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Uporabnost ročne dinamometrije mišic spodnjih udov in testa petih vstajanj pri bolnikih z amiotrofično lateralno sklerozo : magistrsko delo
Valenti, Fabio (Author), Puh, Urška (Mentor) More about this mentor... This link opens in a new window, Leonardis, Lea (Co-mentor)

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Abstract
Uvod: Amiotrofična lateralna skleroza (ALS) je hitro napredujoča nevrodegenerativna bolezen, ki povzroča propad motoričnih nevronov in ima smrtni izid. Klinična slika se med pacienti razlikuje, kar otežuje ocenjevanje in spremljanje zdravstvenega stanja pacientov. Njihovo sposobnost funkcioniranja običajno ocenjujemo s standardiziranimi ocenjevalnimi lestvicami in izvedbenimi testi, za oceno upada mišične jakosti spodnjih udov pa se priporoča uporaba ročnega dinamometra. Test vstajanja in sedanja se lahko uporablja za oceno funkcijske zmogljivosti spodnjih udov. Namen: Namen raziskave je bil oceniti zanesljivost posameznega preiskovalca za protokol TRICALS pri zdravih preiskovancih in ugotoviti najprimernejše število ponovitev za določanje izida ter in primerjati rezultate ročne dinamometrije spodnjih udov, testa vstajanja 5TSTS in lestvice ALSFRS-R. Metode dela: V raziskavi je sodelovalo 20 zdravih preiskovancev in 30 bolnikov z ALS, ki so opravili testiranje z ročno dinamometrijo za spodnje ude. Za zagotavljanje zanesljivosti posameznega preiskovalca so bili izračunani intraklasni koeficienti korelacije (ICC) za skupino zdravih preiskovancev. Meritve smo izvedli dvakrat v razmiku 5 dni. Izbor izidov testa smo preverjali z analizo variance (ANOVA) in izračunali standardno napako merjenja (SEM) za obe skupini preiskovancev. Za oceno veljavnosti konstrukta smo izračunali Spearmanove koeficiente korelacije. Rezultati: Pri ugotavljanju najprimernejšega izida meritev pri uporabi ročne dinamometrije s protokolom TRICALS nobena izmed izbranih vrednosti ni pokazala statistično značilnih razlik za vse testirane mišične skupine. V primerjavi z najvišjo pridobljeno vrednostjo so bile vrednosti standardne napake merjenja (SEM) pri uporabi povprečja treh meritev nižje. Zanesljivost posameznega preiskovalca za ročno dinamometrijo je pri zdravih preiskovancih pokazala dobro do odlično ujemanje pri merjenju vseh mišičnih skupin desnega uda (ICC = 0,87–0,97) in zmerno do dobro ujemanje za vse mišične skupine levega uda (ICC = 0,74–0,97). Veljavnost konstrukta merjenja mišične jakosti po protokolu TRICALS in 5TSTS ni pokazala statistično značilnih korelacij (ro = od 0,16 do -0,56). Povezanost med ročno dinamometrijo in funkcijskim testom ALSFRS-R je bila nizka (ro = 0,001–0,28). Povezanost med izidi 5TSTS in lestvico ALSFRS-R je bila zmerna do dobra (ro = 0,61). Zaključek: Zanesljivost posameznega preiskovalca pri merjenju mišične jakosti spodnjih udov zdravih preiskovancev je, po protokolu TRICALS, za vse mišične skupine visoka. Za izid meritev ročne dinamometrije je bolj smiselno uporabiti povprečno vrednost vseh meritev kot meritev z največjo vrednostjo. Zmerno do dobro povezanost smo za bolnike z ALS ugotovili le med testom 5TSTS in lestvico ALSFRS-R, med tem ko je bila povezanost ročne dinamometrije z drugima testoma nizka. V prihodnjih raziskavah bi bilo smiselno preveriti zanesljivost posameznega preiskovalca in zanesljivost med različnimi preiskovalci za testiranje z ročno dinamometrijo s protokolom TRICALS pri bolnikih z ALS, ter k pacientovi oceni v klinični praksi dodati 5TSTS, saj ocena sposobnosti vstajanja in sedanja ni vključena v lestvico ALSFRS-R.

Language:Slovenian
Keywords:ročna dinamometrija, merjenje mišične jakosti, amiotrofična lateralna skleroza, funkcija spodnjega uda
Work type:Master's thesis/paper (mb22)
Organization:ZF - University College of Health Studies
Year:2018
COBISS.SI-ID:5564267 This link opens in a new window
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Downloads:321
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Secondary language

Language:English
Title:Usability of hand-held dynamometry in lower extremities muscles and sit to stand test in patients with amyotrophic lateral sclerosis : master thesis
Abstract:
Background: Amyotrophic lateral sclerosis (ALS) is a rapidly progressive neurodegenerative disease, which causes motoneuron death and has fatal outcome. The clinical picture differs between patients, making the assessment and follow-up much more difficult. Functional ability of such patients is normally assessed using standardized assessment scales and performance tests, while the use of hand-held dynamometry is recommended for assessment of the decrease of the lower limb muscle strength. Sit to stand test can be used to assess functional ability of lower limbs. Purpose: The aim of the study was to evaluate intra-rater reliability of the TRICALS protocols on healthy subjects and to determine the most appropriate number of repetitions to determine the stable outcome of the measurements and to compare results of hand-held dynamometry of lower limbs, five times sit to stand test (5TSTS) and ALSFRS-R scale. Methods: The study included 20 healthy subjects and 30 ALS patients who underwent hand-held dynamometry testing for lower limbs. To assure intra-rater reliability the interclass correlation coefficients (ICC) for the group of healthy participants were calculated. Measurements were performed twice in a span of 5 days. The selection of test results was checked by analysis of variance (ANOVA) and standard measurement error (SEM) was calculated for both groups. To evaluate correlation between the measurements Spearman coefficient was calculated. Results: For determining the most suitable measurement outcome in the use of hand-held dynamometry with the TRICALS protocol, none of the selected values showed statistically significant differences for all tested muscle groups. Compared to the maximum value obtained, the standard measurement error (SEM) values were lower when using an average of three measurements. The intra-rater reliability for hand-held dynamometry in healthy subjects showed a good to high correspondence between the measurements for all muscle groups of the right leg (ICC = 0.87 – 0.97) and moderate to good correspondence for all muscle groups of the left leg (ICC = 0.74 – 0.97). The validity of the muscle strength measurement construct following the TRICALS and 5TSTS protocols did not show statistically significant correlations (ro = -0.16 – -0.56). The correlation between hand-held dynamometry and the functional ALSFRS-R scale was low (ro = 0.001 – 0.28). The correlation between the results of 5TSTS and ALSFRS-R was good (ro = 0.61). Conclusion: The reliability of the intra-rater measurements for muscle strength of the lower limbs in healthy subjects, while following the TRICALS protocol, is high for all muscle groups. For the outcome of hand-held dynamometry, the use of the average value of all measurements seems more reasonable than the use of maximum scores. Moderate to good association was observed in ALS patients between the 5TSTS test and the ALSFRS-R scale, whereas the correlation between hand-held dynamometry and other tests was low. In the future studies it would be reasonable to test the reliability of an individual investigator and reliability among various investigators for hand-held dynamometry following the TRICALS protocol in patients with ALS and to include the 5TSTS test in the clinical patient evaluation, as the assessment of the ability to sit down and stand up is not included in the ALSFRS-R scale.

Keywords:hand-held dynamometry, muscle strength measurement, amyotrophic lateral sclerosis, lower limb function

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