Uporabnost ročne dinamometrije, merjenja jakosti prijemov in funkcijskega testa zgornjih udov pri bolnikih z amiotrofično lateralno sklerozo : magistrsko delo

Lubej, Sanja (author), Puh, Urška (mentor), Leonardis, Lea (co-mentor)

Uvod: Pri bolnikih z ALS je ocenjevanje z ročno dinamometrijo eden izmed načinov, kako v kliničnem okolju na preprost, standardiziran in poceni način spremljati upad mišične jakosti. Potrebno je oceniti tudi funkcioniranje in sposobnosti izvajanja dejavnosti na zgornjem udu, za kar lahko uporabimo standardizirane ocenjevalne lestvice in izvedbene teste. Namen: Preveriti zanesljivost postopka za testiranje z ročno dinamometrijo pri zdravih preiskovancih, opredeliti najprimernejši način za določanje izida, preučiti uporabnost merjenja jakosti mišic zgornjega uda z ročno dinamometrijo in jakosti prijema roke po postopku TRICALS ter jakosti finih prijemov in ocenjevanja z ARAT pri bolnikih z ALS. Metode dela: V raziskavi je sodelovalo 21 zdravih preiskovancev in 30 bolnikov z ALS, ki so opravili testiranje z ročno dinamometrijo za zgornje ude. Izvedli smo analizo variance ANOVA s primerjavo več možnih izbir izida ter izračunali standardno napako merjenja (SEM). Pri bolnikih z ALS smo izvedli še testiranje ARAT, dinamometrijo roke in finih prijemov ter ocenjevanje z ALSFRS-R in preverili veljavnost konstrukta. Za zanesljivost posameznega preiskovalca pri ročni dinamometriji so bili izračunani intraklasni koeficienti korelacije za skupino zdravih preiskovancev. Meritve smo izvedli dvakrat v razmiku od 9 ali 17 dni. Za oceno veljavnosti konstrukta med uporabljenimi merilnimi orodji smo izračunali Spearmanove koeficiente korelacije. Rezultati: ANOVA ni pokazala značilnih razlik med različnimi izidi pri ročni dinamometriji pri zdravih preiskovancih in bolnikih z ALS. V primerjavi z največjo meritvijo smo nižje SEM izmerili pri povprečju treh meritev, zato smo za nadaljnjo analizo uporabili ta izid. Zanesljivost posameznega preiskovalca ročne dinamometrije je bila na dominantnem udu dobra do odlična (ICC = 0,80–0,96), na nedominantnem udu pa zmerna do dobra (ICC = 0,64–0,93). Sočasna veljavnost med ARAT in ročno dinamometrijo je bila dobra do odlična (ro = 0,77–0,91), med ALSFRS-R in ročno dinamometrijo srednja (ro = 0,41–0,70), med jakostjo prijema roke ter finih prijemov in ARAT zmerna do dobra (ro = 0,54–0,80) ter med ARAT in ALSFRS-R zmerna do dobra (ro = 0,53–0,74). Zaključek: Priporočamo, da se za izid ročne dinamometrije izračuna povprečje meritev oziroma da se po dogovoru uporabi vedno isti izid. Za testiranje po protokolu TRICALS smo pri zdravih preiskovancih ugotovili dobro zanesljivost posameznega preiskovalca. Veljavnost konstrukta je bila pri bolnikih z ALS ovrednotena kot srednja do odlična povezanost med testi, s čimer smo potrdili, da ocenjujejo podobno funkcijo. Za nekatere meritve mišične jakosti smo zaznali učinek tal, zato bi bilo smiselno v ocenjevanje vključiti ARAT poleg ALSFRS-R. Potrebno bi bilo preveriti tudi zanesljivost posameznega preiskovalca in med preiskovalci za testiranje z ročno dinamometrijo pri bolnikih z ALS.

• Language: Slovenian
• Keywords: merjenje mišične jakosti, merske lastnosti, amiotrofična lateralna skleroza, funkcija zgornjega uda
• Work type: Master's thesis/paper
• Organization: ZF - Faculty of Health Sciences
• Year: 2018
• PID: 20.500.12556/RUL-104020
• COBISS.SI-ID: 5506411
• Publication date in RUL: 30.09.2018

Secondary language

• Language: English
• Title: Usability of hand-held dynamometry for upper limbs, grip strength measurement and Action research arm test in patients with amyotrophic lateral sclerosis : master thesis

Abstract

Introduction: Hand-held dynamometry is a simple, standardized, relatively inexpensive way to assess decline in muscle strength in ALS patients. Comprehensive assessment of patients includes measurements of functioning and performance of upper limb activities, using standardized global assessment scales and upper limb tests of function and activity. Purpose: To assess reliability of a testing protocol for hand-held dynamometry in healthy subjects, to determine the appropriate way of reporting the outcome, to consider the usability of the upper limb muscle strength measurements with the TRICALS protocol, grip and pinch and ARAT assessment in patients with ALS. Methods: 21 healthy subjects and 30 ALS patients participated in the study. ANOVA variance analysis was performed for comparison of possible outcome choices, standard error of measurement (SEM) was reported and construct validity between ARAT, hand-held dynamometry, grip and pinch strength and ALSFRS-R. Reliability of a single rater was reported for healthy subjects using the intraclass correlation coefficients. Measurement were performed twice between 9 or 17 days. Construct validity was evaluated with Spearman correlation coefficients between all outcome measures. Results: ANOVA found no significant differences between various methods of selecting the outcome in hand-held dynamometry. Compared with the maximum measurement, the lower SEM was measured for the average of three measurements, and this outcome was used for further analyses. Reliability of a single rater in healthy subjects was good to excellent on the dominant side (ICC = 0.799–0.963) and moderate to good (ICC = 0.641–0.931) on non-dominant side. The concurrent validity between ARAT and hand-held dynamometry was good to excellent (ro = 0.765–0.913), between ALSFRS-R and hand-held dynamometry fair (ro = 0.409–0.699), between grip and pinch grip strength and ARAT moderate to good (ro = 0.535–0.804) and between ARAT and ALSFRS-R moderate to good (ro = 0.527–0.741). Discussion and conclusion: We recommend using an average of measurements as a result of hand-held dynamometry or that the reported results are a matter of agreement and should be always the same. In healthy subjects, we showed good reliability for a single rater. The calculated coefficients of correlation between the measured tests showed a fair to excellent correlation between tests in patients with ALS, which confirms that they assess similar function. Some of the muscle strength dynamometry measurements showed a floor effect in the studied group of patients. For more accurate assessment of leftover function in this group, we recommend that performance, ability and function tests (ARAT) or global function scales (ALSFRS-R), are performed. Future research should focus on the reliability of hand-held dynamometry for a single rater and between raters in patients with ALS.

• Keywords: muscle strength measurements, upper limb function, psychometric properties, amyotrophic lateral sclerosis