Intraexaminer reliability of hand-held dynamometry in the upper extremity: a systematic review.

OBJECTIVE: To summarize and appraise the literature on the intraexaminer reliability of hand-held dynamometry (HHD) in the upper extremity. DATA SOURCES: MEDLINE, CINAHL, and EMBASE were searched for relevant studies published up to December 2011. In addition, experts were contacted, and journals and reference lists were hand searched. STUDY SELECTION: To be included in the review, articles needed to (1) use a repeated-measures, within-examiner(s) design; (2) include symptomatic or asymptomatic individuals, or both; (3) use HHD to measure muscle strength in any of the joints of the shoulder, elbow, or wrist with the "make" or the "break" technique; (4) report measurements in kilogram, pound, or torque; (5) use a device that is placed between the examiner's hand and the subject's body; and (6) present estimates of intraexaminer reliability. DATA EXTRACTION: Quality assessment and data extraction were performed by 2 reviewers independently. DATA SYNTHESIS: Fifty-four studies were included, of which 26 (48%) demonstrated acceptable intraexaminer reliability. Seven high-quality studies showed acceptable reliability for flexion and extension of the elbow in healthy subjects. Conflicting results were found for shoulder external rotation and abduction. Reliability for all other movements was unacceptable. Higher estimates were reached for within-sessions reliability and if means of trials were used. CONCLUSIONS: Intraexaminer reliability of HHD in upper extremity muscle strength was acceptable only for elbow measurements in healthy subjects. We provide specific recommendations for future research. Physical therapists should not rely on HHD measurements for evaluation of treatment effects in patients with upper extremity disorders.

Measurement of clinically relevant functional health perceptions in patients with whiplash-associated disorders: the development of the whiplash specific activity and participation list (WAL).

PURPOSE: The International Classification of Human Functioning Disability and Health (ICF) provides insight into functional health status in patients with whiplash-associated disorders (WAD). In the assessment of functional limitations in patients with WAD, there are several condition-specific questionnaires available. Estimation of the true relationship between the separate constructs of the ICF is only possible if the items of the salient questionnaires measure exactly the constructs of interest, while not simultaneously measuring other constructs of the model. This study aimed to develop a condition specific and clinically relevant and usable instrument for patients with WAD that measures activity limitations and participation restrictions, as defined by the ICF framework. METHODS: Item generation consisted of (1) a semi-structured interview which was conducted among 69 WAD patients; (2) a Delphi study involving 13 health professionals experienced in the assessment of patients with WAD; (3) a literature search for items from self-assessment questionnaires for neck pain. RESULTS: A 35-item condition-specific self-assessment questionnaire for patients with WAD was developed. This new questionnaire measures purely activity limitations and participation restrictions according to the ICF and is based on patients' opinions and expert opinions. CONCLUSION: The whiplash activity and participation list tends to measure clinically relevant activity limitations and participation restrictions in WAD patients.