Download PDF
Int J Sports Med 2015; 36(14): 1201-1205
DOI: 10.1055/s-0035-1555855
Clinical Sciences
© Georg Thieme Verlag KG Stuttgart · New York

Strength and Pain Threshold Handheld Dynamometry Test Reliability in Patellofemoral Pain

R. A. van der Heijden
1   General Practice, Erasmus MC University Medical Centre, Rotterdam, Netherlands
,
T. Vollebregt
1   General Practice, Erasmus MC University Medical Centre, Rotterdam, Netherlands
,
S. M. A. Bierma-Zeinstra
1   General Practice, Erasmus MC University Medical Centre, Rotterdam, Netherlands
,
M. van Middelkoop
1   General Practice, Erasmus MC University Medical Centre, Rotterdam, Netherlands
› Author Affiliations
Further Information

Publication History



accepted after revision 08 June 2015

Publication Date:
30 September 2015 (online)

Also available at
    Permissions and Reprints

Abstract

Patellofemoral pain syndrome (PFPS), characterized by peri- and retropatellar pain, is a common disorder in young, active people. The etiology is unclear; however, quadriceps strength seems to be a contributing factor, and sensitization might play a role. The study purpose is determining the inter-rater reliability of handheld dynamometry to test both quadriceps strength and pressure pain threshold (PPT), a measure for sensitization, in patients with PFPS. This cross-sectional case-control study comprises 3 quadriceps strength and one PPT measurements performed by 2 independent investigators in 22 PFPS patients and 16 matched controls. Inter-rater reliability was analyzed using intraclass correlation coefficients (ICC) and Bland-Altman plots. Inter-rater reliability of quadriceps strength testing was fair to good in PFPS patients (ICC=0.72) and controls (ICC=0.63). Bland-Altman plots showed an increased difference between assessors when average quadriceps strength values exceeded 250 N. Inter-rater reliability of PPT was excellent in patients (ICC=0.79) and fair to good in controls (ICC=0.52). Handheld dynamometry seems to be a reliable method to test both quadriceps strength and PPT in PFPS patients. Inter-rater reliability was higher in PFPS patients compared to control subjects. With regard to quadriceps testing, a higher variance between assessors occurs when quadriceps strength increases.

Key words

anterior knee pain - patellofemoral pain syndrome - patella - quadriceps muscle - pain measurement
 

