• Claire E Baldwin.
• Faculty of Health Sciences, School of Medicine, Department of Critical Care Medicine, Flinders University, Flinders Drive, Bedford Park, South Australia, 5042, Australia. claire.baldwin@health.sa.gov.au
• J Crit Care. 2013 Feb 1;28(1):77-86.

PurposeDynamometry is an objective tool for volitional strength evaluation that may overcome the limited sensitivity of the Medical Research Council scale for manual muscle tests, particularly at grades 4 and 5. The primary aims of this study were to investigate the reliability, minimal detectable change, and time to peak muscle force, measured with portable dynamometry, in critically ill patients.Materials And MethodsIsometric hand grip, elbow flexion, and knee extension were measured with portable dynamometry.ResultsInterrater consistency (intraclass correlation coefficient [95% confidence interval]) (0.782 [0.321-0.930] to 0.946 [0.840-0.982]) and test-retest agreement (0.819 [0.390-0.943] to 0.918 [0.779-0.970]) were acceptable for all dynamometry forces, with the exception of left elbow flexion. Despite generally good reliability, a mean change (upper 95% confidence interval) of 2.8 (7.8) kg, 1.9 (5.2) kg, and 2.6 (7.1) kg may be required from a patient's baseline force measurement of right grip, elbow flexion, and knee extension to reflect real force changes. There was also a delay in the time for critically ill patients to generate peak muscle forces, compared with healthy controls (P ≤ .001).ConclusionsDynamometry can provide reliable measurements in alert critically ill patients, but moderate changes in strength may be required to overcome measurement error, during the acute recovery period. Deficits in force timing may reflect impaired neuromuscular control.Copyright © 2013 Elsevier Inc. All rights reserved.

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