Confiabilidade e validade do teste do esfigmonômetro modificado para mensuração clínica da força muscular de membros inferiores e tronco de indivíduos na fase subaguda pós acidente vascular encefálico

Abstract

The modified sphygmomanometer test (MST) is an adequate method for the assessment of muscle strength in subjects with chronic stroke. The MST can also be a promising method for assessing muscle strength in subjects with subacute stroke. These subjects have characteristics specific and distinct from those presented by subjects with chronic stroke. Thus, for MST be used in subjects with subacute stroke,the investigat reliability and validity, is necessary. Therefore, the objectives of this study were to investigate the reliability and validity of the MST for the assessment of muscle strength of the lower limb (LL) and trunk in subjects with subacute stroke (between three and six months post-stroke) and to verify whether the number of trials affectedthe results. A methodological study approved by COEP/UFMG (ETIC0492.0.203.000.10) was conducted with 54 subjects with subacute stroke (62±14 years; 4±1 months post-stroke). Bilateral muscle strength of the LL and trunk (flexors/extensors of the hip, knee, ankle, trunk, hip abductors, lateral flexors and rotators of the trunk) was assessed by the examiner-1 with the hand-held dynamometer (criterion standard) and the MST. Examiners 1 and 2 performed a second evaluation (1-2 weeks apart) with the MST. A third examiner read and recorded all of themeasures. Intraclass correlation coefficient (ICC) was used to investigate test-retest and inter-rater reliabilities (=0.05) and Pearson correlation test was used to assess the correlation between the measures of the hand-held dynamometer (HHD) (Kg) and the MST (mmHg). One-way analysis of variance (ANOVA) was used to compare the MST values using different number of trials (first trial and the means of 2 and 3 trials). Linear regression analyses were employed to identify the best model, which could explain the relationships between the measures obtained with both types of equipment and to provide the estimated regression equations that could predict the strength values, in kg, from those obtained with the MST, in mmHg. Significant values classified from moderate were found for test-retest reliability (0.57ICC0.97; p0.001), inter-rater reliability (0.50ICC0.94; p0.001) and validity (0.70r0.88; p0.001) for the all muscular groups considering the different outcome measures, except for the test-retest reliability considering the first trial for the non-paretic ankle dorsiflexors, which showed low ICC values (ICC=0.47; p0.001), and for the nonparetic ankle plantar flexors considering different number of trials (first trial and the means of 2 and 3 trials), which showed very low to low ICC values (0.20ICC 0.43; p0.001). ANOVA showed similar values among the outcome measures (0.01F0.09; 0.92p1.00). Linear regression analyses demonstrated that the values in mmHg were good predictors of the values in Kg (0.54r20.77; p0.001). The MST showed adequate measurement properties to evaluate the muscle strength of the LL and trunk in subjects with subacute stroke and, therefore, can be used in clinical practice to provide objective measurements of muscle strength in this population. In general, only one trial, after familiarization, can be used without compromising the values obtained and their measurement properties.