Normative Standards for Isokinetic and Anthropometric Classifications of University-Level Netball Players.

CONTEXT: The purpose of the study was to develop normative ranges and standards for knee and shoulder isokinetic and anthropometric values. These standards can be qualitatively interpreted and allow practitioners to classify isokinetic and anthropometric values more objectively for university-level netball players. DESIGN: Posttest only observational study design. All players were only evaluated once during the in-season to generate normative ranges. METHODS: A total of 51 female players volunteered. Participants were evaluated on an isokinetic dynamometer at 60° per second to obtain knee-extensor and knee-flexor values as well as shoulder-flexor and shoulder-extensor values. A total of 16 anthropometric variables were collected including stature, body mass, 8 skinfolds, and 6 circumferences. Between-group differences were calculated to determine whether playing level was a differentiating factor in data. RESULTS: Normative standards were developed for isokinetic parameters associated with the knee and shoulder joints as well as skinfolds and circumference measures. No statistically significant between-group differences were evident (χ2Kruskal-Wallis[2] = 3.96, P = .140). CONCLUSION: These standards can be used by coaches and practitioners to set attainable goals for individual players or those from secondary leagues, classify individual and team-based performances, and facilitate decision-making processes.

How Should Adult Handgrip Strength Be Normalized? Allometry Reveals New Insights and Associated Reference Curves.

INTRODUCTION: Handgrip strength (HGS) is an important indicator of health. Because HGS is strongly associated with body size, most investigators normalize HGS for some measure of body size as a more sensitive indicator of strength within a population. We aimed to 1) identify the optimal body size dimension to remove (normalize) HGS for differences in body size among adults and 2) generate norm-referenced centiles for HGS using the identified body size dimension. METHODS: Data were from the National Health and Nutrition Examination Survey, a representative sample of the US noninstitutionalized civilian population. Exclusions resulted in a final sample of 8690 adults 20 yr and older. HGS was measured using handheld dynamometry. Body size dimensions included body mass, height, and waist circumference. The most appropriate dimension(s) associated with HGS is identified using allometry. We fitted centile curves for normalized HGS using the generalized additive model for location, scale, and shape. RESULTS: Findings suggest that neither body mass nor body mass index is appropriate to normalize HGS. Incorporating all three body size dimensions of body mass, height, and waist circumference, or the reduced subsets of body mass and height, or height alone, suggests that the most appropriate normalizing (body size) dimension associated with HGS should be a cross-sectional or surface area measure of an individual's body size (i.e., L2, where L is a linear dimension of body size). Given that height was also identified as the signally best body size dimension associated with HGS, we recommend HGS be normalized by height2 (i.e., HGS/HT2). Centile curves for HGS/HT2 by age group and gender were therefore provided. CONCLUSIONS: Scaling adult HGS by height2 may help normalize strength for population-based research.

Reference values and factors associated with hand grip strength among older adults living in southeastern Poland.

Handgrip strength (HGS) is used as a biomarker for the state of health of older people, but the number of research publications containing the normative values of HGS in older adult populations is limited. The aim of the study was to define reference values and factors associated with HGS in older adults living in southeastern Poland. A cross-sectional study including 405 participants aged 65 and older was conducted. Handgrip strength for the dominant hand was assessed by the average of three trials using a JAMAR dynamometer. The sample was categorized into the following age groups: 65-69 years, 70-74 years, 75-79 years, 80-84 years, 85 and over. The average HGS was 19.98 kg (16.91 kg for women and 26.19 kg for men). There was a decrease in handgrip strength across the age range in both sexes. The average handgrip strength of the older people was 17.97 kg (14.47 kg for women and 25.66 kg for men) for those aged 80-85 and 16.68 kg (13.51 kg for women and 21.77 kg for men) in the group over 85 years old. In both sexes, marital status was an independent factor associated with reduced handgrip strength. In conclusion, this study described, for the first time, handgrip strength values for the southeastern Polish population aged ≥ 65 years according to age and gender.

Reliability of Quadriceps Femoris Muscle Strength Assessment Using a Portable Dynamometer and Protocol Tolerance in Patients With Chronic Obstructive Pulmonary Disease.

