Confiabilidade e validade do teste do esfigmomanômetro modificado para a mensuração clínica da força muscular de membros superiores de indivíduos na fase subaguda pós acidente vascular encefálico

Abstract

Muscle strengths impairment of the upper limbs (UL) post-stroke have an important contribution to the limitation of activities and restriction of participation. Thus, the measurement of muscle strength in post-stroke evaluation becomes essential. The modified sphygmomanometer test (MST) is an alternative method for the measurement of muscle strength in post-stroke individuals since it provides objective values and has low cost. This test showed adequate measurement properties for the measurement of UL strength with subjects in the chronic phase post-stroke. However, no study has investigated the measurement properties of the MST to assess the muscle strength of UL in subjects in the subacute phase post-stroke. Considering that the measurement properties are specific to the characteristics of the context in which an instrument is employed, among them, the population characteristics, and that individuals in the subacute phase post-stroke presents motor particularities that distinguish them from the ones in the chronic phase, the aims of this study were: a) to evaluate test-retest and inter-rater reliabilities and criterion-related validity of the MST for the measurement of strength of the UL in subjects in the subacute phase post-stroke; b) to establish prediction equations between strength measurements obtained by the MST and dynamometers; c) to verify whether the number of trials of the MST measures (first trial and the means of the first two and of three trials) would affect the results and their measurement properties. The strength (flexors/extensors of shoulder, elbow and wrist, shoulder abductors and grip) of 55 participants in the subacute phase post-stroke (61±13years; 3.7±0.73months since onset of stroke) were measured with portable dynamometers (criterion standard) and with the MST, bilaterally, by the examiner-1. After 1-2 weeks, two examiners independently conducted a second day of evaluation with MST. Examiner-3 read and record the values. One-way ANOVA was used to compare the different forms of outcome measures obtained with the MST. To investigate the test-retest and inter-rater reliabilities, the intraclass correlation coefficient (ICC) was used. To investigate the validity, the Pearson correlation coefficient was employed and, regression analyses were used to provide prediction equations. The values provided by different number of trials were similar (0.01F0.14; 0.87p0.99). Regarding test-retest reliability, the different number of trials showed high to very high ICC values (0.70ICC0.98; p<0.001) for both UL. For the inter-rater reliability, the different number of trials showed moderate to very high ICC values for all muscular groups (0.66ICC0.99; p<0.001). Significant, positive and high to very high correlations were found between the MST and the dynamometer measures for all muscular groups and number of trials (0.74r0.97; p<0.001). The coefficients of determination ranged between 0.55r20.89. The MST showed adequate test-retest and inter-rater reliabilities, as well as criterion-related validity for measuring the strength of the UL muscles of subjects in the subacute phase of stroke, employing only one MST trial, after familiarization.