Ashworth Scales are unreliable for the assessment of muscle spasticity Impact of an exercise program on physical, emotional, and social aspects of quality of life of individuals with Parkinson's disease. Effect of exercise on perceived quality of life of individuals with Parkinson's disease. The limited value of the Health Assessment Questionnaire as an outcome measure in short term exercise trials. Development and validation of a muscular dystrophy-specific functional rating scale Long–term exercise improves functional
impairment but not quality of life
in multiple sclerosis The effect of brochure use versus therapist teaching on patients performing therapeutic exercise and on changes in impairment status. The unreliability of clinical measures of muscle tone: implications for stroke therapy. Intrarater reliability of manual muscle test (Medical Research Council scale) grades in Duchenne's muscular dystrophy. Facioscapulohumeral dystrophy natural history study: standardization of testing procedures and reliability of measurements. The FSH DY Group. Muscle strength and physical performance as predictors of mortality, hospitalization, and disability in the oldest old. Clinimetric Properties of the Motor Activity Log for the Assessment of Arm Use in Hemiparetic Patients Lean body mass, physical activity and quality of life in paediatric patients with inflammatory bowel disease and in healthy controls. Reliability of the PEDro scale for rating quality of randomized controlled trials. Motor Activity Assessment Scale: a valid and reliable sedation scale for use with mechanically ventilated patients in an adult surgical intensive care unit. Measurement of Shoulder Activity Level The use of muscle strength assessed with handheld dynamometers as a non-invasive biological marker in myotonic dystrophy type 1 patients: a multicenter study
Ashworth  Scales  are the most widely used tests to assess the severity of muscle spasticity . These scales offer qualitative and subjective information ; consequently , there are issues concerning validity and reliability . This article presents the results of a study comparing interrater reliability of the original and of the modified Ashworth Scales for measuring muscle spasticity in elbow flexors . Fifteen patients with hemiplegia ( nine men and six women ) with a median age of 52 years ( interquartile range , 28–64 ) participated in this study . Two physiotherapists rated the muscle tone of elbow flexors according to ratings criteria of the  Ashworth and the  modified Ashworth Scales . Kappa values for the original Ashworth  and the modified Ashworth Scales were 0.17 ( SE = 0.21 ; p = 0.41 ) and 0.21 ( SE = 0.12 ; p = 0.08 ) , respectively . The scales showed similar levels of reliability ( χ2 = 0.0285 , df = 1 , p = 0.7 ) . The Ashworth Scales  are not reliable for the assessment of muscle spasticity . In the absence of interrater reliability , the validity of the measurements may also be question ed We evaluated changes in different domains of quality of life ( QL ) for persons with Parkinson 's disease after a program of physical activity . Twenty subjects with a diagnosis of Parkinson 's disease classified as Stages 1 to 3 on the Hoehn and Yahr scale and with a mean age of 61.5 + /- 9.8 years participated in 36 group sessions of a combined group program of aerobic conditioning and muscular strengthening .  QL was investigated by the Nottingham Health Profile , a generic question naire composed of six domains . Student 's paired t tests indicated significant gains associated with the program ( P < 0.05 ) on the total score and those related to emotional reactions ( ER ) , social interactions ( SI ) , and physical ability ( PA ) . SI was the domain that showed the greatest program gains ( 41.4 % ) . The program of physical activity performed with persons with Parkinson 's disease at light to moderate stages result ed in improvements in their perception of QL , mainly in the domains of ER , SI , and PA The purpose of this study was to determine if individuals with Parkinson 's disease ( PD ) who completed an 8-week , supervised PoleStriding exercise program  would undergo significant improvements in cognitive skills , activities of daily living , motor function , and quality of life . The Unified Parkinson 's Disease Rating Scale ( UPDRS ) and the Parkinson 's Disease Question naire ( PDQ-39 ) were used to measure functional independence .  