater Reliability

(Riddle et al 1989; measurements at wrist, elbow, shoulder, hip, knee and ankle)

Excellent intra-rater reliability (ICC = 0.88-0.98)

 

(Bohannon and Andrews, 1987; mixed population; shoulder)

  • Excellent inter-rater reliability (0.84-0.94)

Stroke

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Test/Retest Reliability

(Bertrand et al, 2007, Chronic Stroke)

  • Excellent test-retest reliability (ICC 0.80 to 0.89)

Criterion Validity (Predictive/Concurrent)

Stroke: (Piao et al, 2004; quadriceps femoris muscle strength on affected side)

  • Excellent relationship with isokinetic dynomometry (Pearson r = 0.99)

Construct Validity

(Boissy et al, 1999, stroke >1 yr, Chronic Stroke)

  • Adequate correlation with Fugi-Myer upper limb performance test (r = 0.84)
  • Adequate correlation with TEMPA upper limb function test
  • Adequate correlation with Box and Block affected upper limb score
  • Adequate correlation with finger-to-nose affected limb score

 

(Dorsch et al, 2012, chronic stroke with time since stroke of 1-6 years)

Correlation between strength of the muscle groups of the affected lower limb (adjusted to body weight) and walking speed (10MWT)

Muscle Group

Correlation with 10MWT (Pearson correlation coefficient)

Strength of correlation

Ankle dorsiflexors

0.50

Large

Hip flexors

0.35

Medium

Ankle evertors

0.33

Medium

Knee flexors

0.30

Medium

Hip internal rotators

0.30

Medium

Hip extensors

0.29

Small

Hip adductors

0.29

Small

Ankle plantarflexors

0.29

small

Knee extensors

0.27

Small

Ankle invertors

0.25

Small

Hip abductors

0.24

Small

Hip external rotators

0.22

small

Responsiveness

(Roberts et al, 2011)

Recovery after a stroke estimate the differences in repeat measures of hand grip strength to be between 4.7 kg and 6.2 kg

Pediatric Disorders

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Test/Retest Reliability

(Effgen & Brown, 1992; long-term stability of hand-held dynamometric measurements of shoulder, elbow and wrist in children with myelomeningocele

  • Moderate to Excellent test-retest reliability (0.60-0.98)

  • Excellent test-retest Upper extremity (ICC= 0.75-0.99)

  • Moderate to Excellent test-retest Lower Extremity (ICC= 0.73-0.96)

(Taylor et al, 2004; children with cerebral palsy (CP)).

  • Excellent test-retest reliability (0.81-0.96)
    ankle PF, quads (0.81), hip flex, hip AB and hip ext tested

(Crompton et al, 2007; muscle strength measurement with hand-held dynamometry for children with CP)

  • Excellent test re-test reliability(0.794-0.978) for LE strength testing without stabilization (within session)

  • Excellent test- retest reliability (0.939-0.983) for LE strength with stabilization (within session)

  • Low to moderate test-retest reliability ((0.257-0.890) for LE strength testing without stabilization between sessions (one week apart)

  • Moderate to excellent test-retest reliability (0.622-0.910) for LE strength testing with stabilization between sessions (one week apart)

Interrater/Intrarater Reliability

(Katz-Leurer et al, 2008; children with TBI)

  • Excellent intra-rater reliability (0.91-0.99) within session

Movement and Gait Disorders

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Criterion Validity (Predictive/Concurrent)

Huntington’s disease: (Busse et al, 2008; LE strength)

  • Adequate to Good correlation to Unified Huntington’s Disease Rating Scale (UHDRS) motor scale (Spearman’s r = 0.49-0.74)

Bibliography

Abizanda, P., Navarro, J. L., et al. (2012). "Validity and usefulness of hand-held dynamometry for measuring muscle strength in community-dwelling older persons." Arch Gerontol Geriatr 54(1): 21-27. Find it on PubMed

Agre, J. C., Magness, J. L., et al. (1987). "Strength testing with a portable dynamometer: reliability for upper and lower extremities." Archives of Physical Medicine and Rehabilitation 68(7): 454-458. Find it on PubMed

Andrews, A. W., Thomas, M. W., et al. (1996). "Normative values for isometric muscle force measurements obtained with hand-held dynamometers." Physical Therapy 76(3): 248-259. Find it on PubMed

Bertrand, A. M., Mercier, C., et al. (2007). "Reliability of maximal static strength measurements of the arms in subjects with hemiparesis." Clin Rehabil 21(3): 248-257. Find it on PubMed

Bohannon, R. W. (1986). "Test-retest reliability of hand-held dynamometry during a single session of strength assessment." Physical Therapy 66(2): 206-209. Find it on PubMed

