Isokinetic testing of muscle strength of older individuals post-stroke: An integrative review
Abstract
BACKGROUND:
Muscle weakness is a common impairment accompanying stroke.
OBJECTIVE:
Describe isokinetic testing procedures and clinimetric findings associated with the testing of older individuals with weakness following stroke.
METHODS:
Relevant articles were identified by an electronic PubMed search using the search string “isokinet
RESULTS:
Seventy-six relevant articles were found. The articles largely support the validity and reliability of isokinetic strength testing of older patients with stroke. Little data are available that provides specific information on the responsiveness for such measures.
CONCLUSIONS:
Isokinetic dynamometry is a valid and reliable measure of muscle strength after stroke. However, it is not particularly practical and information is lacking regarding its responsiveness.
1.Introduction
Stroke is the most common neurological disorder in the world today. The World Stroke Organization has estimated that the worldwide incidence of stroke is 15 million per year and that stroke is the second leading cause of death for adults older than 60 years [1]. Although numerous impairments can result directly from stroke, muscle weakness is probably the most common and obvious [2]. Several options are available for measuring muscle strength after stroke, among them are self-report [3] manual muscle testing [4], field tests such as sit-to-stand [5], hand-held dynamometry [6], hand-grip dynamometry [7], and isokinetic dynamometry [8]. This review focuses on isokinetic dynamometry. Specifically, it seeks to describe the isokinetic testing procedures that have been applied to older individuals with stroke and the findings obtained using the procedures.
2.Methods
Potentially relevant articles were identified by a search of PubMed on February 10, 2019. The search string used was “isokinet
Table 1
Summary of studies describing the isokinetic measurement of strength after stroke
Study | Participants | Procedures | Findings |
---|---|---|---|
Abdollahi et al. (2015) [8] | Iranians with chronic stroke ( | Cybex Model 770 dynamometer measured concentric strength (PT normalized against nonparetic side & bodyweight) of knee extension @ 90 | Validity: paretic side strength normalized against nonparetic side correlated SGNF ( |
An and Jo (2017) [9] | Koreans with chronic stroke assigned to ankle mobilization group ( | Biodex dynamometer measured B⃝ concentric paretic ankle dorsiflexion & plantarflexion strength (PT normalized against body weight) @ 30 | Responsiveness: ankle strength |
Andersen et al. (2011) [10] | Danish with chronic stroke ( | KinCom dynamometer measured B⃝ knee flexion & extension strength (normalized average torque) concentrically @ 30 & 240 | Validity: paretic side strength |
Avila et al. (2013) [11] | Brazilians with chronic stroke ( | Biodex Multi-joint System 3 dynamometer measured B⃝ concentric shoulder abduction strength (PT, total work, average power) @ 60 | Validity: all paretic side strength measures |
Barbic and Brouwer (2008) [12] | Canadians with chronic stroke ( | Biodex System 3 dynamometer measured B⃝ concentric hip flexion & extension strength (gravity normalized PT) @ 60 | Validity: strength of patients with stroke |
Bohannon (1992) [13] | Americans with subacute stroke ( | Lido Active Rehabilitation System measured B⃝ knee extension strength (maximum velocity, isometric PT & power). Speed was set @ 400 | Validity: strength of paretic side SGNF |
Bohannon (1987) [14] | Americans with subacute stroke ( | Cybex II measured B⃝ knee extension strength (torque) @ 30, 60, 120, & 189 | Validity: strength of paretic side |
Brogårdh et al. (2012) [15] | Swedes with chronic stroke assigned to vibration group ( | Biodex Multi-Joint System 3 PRO dynamometer measured B⃝ isokinetic concentric knee extension & flexion strength (PT) @ 60 | Validity: strength of paretic side |
Calmels et al. (2011) [16] | French with subacute or chronic stroke ( | Cybex 6000 dynamometer measured B⃝ knee extension strength (body weight normalized PT) concentrically @ 60 & 120 | Validity: strength of paretic side |