OBJECTIVE: This study aimed to evaluate the intrarater and interrater reliability of isometric quadriceps strength (IQS) using a portable dynamometer in individuals with chronic obstructive pulmonary disease (COPD) and to verify their tolerance to the protocol. METHODS: A cross-sectional reliability study was conducted with 50 individuals with stable COPD (34 men and 16 women; mean age = 70 years [SD = 8]). The main outcome measure was obtained using a portable dynamometer (Microfet 2) to assess IQS. Two masked raters performed 2 assessments in the dominant lower limb on 2 nonconsecutive days. The intraclass correlation coefficient (ICC) was used to verify the intrarater and interrater reliability and was considered excellent when >0.90, with a 5% significance level. RESULTS: Rater 1 and 2 intrarater reliability was as follows: ICC = 0.96 (95% CI = 0.94 to 0.98) and ICC = 0.97 (95% CI = 0.95 to 0.98), respectively. The interrater reliability was as follows: ICC = 0.96 (95% CI = 0.93 to 0.98). The minimum detectable difference was 4 to 5 peak isometric strength, in mean, for intrarater and interrater reliability. Not all patients presented relevant changes in physiological responses, dyspnea, and lower limb fatigue. CONCLUSION: There was an excellent intrarater and interrater reliability for IQS, and the participants tolerated the protocol. IMPACT: This tool can be used to assess quadriceps strength in clinical practice in patients with COPD.

The concurrent validity and intrarater reliability of a hand-held dynamometer for the assessment of neck strength in semi-professional rugby union players.

OBJECTIVES: The main objective of this study was to determine the concurrent validity between a hand-held (HHD) and mounted hand-held dynamometer (MHHD) for assessing isometric neck strength. DESIGN: Observational design. SETTING: Semiprofessional rugby club. PARTICIPANTS: Nineteen semi-professional rugby players (age = 26 ± 5 years, stature = 186.5 ± 6.5 cm, body mass = 98.7 ± 12.8 kg). MAIN OUTCOME MEASURES: Concurrent validity (limits of agreement, correlation) between HHD and MHHD, the intrarater reliability (intra-class correlation, ICC) and comparison between playing positions. RESULTS: Absolute peak and mean peak force were systematically lower when using the HHD compared to MHHD, with the mean bias ranging from -1.8 to -3.8 kgf (P < 0.05). Differences were not evident for flexion when applying the correction equations (-0.5 to 2.1 kgf, P > 0.05) but remained for extension. Correlations between methods were large-to-very large; the ICCs for both methods were good (ICC = 0.72-0.89), with no difference between positions (P < 0.05). CONCLUSION: The concurrent validity of HHD was considered acceptable when compared to the MHHD and the correction equation applied. Both methods are reliable and useful for assessing neck strength in rugby players, though, caution is needed when determining strength during neck extension.

Concurrent Validity and Reliability of a Low-Cost Dynamometer to Assess Maximal Isometric Strength in Neck Movements.

OBJECTIVE: This study aimed to evaluate the concurrent validity and reliability of a low-cost digital dynamometer to assess maximal isometric strength in neck movements. METHODS: Twelve recreationally active participants (6 women, 6 men; age: 24.1 ± 3.4 years; height: 1.71 ± 0.06 m; weight: 64.6 ± 11.7 kg) performed neck flexion, extension, and lateral flexion, and maximal isometric strength was simultaneously measured using an isokinetic dynamometer (gold standard) and a digital dynamometer to evaluate the concurrent validity of the latter. One week later, all the participants repeated 3 trials of each neck movement (3 minutes apart) registered only with the digital dynamometer. The first and second trial were guided by tester 1 and the third trial was guided by tester 2. RESULTS: The concurrent validity of the digital dynamometer showed a nearly perfect correlation between both devices (r > 0.986, P < .001), with Bland-Altman plots showing absolute agreement. Intertester and intratester reliability were nearly perfect for all neck movements (intraclass correlation coefficient > 0.86). CONCLUSION: The low-cost digital dynamometer showed valid and reliable measurements of maximal isometric strength in neck movements.

