Validation of manual muscle testing and a subset of eight muscles for adult and juvenile idiopathic inflammatory myopathies |
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| Authors: | Lisa G. Rider Deloris Koziol Edward H. Giannini Minal S. Jain Michaele R. Smith Kristi Whitney‐Mahoney Brian M. Feldman Susan J. Wright Carol B. Lindsley Lauren M. Pachman Maria L. Villalba Daniel J. Lovell Suzanne L. Bowyer Paul H. Plotz Frederick W. Miller Jeanne E. Hicks |
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| Affiliation: | 1. Environmental Autoimmunity Group, Office of Clinical Research, National Institute of Environmental Health Sciences, NIH, Department of Health and Human Services, Bethesda, Maryland;2. Clinical Center, NIH, Department of Health and Human Services, Bethesda, Maryland;3. Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio;4. The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada;5. University of Kansas Medical Center and University of Kansas, Kansas City;6. Children's Memorial Hospital and Northwestern University, Chicago, Illinois;7. National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Department of Health and Human Services, Bethesda, Maryland;8. Indiana University School of Medicine, Indianapolis |
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| Abstract: | Objective To validate manual muscle testing (MMT) for strength assessment in juvenile and adult dermatomyositis (DM) and polymyositis (PM). Methods Patients with PM/DM (73 children and 45 adults) were assessed at baseline and reevaluated 6–9 months later. We compared Total MMT (a group of 24 proximal, distal, and axial muscles) and Proximal MMT (7 proximal muscle groups) tested bilaterally on a 0–10 scale with 144 subsets of 6 and 96 subsets of 8 muscle groups tested unilaterally. Expert consensus was used to rank the best abbreviated MMT subsets for face validity and ease of assessment. Results The Total, Proximal, and best MMT subsets had excellent internal reliability (Total MMT rs = 0.91–0.98), and consistency (Cronbach's α = 0.78–0.97). Inter‐ and intrarater reliability were acceptable (Kendall's W 0.68–0.76, rs = 0.84–0.95). MMT subset scores correlated highly with Total and Proximal MMT scores and with the Childhood Myositis Assessment Scale, and correlated moderately with physician global activity, functional disability, magnetic resonance imaging, and axial and distal MMT scores, and, in adults, with creatine kinase level. The standardized response mean for Total MMT was 0.56 in juveniles and 0.75 in adults. Consensus was reached to use a subset of 8 muscles (neck flexors, deltoids, biceps, wrist extensors, gluteus maximus and medius, quadriceps, and ankle dorsiflexors) that performed as well as the Total and Proximal MMT, and had good face validity and ease of assessment. Conclusion These findings aid in standardizing the use of MMT for assessing strength as an outcome measure for myositis. |
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