Table 1, continued | |||
---|---|---|---|
Study | Participants | Procedures | Findings |
Carvalho et al. (2013) [17] | Swedes with chronic stroke ( | Biodex Multi-Joint System 3 PRO dynamometer measured concentric B⃝ knee flexion & extension strength (maximum torque) @ 60 | Validity: mean strength of paretic side of patients was |
Chen et al. (2015) [18] | Taiwanese with subacute stroke assigned to isotonic training ( | Biodex dynamometer measured B⃝ isometric knee flexion & extension strength (PT) @ 90 | Responsiveness: knee strength |
Clark et al. (2006) [19] | Americans with chronic stroke ( | Biodex System 3 Pro dynamometer measured paretic knee extension strength (torque & power) isometrically @ 0 | Validity: knee extension strength (as % of maximum capacity) of paretic knee extensors |
Cohen et al. (2018) [20] | Canadians with subacute stroke ( | Biodex System 3 Pro dynamometer measured B⃝ concentric knee & hip flexion & extension strength (PT & power) @ 60 | Validity: strength of the nonparetic lower limb was SGNF |
Coroian et al. (2018) [21] | French with chronic stroke assigned to isokinetic strengthening ( | CON-TREX dynamometer measured elbow flexor & extensor strength (PT) @ 30 | Responsiveness: strength |
Dehkordi et al. (2008) [22] | Iranians with chronic stroke ( | Biodex dynamometer measured B⃝ concentric knee flexion & extension strength (PT & normalized PT) @ 60 & 120 | Validity: strength of the affected side SGNF |
Dias et al. (2017) [23] | Brazilians with chronic stroke ( | Biodex dynamometer measured isometric ankle plantar flexion strength (PT normalized against body mass) at maximum dorsiflexion, 0 | Validity: strength of affected limb SGNF |
Ekiz et al. (2015) [24] | Turks with subacute/ chonic stroke assigned to kinesio tape ( | Biodex System 3 Pro Multijoint System dynamometer measured B⃝ knee flexion and extension strength (PT) @ 60 & 180 | Responsiveness: after 4 weeks of training, paretic side & nonparetic side strength |
Table 1, continued | |||
---|---|---|---|
Study | Participants | Procedures | Findings |
Ekstrand et al. (2015) [25] | Swedes with chronic stroke ( | Biodex System 3 PRO dynamometer measured B⃝ shoulder isometric abduction strength (torque) @ 15 | Reliability: test-retest (1 week apart) – ICC (less affected/more affected) isometric shoulder abduction |
Ekstrand et al. (2016) [26] | Swedes with chronic stroke ( | Biodex System 3 PRO dynamometer measured B⃝ isometric shoulder abduction @ 15 | Validity: grip strength was correlated SGNF with other strength measures of both sides: isometric shoulder abduction ( |
Eng et al. (2002) [27] | Canadians with chronic stroke ( | Kim-Com dynamometer measured B⃝ concentric hip, knee, & ankle flexion & extension strength (PT & average torque) @ 60 | Validity: all strength measures of non-involved side SGNF |
Eng et al. (2009) [28] | Canadians with chronic stroke ( | Kin-Com dynamometer measured B⃝ concentric & eccentric hip, knee, & ankle flexor & extensor strength (PT) @ 30 | Validity: strength of controls |
Engardt et al. (1995) [29] | Swedes ambulatory after stroke assigned to concentric training ( | Kin-Com 500H dynamometer measured B⃝ concentric and eccentric strength (average torque) @ 60, 120, & 180 | Responsiveness: concentric & eccentric strength |
Fernandez-Gonzalo et al. (2014) [30] | Swedes with chronic stroke ( | IsoMed 2000 dynamo-meter measured B⃝ concentric and eccentric knee extension strength (PT over 1 s window) @ 30, 60, & 90 | Validity: all strength measures of affected limb SGNF |
Flansbjer et al. (2006) [31] | Swedes with chronic stroke ( | Biodex Multi-joint System II dynamometer measured B⃝ concentric knee extension & flexion strength (PT) @ 60 | Validity: strength of paretic knee extension & flexion |
Table 1, continued | |||
---|---|---|---|
Study | Participants | Procedures | Findings |
Flansbjer et al. (2005) [32] | Swedes with chronic stroke ( | Biodex Multijoint System II dynamometer measured B⃝ knee strength (torque) at 60 | Reliability: test-retest 7 days apart – ICC |
