手握測力器量測下肢肌力之效度與信度研究

Validity and Reliability of Hand-Held Dynamometer in Measuring Strength of the Lower Extremity Muscles

林千禾(Chien-Ho Lin) ； 胡名霞(Ming-Hsia Hu) ； 鄭世忠(Shih-Chung Cheng) ； 曹昭懿(Jau-Yih Tsauo)

《物理治療》 25卷4期 (2000/07) Pp. 232-238

摘要

研究背景：傳統的徒手肌力測試分級，時常難以反映微小的肌力改變，而手握測力器則可彌補此缺點。但應用手握測力器測試機能障礙者之肌力時，許多傳統肌力測試的擺位方式，卻不一定適用。研究目的：設計適用於髖部骨折經手術固定後病患的肌力測試擺位姿勢，並檢測手握測力器(Powertrack Ⅱ)之同一測試者的再測信度、以及不同測試者問之信度與效度。方法：由2名有兩年以上臨床經驗之物理治療師以手握測力器測量17名病患雙側下肢5組肌肉群，每組肌肉群由每位施測者測試三次；效度的檢測則以7種質量的砝碼與測力器顯示的讀值來做比較。主要之新發現：同一測試者之再測信度ICC(Intraclass Correlation Coefficient)值皆大於0.95；而不同測試者間之ICC值在髖伸直肌(ICC=0.9435)、髖外展肌(ICC=0.8751)、膝屈曲肌(ICC=0.9625)呈現高度信度；但在膝伸直肌(ICC=0.3825)及踝背屈肌(ICC=0.5728)的信度則不高。在效度方面，砝碼質量及各次測量值間之ICC值皆大於0.99。結論：由本研究結果可知，Power Track Ⅱ手握測力器使用於修正擺位後之下肢肌力測試時，具有良好之效度及信度；但應用於下肢小肌肉群及肌力太強的肌肉時，宜抱持較審慎的態度。

關鍵字

肌力測試 ； 手握測力器 ； 信度 ； 效度

並列摘要

Background: Hand-held dynamometers offer better discrimination of subtle muscle strength differences than the manual muscle testing procedure. This advantage may help physical therapists to better document the strength of their patients. However the hand-held dynamometer is not commonly used clinically in Taiwan and the validity and reliability remains unclear for patients with total hip replacements (THRs). Purpose: This study examined the intra-and inter-tester reliability of a hand-held dynamometer system (Power Track Ⅱ) in 5 muscle groups in the lower extremity of the THR patients. Methods: Seventeen THR patients (average 72 years old, 10 females and 7 males) who were at least one year post-operation participated in this study. The authors developed standard testing positions for each of the 5 lower extremity muscles. The knee extensors, knee flexors, and ankle dorsiflexors were tested in a sitting position. The hip extensors and hip abductors were tested in a sidelying position. Two physical therapists measured the strength of the 5 muscle groups in each leg of each patient. Each muscle was tested 3 times repeatedly with 15 seconds break by each therapists. Thus each patient made a total of 60 contractions (5 muscles x 3 repetitions x 2 legs x 2 therapists). The intra-tester reliability of one therapist is determined by the AMICC (Averaged Mean Intraclass Coefficients) of the 3 trials. The inter-tester reliability is determined by the AMICC of the means of the 3 trials between therapists. Validity is determined by calculating the AMICC of monitor readouts on the dynamometer using various weights (2.2, 4.4, 6.6, 10, 25, 50, 75 lbs). Results: The results revealed high intra-tester reliability (ICC＞0.95). Inter-tester reliability was high in hip extensors (ICC＞0.94), hip abductors (ICC＞0.87) and knee flexors (ICC＞0.96); but it was low in knee extensors (ICC＞0.38) and ankle dorsiflexors (ICCA＞0.5728). The ICC value between the weights and the monitor readouts is very high (ICC＞ 0.99) indicating excellent validity. Conclusion: There were good validity and reliability in measuring lower extremity strength using Power Track Ⅱ hand-held dynamometer. However, it still needs practice to improve the reliability of the knee extensors and ankle dorsiflexors.

並列關鍵字

Muscle strength ； Hand-held dynamometer ； Validity ； Reliability