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VOLUME 20 , ISSUE 1 ( 2016 ) > List of Articles


Measurement of muscle strength with handheld dynamometer in Intensive Care Unit

Nidhi R. Samosawala, K. Vaishali, B. Chakravarthy Kalyana

Keywords : Critical care units, critical illness polyneuromyopathy, immobilization, objective assessment, physiotherapy

Citation Information : Samosawala NR, Vaishali K, Kalyana BC. Measurement of muscle strength with handheld dynamometer in Intensive Care Unit. Indian J Crit Care Med 2016; 20 (1):21-26.

DOI: 10.4103/0972-5229.173683

License: CC BY-ND 3.0

Published Online: 01-06-2013

Copyright Statement:  Copyright © 2016; The Author(s).


Background: Intensive Care Unit (ICU) acquired weakness is a common complication in critically ill patients affecting their prognosis. The handheld dynamometry is an objective method in detecting minimum muscle strength change, which has an impact on the physical function of ICU survivors. The minimal change in the force can be measured in units of weight such as pounds or kilograms. Aim of the Study: To detect the changes in peripheral muscle strength with handheld dynamometer in the early stage of ICU stay and to observe the progression of muscle weakness. Methodology: Three upper and three lower limb muscles force measured with handheld dynamometer during ICU stay. Data were analyzed using repeated measures ANOVA to detect changes in force generated by muscle on alternate days of ICU stay. Results: There was a reduction in peripheral muscle strength from day 3 to day 5 as well from day 5 to day 7 of ICU stay (P < 0.01). The average reduction in peripheral muscle strength was 11.8% during ICU stay. Conclusion: This study showed a progressive reduction in peripheral muscle strength as measured by handheld dynamometer during early period of ICU stay.

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  1. ICU Planning and Designing in India-Guidelines 2010. Indian Society for Critical Care Medicine; 2010. Available from: [Last cited on 2015 Sep 16].
  2. Desai SV, Law TJ, Needham DM. Long-term complications of critical care. Crit Care Med 2011;39:371-9.
  3. Chambers MA, Moylan JS, Reid MB. Physical inactivity and muscle weakness in the critically ill. Crit Care Med 2009;37 10 Suppl: S337-46.
  4. Puthucheary Z, Montgomery H, Moxham J, Harridge S, Hart N. Structure to function: Muscle failure in critically ill patients. J Physiol 2010;588(Pt 23):4641-8.
  5. Schefold JC, Bierbrauer J, Weber-Carstens S. Intensive care unit-acquired weakness (ICUAW) and muscle wasting in critically ill patients with severe sepsis and septic shock. J Cachexia Sarcopenia Muscle 2010;1:147-157.
  6. Hermans G, Clerckx B, Vanhullebusch T, Segers J, Vanpee G, Robbeets C, et al. Interobserver agreement of medical research council sum-score and handgrip strength in the intensive care unit. Muscle Nerve 2012;45:18-25.
  7. De Jonghe B, Sharshar T, Lefaucheur JP, Authier FJ, Durand-Zaleski I, Boussarsar M, et al. Paresis acquired in the intensive care unit: A prospective multicenter study. JAMA 2002;288:2859-67.
  8. Deem S. Intensive-care-unit-acquired muscle weakness. Respir Care 2006;51:1042-52.
  9. Waak K, Zaremba S, Eikermann M. Muscle strength measurement in the intensive care unit: Not everything that can be counted counts. J Crit Care 2013;28:96-8.
  10. Bednarik J, Lukas Z, Vondracek P. Critical illness polyneuromyopathy: The electrophysiological components of a complex entity. Intensive Care Med 2003;29:1505-14.
  11. Baldwin CE, Paratz JD, Bersten AD. Muscle strength assessment in critically ill patients with handheld dynamometry: An investigation of reliability, minimal detectable change, and time to peak force generation. J Crit Care 2013;28:77-86.
  12. Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O′Neal PV, Keane KA, et al. The Richmond agitation-sedation scale: Validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 2002;166:1338-44.
  13. Deem S, Lee CM, Curtis JR. Acquired neuromuscular disorders in the intensive care unit. Am J Respir Crit Care Med 2003;168:735-9.
  14. Vanpee G, Segers J, Van Mechelen H, Wouters P, Van den Berghe G, Hermans G, et al. The interobserver agreement of handheld dynamometry for muscle strength assessment in critically ill patients. Crit Care Med 2011;39:1929-34.
  15. Hough CL, Lieu BK, Caldwell ES. Manual muscle strength testing of critically ill patients: Feasibility and interobserver agreement. Crit Care 2011;15:R43.
  16. Fan E, Ciesla ND, Truong AD, Bhoopathi V, Zeger SL, Needham DM. Inter-rater reliability of manual muscle strength testing in ICU survivors and simulated patients. Intensive Care Med 2010;36:1038-43.
  17. O′Shea SD, Taylor NF, Paratz JD. Measuring muscle strength for people with chronic obstructive pulmonary disease: Retest reliability of hand-held dynamometry. Arch Phys Med Rehabil 2007;88:32-6.
  18. Fan E, Zanni JM, Dennison CR, Lepre SJ, Needham DM. Critical illness neuromyopathy and muscle weakness in patients in the intensive care unit. AACN Adv Crit Care 2009;20:243-53.
  19. Judemann K, Lunz D, Zausig YA, Graf BM, Zink W. Intensive care unit-acquired weakness in the critically ill: Critical illness polyneuropathy and critical illness myopathy. Anaesthesist 2011;60:887-901.
  20. Click Fenter P, Bellew JW, Pitts TA, Kay RE. Reliability of stabilised commercial dynamometers for measuring hip abduction strength: A pilot study. Br J Sports Med 2003;37:331-4.
  21. Lee JJ, Waak K, Grosse-Sundrup M, Xue F, Lee J, Chipman D, et al. Global muscle strength but not grip strength predicts mortality and length of stay in a general population in a surgical intensive care unit. Phys Ther 2012;92:1546-55.
  22. Garnacho-Montero J, Madrazo-Osuna J, García-Garmendia JL, Ortiz-Leyba C, Jiménez-Jiménez FJ, Barrero-Almodóvar A, et al. Critical illness polyneuropathy: Risk factors and clinical consequences. A cohort study in septic patients. Intensive Care Med 2001;27:1288-96.
  23. Schweickert WD, Hall J. ICU-acquired weakness. Chest 2007;131:1541-9.
  24. Bierbrauer J, Koch S, Olbricht C, Hamati J, Lodka D, Schneider J, et al. Early type II fiber atrophy in intensive care unit patients with nonexcitable muscle membrane. Crit Care Med 2012;40:647-50.
  25. de Ruiter CJ, Jones DA, Sargeant AJ, de Haan A. Temperature effect on the rates of isometric force development and relaxation in the fresh and fatigued human adductor pollicis muscle. Exp Physiol 1999;84:1137-50.
  26. Wang GC, Chi WM, Perng WC, Huang KL. Body temperature control in sepsis-induced acute lung injury. Chin J Physiol 2003;46:151-7.
  27. Wiles CM, Edwards RH. The effect of temperature, ischaemia and contractile activity on the relaxation rate of human muscle. Clin Physiol 1982;2:485-97.
  28. Smith MA, Reid MB. Redox modulation of contractile function in respiratory and limb skeletal muscle. Respir Physiol Neurobiol 2006;151:229-41.
  29. van Hees HW, Schellekens WJ, Linkels M, Leenders F, Zoll J, Donders R, et al. Plasma from septic shock patients induces loss of muscle protein. Crit Care 2011;15:R233.
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