Design and validation of an automated dual-arm instrumented intravaginal dynamometer.

AIMS: (1) To present the design of a novel intravaginal dynamometer (IVD) capable of measuring vaginal closure force on both the anterior and posterior arms, (2) to use bench testing to validate the force, speed of arm opening, and positional accuracy of load measurement along the IVD arms, and (3) to present in vivo force measurements made with this device, comparing forces measured by the anterior and posterior arms. METHODS: IVD load measurements were validated against an Instron® Universal Tester, arm opening speeds were validated using video analysis, and position-load accuracy was validated against calibration weights. In vivo IVD data were acquired from female volunteers during passive opening and pelvic floor muscle contraction tasks. Anterior and posterior IVD arm force outcomes were compared. RESULTS: Forces measured by the IVD and Instron® exhibited a strong linear relationship with excellent model fit. The speed control system was valid when tested under physiological loading conditions, however smaller antero-posterior opening diameters (25 and 30 mm) exhibited some error. The loading position along the IVD arms had no effect on force outcomes. In vivo data exhibited differences between force outcomes measured at the anterior and posterior aspects of the vagina during active contraction and passive elongation of the pelvic floor muscles. CONCLUSIONS: This IVD design demonstrates valid load measurement and speed control during bench testing. Active and passive forces measured are consistent with the literature. With dual instrumented arms, this device allows for further investigation into the source of measured vaginal closure forces.

Reliability and Validity of Clinical Tests for Measuring Strength or Endurance of Cervical Muscles: A Systematic Review and Meta-analysis.

OBJECTIVE: To evaluate the reliability and validity of clinical tests for measuring cervical muscle strength or endurance in participants with and without neck pain. DATA SOURCE: Systematic review and meta-analysis on reliability and validity. Literature search was conducted on January 28, 2020, using 5 databases: MEDLINE, Cumulative Index to Nursing and Allied Health, EMBASE, SPORTDiscus, and Scopus. STUDY SELECTION: We included studies that investigated the reliability or validity of clinical tests for measuring cervical muscle strength or endurance in participants with nonspecific chronic neck pain, with or without irradiation, or healthy participants. We included only those that were viable for daily practice and of low cost. DATA EXTRACTION: Data were extracted as follows: (1) author and year of publication, (2) demographic values and health condition, (3) reported clinical tests, (4) inclusion and exclusion criteria, (5) description of test, (6) interrater reliability, and (7) intrarater reliability. For validity studies we also extracted the (8) reference method and (9) validity estimates. DATA SYNTHESIS: Methodological quality was assessed with the Quality Appraisal of Diagnostic Reliability and the Guidelines for Reporting Reliability and Agreement Studies. Data on reliability and validity were extracted from included articles and then analyzed. RESULTS: Thirty-one studies were included. Cervical flexor and extensor endurance test, craniocervical flexion test (CCFT), AND cervical muscle strength using a handheld dynamometer (HHD) showed moderate to good intra- and interrater reliability (intraclass correlation coefficients ranging from 0.64-0.90). Concurrent validity was measured by only 2 studies, which do not provide adequate evidence for a recommendation. CONCLUSIONS: The cervical flexor and extensor endurance tests, CCFT, and HHD for measuring cervical strength presented an acceptable interrater and intrarater reliability.

Hand-Held Dynamometry in the Inpatient Care Setting After Total Knee Arthroplasty: Reliability of Static Knee Strength Measurements.