Flansbjer et al. (2012) [33] | Swedes with chronic stroke (mean age | Biodex Multijoint System 3 PRO dynamometer measured B⃝ knee flexion & extension strength (torque) @ 60 | Validity: strength of nonparetic side SGNF |
Flansbjer et al. (2008) [34] | Swedes with chronic stroke assigned to resistance training ( | Biodex Multi-Joint System 3 PRO dynamometer measured B⃝ concentric knee flexion & extension strength (PT) @ 60 | Validity: strength of paretic knee muscles |
Freire et al. (2017) [35] | Brazilians with chronic stroke ( | Biodex Medical System 3 dynamometer measured B⃝ isometric ankle plantarflexion strength (normalized torque) @ 0 | Validity: maximum plantarflexion strength and strength @ 0 |
Gray et al. (2017) [36] | Americans with chronic stroke ( | Biodex System Pro4 dynamometer measured B⃝ isokinetic ankle dorsiflexion & plantarflexion strength & hip abduction & adduction strength (PT) @ 30 | Validity: all strength measures of paretic limb |
Hameau et al. (2014) [37] | French with chronic stroke ( | ConTrex – MJ dynamometer measured paretic isokinetic knee flexion & extension strength (PT) @ 30, 60, & 90 | Responsiveness: all strength measures except knee flexion @ 90 |
Hamrin et al. (1982) [38] | Swedes with chronic stroke assigned to special activation ( | Cybex II dynamometer measured knee extension & flexion strength & elbow extension and flexion strength (torque) @ 45 & 60 | Validity: paretic limb strength |
Hsu et al. (2003) [39] | Taiwanese with chronic stroke ( | Cybex 6000 dynamometer measured B⃝ hip flexor, knee extensor, & ankle plantarflexor strength (normalized PT & total work) @ 30 | Validity: affected limb strength |
Hsu et al. (2002) [40] | Taiwanese with chronic stroke ( | Cybex 6000 dynamometer measured B⃝ hip flexor, knee extensor, & ankle plantarflexor strength (normalized PT, total work & average power) @ 30 | Validity: affected limb strength |
Table 1, continued | |||
---|---|---|---|
Study | Participants | Procedures | Findings |
Hyun et al. (2015) [41] | Koreans with subacute stroke ( | Humac Norm measured B⃝ isometric knee flexion & extension strength (gravity-corrected PT) @ 60 | Validity: paretic limb strength |
Karatas et al. (2004) [42] | Turks with acute stroke ( | Cybex 770 NORM dynamometer measured concentric & isometric trunk flexion & extension strength (PT) @ 60, 90, 120 & 0 | Validity: strength measures of healthy controls |
Kim and Eng (2003) [43] | Canadians with chronic stroke ( | Kin-Com measured B⃝ hip, knee, and ankle flexors & extensor strength (average torque normalized to body mass) @ 60 | Validity: paretic side strength |
Kim et al. (2001) [44] | Canadians with chronic stroke assigned to isokinetic strength training ( | Kin-Com dynamometer measured B⃝ hip flexion & extension, knee flexion & extension, & ankle dorsiflexion & plantarflexion strength (average torque normalized against body mass) @ 60 | Validity: strength of paretic side |
Kim et al. (2005) [45] | Americans with chronic stroke ( | Biodex System 3.0 measured B⃝ elbow flexion & extension & shoulder flexion strength (torque, speed, power) at 30, 75 & 120 | Validity: strength of paretic side |
Kim et al. (2016) [46] | Koreans with chronic stroke assigned to ankle biofeedback training ( | Biodex dynamometer measured isometric affected ankle dorsiflexion & plantar flexion strength (PT) with ankle @ 60 | Responsiveness: strength |
Knorr et al. (2010) [47] | Canadians with chronic stroke ( | Biodex dynamometer measured B⃝ concentric hip & knee flexion & extension strength (body-weight normalized PT) @ 60 | Validity: strength of paretic lower limb SGNF |
Kwong et al. (2017) [48] | Chinese with chronic stroke ( | Cybex 6000 dynamometer measured paretic concentric knee extensor and flexor strength (PT) @ 90 | Validity: strength measures correlated SGNF with one another ( |
Table 1, continued | |||
---|---|---|---|
Study | Participants | Procedures | Findings |
Lau et al. (2012) [49] | Hong Kongese with chronic stroke assigned to whole body vibration ( | Cybex dynamometer measured paretic side isometric knee flexion & extension strength (body mass normalized PT) @ 70 | Responsiveness: strength |
