| 제목 |
Reliability of the portable dynamometer anchoring system in critically ill patients |
| 소속 |
Seoul National University Hospital, Department of Rehabilitation Medicine1, Seoul National University College of Medicine, Department of Rehabilitation Medicine2, VHS Medical Center, Department of Rehabilitation Medicine3 |
| 저자 |
Min Yong Lee1*, hyung-suk Ham1, Kwan-Sik Sung1, You Gyoung Yi3, Hyung-Ik Shin1,2† |
Introduction: It is well known that hospitalization has detrimental physiologic effects on muscle strength and function. In addition, in patients in intensive care unit (ICU), ICU-acquired weakness (ICUAW) may develop. However, because most of them cannot ambulate independently, it is difficult to measure strength, objectively. Therefore, for the use on a hospital bed, we developed a portable dynamometer anchoring system that can measure knee extensor strength in a supine position (Figure 1). In the previous study, for 39 healthy people, we confirmed that this portable dynamometer anchoring system was a reliable and valid tool. In the present study, we aimed to investigate the reliability of knee extensor strength measurement using a portable dynamometer anchoring system in a supine position in critically ill patients.
Methods: The patients admitted in Seoul National University Hospital, who can obey command 3 steps and cannot ambulate independently with age above 18 years were included. Three trials of three contractions were assessed by two raters using the portable dynamometer anchoring system while the participant was in the supine position. After the measurement, one investigator assessed the Medical Research Council (MRC) sum score and de Morton Mobility Index (DEMMI) for evaluating their functional status. The intraclass correlation coefficient (ICC) and 95% limits of agreement (LOA) for intra- and inter-rater reliability were obtained.
Results: The mean age of analyzed subjects (n = 33, 18 male and 15 female) is 69.24 ± 13.91 years old. The ICC for intra-rater reliability was 0.974 for the maximum measurements of knee extensor strength (95% confidence interval [CI]: 0.948–0.987) and 0.959 (95% CI: 0.917–0.980) for inter-rater reliability (Table 1). The mean difference (%) between the maximum knee extensor strength measurements of each trial was 2.51% (LOA range: -19.79 to 24.81%) for intra-rater and 7.81% (LOA range: -21.45 to 37.07%) for inter-rater measurements, respectively (Figure 2).
Conclusions: The portable dynamometer anchoring system is a reliable for measuring isometric knee extensor strength in a supine position in critically ill patients.
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Figure 1. Portable dynamometer anchoring system in a supine position. A : The frame which can be movable to adjust the HHD depending to the thickness of leg B : The frame which can be movable to adjust the HHD depending to the length of leg C : The Belts which fix the portable dynamometer anchoring system to bed D : Velcro strap to fix the thigh of the patients for minimizing the hip flexion movement E : The frame was designed at an angle of 145 degrees to flex the knee at 35 degrees
Figure 2. Distribution from Bland and Altman for intra and inter-observer measurements. A. Intra-rater measurements : The average difference between two sessions was 2.51 %. The ± 1.96 standard deviation range represents -19.79 to 24.81 %. B. Inter-rater measurements : The average difference between the 1st and the 2nd rater was 7.81 %. The ± 1.96 standard deviation range represents -21.45 to 37.07 %.
Table 1. Reliability of the portable dynamometer anchoring system in critically ill patients.
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