OBJECTIVE: The aim of the study was to determine intrarater and interrater reliabilities for static strength assessment of knee flexors and knee extensors in patients with total knee arthroplasty, during the acute postoperative rehabilitation. DESIGN: Forty-five total knee arthroplasty patients were included in the study. Two physical therapists performed strength assessments by using hand-held dynamometry. Patients performed three trials and a 30-sec rest was provided between each trial. After this, a 5-min rest was provided, and then, a second investigator performed the same procedure for interrater reliability. Assessments for intrarater reliability were performed 1 hr later. RESULTS: The intrarater reliability of knee extensors and knee flexors strength measurements were 0.96 and 0.94, respectively. The standard error of measurement and minimal detectable change 95% confidence level were 6.17 and 17.01 Nm for knee extensors and were 8.89 and 24.51 Nm for knee flexors, respectively. The interrater reliability of knee flexors and knee extensors strength measurement was 0.96 for both. The standard error of measurement and minimal detectable change values at 95% confidence level were 6.00 and 16.54 Nm for knee extensors and were 6.32 and 17.42 Nm for knee flexors, respectively. CONCLUSIONS: Hand-held dynamometry is a reliable method to assess static knee strength. Hand-held dynamometry assessment can be implemented during acute postoperative rehabilitation. Our results may assist the clinicians in determining an accurate postoperative rehabilitation program after total knee arthroplasty surgery.

Measurement Properties of Isokinetic Dynamometry for Assessment of Shoulder Muscle Strength: A Systematic Review.

OBJECTIVE: To investigate the evidence of measurement properties of isokinetic dynamometry (ID) for assessment of shoulder muscle strength in healthy individuals and patients with nonneurologic shoulder pathology. DATA SOURCES: Cochrane Central Register of Controlled Trials, PubMed, EMBASE, and Physiotherapy Evidence Database were searched up to February 2020 without restrictions. Reference lists and citations were hand-searched. STUDY SELECTION: Two review authors independently included studies that met the following criteria: (1) evaluated measurement properties of ID when used on the glenohumeral joint and (2) included individuals 18 years and older. Studies including patients with neurologic, neuromuscular, or systemic diseases or critical illness were excluded. DATA EXTRACTION: The quality assessment and data synthesis were performed according to the COnsensus-based Standards for the selection of health Measurement INstruments methodology. DATA SYNTHESIS: Twenty-one studies with a total of 597 participants were included. The results were combined separately for isometric, concentric, and eccentric test mode; for the velocities 30°/s-60°/s, 90°/s, 120°/s, and 240°/s; for the seated, supine, and standing position; and for internal rotation (IR), external rotation (ER), and the ER/IR ratio. The reliability of ID was overall sufficient with the majority of intraclass correlation coefficients ≥0.70. The quality of evidence was moderate or low for 20 of 30 strata examined. The measurement error results were rated as insufficient for all strata. The SEM ranged from 4%-28%. The quality of evidence varied depending of strata examined. CONCLUSIONS: The reliability of ID for measurement of shoulder strength was overall sufficient for all positions, velocities, and modes of strength. The measurement error was not sufficient. Because most studies used the seated position, the velocities 30°/s-60°/s or 120°/s, and the concentric test mode, the quality of evidence was highest for these conditions.

Portable, One-Dimensional, Trunk-Flexor Muscle Strength Measurement System.

Trunk-flexor muscle strength plays a fundamental role in athletic performance, but objective measurements are usually obtained using expensive and nonportable equipment, such as isokinetic dynamometers. The aim of this study was to assess the concurrent validity of a portable, one-dimensional, trunk-flexor muscle strength measurement system (Measurement System) that uses calibrated barbells and the reliability of the measurements obtained using the Measurement System, by conducting test-retests. As a complementary assessment, the measurements obtained during a maximum contraction test performed by a group of 15 subjects were also recorded. Four conditions were assessed: repeatability, time reproducibility, position reproducibility, and subject reproducibility. The results demonstrate that both the concurrent validity and the measured reliability (intraclass correlation coefficient > .98) of the Measurement System are acceptable. The Measurement System provides valid and reliable measures of trunk-flexor muscle strength.

Validity of an Inexpensive Hanging Scale During Isometric Shoulder Movements.

