INTER- AND INTRA-TESTER MEASUREMENT RELIABILITY OF THE RATIO OF ISOMETRIC INTERNAL TO EXTERNAL SHOULDER ROTATION STRENGTH USING A HAND HELD DYNAMOMETER IN HEALTHY VOLUNTEERS
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Objective To evaluate the intra- and inter-tester reliability of measuring shoulder external rotation (ER) and internal rotation (IR) strength and the ratio between the two (ER:IR) using a hand held dynamometer (HHD) and to establish a reliable protocol for objective measurement. The study was conducted on a cohort of healthy military and civilian participants between 18 to 40 years old. Design Cohort study Setting British Army Regional Rehabilitation Unit. Participants 25 healthy volunteers (17 male, 8 female), aged 18 – 40 (mean ± standard deviation) 30.9 ± 6.3 years, body mass = 80.6 ± 15.1 kg, and stature = 1.73 ± 0.08 m. (17 males aged 33.1 ± 6.1 years, body mass = 87.3 ± 10.9 kg, and stature = 1.8 ± 0.1 m. Eight females aged 26.1 ± 4.0 years, body mass = 66.3 ± 13.0 kg, and stature = 1.7 ± 0.04 m). Method Shoulder ER and IR isometric muscle strength was measured on two occasions seven days apart using the HHD. Subjects sitting with their glenohumeral joint in neutral and elbow flexed to 90 degrees, conducted three x six second tests for ER and IR. Two testers administered the test to each subject within each session, separated by a 10 minute rest. The level of agreement between strength tests was quantified using the 3 Bland-Altman plotting method and applying the 95% limits of agreement (LoA). The 95% standard error of measurement (SEM) was calculated to quantify variation in individual performance. As a comparator to previous research, ICC (3,1) was also reported. Results ER measurements showed the best agreement with the 95% LoA of 0.3 ± 3.0 kg (Meandiff ± (1.96 × SDdiff)). The SEM was 2.1 kg and ICC = 0.961. The IR measurements showed less agreement with the 95% LoA ranging from 0.2 ± 6.1 kg, a greater SEM of 4.3 kg and ICC = 0.959. Ratio data showed the least agreement between trials with the 95% LoA of 4.0 ± 20.3%, a large SEM of 14.4% and lower ICC = 0.745. Conclusion The study demonstrated that measuring the ratio is not a reliable method but individual scores of ER more than IR are considered reliable. Caution is to be taken when measuring strong participants, as more variation in the scores is obtained. The methodology described can easily be used as protocol in a clinical setting.
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