Lee et al. (2015) [50] | Koreans with stroke assigned to overground treadmill walking ( | Biodex dynamometer measured knee flexion & extension strength (PT) @ 60 & 120 | Responsiveness: After 6 wk of training all strength measures |
Lee and Kang (2013) [51] | Korean inpatients with stroke assigned to isokinetic eccentric strengthening ( | Cybex 770 dynamometer measured hip flexion & extension strength (PT) @ 90 | Responsiveness: after 6 wk the eccentric training group demonstrated a SGNF |
Lee et al. (2018) [52] | Koreans with subacute stroke assigned to hydrotherapy ( | Humac Norm dynamometer measured B⃝ isometric knee flexion & extension strength (PT) while knees were @ 60 | Responsiveness: |
Liao et al. (2016) [53] | Chinese with chronic stroke assigned to low intensity whole body vibration ( | Humac NormTM dynamometer measured B⃝ knee flexion & extension strength (body mass normalized torque) isometrically while knees were at 30 & 70 | Responsiveness: most strength measures stayed the same or increased. SGNF |
Lindmark et al. (1995) [54] | Swedes with subacute stroke ( | Cybex II dynamometer measured B⃝ knee flexion & extension strength (torque) @ 90 & 12 | Validity: strength of nonparetic limb |
Lindström et al. (1998) [55] | Swedes with stroke ( | Cybex II measured B⃝ knee flexion and extension strength (PT) @ 90 | Validity: strength of controls |
Lomaglio and Eng (2005) [56] | Canadians with chronic stroke ( | Kin-Com measured B⃝ concentric strength (average body mass normalized torque) of ankle plantar flexion & dorsiflexion @ 30 | Validity: 3 of 6 strength measures of the paretic lower limb correlated SGNF with self-paced STS ( |
Lum et al. (2004) [57] | Americans with chronic stroke ( | Biodex System 3 Pro measured B⃝ elbow flexion & extension strength (isokinetic torque normalized against isometric torque) isometrically @ 90 | Validity: strength of paretic limb SGNF |
Table 1, continued | |||
---|---|---|---|
Study | Participants | Procedures | Findings |
MacIntyre et al. (2010) [58] | Canadians with subacute stroke ( | Biodex System 3 measured knee extension and ankle plantarflexion strength (body mass normalized torque) at 60 & 30 | Validity: strength of patients with stroke SGNF |
Maeshima et al. (2003) [59] | Japanese with stroke assigned to conventional training ( | Biodex System 3 measured nonparetic knee extension and flexion strength (body mass normalized PT) @ 60 | Validity: strength of ambulatory patients SGNF |
Marigold et al. (2004) [60] | Canadians with stroke ( | Kin-Com dynamometer measured B⃝ concentric strength (PT) of the ankle flexors & extensors (30 | Validity: Muscle strength had SGNF relationships ( |
Marque et al. (1997) [61] | French with acute stroke ( | Cybex 600 measured non paretic flexion & extension strength of hip @ 60 | Validity: nonparetic strength of patients was |
Nakamura et al. (1985) [62] | Japanese with chronic stroke ( | Cybex II dynamometer measured B⃝ extension strength (PT) isokinetically @ 30 | Validity: affected side strength measures SGNF |
Nascimento et al. (2014) [63] | Brazilians with chronic stroke ( | Biodex Medical System 3 Pro dynamometer measured B⃝ shoulder internal & external rotation, shoulder flexion & extension, & scapular protraction & retraction strength (PT & work expressed as % of control group) @ 60 | Validity: all strength measures of patients with stroke |
Novak and Brouwer (2012) [64] | Canadians with chronic stroke ( | Biodex System 3 measured B⃝ concentric & eccentric strength (body mass normalized torque) of ankle plantarflexion @ 30 | Validity: strength of controls SGNF |
Pang et al. (2013) [65] | Chinese with chronic stroke assigned to a whole body vibration group ( | Cybex NUMAC dynamometer measured concentric and eccentric knee extension & flexion strength (peak power normalized to body mass) @ 60 | Responsiveness: most strength measures |
Ploutz-Snyder et al. (2006) [66] | Americans with chronic stroke ( | Biodex System 3 dynamometer measured B⃝ isometric elbow flexion and extension strength (torque) @ 90 | Validity: strength of affected side SGNF |
Table 1, continued | |||
---|---|---|---|
Study | Participants | Procedures | Findings |