Six male volunteers ( 72.7+/-3.7 years of age ) performed PoleStriding exercise three times per week for 37+/-3 minutes . Differences in the participants ' pre- and post-training scores on the UPDRS and PDQ-39 were analyzed using the Wilcoxin Signed Ranks Test . A statistically significant improvement occurred in the UPDRS ( P<0.026 ) and PDQ-39 ( P<0.028 ) scores following the moderate-intensity exercise intervention . The results of this nonr and omized clinical trial indicate that an 8-week individualized PoleStriding exercise program increases perceived functional independence and quality of life in individuals with PD OBJECTIVE To examine the value of the  Health Assessment Question naire ( HAQ ) as an outcome measure in short term exercise trials . We studied the association of the objectives of exercise , namely joint mobility , muscle strength , and physical condition , with the HAQ . METHODS Data for 100 patients with rheumatoid arthritis ( RA ) included in a study to examine the effect of exercise therapy were used for secondary analysis . Disease activity was determined by the disease activity score ( DAS3 ) , pain was scored on a visual analog scale ( VAS ) , and depression was measured by the Dutch Arthritis Impact Measurement Scale . Aerobic capacity ( VO2max ) estimated from a submaximal ergometer test , grip strength ( kPa ) ,  isokinetic muscle strength of the knee  ( Nm/kg ) , and the  Escola Paulista de Medicina range of motion ( EPM-ROM ) score , a measure of general flexibility , were used as indicators for physical impairments . All variables were entered in a forward multiple regression analysis with the HAQ as dependent variable . RESULTS The HAQ was significantly correlated with the DAS3 score ( r = 0.53 ) , pain ( r = 0.51 ) , depression ( r = 0.40 ) , joint mobility ( r = 0.27 ) , quadriceps strength ( r = -0.35 ) , and grip strength ( r = -0.50 ) , but not with physical condition . The DAS3 score was first entered in the multiple regression analysis model , followed by pain , quadriceps strength , and grip strength ( R2 = 0.45 ) . After 12 weeks of exercise therapy changes in the HAQ were significantly correlated with changes in pain ( r = 0.41 ) , in depression ( r = 0.33 ) , and in quadriceps strength ( r = -0.25 ) , but not with changes in joint mobility or physical condition . CONCLUSION Physical impairments are weakly associated with the HAQ .  The HAQ is not an appropriate instrument to detect changes in physical impairments due to short term exercise therapy Objective : To develop a reliable and valid new rating scale for measuring the functional impact of muscular dystrophy . Design : Prospect i ve and longitudinal investigation . Setting : Three academic medical centres in Taiwan and the Muscular Dystrophy Association of Taiwan . Measures : The Brooke Scale , the Vignos Scale , the Barthel Index , muscular strength , contracture severity , and predicted forced vital capacity ( FVC% ) . Methods : Scale development was in three stages . In stage I , a preliminary pool of 53 items was generated from patient interviews ( n-/25 ) , literature review , existing functional rating scales and expert opinion . In stage II , these items were administered to 85 patients with muscular dystrophy . The result ing data were analysed to construct a rating scale ( the Muscular Dystrophy Functional Rating Scale , MDFRS ) that encompassed four unidimensional constructs : mobility , basic activities of daily living , arm function and impairment . In stage III , the measurement properties of this rating scale were assessed in 121 muscular dystrophy patients different from those examined with the preliminary instrument . Results : Internal consistency reliability was excellent for all domains of the final 33-item scale , with values of Cronbach ’s alpha ranging from 0.84 to 0.97 . Intraclass correlation coefficients for test-retest and inter-rater reliability were 0.99 for all domains of the MDFRS . The MDFRS showed moderate to high correlations with a range of functional rating scales measuring similar aspects and impairment parameters ( Spearman ’s rho=0.65 - 0.91 ; P<0.001 , each ) . Confirmatory factor analysis supported a unitary construct of the four-dimensional MDFRS . The MDFRS had small floor and ceiling effects in the study sample s. Sensitivity to change was confirmed by large st and ardized response means for the MDFRS total score . Conclusions : The MDFRS is a reliable and valid disease-specific measure of functional status for patients with muscular dystrophy Abstract Regular exercise is important for patients with multiple sclerosis ( MS ) to maintain their functional ability and general health . The aim of this study was to determine whether a long – term exercise program has any effect on functional impairment or healthrelated quality of life ( HRQOL ) in subjects with mild to moderate MS . In a r and omised controlled trial , subjects in the intervention group ( n = 47 )  exercised according to a progressive exercise program , mainly consisting of resistance training , for six months . Subjects in the control group ( n = 48 ) received no intervention . The subjects were