CONTEXT: Strength assessment is essential to prescribe exercise in sports and rehabilitation. Low-cost valid equipment may allow continuous monitoring of training. OBJECTIVE: To examine the validity of a very low-cost hanging scale by comparing differences in the measures of peak force to a laboratory grade load cell during shoulder abduction, flexion, extension, and internal and external rotations. DESIGN: Analytical study. PARTICIPANTS: Thirty-two healthy subjects (18 women, age 26 [10] y, height 172 [8] cm, mass 69 [13] kg, body mass index 23 [4] kg/m2). MAIN OUTCOME MEASURES: The dependent variable was the maximal peak force (in kilogram-force). The independent variable was the instrument (laboratory grade load cell and hanging scale). RESULTS: No differences were observed while comparing the results. The intraclass correlation coefficients1,1 ranged from .96 to .99, showing excellent results. The Cronbach alpha test also returned >.99 for all comparisons. The SEM ranged from 0.02 to 0.04 kgf, with an averaged SD from 0.24 to 0.38 kgf. The correlation was classified as high for all tested movements (r > .99; P < .001), with excellent adjusted coefficients of determination (.96 < r2 < .99). Bland-Altman results showed high levels of agreement with bias ranging from 0.27 to 0.48. CONCLUSIONS: Hanging scale provides valid measures of isometric strength with similar output measures as laboratory grade load cell.

Reliability and validity of a novel device for quantifying ankle dorsiflexion force in persons with multiple sclerosis.

BACKGROUND: With emerging treatment modalities and therapeutics for Multiple Sclerosis (MS), there is a critical need for improved measures of disability. Routine clinical practice and trials will benefit from devices that are capable of objectively quantifying muscle strength/weakness. We have developed a device for measuring Tibialis Anterior (TA) force that is both objective and easy to use - the Rapid Objective Quantification - TA (ROQ-TA). The purpose of this study was to determine the reliability and validity of the ROQ-TA versus Manual Muscle Testing and Isokinetic Dynamometry (IKD) for evaluating TA force in persons with MS (PwMS). METHODS: Ankle dorsiflexion of 20 PwMS was assessed by three modalities: ROQ-TA, MMT, and IKD over 2 testing sessions. ICC(2,1) values and Bland-Altman plots were used to assess reliability and validity of the ROQ-TA. RESULTS: The ICC(2,1) for reliability for the ROQ-TA was found to be 0.884 (0.690-0.957) while the IKD produced a similar ICC(2,1) of 0.919 (0.784-0.970). The mean difference between the two sessions for the ROQ-TA was -6.4 N with limits of agreement of 42.5 to -55.4 N as inferred by the Bland-Altman plots. With respect to validity, the ROQ-TA versus IKD yielded similar values for both sessions- the mean bias was 9.3 N (SE range: -3.4 to 22 N) for session 1 and 9.9 N for session 2 (SE range: -3.2 to 23.0 N). The ICC(2,1) values between the two devices were in moderate agreement - session 1: 0.579 (-0.125-0.843) and session 2: 0.490 (-0.363-0.809). CONCLUSION: The ROQ-TA is a valid and highly reliable device to test dorsiflexion force in PwMS.

Measurement properties of handheld dynamometry for assessment of shoulder muscle strength: A systematic review.

Like any assessment tool, handheld dynamometry (HHD) must be valid and reliable in order to be meaningful in clinical practice and research. To summarize the evidence of measurement properties of HHD for the assessment of shoulder muscle strength. Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, and PEDro were searched up to February 2020. Inclusion criteria were studies (a) evaluating HHD used on the glenohumeral joint, (b) evaluating measurement properties, and (c) included individuals ≥ 18 years old with or without shoulder symptoms. Exclusion criteria were studies (a) including patients with neurologic, neuromuscular, systemic diseases, or critical illness or bed-side patients and (b) that did not report the results separately for each movement. In total, 28 studies with 963 participants were included. The reliability results showed that 98% of the intraclass correlation coefficient (ICC) values were ≥0.70. The measurement error showed that the minimal detectable change in percent varied from 0% to 51.0%. The quality of evidence was high or moderate for the majority of movements and type of reliability examined. Based on the evidence of low or very low quality of evidence, the convergent validity and discriminative validity of HHD were either sufficient, indeterminate, or insufficient. The reliability of HHD was overall sufficient, and HHD can be used to distinguish between individuals on the group level. The measurement error was not sufficient, and evaluation of treatment effect on the individual level should be interpreted with caution.