Bohannon RW, Andrews AW. Interrater reliability of hand-held dynamometry. Phys Ther 1987; 67(6):931-933. Find it on PubMed

Burns, S. P., Breuninger, A., et al. (2005). "Hand-held dynamometry in persons with tetraplegia: comparison of make-versus break-testing techniques." American Journal of Physical Medicine and Rehabilitation 84(1): 22. Find it on Pubmed

Busse ME, Hughes G, Wiles CM, Rosser AE. Use of hand-held dynamometry in the evaluation of lower limb muscle strength in people with Huntington's disease. J Neurol 2008; 255(10):1534-1540.Find it on PubMed

Crompton J, Galea MP, Phillips B. Hand-held dynamometry for muscle strength measurement in children with cerebral palsy. Dev Med Child Neurol 2007; 49(2):106-111.Find it on PubMed

Dorsch S, Ada L, Canning CG, Al-Zharani M, Dean C. The strength of the ankle dorsiflexors has a significant contribution to walking speed in people who can walk independently after stroke: an observational study. Archives of physical medicine and rehabilitation. 2012;93(6):1072-6.Find it on PubMed

Effgen SK, Brown DA. Long-term stability of hand-held dynamometric measurements in children who have myelomeningocele. Phys Ther 1992; 72(6):458-465.Find it on PubMed

Herbison, G. J., Isaac, Z., et al. (1996). "Strength post-spinal cord injury: myometer vs manual muscle test." Spinal Cord 34(9): 543-548. Find it on PubMed

May, L. A., Burnham, R. S., et al. (1997). "Assessment of isokinetic and hand-held dynamometer measures of shoulder rotator strength among individuals with spinal cord injury." Archives of Physical Medicine and Rehabilitation 78(3): 251-255. Find it on PubMed

Katz-Leurer M, Rottem H, Meyer S. Hand-held dynamometry in children with traumatic brain injury: within-session reliability. Pediatr Phys Ther 2008; 20(3):259-263.Find it on PubMed

Larson CA, Tezak WD, Malley MS, Thornton W. Assessment of postural muscle strength in sitting: reliability of measures obtained with hand-held dynamometry in individuals with spinal cord injury. J Neurol Phys Ther 2010; 34(1):24-31.Find it on PubMed

Nitschke, J. E., McMeeken, J. M., et al. (1999). "When is a change a genuine change?: A clinically meaningful interpretation of grip strength measurements in healthy and disabled women." Journal of Hand Therapy 12(1): 25-30. Find it on PubMed

Noreau, L. and Vachon, J. (1998). "Comparison of three methods to assess muscular strength in individuals with spinal cord injury." Spinal Cord 36(10): 716-723. Find it on PubMed

Piao C, Yoshimoto N, Shitama H, Makino K, Wada F, Hachisuka K. Validity and reliability of the measurement of the quardriceps femoris muscle strength with a hand-held dynamometer on the affected side in hemiplegic patients. J UOEH 2004; 26(1):1-11.Find it on PubMed

Reddon, J. R., Stefanyk, W. O., et al. (1985). "Hand dynamometer: effects of trials and sessions." Percept Mot Skills 61(3 Pt 2): 1195-1198. Find it on PubMed

Riddle DL, Finucane SD, Rothstein JM, Walker ML. Intrasession and intersession reliability of hand-held dynamometer measurements taken on brain-damaged patients. Phys Ther 1989; 69(3):182-194.Find it on PubMed

Roberts, H. C., Denison, H. J., et al. (2011). "A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach." Age Ageing 40(4): 423-429. Find it on PubMed

Schwartz, S., Cohen, M. E., et al. (1992). "Relationship between two measures of upper extremity strength: manual muscle test compared to hand-held myometry." Archives of Physical Medicine and Rehabilitation 73(11): 1063-1068. Find it on PubMed

Sullivan SJ, Chesley A, Hebert G, McFaull S, Scullion D. The validity and reliability of hand-held dynamometry in assessing isometric external rotator performance. J Orthop Sports Phys Ther 1988; 10(6):213-217.Find it on PubMed

Taylor NF, Dodd KJ, Graham HK. Test-retest reliability of hand-held dynamometric strength testing in young people with cerebral palsy. Arch Phys Med Rehabil 2004; 85(1):77-80.Find it on PubMed

Wadsworth C, Nielsen DH, Corcoran DS, Phillips CE, Sannes TL. Interrater reliability of hand-held dynamometry: effects of rater gender, body weight, and grip strength. J Orthop Sports Phys Ther 1992; 16(2):74-81.Find it on PubMed

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