  • References

  • 1 Arnold CM, Warkentin KD, Chilibeck PD, Magnus CR. The reliability and validity of handheld dynamometry for the measurement of lower-extremity muscle strength in older adults. J Strength Cond Res 2010; 24: 815-824
    CrossrefPubMedGoogle Scholar
  • 2 Baldwin CE, Paratz JD, Bersten AD. Muscle strength assessment in critically ill patients with handheld dynamometry: An investigation of reliability, minimal detectable change, and time to peak force generation. J Crit Care 2013; 28: 77-86
    CrossrefPubMedGoogle Scholar
  • 3 Boles CA, Ferguson C. The female athlete. Radiol Clin North Am 2010; 48: 1249-1266
    CrossrefPubMedGoogle Scholar
  • 4 Delaney GA, McKee AC. Inter- and intra-rater reliability of the pressure threshold meter in measurement of myofascial trigger point sensitivity. Am J Phys Med Rehabil 1993; 72: 136-139
    CrossrefPubMedGoogle Scholar
  • 5 Dixit S, DiFiori JP, Burton M, Mines B. Management of patellofemoral pain syndrome. Am Fam Physician 2007; 75: 194-202
    PubMedGoogle Scholar
  • 6 Fleiss J. The design and analysis of clinical experiments. New York, NY: J.W.S. Inc; 1986
    Google Scholar
  • 7 Geber C, Klein T, Azad S, Birklein F, Gierthmuhlen J, Huge V, Lauchart M, Nitzsche D, Stengel M, Valet M, Baron R, Maier C, Tolle T, Treede RD. Test-retest and interobserver reliability of quantitative sensory testing according to the protocol of the German Research Network on Neuropathic Pain (DFNS): a multi-center study. Pain 2011; 152: 548-556
    CrossrefPubMedGoogle Scholar
  • 8 Harriss DJ, Atkinson G. Ethical standards in sport and exercise science research: 2014 update. Int J Sports Med 2013; 34: 1025-1028
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Jensen R, Hystad T, Kvale A, Baerheim A. Quantitative sensory testing of patients with long lasting Patellofemoral pain syndrome. Eur J Pain 2007; 11: 665-676
    CrossrefPubMedGoogle Scholar
  • 10 Jensen R, Kvale A, Baerheim A. Is pain in patellofemoral pain syndrome neuropathic?. Clin J Pain 2008; 24: 384-394
    CrossrefPubMedGoogle Scholar
  • 11 Kannus P, Natri A, Paakkala T, Jarvinen M. An outcome study of chronic patellofemoral pain syndrome. Seven-year follow-up of patients in a randomized, controlled trial. J Bone Joint Surg Am 1999; 81: 355-363
    CrossrefPubMedGoogle Scholar
  • 12 Kwoh CK, Petrick MA, Munin MC. Inter-rater reliability for function and strength measurements in the acute care hospital after elective hip and knee arthroplasty. Arthritis Care Res 1997; 10: 128-134
    CrossrefPubMedGoogle Scholar
  • 13 Lankhorst NE, Bierma-Zeinstra SM, van Middelkoop M. Factors associated with patellofemoral pain syndrome: a systematic review. Br J Sports Med. 2012
    PubMedGoogle Scholar
  • 14 Lankhorst NE, Bierma-Zeinstra SM, van Middelkoop M. Risk factors for patellofemoral pain syndrome: a systematic review. J Orthop Sports Phys Ther 2012; 42: 81-94
    CrossrefPubMedGoogle Scholar
  • 15 Martin HJ, Yule V, Syddall HE, Dennison EM, Cooper C, Aihie Sayer A. Is hand-held dynamometry useful for the measurement of quadriceps strength in older people? A comparison with the gold standard Bodex dynamometry. Gerontology 2006; 52: 154-159
    CrossrefPubMedGoogle Scholar
  • 16 Nussbaum EL, Downes L. Reliability of clinical pressure-pain algometric measurements obtained on consecutive days. Phys Ther 1998; 78: 160-169
    PubMedGoogle Scholar
  • 17 Post WR. Clinical evaluation of patients with patellofemoral disorders. Arthroscopy 1999; 15: 841-851
    CrossrefPubMedGoogle Scholar
  • 18 Powers CM, Bolgla LA, Callaghan MJ, Collins N, Sheehan FT. Patellofemoral pain: proximal, distal, and local factors, 2nd International Research Retreat. T J Orthop Sports Phys Ther 2012; 42: A1-A54
    PubMedGoogle Scholar
  • 19 Rathleff MS, Roos EM, Olesen JL, Rasmussen S, Arendt-Nielsen L. Lower mechanical pressure pain thresholds in female adolescents with patellofemoral pain syndrome. J Orthop Sports Phys Ther 2013; 43: 414-421
    CrossrefPubMedGoogle Scholar
  • 20 Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull 1979; 86: 420-428
    CrossrefPubMedGoogle Scholar
  • 21 Stone CA, Nolan B, Lawlor PG, Kenny RA. Hand-held dynamometry: tester strength is paramount, even in frail populations. J Rehabil Med 2011; 43: 808-811
    CrossrefPubMedGoogle Scholar
  • 22 Taunton JE, Ryan MB, Clement DB, McKenzie DC, Lloyd-Smith DR, Zumbo BD. A retrospective case-control analysis of 2002 running injuries. Br J Sports Med 2002; 36: 95-101
    CrossrefPubMedGoogle Scholar
  • 23 Thomee R, Augustsson J, Karlsson J. Patellofemoral pain syndrome: a review of current issues. Sports Med 1999; 28: 245-262
    CrossrefPubMedGoogle Scholar
  • 24 Thorborg K, Petersen J, Magnusson SP, Holmich P. Clinical assessment of hip strength using a hand-held dynamometer is reliable. Scand J Med Sci Sports 2010; 20: 493-501
    PubMedGoogle Scholar
  • 25 van Wilgen CP, Keizer D. Neuropathic pain mechanisms in patients with chronic sports injuries: a diagnostic model useful in sports medicine?. Pain Med 2011; 12: 110-117
    CrossrefPubMedGoogle Scholar
  • 26 van Wilgen P, van der Noord R, Zwerver J. Feasibility and reliability of pain pressure threshold measurements in patellar tendinopathy. J Sci Med Sport 2011; 14: 477-481
    CrossrefPubMedGoogle Scholar
  • 27 Vanpee G, Segers J, Van Mechelen H, Wouters P, Van den Berghe G, Hermans G, Gosselink R. The interobserver agreement of handheld dynamometry for muscle strength assessment in critically ill patients. Crit Care Med 2011; 39: 1929-1934
    CrossrefPubMedGoogle Scholar
  • 28 Walton DM, Macdermid JC, Nielson W, Teasell RW, Chiasson M, Brown L. Reliability, standard error, and minimum detectable change of clinical pressure pain threshold testing in people with and without acute neck pain. J Orthop Sports Phys Ther 2011; 41: 644-650
    CrossrefPubMedGoogle Scholar
  • 29 Whiteley R, Jacobsen P, Prior S, Skazalski C, Otten R, Johnson A. Correlation of isokinetic and novel hand-held dynamometry measures of knee flexion and extension strength testing. J Sci Med Sport 2012; 15: 444-450
    CrossrefPubMedGoogle Scholar
  • 30 Witvrouw E, Danneels L, Van Tiggelen D, Willems TM, Cambier D. Open versus closed kinetic chain exercises in patellofemoral pain: a 5-year prospective randomized study. Am J Sports Med 2004; 32: 1122-1130
    CrossrefPubMedGoogle Scholar