Inter-rater reliability of manual muscle strength testing in ICU survivors and simulated patients

Eddy Fan, Nancy D. Ciesla, Alex D. Truong, Vinodh Bhoopathi, Scott L. Zeger, Dale M. Needham

Research output: Contribution to journalArticlepeer-review

93 Scopus citations


Objective: The goal of the paper is to determine inter-rater reliability of trained examiners performing standardized strength assessments using manual muscle testing (MMT). Design, subjects, and setting: The authors report on 19 trainees undergoing quality assurance within a multi-site prospective cohort study. Intervention: Inter-rater reliability for specially trained evaluators ("trainees'') and a reference rater, performing MMT using both simulated and actual patients recovering from critical illness was evaluated. Measurements and results: Across 26 muscle groups tested by 19 trainee-reference rater pairs, the median (interquartile range) percent agreement and intraclass correlation coefficient (ICC; 95% CI) were: 96% (91, 98%) and 0.98 (0.95, 1.00), respectively. Across all 19 pairs, the ICC (95% CI) for the overall composite MMT score was 0.99 (0.98- 1.00). When limited to actual patients, the ICC was 1.00 (95% CI 0.99-1.00). The agreement (kappa; 95% CI) in detecting clinically significant weakness was 0.88 (0.44- 1.00). Conclusions: MMT has excellent inter-rater reliability in trained examiners and is a reliable method of comprehensively assessing muscle strength.

Original languageEnglish (US)
Pages (from-to)1038-1043
Number of pages6
JournalIntensive Care Medicine
Issue number6
StatePublished - Jun 2010


  • Diagnostic techniques and procedures
  • Epidemiologic research design
  • Muscle strength
  • Muscle weakness
  • Physical examination
  • Reproducibility of results

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine


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