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RehabMeasures Instrument

Manual Muscle Test

Last Updated

Purpose

MMT is a standardized set of assessments that measure muscle strength and function.

Acronym MMT

Area of Assessment

Strength

Assessment Type

Performance Measure

Cost

Free

Diagnosis/Conditions

  • Spinal Cord Injury

Key Descriptions

  • Score range 0-5, minimum 0, maximum 5/5.
  • There are three manual muscle tests grading systems:
    1) The Medical Research Council Scale
    2) Daniels and Worthingham
    3) Kendall and McCreary

Number of Items

Determined by the number of muscles being tested

Time to Administer

Less than 1 minutes

Required Training

No Training

Instrument Reviewers

Initially 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 7/2012.

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 (SCI 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 for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post)

(Vestibular < 6 weeks post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

SCI EDGE

R

R

R

Recommendations based on SCI AIS Classification:

 

AIS A/B

AIS C/D

SCI EDGE

R

R

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

Considerations

  • MMT may not be sufficiently sensitive to measure strength in good and normal range. (Schwartz et al, 1992)
  • Herbison et al (1996) and Schwartz et al (1992) 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.

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

Spinal Injuries

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Interrater/Intrarater Reliability

Spinal Cord Injury:

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

  • Excellent interrater reliability (ICC = 0.94)

Construct Validity

Convergent Validity

 

SCI:

(Schwartz et al, 1992, = 122)

Correlation between MMT and Myometry: Time post SCI

 

 

 

 

 

 

Muscle

72 hours

1 week

1 month

3 months

6 months

12 months

L bicep

0.86**

= 31

0.84**

= 30

0.68**

= 37

0.82**

= 33

0.59*

= 24

0.42*

= 20

R bicep

0.80**

= 29

0.83**

= 29

0.79**

= 26

0.68**

= 34

0.59*

= 23

0.18

= 20

L ECR

0.92**

= 15

0.86**

= 22

0.81**

= 30

0.84**

= 21

0.84**

= 16

0.77**

= 18

R ECR

0.94**

= 18

0.78**

= 19

0.93**

= 26

0.79**

= 24

0.75**

= 17

0.71**

= 17

** = Excellent correlation > 0.6

* = Adequate correlation 0.31-0.59

 

 

 

 

 

 

 

 

SCI:

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

Spearman Correlation Coefficients between MMT and Myometry

 

 

 

 

Muscles

Paraplegia at Admit (= 23)

Paraplegia at Discharge (= 23)

Tetraplegia at Admit (= 15)

Tetraplegia at Discharge (= 15)

Elbow flexors

0.48*

0.26

0.58**

0.48*

Elbow extensors

0.46*

0.55*

0.95**

0.88**

Shoulder flexors

0.63**

0.60**

0.83**

0.50*

Shoulder extensors

0.44*

0.49*

0.67**

0.57*

Shoulder abductors

0.64**

0.57*

0.55*

0.59*

Shoulder adductors

0.67**

0.34*

0.84**

0.73**

** = Excellent correlation > 0.6

* = Adequate correlation 0.31-0.59

 

 

 

 

Osteoarthritis

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Standard Error of Measurement (SEM)

Osteoarthritis (OA):

(Youdas et al, 2010; n = 20 subjects with OA and 20 healthy subjects; mean age = 53.4(9.0) for subjects with OA and 50.4(7.2) for healthy subjects)

  • SEM for right side MMT using handheld dynanometer (HHD) = 1%
  • SEM for left side MMT using handheld dynanometer (HHD) = 2%

Minimal Detectable Change (MDC)

Osteoarthritis (OA):

(Youdas et al, 2010)

  • MDC for right side MMT using handheld dynanometer (HHD) = 4%
  • MDC for left side MMT using handheld dynanometer (HHD) = 4%

Test/Retest Reliability

Osteoarthritis (OA):

(Youdas et al, 2010)

  • Excellent test-retest reliability for right side (ICC = 0.98)
  • Excellent test-retest reliability for left side (ICC = 0.97)

Responsiveness

Osteoarthritis (OA):

(Youdas et al, 2010)

  • Sensitivity = 0.35
  • Specificity = 0.90
  • Positive likelihood ratio = 3.5

Non-Specific Patient Population

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Interrater/Intrarater Reliability

ICU survivors and simulated patients:

(Fan et al, 2010, = 19, 26 muscle groups, 19 clinicians)

  • Adequate to Excellent overall interrater reliability of Upper extremity muscles (ICC = 0.62-1.00)
  • Adequate to Excellent overall interrater reliability of Lower Extremity muscles (ICC = 0.66-1.00)

Bibliography

Fan, E., Ciesla, N. D., et al. (2010). "Inter-rater reliability of manual muscle strength testing in ICU survivors and simulated patients." Intensive Care Medicine 36(6): 1038-1043. 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

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

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

Youdas, J. W., Madson, T. J., et al. (2010). "Usefulness of the Trendelenburg test for identification of patients with hip joint osteoarthritis." Physiother Theory Pract 26(3): 184-194. Find it on PubMed

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