assessed at baseline and at six months using the Multiple Sclerosis Functional Composite ( MSFC ) , the Exp and ed Disability Status Scale ( EDSS ) , the Functional Independence Measure ( FIM ) , the MS Quality of Life–54 ( MSQOL–54 ) question naire and the Centre for Epidemiologic Studies Depression Scale ( CES – D ) . The drop – out rate was low ( 4 % ) with 91 subjects completing the study . At six months , the exercising subjects showed improvement on the MSFC ( mean score change 0.114 , 95 % confidence interval [ CI ] 0.010 to 0.218 ) , whereas the control subjects showed deterioration ( mean score change –0.128 , 95 % CI –0.232 to –0.025 ) . The change between groups was statistically significant ( interaction , p = 0.001 ) . Consistent with the physical nature of the intervention , the change predominantly occurred in leg function/ambulation . The effect seen in the EDSS , FIM , MSQOL–54 or CES – D was nil . These findings indicate that MSFC is more sensitive than EDSS in the detection of improvement in functional impairment as a result of regular exercise . The unfavourable results from HRQOL do not rule out the possibility that other types of exercise programs may improve it in MS BACKGROUND AND PURPOSE The purpose of this study was to investigate whether the mode of teaching exercises ( use of brochures versus therapist teaching ) affects whether patients correctly perform the exercises and whether it affects changes in impairment . SUBJECTS Eighty-seven patients ( 33 women , 54 men ) with neck pain and low back pain were examined . The average age was 48 years ( SD = 12.7 , range = 21 - 67 ) . METHODS Two groups of patients were analyzed . The supervised ( physical therapist-instructed ) group ( n = 47 ) exercised under the supervision of a physical therapist , whereas the brochure group ( n = 40 ) received their instructions only from one of three brochures . A rating scale was used to assess the correctness of exercise performance . Muscle status was registered using a st and ardized procedure for determination of muscle force and length . Pain severity was determined by means of a visual analogue scale . RESULTS On the rating scale evaluating the correctness of exercise performance at follow-up , the patients in the supervised group performed better than the patients in the brochure group . In addition , there was a strong correlation between the quality of exercise performance and decrease in pain . CONCLUSION AND DISCUSSION Exercises learned only from a brochure without being monitored by a physical therapist were done properly by only about half of the patients and appeared to result in fewer improvements in impairments BACKGROUND the central tenet of the neurofacilitatory approach to stroke therapy is that muscle tone needs to be normal before normal movement can occur . A reliable clinical measure of the full spectrum of muscle tone is needed to test : ( i ) the purported relationship between muscle tone , other motor impairments and disability , and ( ii ) the effectiveness of stroke therapy to restore movement . AIM the purpose of the study was to test the inter-rater reliability of clinical categorization of muscle tone ( spastic/normal/flaccid ) and also a visual analogue scale with anchor points of ' lowest tone possible ' ( score 0 ) and ' highest tone possible ' ( score 100 ) . METHODS four independent raters assessed  tone  of  elbow flexors and knee extensors of 14 stroke rehabilitation in patients using the categorical scale . Six independent raters assessed tone of elbow flexors and knee extensors of 25 chronic stroke patients and two healthy volunteers using the visual analogue scale . All assessment orders were r and omized . RESULTS both scales were unreliable , with K coefficients for the categorical scale ranging from -0.046 to 0.56 for the categorical scale , and intra-class correlation coefficients for the visual analogue scale of 0.595 for elbow flexors and 0.451 for knee extensors . Assessment order effects for the visual analogue scale were non-significant for elbow flexors ( P= 0.545 ) and knee extensors ( P= 0.911 ) . CONCLUSIONS these results , and those of earlier studies , suggest that clinical measures of muscle tone are consistently unreliable . Systematic investigation of the therapy rationale for planning and evaluating treatment is required before relevant clinical measures can be developed The purpose of this study was to document the intrarater reliability of manual muscle test ( MMT ) grade s in assessing muscle strength in patients with Duchenne 's muscular dystrophy ( DMD ) . Subjects were 102 boys , aged 5 to 15 years , who were participating in a double-blind , multicenter trial to document the effects of prednisone on muscle strength in patients with DMD . Four physical therapists