Clinical Measures of Muscular Strength in Individuals Treated for - - PowerPoint PPT Presentation

Clinical Measures of Muscular Strength in Individuals Treated for Breast Cancer

Genesis Research Summit June 3, 2014 Christine H. Beuthin, PT , DPT , GCS, CLT

Session Objectives

• 1. Provide evidence of strength impairments in breast

cancer patients secondary to cancer treatments.

• 2. Identify strength assessment techniques with sound

psychometric properties used with breast cancer patients.

• 3. Recognize the role of consistency in outcome

measures to assess patient status and demonstrate intervention effectiveness in individual and patient groups.

Operational Definition

• Muscular strength
• Force generation by muscles
• The ability to resist being moved or give way to a

force

Evidence of Impairment in BC

Acute

• Strength
• Elevation strength: up to 20% deficit compared to

the contralateral limb

• Strength deficits up to 27% compared to age-

matched controls

Blomqvist Acta Oncol 2004, Harrington J Ca Surviv 2011, Hayes Br Ca Res Treat 2005

Long Term

• Strength
• 8% loss in shoulder abduction strength compared to

pre-operative status

• 7-18% for shoulder elevation strength deficits

EDGE: Evaluation Database to Guide Effectiveness

• American Physical Therapy Association
• Oncology Section
• Breast Cancer EDGE Taskforce

Oncology Section Task Force on Breast Cancer Outcomes:

Muscular Strength

Originally presented: February 2014

• Mary I. Fisher, PT

, PhD, OCS, CLT

• Claire Davies, PT

, PhD, CLT-LANA

• Cindy Pfalzer, PT

, PhD, FACSM, FAPTA

• Chris Beuthin, PT

, DPT , GCS, CLT

• Brittany Zoll, DPT
• Genevieve Colon, SPT

Strength Outcome Measures

• Systematic Review used to assess:
• Reliability
• Validity
• Sensitivity to Change
• Clinical Utility

Search Strategy

Databases and Sites Searched

(Total hits = 471 including repeats)

Search Terms/Strings (hits with potential for review)

 Google Scholar  Ovid  Pubmed/Medline  CINAHL  Sports Discus  Web of Science  Cochrane Review  PEDro  Academic Search  Strength measure/measurement/ test  Manual muscle test  Psychometric properties/clinimetrics  Power  Energy

Article Selection

Inclusion Criteria

• Strength measures
• Strength tools
• Adults, preferably female (human subjects)
• English language
• Clinically feasible methods
• Psychometric properties reported

Article Selection

Exclusion Criteria

• Non-clinical measures of strength
• Functional mobility measures (TUG, STS,

Gait speed, etc.)

Consensus Selection

• Final number of articles reviewed for

inclusion: 29

• Review of testing methods – 16 articles
• 13 removed as not meeting criteria (lacking

psychometric data, not in compared in comparable population, lacked clinical utility)

• Each outcome measure reviewed independently

and rated by two reviewers

• If outcome measure rating in disagreement,

discussion with 4 reviewers until agreement

• btained

Breast Cancer EDGE Rating Scale

Oncolog

• logy EDGE

4 Highly Recommend Highly recommended; the outcome measure has excellent psychometric properties and clinical utility; the measure has been used in research on individuals with or post breast cancer. 3 Recommend Recommended; the outcome measure has good psychometric properties and good clinical utility; no published evidence that the measure has been applied to research on individuals with or post breast cancer. 2A Unable to Recommend at this time Unable to recommend at this time; there is insufficient information to support a recommendation of this

• utcome measure; the measure has been used in research
• n individuals with or post breast cancer.

2B Unable to Recommend at this time Unable to recommend at this time; there is insufficient information to support a recommendation of this

• utcome measure; no published evidence that the

measure has been applied to research on individuals with

• r post breast cancer.

1 Do not Recommend Poor psychometrics &/or poor clinical utility (time, equipment, cost, etc.)

Outcome Measures Selected

• Manual Muscle Testing
• 1 RM Strength Testing
• Hand-grip Strength
• Hand-held Dynamometry

Manual Muscle Testing

6 Point Scale 0 = no contraction 1 = flicker of contraction 2 = active movement with gravity eliminated 3 = active movement against gravity 4 = active movement against gravity and resistance 5 = normal power

Final Analysis: MMT

• No studies yielded a rating 3 or 4
• No studies with methodology designed

specifically for the breast cancer population

• High clinical utility
• Reliability Poor
• Rating 2B = unable to recommend

1 RM Strength Testing

• 1RM defined as the heaviest load that can be

moved over a specific range of motion with correct performance one time. (Pereira 2003)

• Psychometric properties have not been

examined in upper extremity activities

• Further research is needed, especially in BCS
• Rating 2B = unable to recommend at this time

Hand Grip Strength

• Often used as a proxy for overall functional

health

• Measured with objective tool

Final Analysis: Hand Grip Strength

• No studies rated 4 (Highly Recommended)
• Has been used in a study of breast cancer

survivors

• Good but incomplete psychometric properties
• Clinical Utility excellent: equipment easy to

use, staff training simple

• Need studies examining psychometrics in BCS
• Rating 3 = recommended

Hand Held Dynamometry

Hand Held Dynamometry

• Easy to use clinically
• Methodology similar to MMT
• Normative data available

Final Analysis for HHD

• No studies yielded a rating of 4 (Highly

Recommended)

• Not utilized in BC population
• Good psychometric qualities: reliability
• Clinically feasible
• Rating 3 = recommended

Muscle Strength

Outcome Measure Rating Manual Muscle Testing 2B – Unable to recommend 1 RM Strength Testing 2B – Unable to recommend Grip Strength - Dynamometry 3 - Recommended Hand Held Dynamometry 3 – Recommended

Limitations of Recommended Measures:

• Lack of validation in the breast cancer population: more research

needed

• Lack of MCID values: change of measure considered clinically
• relevant to patient
• Lack of Hand Held Dynamometers in many clinics

Impact on Patient Care

• Physical therapists can use the two

recommended outcome measures to show the before and after results of treatment

• This is motivational for patient as well as
• bjective evidence of improvement in

documentation reviewed by payer sources

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Questions? Thank you !