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Validity of the handheld dynamometer compared to the Biodex dynamometer in measuring peak hip extension… Keep, H.; Berson, A.; Luu, L.; Ivanova, T. D.; Garland, S. J. 2013-09-27

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 Validity of the handheld dynamometer compared  to the Biodex dynamometer in measuring peak hip extension strength H. Keep, A. Berson, L. Luu, T.D. Ivanova, S.J. Garland Department of Physical Therapy   University of British Columbia Introduction ? Muscle imbalances at the hip have been linked to a variety of musculoskeletal conditions. To objectively assess these imbalances, a valid, cost-effective means of measuring strength is needed. ? Handheld dynamometers (HHD) are used to obtain objective measures of muscle strength and have been found valid and reliable at other joints.1 ? HHDs have been found to have high interrater and intrasession reliability in measuring hip extension strength using a prone standing position.2,3 ? To date, there is limited information on the validity of the HHD in measuring peak hip extension strength.4  Purpose  ? To establish the intrasession reliability of the prone standing position as measured by novice therapists. ? To evaluate the validity of the HHD in measuring peak hip extension torque compared to the Biodex dynamometer. ? To determine the validity of taking single- versus multi-trial measures.  Results ? Novice therapists, with practice, are able to use the HHD with a high level of reliability. ? The HHD in the prone standing position is valid in measuring peak hip extension strength in healthy adults aged 20-53.  ? Single trial measures with the HHD have high correlations with 3 trial average values and therefore may be clinically appropriate.  Conclusions ? Subjects: 9 males, 11 females, 20-53 years of age. ? Peak hip extension strength measures were collected in 3 ways:  HHD -  prone standing position (Figure 1)    Biodex Prone ? prone standing position   Biodex Supine ? supine position with hip in 90? flexion ? Prone standing positions were compared to the reference supine Biodex position recommended by the manufacturer. ? Data were analyzed using peak torques calculated from: trial one, the mean of all five trials and the mean of three trials where the highest and lowest values from the five trials were excluded. ? Intrasession reliability was assessed using intraclass correlation coefficients (ICC). Criterion validity for multi and single-trial measures was determined using regression analyses and Pearson product moment correlation coefficients (r).   Methods Figure 1. Subject in prone standing position. The participant's trunk was supported on a height-adjustable plinth. Hip was extended to 45 degrees as measured by the goniometer, with the knee extended . The participant's pelvis was stabilized by one examiner. The HHD was placed 5cm superior to the midpoint of the knee joint line, perpendicular to the posterior thigh. Trial 1 Average of 3 Trials Average of 5 Trials Measures M (SD) M(SD) ICC3,1 M(SD) ICC3,1 HHD    L 57.97 (12.55) 57.73 (11.38) 0.95* 57.56 (11.37) 0.81*    R 58.98 (10.78) 59.13 (10.62) 0.93* 59.38 (10.20) 0.80* Biodex Prone            L 47.55 (24.05) 48.02 (23.31) 0.96* 48.24 (22.42) 0.82*    R 53.74 (23.17) 52.79 (23.31) 0.87* 52.94 (23.60) 0.91* Biodex Supine            L 164.57 (53.35) 164.44 (51.82) 0.97* 164.22 (50.13) 0.90*    R 183.92 (74.96) 184.64 (72.65) 0.99* 184.23 (73.28) 0.97* Selected References: (1) Stark et al., Pm. R., 3:472, 2011. (2) Lue et al., Kaohsiung J. Med. Sci., 25:126, 2009. (3) Wang et al., Arch. Phys. Med. Rehabil., 83:811, 2002. (4) Arnold et al.,  J. Strength Cond. Res., 24: 815, 2010.  Table 1. Mean peak torque (Nm) and intrasession reliability of the peak torque values on the HHD, Biodex Prone and Biodex Supine Note. M = mean; SD = standard deviation; ICC = intraclass correlation coefficient; HHD = handheld dynamometer; L = left; R = right *(p?0.0001)  ICC 3,1 values were larger using 3 versus 5 trial measures, thus validity was assessed using the means of 3 trials. The results of ANOVAs for each of the measures did not reveal any significant differences between legs; therefore the data of the legs were combined.  Figure 2. Scatter plot of three trial mean peak torques (Nm) comparing the HHD to the Biodex prone-standing position (A), to the Biodex Supine position (B) and comparing the Biodex Prone to the Biodex Supine position (C). Line of best fit, equations and r values are included. When compared to the standardized Biodex Supine position, the HHD demonstrates moderate validity.  Figure 3.  Scatter plot comparing Trial 1 peak torques (Nm) to the three trial average peak torque (Nm) of the HHD (A), Biodex Prone (B) and Biodex Supine (C). Line of unity and r values are included. When compared to the three trial average, the first trial demonstrates high validity.  Limitations & Future Directions ? Limitations: small sample size, potential for muscle fatigue, using an untested and non-standardized position on the Biodex (prone standing). ? Future directions: assess the validity of the HHD in patients with specific musculoskeletal conditions that may present with muscle imbalances at the hip.   


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