participated in the study . Two identical ( duplicate ) evaluations were performed within 5 days of each other by the same examiner initially and after 6 and 12 months of treatment . A total of 18 muscle groups were tested on each patient , 16 of them bilaterally , using a modification of the Medical Research Council scale . Reliability of muscle strength grade s obtained for individual muscle groups and of individual muscle strength grade s was analyzed using Cohen 's weighted Kappa . The reliability of grade s for individual muscle groups ranged from .65 to .93 , with the proximal muscles having the higher reliability values . The reliability of individual muscle strength grade s ranged from .80 to .99 , with those in the gravity-eliminated range scoring the highest . We conclude the MMT grade s are reliable for assessing muscle strength in boys with DMD when consecutive evaluations are performed by the same physical therapist BACKGROUND AND PURPOSE The natural history of facioscapulohumeral muscular dystrophy ( FSHD ) has not been studied prospect ively . Knowledge of the natural progression of any disease provides essential information for the design of clinical trials . We present a protocol for the study of the natural history of FSHD using quantitative muscle testing ( QMT ) , manual muscle testing ( MMT ) , and functional testing . SUBJECTS Thirty-two persons with FSHD ( mean age = 36.1 years , SD = 9.6 , range = 17 - 49 ) and 32 age- and gender-matched volunteer controls ( mean age = 35.8 years , SD = 8.0 , range = 23 - 50 ) served as subjects . METHODS Using st and ardized testing procedures , we examined intrarater reliability of the  MMT , QMT  , and  functional testing  measurements in both groups . We also examined interrater reliability in 7 subjects with FSHD . Eighteen muscle groups were tested for each subject using QMT and MMT . RESULTS Intraclass correlation coefficient ( ICC ) values ranged from .86 to .99 for intrarater reliability and from .86 to .99 for interrater reliability of QMT measurements . Weighted kappa values of .81 to .98 for intrarater reliability and .50 to 1.00 for interrater reliability were obtained for MMT measurements . Intrarater ICCs for various functional testing measures ranged from .60 to .97 . In addition , the comparability of the two QMT machines used in the study was demonstrated by testing the same set of volunteer controls on each machine 's linear force transducer ( ICC = .89-.98 ) . CONCLUSION AND DISCUSSION We conclude that this st and ardized testing protocol produces reliable measurements of muscle strength and functional ability in subjects with FSHD OBJECTIVES To evaluate the predictive value of muscle strength and physical performance in the oldest old for all-cause mortality ; hospitalization ; and the onset of disability , defined as a decline in activities of daily living ( ADLs ) , independent of muscle mass , inflammatory markers , and comorbidities . DESIGN A prospect i ve , observational , population -based follow-up study . SETTING Three well-circumscribed areas of Belgium . PARTICIPANTS Five hundred sixty participants aged 80 and older were followed for 33.5 months ( interquartile range 31.1 - 35.6 months ) . MEASUREMENTS  Grip strength , Short Physical Performance Battery ( SPPB ) score , and muscle mass  were measured at baseline ; ADLs at baseline and after 20 months ; and all-cause mortality and time to first hospitalization from inclusion onward . Kaplan-Meier curves and Cox proportional hazards models were calculated for all-cause mortality and hospitalization . Logistic regression analysis was used to determine predictors of decline in ADLs . RESULTS Kaplan-Meier curves showed significantly higher all-cause mortality and hospitalization in subjects in the lowest tertile of grip strength and SPPB score . The adjusted Cox proportional hazards model showed that participants with high grip strength or a high SPPB score had a lower risk of mortality and hospitalization , independent of muscle mass , inflammatory markers , and comorbidity . A relationship was found between SPPB score and decline in ADLs , independent of muscle mass , inflammation , and comorbidity . CONCLUSION In people aged 80 and older , physical performance is a strong predictor of mortality , hospitalization , and disability , and muscle strength is a strong predictor of mortality and hospitalization . All of these relationships were independent of muscle mass , inflammatory markers , and comorbidity Background and Purpose — The Motor Activity Log ( MAL ) is a semistructured interview for hemiparetic stroke patients to assess the use of their paretic arm and h and ( amount of use [ AOU ] ) and quality of movement [ QOM ] ) during activities of daily living . Scores range from 0 to 5 . The