Elsevier

Journal of Critical Care

Volume 28, Issue 1, February 2013, Pages 96-98
Journal of Critical Care

Editorials and Commentaries
Muscle strength measurement in the intensive care unit: Not everything that can be counted counts

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Variability of muscle strength measurements

Obtaining accurate strength measures in the critical care setting can be a complex task influenced by a variety of factors (see Fig. 1). Clinical examination of muscle strength in ICU patients is often limited by inadequate arousal, attention, or cognitive performance. The impact of altered levels of arousal on the reliability of measurement is likely to increase with rising complexity of the measurement method. Even in patients without impaired wakefulness or cognition, CIP-associated distal

What does the work of Baldwin et al add to the existing literature?

In their sample of 17 patients of 189 screened, the authors found good interrater consistency and test-retest reliability of dynamometry and MRC grading for all tested muscle groups, with the exception of left elbow flexion. These results are in line with recently published findings of Hermans et al [9], which showed good interrater reliability for MRC score and dynamometry in a sample of 75 critically ill surgical and medical ICU patients [9]. However, Baldwin et al found wide variability in

Does technique used for measuring voluntary contraction force matter in the ICU population?

The authors found a wide variation of dynamometry forces representing MRC grades 4 and 5 throughout all muscle groups. Prior research has suggested that handgrip dynamometry might serve as a surrogate for overall body strength in the ICU population [3]. The findings in this article support the view that measurement of strength from a singular muscle does not reliably reflect overall strength, which is further supported by our own data [5], [6]. In a recent prospective study [11], we examined

Future direction for research

The authors have added important new evidence to the body of literature regarding strength testing in the ICU. As a stand-alone measure, dynamometry may be useful for tracking change within a given patient over time. As an outcome prediction instrument, the MRC scale seems superior given that reliability is high both in grading strength and diagnosing ICU-acquired weakness and that its validity has been demonstrated in multiple studies. Further research is needed to examine the predictive

References (12)

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    During the standardized evaluation, the subject need to be sitting on a standard chair with their forearms resting flat on the armchairs. Clinicians should demonstrate the use of the dynamometer and encourage the patients to squeeze the dynamometer as hard and as tightly as possible during 3–5 s. Three measures of each arm should be performed and, usually, the highest reading of the 6 measurements is reported as the final result (Waak et al., 2013). A variety of thresholds of grip strength have been proposed to characterize low muscle strength, ranging from 16 to 20 kg for women and 26–30 kg for men (Cruz-Jentoft et al., 2010; Studenski et al., 2014; Lauretani et al., 2003; Dodds et al., 2014).

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