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Updated: Mar 9, 2026
Lower Limb Biomechanical Analysis of Healthy Participants
Published on: April 15, 2020
Reproducibility of Muscle Strength Testing for Children with Spina Bifida
Jia Ling Tan1, Nicole Maree Thomas2, Leanne Marie Johnston1
1a Division of Physiotherapy, School of Health and Rehabilitation Sciences , The University of Queensland , Brisbane , Australia.
Aims:
Examine the inter-rater reliability of the Daniels and Worthingham (D&W) manual muscle test (MMT) protocol for children with spina bifida between experienced and novice physiotherapists.
Methods:
Thirteen children with spina bifida (two males) aged 6 to 18 years were recruited from a spina bifida service in a state-wide tertiary children's hospital. Each child had the muscle strength of 19, and lower limb muscles were measured bilaterally by one experienced and one novice physiotherapist using the D&W MMT protocol. Examiner and limb order were counterbalanced. Standard training and recording sheets were used. Agreement between raters was examined with quadratic weighted kappa (κw2), percentage exact agreement (%EA), and the Bland-Altmann Limits of Agreement (LoA). Minimal detectable change (MDC) was calculated.
Results:
Inter-rater agreement between the experienced and novice raters was excellent (κw2 = 0.95; 95% confidence interval: 0.94-0.96); %EA was good (72.3%); and clinically appropriate LoA levels were -1.30-1.40. The MDC was 1.11 points on a six-point MMT scale.
Conclusions:
The D&W MMT protocol, when used after standard training and with standard recording sheets, was reproducible for children with spina bifida, aged 6-18 years.
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