Pohl et al. (2000) [67] | Americans with stroke ( | Cybex II dynamometer measured B⃝ knee extension & flexion strength (PT & average torque) @ 60 | Validity: affected side strength |
Quintino et al. (2018) [68] | Brazilians with stroke ( | Biodex dynamometer measured concentric trunk flexion & extension strength (PT, torque @ 90 | Validity: all strength measures of patients with stroke were SGNF |
Rabelo and Fachin-Martins (2018) [69] | Brazilians with chronic stroke ( | Biodex System 3 Pro measured trunk flexion and extension strength (PT, PT normalized to body weight, power & total work) @ 60 | Reliability: inter-rater reliability – ICC |
Ryan et al. (2011) [70] | Americans with chronic stroke ( | Kin-Com 125AP measured B⃝ knee concentric & eccentric strength (PT) @ 90 & 120 | Validity: strength of paretic knee SGNF |
Şen et al. (2015) [71] | Turks with subacute- chronic stroke assigned to isokinetic exercise ( | Biodex System 3 Pro Multijoint System dynamometer measured B⃝ knee extension and flexion strength (PT) @ 60 | Validity: strength of nonparetic strength measures all SGNF |
Sharp et al. (1997) [72] | Canadians with chronic stroke ( | Cybex 2 dynamometer measured B⃝ knee extension and flexion strength (PT) @ 30, 60, & 120 | Validity: strength of the paretic side SGNF |
Shimodozono et al. (2010) [73] | Japanese with subacute stroke assigned to isokinetic training | Cybex 6000 dynamometer measured nonparetic knee flexion & extension strength (bodyweight normalized PT) isometrically, isotonically & @ 60, 120 & 180 | Responsiveness: strength of nonparetic side |
Silva et al. (2015) [74] | Brazilians with stroke ( | Biodex dynamometer measured concentric trunk flexion & extension strength (PT & total normalized work) @ 60 | Validity: all strength measures of patients with stroke were SGNF |
Sunnerhagen and Mattsson (2005) [75] | Swedes with chronic stroke ( | Kin-Com dynamometer measured B⃝ knee flexion & extension strength (torque) isometrically @ 60 | Validity: strength of paretic limb |
Suzuki et al. (1999) [76] | Japanese with subacute stroke ( | Cybex II dynamometer measured B⃝ knee extension strength (PT) @ 30 | Validity: strength correlated SGNF with most balance measures: sway path ( |
Table 1, continued | |||
---|---|---|---|
Study | Participants | Procedures | Findings |
Suzuki et al. (1990) [77] | Japanese with stroke ( | Cybex II dynamometer measured B⃝ knee extension strength (PT) @ 30 | Validity: strength of paretic side |
Tanaka et al. (1997) [78] | Japanese men with stroke ( | Cybex trunk Extension-Flexion dynamometer measured trunk flexion & extension strength (PT) @ 0, 60, 120, & 150 | Validity: strength of men with stroke SGNF |
Tanaka et al. (1997) [79] | Japanese men with stroke ( | Cybex Torso Rotation dynamometer measured left & right rotation strength (PT & best work) @ 60, 120, & 150 | Validity: strength of men SGNF |
Tankisheva et al. (2014) [80] | Belgians with chronic stroke assigned to vibration training ( | Biodex dynamometer measured B⃝ isometric knee flexion & extension strength (torque) at 60 | Responsiveness: all strength measures |
Teixeira-Salmela et al. (1999) [81] | Canadians with chronic stroke assigned to exercise group ( | Cybex II dynamometer measured hip & knee flexion & extension & ankle plantarflexion & dorsiflexion strength (total PT) @ 30 & 60 | Validity: torques generated at 2 speeds correlated SGNF ( |
Tyson et al. (2013) [82] | British with stroke receiving electrical stimulation via a sock electrode ( | Biodex dynamometer measured B⃝ dorsiflexion & plantarflexion strength (mean torque) @ 60 | Responsiveness: strength |
Wang et al. (2014) [83] | Taiwanese with chronic stroke ( | Biodex dynamometer measured B⃝ concentric knee extension strength (torque) @ 60 | Validity: all strength measures correlated SGNF with walking speed ( |
3.Results and discussion
The PubMed search identified 161 potentially relevant articles. An additional 3 possibly relevant articles were identified by hand searches. Ultimately, 76 articles were found that met inclusion and exclusion criteria. Relevant information from those articles is summarized alphabetically by author in Table 1 [8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83].
