Agreement and reliability of repeated bedside respiratory muscle strength measurements in acute and subacute stroke

Agnieszka Lewko, Marta Sidaway, Stefan Tino Kulnik, Maciej Krawczyk

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)
7 Downloads (Pure)

Abstract

Background and Purpose
Many stroke trials include maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and sniff nasal inspiratory pressure (SNIP) outcome measurements. However, data on agreement and reliability of repeated MIP, MEP, and SNIP measurements in acute and subacute stroke patients are scarce.

Methods
This study employed a test–retest design. Eighteen patients (seven female) with mean (SD) age 59 (14.5) years were recruited from neurological wards. Median (range) time since first stroke was 50.5 (21–128) days. MIP, MEP, and SNIP were measured repeatedly in three testing sessions (S1–3) conducted within 24 h and following international standards. Intra-rater agreement between testing sessions was analyzed using the Bland–Altman method. Test–retest reliability was analyzed using intra-class correlation coefficient (ICC). Association between individual measurement variability, time poststroke, and level of stroke impairment was analyzed using Spearman's rho.

Results
Mean difference and 95% limits of agreement for MIP were −0.40 (−23.02, 22.22) cmH2O between S1 and S2, and 2.14 (−12.79, 16.99) cmH2O between S2 and S3; for MEP, −4.56 (−29.01, 19.90) cmH2O between S1 and S2, and 0.29 (−24.28, 24.87) cmH2O between S2 and S3; and for SNIP, −10.56 (−38.48, 17.37) cmH2O between S1 and S2, and −6.06 (−27.32, 15.20) cmH2O between S2 and S3. ICCs for MIP, MEP, and SNIP were ≥0.9 throughout. There were no strong correlations between individual measurement variability and time poststroke or level of stroke impairment.

Discussion
MIP, MEP, and SNIP in acute and subacute stroke patients show good test–retest reliability for group averages; however, absolute agreement can vary considerably for some individuals.
Original languageEnglish
Article numbere1892
Number of pages11
JournalPhysiotherapy Research International
Volume26
Issue number2
Early online date20 Jan 2021
DOIs
Publication statusPublished - 1 Apr 2021
Externally publishedYes

Bibliographical note

This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Publisher Copyright:
© 2021 The Authors. Physiotherapy Research International published by John Wiley & Sons Ltd.

Funder

This work was supported by a Santander Mobility Grant, and a Private Physiotherapy Educational Foundation (PPEF) Individual Scholarship Award.

Keywords

  • agreement
  • maximal mouth pressure
  • reliability
  • respiratory muscle strength
  • smallest detectable change
  • standard error of measurement

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation

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