Multiple-Joint Isokinetic Dynamometry: A Critical Review.

Dvir, Z and Müller, S. Multiple-joint isokinetic dynamometry: a critical review. J Strength Cond Res 34(2): 587-601, 2020-Angular isokinetic dynamometry (AID) is widely regarded as the gold standard for dynamic muscle performance testing. Based on the rotational movement of its actuator, AID targets "single-joint" (knee, shoulder, hip, etc.) configurations namely measurement of muscle potential while it moves the lever arm-limb assembly ostensibly around a single fixed axis. On the other hand, the application of multiple-joint isokinetic dynamometry (MID) is relatively narrow, both in research and in practice. This situation is due, possibly, to the fact that these dynamometers are generally more limited in scope namely to testing/conditioning of combined hip, knee, ankle motion (leg press), combined shoulder, elbow motion, and lifting motion patterns, despite the fact that all 3 are associated with higher functionality. However, with the emerging importance of MID, this critical review takes a fresh look at its various aspects including the terminology and classification of multiple-joint isokinetic dynamometers; the problem of scaling namely the need to adjust the range of motion and linear velocities to subjective anthropometric measures; specific technical and methodological issues that underlie the valid application of these dynamometers; available reference values; and the reproducibility of MID-based test findings. Analysis of these topics indicates that MID may validly and effectively be applied for the assessment and conditioning of specific muscle action patterns. However, there is a clear need for standardization of tests and for conditioning protocols alongside research into the use of this method in various clinical cohorts.

Defining sarcopenia: some caveats and challenges.

PURPOSE OF REVIEW: To summarize the latest advances and caveats in defining sarcopenia and discuss the implications of the most recent worldwide initiatives which are trying to harmonize the definition. RECENT FINDINGS: The evolution over time of the definitions of sarcopenia is discussed, with a focus on the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) definition and the Sarcopenia Definitions and Outcomes Consortium (SDOC) conference. The EWGSOP2 and the SDOC agree on the overall concept of sarcopenia, which involves both impaired function (low muscle strength) and structural damage (low muscle mass/quality). However, physical performance is considered as a diagnostic criterion (EWGSOP), a severity grading assessment (EWGSOP2) or an outcome (SDOC) pending on the definition used. Muscle strength has been recognized as the best predictor of health outcomes. Muscle mass alone, as part of the definition of cachexia, sarcopenia and malnutrition, is a nondefining parameter. Furthermore, there is a lack of precision in measurement techniques and variability of the cut-off points in defining it. SUMMARY: We discuss the relationship of sarcopenia with cachexia, malnutrition and frailty, and the areas that are hampering agreement. We summarize key scientific evidence, consider future study of this nutrition-related disease and raise concern about the need for a universal definition of sarcopenia.

Reliability and Diagnostic Accuracy of a New Vaginal Dynamometer to Measure Pelvic Floor Muscle Strength.

AIMS: Assess the intrarater and interrater reliabilities and diagnostic accuracy of a new vaginal dynamometer to measure pelvic floor muscle (PFM) strength in incontinent and continent women. METHODS: A test-retest reliability study including 152 female patients. EXCLUSION CRITERIA: history of urge urinary incontinence, prolapse of pelvic organ, pregnancy, previous urogynecological surgery, severe vaginal atrophy, or neurological conditions. The examination comprised digital assessment using the modified Oxford scale (MOS) and dynamometry measurements with a new prototype hand-held dynamometer. The MOS score ranges from 0 to 5: 0, no contraction; 1, flicker; 2, weak; 3, moderate; 4, good; 5, strong. Examinations were performed by a physiatrist, a physiotherapist and a midwife. The rest period between each rater measurement was 5 minutes. Assessment of intrarater and interrater reliability was calculated with the intraclass correlation coefficient. RESULTS: One hundred twenty-two incontinent women and 30 continent women were included. Scores between 0 and 2 in MOS were recorded in 72% of incontinent women versus 20% in continent patients (P < 0.001). Intrarater reliability of the dynamometer was 0.942 (95% confidence interval [CI], 0.920-0.958) and the interrater reliability was 0.937 (95% CI, 0.913-0.954). The analysis of variance analysis showed significant differences in PFM strength across digital assessment categories. The post-hoc analysis showed statistical differences between adjacent categories of MOS 1-2 and 2-3. The diagnostic accuracy showed an area under the curve of 0.82 (95% C,: 0.75-0.89), 0.87 (95% CI, 0.81-0.92), and 0.83 (95% CI, 0.77-0.90) for the physiatrist, midwife, and physiotherapist, respectively. CONCLUSIONS: The results obtained show a good reliability and validity of this new vaginal dynamometer to quantify PFM strength.

