INTERTESTER RELIABILITY OF MANUAL MUSCLE STRENGTH TESTING IN LEPROSY PATIENTS

This study reports the results of a study on the intertester reliabili ty of manual muscle strength testing in leprosy patients with confirme d motor function loss of at least one nerve. Three testers graded the muscle strength of 72 patients in random order. Both hands and feet we re graded. Strength was graded on a modified Medical Research Council Scale (9 points, 5, 4+, 4, 3+, 3, 2+, 2, I, 0). The following movement s were tested for strength: little finger and index finger abduction, intrinsic position of all four fingers, thumb abduction and opposition , foot dorsiflexion and eversion and extension of the big toe. The wei ghted kappa statistic was used to calculate the chance-corrected perce ntage of agreement between observers. Overall agreement for each of th e II tests appeared to be good or very good (0.61-1.00). However, when data for hands or feet with normal strength or complete paralysis wer e excluded from the analysis, the reliability of the remaining mid-ran ge scale was not acceptable (kappa 0.55-0.88, direct agreement range 1 1-41%). While the reliability of this scale could possibly be improved by special training, we feel that, for the evaluation of nerve functi on for leprosy patients with (suspected) nerve function loss, the exte nded 9-point VMT scale should only be used when direct intra-or intert ester agreement is more than 80%.