title: Is one trial enough for repeated testing? Same-day assessments of walking, mobility and fine hand use in people with myotonic dystrophy type 1.
abstract: Performance-based assessments of physical function are essential in people with myotonic dystrophy type 1 (DM1) to monitor disease progression and evaluate interventions. Commonly used are the six-minute walk test, the 10 m-walk test, the timed up-and-go test, the timed-stands test, grip strength tests and the nine-hole peg test. The number of trials needed on a same-day test occasion and whether the first, best or average of trials should be reported as result is unknown. Thus, the aim was to describe and explore differences between trials in these measures of walking, mobility and fine hand use in 70 adults with DM1. Three trials were performed for each test except for the six-minute walk test where two trials were allowed. There were statistical significant differences over trials in all tests except for the 10 m-walk test and grip strength tests. Pair-wise comparisons showed that the second and third trials were in general better than the first, although effect sizes were small. At which trial the individuals performed their best differed between individuals and tests. People with severe muscular impairment had difficulties to perform repeated trials. Intraclass correlation coefficients were all high in analyses exploring how to report results. The conclusion and clinical implication is that, for a same-day test occasion, one trial is sufficient for the 10 m-walk test and grip strength tests, and that repeated trials should be allowed in the timed up-and-go test, timed-stands test and nine-hole peg tests. We recommend that two trials are performed for these latter tests as such a protocol could accommodate people with various levels of impairments and physical limitations.
authors.affiliation: Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Functional Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm SE-171 76, Sweden; Centre de recherche Charles-Le-Moyne, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 2500, Boul. de l'Université, Sherbrooke, Québec J1K 2R1, Canada; Groupe de Recherche Interdisciplinaire sur les Maladies Neuromusculaires (GRIMN), CIUSSS du Saguenay-Lac-St-Jean, Site Jonquière, 2230 rue de l'Hôpital, Saguenay, Québec G7X 7X2, Canada. Electronic address: marie.kierkegaard@ki.se.
authors.forename: Marie
authors.initials: M
authors.lastname: Kierkegaard
authors.affiliation: Centre de recherche Charles-Le-Moyne, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 2500, Boul. de l'Université, Sherbrooke, Québec J1K 2R1, Canada; Groupe de Recherche Interdisciplinaire sur les Maladies Neuromusculaires (GRIMN), CIUSSS du Saguenay-Lac-St-Jean, Site Jonquière, 2230 rue de l'Hôpital, Saguenay, Québec G7X 7X2, Canada.
authors.forename: Emilie
authors.initials: E
authors.lastname: Petitclerc
authors.affiliation: Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), CIRRIS-IRDPQ, 525, Boulevard Wilfrid-Hamel (H-1702), Québec G1M 2S8, Canada; Departments of Rehabilitation and Radiology/Nuclear Medicine, Faculty of Medicine, Laval University, Pavillon Ferdinand-Vandry, Université Laval, 1050 Avenue de la Médecine, Québec G1V 0A6, Canada.
authors.forename: Luc J
authors.initials: LJ
authors.lastname: Hébert
authors.affiliation: Centre de recherche Charles-Le-Moyne, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 2500, Boul. de l'Université, Sherbrooke, Québec J1K 2R1, Canada; Groupe de Recherche Interdisciplinaire sur les Maladies Neuromusculaires (GRIMN), CIUSSS du Saguenay-Lac-St-Jean, Site Jonquière, 2230 rue de l'Hôpital, Saguenay, Québec G7X 7X2, Canada.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Gagnon
mesh_terms: D000328:Adult; D000368:Aged; D005080:Exercise Test / Q000592:standards*; D005260:Female; D006225:Hand / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology*; D009223:Myotonic Dystrophy / Q000175:diagnosis* / Q000503:physiopathology; D009483:Neuropsychological Tests / Q000592:standards*; D015203:Reproducibility of Results; D016138:Walking / Q000502:physiology*; D055815:Young Adult
keywords: Myotonic dystrophy; Number of trials; Outcome measures; Rehabilitation; Reliability; Repeated measures