Handheld dynamometer reliable and safe to assess lower limb strength during dialysis
Key takeaways:
- Results showed high to very high relative reliability among patients.
- Interrater reliability had wider value ranges.
Using a handheld dynamometer to assess hip flexion and abduction strength during dialysis was reliable and safe, researchers found in a cross-sectional study.
“Subjects in stages 3 and 4 of [chronic kidney disease] CKD already show a decreased level of physical activity, physical function and decreased muscle mass, but subjects with CKD stage 5 in hemodialysis treatment have the lowest activity and functional levels,” Eva Segura-Orti, PhD, PT, of the Universidad Cardenal Herrera-CEU Department of Nursing and Physiotherapy in Valencia, Spain, wrote with colleagues. “Therefore, it seems sensible to include muscle strength assessment in the clinical routine.”
Researchers recruited 56 patients ( mean age, 67 years) with stage 5 CKD who were on hemodialysis for at least 3 months. The study was conducted at two dialysis centers between 2020 and 2024, and aimed to evaluate the intra-rater and interrater reliability of handheld dynamometry testing on lower limb muscle strength.
Hip and ankle assessments were run four parts: two trials by rater A and two by rater B.
Data showed high to very high relative reliability among patients, with intraclass correlation coefficients, used to test relative intra-rater and interrater reliability, ranging from 0.75 to 0.98. For intra-rater absolute reliability, the minimal detectable change values for hip muscles varied between 27 N and 41.6 N but increased in range with ankle muscles.
Segura-Orti and colleagues highlighted that interrater reliability had wider value ranges, and the mean difference between tests ranged across the two time points for raters A (1 N-19.3 N) and raters B (1.3 N -11.4 N). Meanwhile, mean difference in strength between raters ranged from 2.4 N to 13.5 N, showing systematic bias for raters A in ankle plantar flexion, according to researchers.
“Handheld dynamometry of the hip muscle strength is a clinically feasible procedure to detect those patients with sarcopenia who need further treatment to avoid a decrease in their physical function,” the researchers wrote. “It is specially indicated for low functioning, frail subjects who are unable to perform the sit-to-stand tests before hemodialysis.”
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