Reliabilität der Messung der isometrischen maximalen willkürlichen Kontraktion der Rumpfmuskulatur bei Probanden

P. Bak; C. Anders; B. Bocker; U. C. Smolenski

doi:10.1055/s-2003-37669

Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin, Table of Contents

Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin 2003; 13(1): 28-34
DOI: 10.1055/s-2003-37669

Wissenschaft und Forschung

Reliabilität der Messung der isometrischen maximalen willkürlichen Kontraktion der Rumpfmuskulatur bei Probanden

Reliability of the Measurement of Isometric Maximal Voluntary Contraction of Trunk Muscles in Healthy SubjectsP. Bak¹ , C. Anders² , B. Bocker¹ , U. C. Smolenski¹

¹Institut für Physiotherapie, FSU Jena (komm. Direktor: Prof. Dr. med. U. Smolenski)
²Institut für Pathophysiologie, FSU Jena AG Motorik (Leiter: Prof. Dr. med. H.-Chr. Scholle)

Abstract

Zusammenfassung

Hintergrund: Kraftentfaltung ist einer der wichtigsten Messparameter bei der Beurteilung der Leistungsfähigkeit der Rumpfmuskulatur. Es gibt jedoch in der Literatur widersprüchliche Angaben zur Reliabilität der Messung der maximalen willkürlichen Kontraktion (MVC) entsprechender Muskelgruppen. Zum einen sind die Messprotokolle sehr unterschiedlich, zum anderen gibt es Differenzen in der Auswertung der Ergebnisse. Ziel dieser Arbeit war es, die Intra- und Intersessionreliabilität der MVC-Messung bei Probanden zu bestimmen. Methoden: 34 klinisch gesunde Personen im Alter zwischen 18 und 41 Jahren wurden nach entsprechender Aufwärmung aufgefordert, unter Verwendung der NORSK-Rückenstraße maximale isometrische Kontraktion der Rumpfmuskulatur in sechs Bewegungsrichtungen der drei Hauptkörperebenen mit drei Wiederholungen pro Bewegungsrichtung durchzuführen. Die Probanden wurden im Sitzen getestet mit fixiertem Oberkörper und Beckengürtel. Die Prozedur wurde nach einer Woche unter Beibehaltung der ursprünglichen Reihenfolge der Kontraktionen erneut durchgeführt. Für jede Bewegungsrichtung wurde zur Bestimmung der Intra- und Intersessionreliabilität der ICC berechnet. Ergebnisse: Es zeigte sich eine exzellente Intrasessionreproduzierbarkeit für alle Bewegungsrichtungen mit ICC-Werten zwischen 0,9978 für die Extension und 0,8735 für die Rechtsrotation. Die Intersessionreliabilität lag über 0,8 für alle Bewegungsrichtungen. Die Übereinstimmungswerte waren stabil über das gesamte gemessene Spektrum der MVC-Absolutwerte. Es wurden keine signifikanten Geschlechtsunterschiede bezüglich der Reproduzierbarkeit gefunden. Diskussion: Die Ergebnisse stimmen mit den Hinweisen aus der Literatur weitgehend überein. Bei der vorhandenen Streuung der Absolutwerte kann der ICC die Reliabilität überschätzen. Die Korrelation zwischen Reliabilität und den Absolutwerten kann durch die hohen ICC-Werte (Deckeneffekt) beeinflusst werden. Die Anstrengungsseriosität muss bei der Evaluation der MVC-Reliabilität berücksichtigt werden. Schlussfolgerungen: Die Geräte der NORSK-Rückenstraße ermöglichen eine exzellente Reproduzierbarkeit der MVC-Messungen der Rumpfmuskulatur. Die Ergebnisse sind stabil über das große Spektrum der Absolutwerte. Der minimale Unterschied zwischen Intra- und Intersessionreliabilität deutet auf die Stabilität der Zielvariablen MVC in der Zeit und eine hohe Durchführungsobjektivität der Messungen hin. Als weitere Schritte sind die Bestimmung der Reliabilität bei Patienten, die Untersuchung verschiedener Aspekte der Validität, Abhängigkeit der Reliabilität von der Anstrengungsseriosität sowie Bestimmung der Veränderungssensitivität der Muskelkraftmessungen in Interventionsstudien notwendig.

Abstract

Background: Isometric strength is one of the most common issues for evaluation of the functional performance. Conflicting results have been reported yet for the reliability of isometric measures of trunk muscles strength. The aim of the current study was to determine the intrasession and intersession reproducibility of the maximal voluntary contraction (MVC) of the trunk muscles and to investigate relationships between the reliability and absolute MVC values as well as sincerity of effort in healthy individuals. Method: The study included 34 healthy subjects (17 males and 17 females) aged between 18 and 41 years. The MVC was measured using the NORSK equipment. The participants were in sitting position, with the thorax and the pelvis fixed by adhesive belts. Three consecutive maximal effort contractions of trunk muscles were performed in 6 directions including flexion, extension, rotation in transversal plane and lateral bending with 1 minute of rest between each exercise. The session was repeated after 7 days. ICC was calculated to determine the intrasession and intersession reliability. Results: The measures showed an excellent intrasession reliability ranging between 0.9978 for trunk extension and 0.8735 for rotation to the right. The intersession reliability exceeded 0.8 for all movement directions. The reliability was highly independent from absolute MVC values. No significant gender differences could be found in terms of reproducibility. Discussion: Although the ICC values for isometric testing in the current study are in accordance with those of others, the calculation of the ICC can overestimate reliability because the ICC is strongly influenced by the variation between subjects. The correlation between reliability and absolute values can give a misleading estimate due to ceiling effects. Sincerity of effort must be taken into account when reporting MVC reliability. Conclusions: The reliability of the MVC measures of the trunk muscles was found excellent, as evaluated by NORSK equipment. Due to the minimal differences between intrasession and intersession reliability high level of measurement objectivity can be concluded. Diagnostic value of strength measures should be evaluated in patients with spinal disorders. Estimation of sincerity of effort is crucial because feigned effort could be a part of pain-adaptation strategies in patients with spinal conditions. Further research is needed in terms of validity and responsiveness.

Schlüsselwörter

Muskelfunktion - Muskelkraft - maximale willkürliche Kontraktion - Reliabilität - Rumpfmuskulatur

Key words

Muscular performance - muscular strength - maximal voluntary contraction - reliability - trunk muscles

Full Text

References

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Dr. med. Pawel Bak

Institut für Physiotherapie Friedrich-Schiller-Universität Jena

Kollegiengasse 9

07740 Jena

Email: pbak@mti-n.uni-jena.de