Another quick and reliable way to assess upper limb strength in older clients!

The reliability and validity of novel clinical strength measures of the upper body in older adults.
Legg, H. S., Spindor, J., Dziendzielowski, R., Sharkey, S., Lanovaz, J. L., Farthing, J. P., & Arnold, C. M. (2020) Level of Evidence: 2b Follow recommendation: 👍 👍 Type of study: Diagnostic test Topic: Push off test – Validity and reliability as a strength measure This is a longitudinal study (two repeated measures over 48 hrs) assessing the validity and reliability of the push off test in comparison to hand held dynamometer strength testing of the upper limb. Seventeen healthy participants (11 females, 6 males), who were on average 71 years old, took part in the study. The push off test was completed by inverting the handle of a hand held dynamometer and positioning it on a table. Participants were then asked to put as much weight as possible through it with the elbow and shoulder in 10°-40° of flexion and extension respectively (See picture below from the article). The results from this test were repeated two times (to assess reliability after 48 hrs) and compared to strength measurements of shoulder extension, shoulder abduction, and elbow extension (assessed through a hand held dynamometer) to assess validity. The results showed that the push off test was reliable (meaning that the measurements taken at two different times were very similar) with intraclass correlation coefficient between 0.92 and 0.94 (the closer to 1 the better). The push off test was also valid (it was indeed measuring upper limb strength) with strong correlation with the other measures of upper limb strength ranging from 0.8 to 0.9 (the closer to 1 the better). On average, the push off test was 27kg, and the average weight of the participants was 77kg. This suggests that for healthy patients around the age of 70, they should be able to push off during the test 35% of their weight (27kg/77kg=0.35). Clinical Take Home Message: Based on what we know today, the push off test can be utilised to assess upper limb strength in older people. This test has been previously used to assess late stage TFCC recovery. Getting our clients to achieve 35% of their body weight during this test may be an appropriate goal for our treatment. If our clients are younger, a better test may be the maximum number of push up that they can do in a row without stopping (Reaching 11 push-up may be an appropriate goal). Open Access URL: https://journals.sagepub.com/doi/10.1177/1758998320957373 Abstract Introduction: Research investigating psychometric properties of multi-joint upper body strength assessment tools for older adults is limited. This study aimed to assess the test–retest reliability and concurrent validity of novel clinical strength measures assessing functional concentric and eccentric pushing activities compared to other more traditional upper limb strength measures. Methods: Seventeen participants (6 males and 11 females; 71 ± 10 years) were tested two days apart, performing three maximal repetitions of the novel measurements: vertical push-off test and dynamometer-controlled concentric and eccentric single-arm press. Three maximal repetitions of hand-grip dynamometry and isometric hand-held dynamometry for shoulder flexion, shoulder abduction and elbow extension were also collected. Results: For all measures, strong test–retest reliability was shown (all ICC > 0.90, p < 0.001), root-mean-squared coefficient of variation percentage: 5–13.6%; standard error of mean: 0.17–1.15 Kg; and minimal detectable change (90%): 2.1–9.9. There were good to high significant correlations between the novel and traditional strength measures (all r > 0.8, p < 0.001). Discussion: The push-off test and dynamometer-controlled concentric and eccentric single-arm press are reliable and valid strength measures feasible for testing multi-joint functional upper limb strength assessment in older adults. Higher precision error compared to traditional uni-planar measures warrants caution when completing comparative clinical assessments over time.

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