Reproducibility of Muscle Strength Testing for Children with Spina Bifida

Area of Science:

• Pediatric physiotherapy
• Neuromuscular assessment
• Rehabilitation science

Background:

• Spina bifida impacts muscle function in children, necessitating reliable assessment tools.
• The Daniels and Worthingham (D&W) manual muscle test (MMT) is commonly used but its inter-rater reliability in pediatric spina bifida populations requires examination.

Purpose of the Study:

• To evaluate the inter-rater reliability of the D&W MMT protocol.
• To compare assessments between experienced and novice physiotherapists for children with spina bifida.

Main Methods:

• Thirteen children (aged 6-18 years) with spina bifida participated.
• Muscle strength of 19 lower limb muscles was assessed bilaterally by an experienced and a novice physiotherapist using the D&W MMT protocol.
• Inter-rater agreement was analyzed using quadratic weighted kappa (κw2), percentage exact agreement (%EA), and Bland-Altmann Limits of Agreement (LoA).

Main Results:

• Excellent inter-rater agreement was found (κw2 = 0.95).
• %EA was 72.3%, indicating good agreement.
• The Minimal Detectable Change (MDC) was 1.11 points on the MMT scale.

Conclusions:

• The D&W MMT protocol is reproducible for assessing muscle strength in children with spina bifida aged 6-18 years.
• Standardized training and recording sheets enhance the reliability of the D&W MMT protocol in this pediatric population.