Clinical evaluator reliability for quantitative and manual muscle testing measures of strength in children

D. M. Escolar, E. K. Henricson, J. Mayhew, J. Florence, R. Leshner, K. M. Patel, P. R. Clemens

Research output: Contribution to journalArticlepeer-review

160 Scopus citations


Measurements of muscle strength in clinical trials of duchenne muscular dystrophy have relied heavily on manual muscle testing (MMT). The high level of intra- and interrater variability of MMT compromises clinical study results. We compared the reliability of 12 clinical evaluators in performing MMT and quantitative muscle testing (QMT) on 12 children with muscular dystrophy. QMT was reliable, with an interclass correlation coefficient (icc) of >0.9 for biceps and grip strength, and >0.8 for quadriceps strength. Training of both subjects and evaluators was easily accomplished. MMT was not as reliable, and required repeated training of evaluators to bring all groups to an Icc >0.75 for shoulder abduction, elbow and hip flexion, knee extension, and ankle dorsiflexion. We conclude that QMT shows greater reliability and is easier to implement than MMT. Consequently, QMT will be a superior measure of strength for use in pediatric, neuromuscular, multicenter clinical trials.

Original languageEnglish (US)
Pages (from-to)787-793
Number of pages7
JournalMuscle and Nerve
Issue number6
StatePublished - 2001
Externally publishedYes


  • Duchenne
  • Dystrophy
  • Intrarater reliability
  • Manual muscle testing (MMT)
  • Pediatric neuromuscular testing
  • Quantitative muscle testing (QMT)

ASJC Scopus subject areas

  • Physiology
  • Clinical Neurology
  • Cellular and Molecular Neuroscience
  • Physiology (medical)


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