following clinimetric properties of the MAL were quantified : internal consistency ( Cronbach α ) , test – retest agreement ( Bl and and Altman method ) , cross-sectional construct validity ( correlation between AOU and QOM and with the Action Research Arm [ ARA ] test ) , longitudinal construct validity ( correlation of change on the MAL during the intervention with a global change rating [ GCR ] and with change on the ARA ) , and responsiveness ( effect size ) . Methods — Two baseline measurements 2 weeks apart and 1 follow-up measurement immediately after 2 weeks of intensive exercise therapy either with or without immobilization of the unimpaired arm ( forced use ) were performed in 56 chronic stroke patients . Results — Internal consistency was high ( AOU : α=0.88 ; QOM : α=0.91 ) . The limits of agreement were −0.70 to 0.85 and −0.61 to 0.71 for AOU and QOM , respectively . The correlation with the ARA score ( Spearman ρ ) was 0.63 ( AOU and QOM ) . However , the improvement on the MAL during the intervention was only weakly related to the GCR and to the improvement on the ARA , Spearman ρ was between 0.16 and 0.22 . The responsiveness ratio was 1.9 ( AOU ) and 2.0 ( QOM ) . Conclusion — The MAL is internally consistent and relatively stable in chronic stroke patients not undergoing an intervention . The cross-sectional construct validity of the MAL is reasonable , but the results raise doubt about its longitudinal construct validity BACKGROUND AND AIMS Physical activity is important for muscle and bone strength in the growing child and may be impaired in paediatric patients with inflammatory bowel disease ( IBD ) even during quiescent disease . The SenseWearPro(2 ) armb and allows to measure physical activity under everyday life conditions . METHODS Thirty-nine IBD patients ( 27 Crohn 's disease , 12 ulcerative colitis , 24 boys ) in remission ( n=26 ) or with only mild disease activity ( n=13 ) were compared to 39 healthy age and sex-matched controls .  Body weight , height , body mass index ( BMI ) , lean body mass as phase angle α ( determined by bioelectrical impedance analysis ) , and dynamometric grip force were expressed as age- and sex-related Z-scores . SenseWearPro(2 ) armb and s were applied for three consecutive days to record number of steps , duration of physical activity and sleeping time . Quality of life was assessed with the German KINDL and IMPACT III question naires , energy intake with prospect i ve food protocol s. Differences between patients and pair-matched controls were analysed by paired t-test . RESULTS Patients showed lower Z-scores for phase angle α ( difference -0.72 ; 95 % CI [ -1.10 ; -0.34 ] ) and lower grip strength ( -1.02 [ -1.58 ; -0.47 ] ) than controls . They tended towards lesser number of steps per day ( -1339 [ -2760 ; 83 ] ) and shorter duration of physical activity ( -0.44 h [ -0.94 ; 0.06 ] ) , particularly in females and patients with mild disease . Quality of life and energy intake did not differ between patients and controls . CONCLUSION In spite of quiescent disease lean body mass and physical activity were reduced . Interventions to encourage physical activity may be beneficial in this lifelong disease BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . OBJECTIVE To establish the validity and reliability of a new sedation scale , the Motor Activity Assessment Scale ( MAAS ) . DESIGN Prospect i ve , psychometric evaluation . SETTING Sixteen-bed surgical intensive care unit ( SICU ) of a 937-bed tertiary care , university-affiliated teaching hospital . PATIENTS Twenty-five r and omly selected , adult , mechanically ventilated , nonneurosurgical patients who were admitted to the SICU > or = 12 hrs after surgery and were not receiving neuromuscular blockers . INTERVENTION Four hundred assessment  s ( eight per patient ) were completed consecutively but independently , in pairs , at st and ardized times ( both day and night ) by two nurses who were preselected for each assessment from a pool of 32 pretrained SICU nurses . MEASUREMENTS AND MAIN RESULTS To estimate validity , paired assessment s ( four/patient ) compared the MAAS result with the subjective assessment using a 10-cm visual analog sedation scale , the percent change in blood pressure and heart rate from the previous 4-hr baselines , and the number of recent agitation-related sequelae . To estimate reliability , paired assessment s ( four/patient ) measured correlation between assessment s of the same type ( e.g. , MAAS-MAAS ) . Generalized estimating equations , which accounted for the four repeated measures in each patient , supported MAAS validity by finding a linear trend between MAAS and the visual analog scale ( p < .001 ) , blood pressure ( p < .001 ) , heart rate ( p < .001 ) , and agitation-related sequelae ( p < .001 ) end points . The MAAS ( kappa = 0.83 [ 95 % confidence interval , 0.72 to 0.94 ] ) was found to be more reliable than subjective assessment using the visual analog scale ( intraclass correlation coefficient = 0.32 [ 95 % confidence interval , 0.05 to 0.55 ] ) . CONCLUSIONS The MAAS is a valid and reliable sedation scale for use with mechanically ventilated patients in the SICU . Further studies are warranted regarding the effect of MAAS implementation in our SICU on patient outcomes , such as quality of sedation and length of mechanical ventilation , as well as the use of the MAAS in other patient population s ( e.g. , medical ) There are many measurement tools for assessing patients ’ shoulder symptoms ( pain ) and function  ( what patients can do ) , but they do not measure activity ( how often a patient engages in activity ) . This is relevant because activity level can have an important impact on a patient ’s outcome . Our goal was to develop a short , easy to administer measure of shoulder activity which could be used to predict outcome of shoulder disorders . The activity scale was developed using established principles : item generation , item reduction , pretesting , and reliability and validity testing . The activity rating is a numerical sum of scores for five activities rated on a five-point frequency scale from never performed ( 0 points ) to daily ( 4 points ) . Patients were scored on the following criteria : carrying an object 8 lb or heavier  by h and , h and ling objects overhead ,  weight training with arms , swinging motion ( ie , hitting tennis or golf ball ) , and lifting objects 25 lb or heavier . Two additional multiple choice questions provide a score assessing participation in contact and overhead sports . The activity scale showed excellent reliability and construct validity . It can be completed quickly and used in conjunction with patient-based measures of shoulder outcome to define patient population s for cohort studies , and to assess activity level as a prognostic factor in patients with shoulder disorders . Level of Evidence : Prognostic study , Level I. See the Guidelines for Authors for a complete description of levels of evidence Background Myotonic dystrophy type 1 ( DM1 ) is a multisystem disorder that demonstrates variable symptoms and rates of progression . Muscle weakness is considered one of the main problems with a clinical picture that is characterized by distal weakness of the limbs progressing to proximal weakness . The main objective of this study was to characterize the maximal strength of ankle eversion and dorsiflexion in DM1 patients .  Manual and h and held dynamometer ( HHD ) muscle testing were also compared . Methods The maximal strength of 22 patients from Quebec ( mean age = 41,1 ± 13,8 ) and 24 from Lyon ( mean age = 41,6 ± 10,2 ) were compared to 16 matched controls . Results With the use of HHD , an excellent reproducibility of the torque measurements was obtained for both centers in eversion ( R2 = 0,94/Quebec ; 0,89/Lyon ) and dorsiflexion ( R2 = 0,96/Quebec ; 0,90/Lyon ) . The differences between 3 groups of DM1 ( mild , moderate , severe ) and between them and controls were all statistically significant ( p < 0,001 ) . No statistical differences between sites were observed ( p > 0.05 ) . The degree of muscle strength decline in dorsiflexion ( eversion ) were 60 % ( 47 % ) , 77 % ( 71 % ) , and 87 % ( 83 % ) for DM1 with mild , moderate , and severe impairments , respectively . The smallest mean difference between all DM1 patients taking together was 2.3 Nm , a difference about twice than the st and ard error of measurement . There was a strong relationship between eversion and dorsiflexion strength profiles ( R2 = 0,87;Quebec/0,80;Lyon ) . Using a 10-point scale , manual muscle testing could not discriminate between the 3 groups of DM1 patients . Conclusions The HHD protocol showed discriminative properties suitable for multicentre therapeutic trial . The present results confirmed the capacity of quantitative muscle testing to discriminate between healthy and DM1 patients with different levels of impairments . This study is a preliminary step for the implementation of a valid , reliable and responsive clinical outcome for the measurement of muscle impairments with this population
RESULTS We found that none of the 19 instruments have sufficiently comprehensive reporting of measurement or feasibility performance as would be required by regulatory authorities .
INTRODUCTION In an accompanying study we reported on the content of several activity rating scales that have been used for muscle disease .
To further aid in achieving consensus we conducted a systematic review to assess the quality of the 19 activity rating scales  design ed specifically for muscle disease .