Development of a Standard Set of Outcome Domains and Proposed Measures for Chronic Obstructive Pulmonary Disease in Primary Care Physical Therapy Practice in the Netherlands: a Modified RAND/UCLA Appropriateness Method.

Background: Standardization of measures in a common set opens the opportunity to learn from differences in treatment outcomes which can be used for improving the quality of care. Furthermore, a standard set can provide the basis for development of quality indicators and is therefore useful for quality improvement and public reporting purposes. The aim of this study was to develop a standard set of outcome domains and proposed measures for patients with COPD in Dutch primary care physical therapy practice, including a proposal to stratify patients in subgroups. Material and methods: A consensus-driven modified RAND-UCLA appropriateness method was conducted with relevant stakeholders (patients, physical therapists, researchers, policy makers and health insurers) in Dutch primary physical therapy care in eight steps: (1) literature search, (2) first online survey, (3) patient interviews, (4) expert meeting, resulting in a concept standard set and methods to identify subgroups' (5) consensus meeting, (6) expert meeting (7) second online survey and (8) final approval of an advisory board resulting of the approved standard set. Results: Five outcome domains were selected for COPD: physical capacity, muscle strength, physical activity, dyspnea and quality of life. A total of 21 measures were rated and discussed. Finally, eight measures were included, of which four mandatory measures: Characteristics of practices and physical therapists, Clinical COPD Questionnaire (CCQ) for quality of life, Global Perceived Effect (GPE) for experience, 6-mins Walk Test (6-MWT) for physical capacity; two conditional measures: Hand-Held Dynamometer (HHD) (with Microfet™) for Quadriceps strength, Medical Research Council Dyspnea (MRC) for monitoring dyspnea; and two exploratory measures: Accelerometry for physical activity, and the Assessment of Burden of COPD tool (ABC). To identify subgroups, a method described in the Dutch standard of care from the Lung Alliance was included. Conclusion: This study described the development of a standard set of outcome domains and proposed measures for patients with COPD in primary care physical therapy. Each measure was accepted for relevance and feasibility by the involved stakeholders. The set is currently used in daily practice and tested on validity and reliability in a pilot for the development of quality indicators.

Internal consistency and validity of the Jebsen-Taylor hand function test in an Italian population with hemiparesis.

PURPOSE: The aim of this study was to evaluate the internal consistency and validity of the Italian version of the Jebsen- Taylor Hand Function Test (JTHFT-IT) in Italian post-stroke adults with chronic hemiplegia or hemiparesis. METHODS: The test's internal consistency and validity were assessed by following international guidelines. Its internal consistency was examined using Cronbach's alpha (α) coefficient. Pearson's correlation coefficient was calculated for concurrent validity in comparison with a dynamometer instrument, whereas for construct validity, it was calculated in comparison with the mean execution time of the Wolf Motor Function Test time subscale (WMFT-IT-TIME). RESULTS: The test was administrated to 48 people with chronic stroke. Cronbach's alpha reported a value of 0.96 for the dominant hand and 0.92 for the non-dominant hand. To define the validity of the scale, Pearson's correlation as measured using the WMFT-IT-TIME, and the dynamometer showed statistically significant results. CONCLUSIONS: The present study supports the use of the JTHFT-IT as a measure of hand functionality in post-stroke adults with chronic hemiplegia or hemiparesis. It is an important tool for Italian professionals, and it can be useful both in clinical practice to evaluate improvement after rehabilitation treatments and for research in hand rehabilitation.