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A new tool to measure isometric knee flexor and extensor strength in older adults Jacobs, Rachel; Myring, Alec; Peeters, Mon Jef; Pirie, Ian; Neil, Sarah Aug 31, 2011

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Friday August 19th, 2011  Rachel Jacobs, Alec Myring Mon Jef Peeters, Ian Pirie, Sarah Neil Research Supervisor: Kristin Campbell, PhD     To determine whether the HUR Performance Recorder (PR1) is a tool that could be confidently used as an outcome measure in rehabilitation and research.   To test the HUR PR1?s:  ? intra-rater reliability ? inter-rater reliability ? convergent validity against the Biodex dynamometer.           HUR 5530     HUR PR1 ? Outcome Measure  ? Rehabilitation ? Research   ? Strength may determine: ? functional mobility  ? ability to perform ADL?s    ? Simple to perform, compare, & reproduce  ? Strong predictor of functional capacity   ? Canada?s aging population  ? OA prevalence ? 3rd most common chronic condition in Canada  ? Activity promotion ? Knee OA  ? Predictive of function  ? Limitations of other methods ? The gold standard for validity and reliability in testing muscle strength        ? WHY NOT JUST USE BIODEX? ? Access ? Cost ? Affordable  ? Accessible  ? Has not yet been tested  ? Potential uses in future rehab and research projects   ? Healthy independently living older adults from lower mainland ? Inclusion criteria ? 55-75 years of age ? Exclusion criteria ? Cardiovascular disease, neuromuscular or musculoskeletal disorders ? Par-Q ? No selection criteria for current physical activity level ? Recruitment ? Convenience sample  ? Vancouver Community Centres  ? UBC Changing Aging Program  ? Word of mouth ? Common statistical practice: ? Alpha level 0.05 ? Power ? 0.80  ? Assumptions ? There will not be a great deviation between the HUR PR1 tests ? There will not be a great deviation between the HUR PR1 and Biodex     r Power  .10 .20 .30 .40 .50 .60 .70 .80 .90 ?=.05 .70 470 117 52 28 18 12 8 6 4 .80 617 153 68 37 22 15 10 7 5 .90 854 211 92 50 31 20 13 9 6 Sample Sizes needed for correlation coefficient (r) Adapted from Table C.6 in Portney, L. and M. Watkins , Foundations of Clinical Research  Applications to Practice  ? HUR 5530 and PR1 ? Calibration as per manufacturer* ? Fixed joint angle ? Lateral epicondyle in-line with lever arm rotation axis ? Assess joint angle with goniometer ? Ankle pad proximal to malleoli for comfort  ? Measure = Force (kg) ? Biodex ? Calibration as per manufacturer ? Angles to match HUR  ? Measure = Peak Torque (Nm)  ? Test-Retest Reliability - HUR PR1 ? Intra-rater reliability ? Inter-rater reliability   ? Convergent validity ? Biodex vs. HUR Informed Consent Familiarization 2-5 Days Rest Test Day 1 ?HUR Test 1 (T1) ? Rest ? Biodex Test (T3) 2-5 Days Rest Test Day 2 ?HUR Test 2 (T1) ? Rest ?HUR Test 3 (T1) ? Rest ?HUR Test 4 (T2) ? Randomized and counter-balanced (Using concealed envelope)  ? Test Day 1 ? Randomized order of tests ? Test Day 2 ? Randomized order of examiners  ? Flexion first vs. Extension first  ? Alternated for each testing session   Day 1 HUR1 BD Day 1 BD HUR1 Day 2 HUR2 HUR1 HUR1 Day 2 HUR1 HUR1 HUR2 5 minute warm-up ?Cycle ergometer (50W) 3 minute rest period 3 submaximal trials ?50-60% perceived exertion 3 maximal trials 3 minute rest period 3 submaximal trials ?Opposite movement 3 maximal trials ?Opposite movement ? Dominant leg used ? Data from HUR PR1 converted from kilograms to peak torque (Nm) ?  Mean of 3 trials ?  Group mean  ? Max and mean torque compared using SPSS statistical software ? Reliability ? ICC ? Pearson r   ? Validity ? Pearson r ? Bland-Altman Plot        ? HUR PC software issues ? Defaulted to zeroing HUR PR1 ? Retested select subjects with calibration post-data collection ? Regression equation ? n=3                p < 0.005   Average Torque r Flexion .897 Extension .893 Maximum Torque r Flexion .753 Extension .943 Intra-class Correlation Coefficient (ICC) (CI = Confidence Interval)                p < 0.005   Average Torque r Flexion .881 Extension .886 Maximum Torque r Flexion .749 Extension .954  Intra-class Correlation Coefficient (ICC) (CI = Confidence Interval) Biodex vs. HUR PR1 r p Flexion .847 .001 Extension .873 .000 0.020.040.060.080.0100.0120.0140.0160.0180.0200.00.0 20.0 40.0 60.0 80.0 100.0 120.0 140.0 160.0Flexion Torque: HUR PR1 (Nm) Flexion Torque: Biodex (Nm) 0.050.0100.0150.0200.0250.0300.0350.00.0 50.0 100.0 150.0 200.0 250.0 300.0Extension Torque: HUR PR! (Nm) Extension Torque: Biodex (Nm)   ? Good intra- and inter-rater reliability ? Repeatability of the force transducer ? Standardized protocol  ? Extension vs. Flexion ? Trend toward greater reliability with extension ? Error from counter-moment force ? Counter-moment greater from extensors ? HUR 5530 set-up ? Immovable pad vs. straps ? Good criterion-referenced validity to Biodex ? Unbiased error ? Wide confidence limits ? Calibration issues? ? Regression equation ? HUR PR1 Unit ? Major issues with software ? Hardware malfunctions ? Calibration issues ? Limited access to IT support ? Recruiting ? Slow to recruit adequate sample size ? Time ? Constraints related to course schedule ? Data extrapolated using a regression formula based on a sample within the sample  ? Predetermined joint angle limits clinical applications  ? Generalizability ? Healthy older adults  ? Calibrated trials ? Using HUR PR1 software ? Use with different exercise machines? ? E.g. different movements/muscle groups ? Different age groups? ? Clinical populations? ? Reliable ? Valid ? Software limitations ? Practical-knee flexion/extension Large ICC Small ICC 

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