title: Reproducibility of Muscle Strength Testing for Children with Spina Bifida.
abstract: OBJECTIVE
  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.
authors.affiliation: a Division of Physiotherapy, School of Health and Rehabilitation Sciences , The University of Queensland , Brisbane , Australia.
authors.forename: Jia Ling
authors.initials: JL
authors.lastname: Tan
authors.affiliation: b Department of Physiotherapy , Children's Health Queensland Hospital and Health Service , Brisbane , Australia.
authors.forename: Nicole Maree
authors.initials: NM
authors.lastname: Thomas
authors.affiliation: a Division of Physiotherapy, School of Health and Rehabilitation Sciences , The University of Queensland , Brisbane , Australia.
authors.forename: Leanne Marie
authors.initials: LM
authors.lastname: Johnston
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D053580:Muscle Strength / Q000502:physiology*; D018482:Muscle, Skeletal / Q000502:physiology*; D015203:Reproducibility of Results; D016135:Spinal Dysraphism / Q000503:physiopathology*
keywords: Children; manual muscle test; reliability; reproducibility; spina bifida; strength