The summarized information shows that isokinetic dynamometers have been used extensively to measure strength in individuals with stroke, most often older adults (mean/median age of 48.3 to 74.0 years) with chronic stroke. Isokinetic testing of individuals with stroke has been conducted in at least 15 different countries, but testing is reported most widely in North America and Europe. Utilization of some model of 7 different dynamometers has been described in the literature, with some type of Biodex described most frequently, followed by some model of Cybex or KinCom. Most articles that specified the type of measurement obtained documented concentric torque. Some articles however were inspecific or reported the measurement of eccentric or isometric torque with isokinetic dynamometers. A few articles reported torque normalized against body weight, the nonparetic side, or healthy controls [8, 9, 11, 16, 20, 22, 23, 35, 40, 43, 44, 53, 56, 58, 64, 65, 69, 73], or measures of work, power, or velocity [13, 40, 45, 63, 68, 69, 79]. The speed of concentric and eccentric testing ranged from 15 to 240
The clinimetric properties of isokinetic testing of individuals with stroke is generally well-supported. Validity has been demonstrated most often by differences in known groups and known conditions. Specifically, numerous studies have demonstrated that individuals with stroke are weaker, often significantly (SGNF), than controls in both the paretic [11, 17, 19, 28, 38, 55, 63, 64] and nonparetic [11, 17, 23, 28, 35, 38, 55, 61, 63, 71, 74, 78] limbs, that individuals with stroke are weaker (almost always SGNF) on their paretic side than on their nonparetic side [10, 13, 14, 15, 16, 20, 22, 23, 27, 28, 30, 31, 33, 34, 35, 36, 38, 40, 41, 43, 45, 47, 54, 55, 67, 68, 70, 72, 75, 77], that men tend to be SGNF stronger than women [79], that ambulatory individuals tend to be SGNF stronger than nonambulatory individuals [59], and that community ambulators are SGNF stronger than household ambulators [41]. Validity is also supported by correlations between isokinetically measured strengths of different muscle actions [26, 48] and between isokinetic strength measures at different speeds [14, 62, 81]. Most studies examining the correlation between isokinetic measurements of the lower limbs and mobility [13, 17, 31, 38, 39, 43, 47, 48, 54, 56, 62, 70, 74, 76, 77, 83] and other important variables [20, 60] have also reported SGNF results.
Numerous studies have used intraclass correlation coefficients (ICCs) to describe the relative reliability of strength measures obtained from individuals with stroke tested with isokinetic dynamometers. One study reported ICCs for inter-tester reliability of 0.61 to 0.96 [69]. All other studies addressing reliability focused on the test-retest consistency of measures obtained over periods of 1 day to 6 weeks. With the exception of a few results reported by Hsu et al. [40] and Kim et al. [45] virtually all test-retest ICCs reported exceeded 0.80 [8, 19, 22, 25, 27, 32, 40, 45, 67, 69]. The absolute reliability of isokinetic measures obtained from patients with stroke has received little attention. However, a few studies have reported a wide range of smallest real differences of 1.5 to 85.1% [19, 25, 15, 32], which also reflect on responsiveness. No studies were found that used minimal detectable changes or minimal clinically important differences to reflect responsiveness. What was found in abundance were studies showing a wide range of increases in isokinetic strength, some SGNF in response to strengthening and other interventions as well as the natural course of stroke recovery [11, 16, 18, 21, 24, 29, 30, 33, 34, 37, 44, 46, 49, 50, 51, 52, 53, 61, 65, 71, 72, 73, 76, 80, 81, 82]. Whether described using ICCs, smallest real difference or some other indication of reliability the magnitude of summary descriptions is dependent on the sensitivity of the isokinetic measurement, the time between measurements, the natural course of stroke recovery, and the effectiveness of any intervention applied between measurements.
In spite of precedence and evidence supporting the use of isokinetic testing of strength following stroke, the information in this nonsystematic review is limited. Most notably, a single bibliographic database (PubMed) was used. While it is doubtful that the inclusion of additional databases would have markedly altered the results, such expansion may have added to the evidence for the conclusions presented herein. A more systematic review may have also allowed for a meta-analysis of some variables and for a quality assessment of included articles.
4.Conclusion
There is considerable research support for measuring the isokinetic strength of older individuals who have experienced a stroke. That noted, the data are mostly limited to the young old and information on responsiveness is limited.
Conflict of interest
The author declares no conflict of interest.
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