title: Intraexaminer reliability of hand-held dynamometry in the upper extremity: a systematic review.
abstract: OBJECTIVE
  To summarize and appraise the literature on the intraexaminer reliability of hand-held dynamometry (HHD) in the upper extremity.
  
  
  METHODS
  MEDLINE, CINAHL, and EMBASE were searched for relevant studies published up to December 2011. In addition, experts were contacted, and journals and reference lists were hand searched.
  
  
  METHODS
  To be included in the review, articles needed to (1) use a repeated-measures, within-examiner(s) design; (2) include symptomatic or asymptomatic individuals, or both; (3) use HHD to measure muscle strength in any of the joints of the shoulder, elbow, or wrist with the "make" or the "break" technique; (4) report measurements in kilogram, pound, or torque; (5) use a device that is placed between the examiner's hand and the subject's body; and (6) present estimates of intraexaminer reliability.
  
  
  METHODS
  Quality assessment and data extraction were performed by 2 reviewers independently.
  
  
  RESULTS
  Fifty-four studies were included, of which 26 (48%) demonstrated acceptable intraexaminer reliability. Seven high-quality studies showed acceptable reliability for flexion and extension of the elbow in healthy subjects. Conflicting results were found for shoulder external rotation and abduction. Reliability for all other movements was unacceptable. Higher estimates were reached for within-sessions reliability and if means of trials were used.
  
  
  CONCLUSIONS
  Intraexaminer reliability of HHD in upper extremity muscle strength was acceptable only for elbow measurements in healthy subjects. We provide specific recommendations for future research. Physical therapists should not rely on HHD measurements for evaluation of treatment effects in patients with upper extremity disorders.
authors.affiliation: private practice Leidsevaart, Haarlem, The Netherlands; Stichting Opleidingen Musculoskeletale Therapie, Institute for Master Education in Musculoskeletal Therapy, Amersfoort, The Netherlands. Electronic address: patrickschrama@hotmail.com.
authors.forename: Patrick P M
authors.initials: PP
authors.lastname: Schrama
authors.affiliation: Stichting Opleidingen Musculoskeletale Therapie, Institute for Master Education in Musculoskeletal Therapy, Amersfoort, The Netherlands.
authors.forename: Martijn S
authors.initials: MS
authors.lastname: Stenneberg
authors.affiliation: Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Cees
authors.initials: C
authors.lastname: Lucas
authors.affiliation: Stichting Opleidingen Musculoskeletale Therapie, Institute for Master Education in Musculoskeletal Therapy, Amersfoort, The Netherlands; Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Emiel
authors.initials: E
authors.lastname: van Trijffel
mesh_terms: D004551:Elbow Joint / Q000502:physiology; D006801:Humans; D053580:Muscle Strength; D053581:Muscle Strength Dynamometer; D018482:Muscle, Skeletal / Q000502:physiology*; D015588:Observer Variation; D015203:Reproducibility of Results; D012785:Shoulder Joint / Q000502:physiology; D034941:Upper Extremity / Q000502:physiology*; D014955:Wrist Joint / Q000502:physiology
keywords: Extremities; Isometric contraction; Muscle strength dynamometer; Observer variation; Rehabilitation; Reproducibility of results