Gafner SC1,2, Bastiaenen CHG2, Terrier P3, Punt IM4, Ferrari S5, Gold G6, de Bie R4, Allet L1,7
1HES-SO//University of Applied Sciences and Arts of Western Switzerland, Department of Physiotherapy, Geneva, Switzerland, 2Research Program Functioning and Rehabilitation CAPHRI, Maastricht University, Department of Epidemiology, Maastricht, Netherlands, 3Independent Researcher, Sion, Switzerland, 4Maastricht University, Department of Epidemiology, Maastricht, Netherlands, 5University Hospitals and University of Geneva, Internal Medicine Specialities, Geneva, Switzerland, 6University Hospitals and University of Geneva, Department of Rehabilitation and Geriatrics, Geneva, Switzerland, 7University Hospitals and University of Geneva, Department of Community Medicine, Geneva, Switzerland
Background: Falls in older persons often cause fractures and loss of independency. It is supposed that weak frontal plane hip muscle strength increases the fall risk. Thus, more and more researchers are interested in identifying feasible and reliable testing procedures for these muscle groups.
Purpose: We investigated the reliability of a hip abductor and adductor strength testing procedure (maximum voluntary isometric strength (MVIS) and rate of force generation (RFG)) in older persons aged ≥65 years for which we positioned participants in a side-lying position. We were further interested in the applicability of this measurement method in everyday physical therapy.
Methods: We recruited 76 older persons with or without a fall history from a geriatric hospital and from an outpatients practice in Switzerland. Half of them underwent the abduction and the other half the adduction test. Participants were installed in a side-lying position. The tester held the participant's leg close to a dynamometer attached to a custom made frame. The participant was then asked to push three times in hip abduction or adduction against the dynamometer. The mean MVIS and RFG was retained for analyses. After a break of one to three hours we repeated the measurement procedure to calculate the interclass correlation coefficient (ICCagreement).
Results: Thirty-seven participants (mean age 80.76 years, standard deviation (SD) 7.31) were analyzed for the hip abduction (one drop-out) and 38 participants for adduction (mean age 80.44 years, SD 6.78). The ICC'sagreement for hip abduction MVIS was 0.94 [95% confidence interval 0.87-0.97] and 0.94 [0.91-0.97] for the RFG. The ICC'sagreement for hip adduction was 0.90 [0.84-0.95] for the MVIS and 0.94 [0.90-0.97] for the RFG. The standard error of measurement (SEM) and the smallest detectable difference (SDD) for hip abduction MVIS measures of the total sample was 0.12 N/kg, respectively 32.6% and 1.05 N/kg/s, respectively 51.7% for hip abduction RFG measures. The SEM and SDD for hip adduction MVIS measures of the total sample was 0.17 N/kg, respectively 39.6% and 0.77 N/kg/s, respectively 48.9% for hip adduction RFG measures. The average assessment time for hip abduction or adduction was 10.58 ± 1.56 min.
Conclusion(s): Frontal plane hip strength (MVIS and RFG) can reliably be measured in older persons aged ≥65 years in a side-lying position. Nevertheless, the assessment time is relatively long for the use in everyday clinics and further research is needed to explore other assessment positions and methods.
Implications: Physical therapists are encouraged to routinely assess hip frontal plane strength due to growing evidence that frontal plane stabilizing muscle groups are associated with fall risk. Testing hip frontal plane strength in a side-lying position seems feasible and reliable. However, the significance of moderate changes in these measurements may be limited by the large SDD and SEM. Therefore, physical therapists should be careful when assessing the progress of an individual person with this measurement method in daily clinical practice.
Keywords: muscle strength, measurements, geriatrics
Funding acknowledgements: The study was funded from an internal grant of the University Of Applied
Sciences of Western Switzerland.
Purpose: We investigated the reliability of a hip abductor and adductor strength testing procedure (maximum voluntary isometric strength (MVIS) and rate of force generation (RFG)) in older persons aged ≥65 years for which we positioned participants in a side-lying position. We were further interested in the applicability of this measurement method in everyday physical therapy.
Methods: We recruited 76 older persons with or without a fall history from a geriatric hospital and from an outpatients practice in Switzerland. Half of them underwent the abduction and the other half the adduction test. Participants were installed in a side-lying position. The tester held the participant's leg close to a dynamometer attached to a custom made frame. The participant was then asked to push three times in hip abduction or adduction against the dynamometer. The mean MVIS and RFG was retained for analyses. After a break of one to three hours we repeated the measurement procedure to calculate the interclass correlation coefficient (ICCagreement).
Results: Thirty-seven participants (mean age 80.76 years, standard deviation (SD) 7.31) were analyzed for the hip abduction (one drop-out) and 38 participants for adduction (mean age 80.44 years, SD 6.78). The ICC'sagreement for hip abduction MVIS was 0.94 [95% confidence interval 0.87-0.97] and 0.94 [0.91-0.97] for the RFG. The ICC'sagreement for hip adduction was 0.90 [0.84-0.95] for the MVIS and 0.94 [0.90-0.97] for the RFG. The standard error of measurement (SEM) and the smallest detectable difference (SDD) for hip abduction MVIS measures of the total sample was 0.12 N/kg, respectively 32.6% and 1.05 N/kg/s, respectively 51.7% for hip abduction RFG measures. The SEM and SDD for hip adduction MVIS measures of the total sample was 0.17 N/kg, respectively 39.6% and 0.77 N/kg/s, respectively 48.9% for hip adduction RFG measures. The average assessment time for hip abduction or adduction was 10.58 ± 1.56 min.
Conclusion(s): Frontal plane hip strength (MVIS and RFG) can reliably be measured in older persons aged ≥65 years in a side-lying position. Nevertheless, the assessment time is relatively long for the use in everyday clinics and further research is needed to explore other assessment positions and methods.
Implications: Physical therapists are encouraged to routinely assess hip frontal plane strength due to growing evidence that frontal plane stabilizing muscle groups are associated with fall risk. Testing hip frontal plane strength in a side-lying position seems feasible and reliable. However, the significance of moderate changes in these measurements may be limited by the large SDD and SEM. Therefore, physical therapists should be careful when assessing the progress of an individual person with this measurement method in daily clinical practice.
Keywords: muscle strength, measurements, geriatrics
Funding acknowledgements: The study was funded from an internal grant of the University Of Applied
Sciences of Western Switzerland.
Topic: Older people; Disability & rehabilitation
Ethics approval required: Yes
Institution: CCER Genève
Ethics committee: CCER Genève
Ethics number: 14-235
All authors, affiliations and abstracts have been published as submitted.
