title: Inter-rater reliability of manual muscle strength testing in ICU survivors and simulated patients.
abstract: OBJECTIVE
  The goal of the paper is to determine inter-rater reliability of trained examiners performing standardized strength assessments using manual muscle testing (MMT).
  
  
  METHODS
  The authors report on 19 trainees undergoing quality assurance within a multi-site prospective cohort study.
  
  
  METHODS
  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.
  
  
  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.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1830 East Monument Street, 5th Floor, Baltimore, MD 21205, USA. eddy.fan@jhmi.edu
authors.forename: Eddy
authors.initials: E
authors.lastname: Fan
authors.forename: Nancy D
authors.initials: ND
authors.lastname: Ciesla
authors.forename: Alex D
authors.initials: AD
authors.lastname: Truong
authors.forename: Vinodh
authors.initials: V
authors.lastname: Bhoopathi
authors.forename: Scott L
authors.initials: SL
authors.lastname: Zeger
authors.forename: Dale M
authors.initials: DM
authors.lastname: Needham
mesh_terms: D015331:Cohort Studies; D006801:Humans; D007362:Intensive Care Units; D053580:Muscle Strength / Q000502:physiology*; D015588:Observer Variation; D016544:Patient Simulation; D010808:Physical Examination / Q000379:methods*; D011446:Prospective Studies; D015203:Reproducibility of Results; D017741:Survivors