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

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

doi:10.1002/pri.1892

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

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

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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 language	English
Article number	e1892
Number of pages	11
Journal	Physiotherapy Research International
Volume	26
Issue number	2
Early online date	20 Jan 2021
DOIs	https://doi.org/10.1002/pri.1892
Publication status	Published - 1 Apr 2021
Externally published	Yes

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

Access to Document

10.1002/pri.1892Licence: CC BY-NC

PublishedFinal published version, 1.17 MBLicence: CC BY-NC

https://eprints.kingston.ac.uk/id/eprint/48059/

Cite this

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title = "Agreement and reliability of repeated bedside respiratory muscle strength measurements in acute and subacute stroke",

abstract = "Background and PurposeMany 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.MethodsThis 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.ResultsMean 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.DiscussionMIP, 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.",

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author = "Agnieszka Lewko and Marta Sidaway and Kulnik, {Stefan Tino} and Maciej Krawczyk",

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AU - Lewko, Agnieszka

AU - Sidaway, Marta

AU - Kulnik, Stefan Tino

AU - Krawczyk, Maciej

N1 - 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.

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N2 - Background and PurposeMany 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.MethodsThis 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.ResultsMean 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.DiscussionMIP, 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.

AB - Background and PurposeMany 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.MethodsThis 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.ResultsMean 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.DiscussionMIP, 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.

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

Abstract

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Keywords

ASJC Scopus subject areas

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