title: Validation of manual muscle testing and a subset of eight muscles for adult and juvenile idiopathic inflammatory myopathies.
abstract: OBJECTIVE
  To validate manual muscle testing (MMT) for strength assessment in juvenile and adult dermatomyositis (DM) and polymyositis (PM).
  
  
  METHODS
  Patients with PM/DM (73 children and 45 adults) were assessed at baseline and reevaluated 6-9 months later. We compared Total MMT (a group of 24 proximal, distal, and axial muscles) and Proximal MMT (7 proximal muscle groups) tested bilaterally on a 0-10 scale with 144 subsets of 6 and 96 subsets of 8 muscle groups tested unilaterally. Expert consensus was used to rank the best abbreviated MMT subsets for face validity and ease of assessment.
  
  
  RESULTS
  The Total, Proximal, and best MMT subsets had excellent internal reliability (Total MMT r(s) = 0.91-0.98), and consistency (Cronbach's alpha = 0.78-0.97). Inter- and intrarater reliability were acceptable (Kendall's W 0.68-0.76, r(s) = 0.84-0.95). MMT subset scores correlated highly with Total and Proximal MMT scores and with the Childhood Myositis Assessment Scale, and correlated moderately with physician global activity, functional disability, magnetic resonance imaging, and axial and distal MMT scores, and, in adults, with creatine kinase level. The standardized response mean for Total MMT was 0.56 in juveniles and 0.75 in adults. Consensus was reached to use a subset of 8 muscles (neck flexors, deltoids, biceps, wrist extensors, gluteus maximus and medius, quadriceps, and ankle dorsiflexors) that performed as well as the Total and Proximal MMT, and had good face validity and ease of assessment.
  
  
  CONCLUSIONS
  These findings aid in standardizing the use of MMT for assessing strength as an outcome measure for myositis.
authors.affiliation: Environmental Autoimmunity Group, Office of Clinical Research, National Institute of Environmental Health Sciences/NIH, 10 Center Drive, Bethesda, MD 20892-1301, USA. riderl@mail.nih.gov
authors.forename: Lisa G
authors.initials: LG
authors.lastname: Rider
authors.forename: Deloris
authors.initials: D
authors.lastname: Koziol
authors.forename: Edward H
authors.initials: EH
authors.lastname: Giannini
authors.forename: Minal S
authors.initials: MS
authors.lastname: Jain
authors.forename: Michaele R
authors.initials: MR
authors.lastname: Smith
authors.forename: Kristi
authors.initials: K
authors.lastname: Whitney-Mahoney
authors.forename: Brian M
authors.initials: BM
authors.lastname: Feldman
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Wright
authors.forename: Carol B
authors.initials: CB
authors.lastname: Lindsley
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Pachman
authors.forename: Maria L
authors.initials: ML
authors.lastname: Villalba
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Lovell
authors.forename: Suzanne L
authors.initials: SL
authors.lastname: Bowyer
authors.forename: Paul H
authors.initials: PH
authors.lastname: Plotz
authors.forename: Frederick W
authors.initials: FW
authors.lastname: Miller
authors.forename: Jeanne E
authors.initials: JE
authors.lastname: Hicks
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003882:Dermatomyositis / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000175:diagnosis*; D009220:Myositis / Q000175:diagnosis; D015588:Observer Variation; D010808:Physical Examination; D017285:Polymyositis / Q000175:diagnosis*; D015203:Reproducibility of Results; D012720:Severity of Illness Index
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