Inter-rater reliability of manual muscle strength testing in ICU survivors and simulated patients

Intensive Care Med. 2010 Jun;36(6):1038-43. doi: 10.1007/s00134-010-1796-6. Epub 2010 Mar 6.


Objective: The goal of the paper is to determine inter-rater reliability of trained examiners performing standardized strength assessments using manual muscle testing (MMT).

Design, subjects, and setting: The authors report on 19 trainees undergoing quality assurance within a multi-site prospective cohort study.

Intervention: Inter-rater reliability for specially trained evaluators ("trainees") and a reference rater, performing MMT using both simulated and actual patients recovering from critical illness was evaluated.

Measurements and results: Across 26 muscle groups tested by 19 trainee-reference rater pairs, the median (interquartile range) percent agreement and intraclass correlation coefficient (ICC; 95% CI) were: 96% (91, 98%) and 0.98 (0.95, 1.00), respectively. Across all 19 pairs, the ICC (95% CI) for the overall composite MMT score was 0.99 (0.98-1.00). When limited to actual patients, the ICC was 1.00 (95% CI 0.99-1.00). The agreement (kappa; 95% CI) in detecting clinically significant weakness was 0.88 (0.44-1.00).

Conclusions: MMT has excellent inter-rater reliability in trained examiners and is a reliable method of comprehensively assessing muscle strength.

Publication types

  • Evaluation Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cohort Studies
  • Humans
  • Intensive Care Units*
  • Muscle Strength / physiology*
  • Observer Variation*
  • Patient Simulation*
  • Physical Examination / methods*
  • Prospective Studies
  • Reproducibility of Results*
  • Survivors*