Reliability of Muscle Testing Under Scrutiny, Article Critique Example

Cuthbert, S.C. & Goodheart, G.J. Jr. 2007On the reliability and validity of manual muscle testing: a literature review.

The title of the article clearly states the purpose of the examination, which is to scrutinize the validity and reliability of manual muscle testing. The abstract is clear and precise. It details the pertinent aspects of each section of the article and succinctly summarizes all the relevant details. The introduction concisely states the purpose and intent of the article: “The aim of this report is to provide an historical overview, literature review, description, synthesis and critique of the reliability and validity of MMT in the evaluation of the musculoskeletal and nervous systems” (Cuthbert & Goodheart, 2007, p.2). Reading the article did not reveal any major flaws or defects in the reasoning or logical review of the relevant literature cited within the context.

The researchers do not seem to use superfluous references and have done thorough research, conducting a plethora of sources discussing the topic of the muscle system in spinal function and Manual muscle testing (MMT) as a method of diagnosis for spinal dysfunction. The article presents an appropriate assessment of all of the facts and details garnered from the research and provide examples of various methods used for muscle testing, such as the methods demonstrated in, and express their intent to avoid “…preconceived impressions regarding the test outcome” (Cuthbert & Goodheart, 2007, pg. 5; Lu, Lin, Hsiao, Liu, Chen, & Lue, 2011). The study also discusses the history of how manual muscle testing was previously performed by practitioners’ hands, isokinetic machines, and other handheld devices and that isokinetic machines and dynamometers are still too expensive or cumbersome for clinical use or for more objective muscle tests, but is useful for research purposes (Cuthbert & Goodheart, 2007). The article continues with much relevant discussion regarding the methods used to gather the data as well as the tools and process used to analyze, quantify, and interpret the information gathered. It is important to select the best method of assessment for muscle testing and the examination of the literature relevant was thoroughly conducted to provide current details regarding the most popular methods and the established determinations of their accuracy (Shimon, Darden, Martinez, & Clouse-Snell, 2010).

The author has cited a variety of pertinent literary sources pertinent to the topic in question and has covered numerous areas of import as well as a variety of ideas on the subject, without stressing or over-emphasizing any particular areas of discussion. This allows for a greater range of facts to be presented on the topic and enables the reader to receive a larger amount of information from many sources. As Cuthbert & Goodheart (2007) state, “This review of the literature shows the importance of clinical experience and expertise, and this factor has been highlighted in many papers discussing the reliability of the MMT” (p.8). However, the authors also state that involving a large number of variables related to multiple joint movements and handling techniques results in too many options that are difficult to control, which warrants the suggestion that fewer sources and variables be introduced to make the results easier to determine (Cuthbert & Goodheart, 2007, pp.6-7).

In addition, this journal article may have only touched on those many difficulties associated with manual muscle testing and the authors have an admitted personal interest in results. On the positive side, the point made about objective scientific methods and how they may not be as good as the subjective ability of the practitioner because of the limits of science is also a pertinent facet of the study that must be considered and is mentioned in the article. The authors use the example of a statement made by Kendall et al (1993), stating that:

“As tools, our hands are the most sensitive, fine-tuned instruments available……….All the while this instrument we call the hand is hooked up to the most marvelous computer ever created. It is the examiner’s very own personal computer and it can store valuable and useful information of the basis of which judgments about evaluation and treatment can be made. Such information contains objective data that is obtained without sacrificing the art and science of manual muscle testing to the demand for objectivity” (Cuthbert & Goodheart, 2007, p.7).

In this manner, the authors make clear statements regarding their interpretation of the importance of manual muscle testing and the role of the practitioner in this process. The author states that “This holistic system of approach for the evaluation of neuromuscular function continues to be updated on a regular basis with new and exciting research” and that they consider such practice as a form of art (Cuthbert & Goodheart, 2007, p.14).

These statements also project the underlying assumptions of the authors that the use of manual procedures in muscle testing allows for sensitivities absent when mechanized and that it detracts from the closeness of the doctor-patient relationship. It is expressed by the authors that the physician has the unique ability to specifically determine areas of dysfunction and thereby individualize the treatment given (Cuthbert & Goodheart, 2007). The cost effective nature of the absence of machines in testing is also a significant factor commented on regarding the estimation of best practices when using these techniques (Reiman, Krier, Nelson, Rogers, Stuke, & Smith, 2010). However, although the authors clearly have a preference regarding the most effective methods, they do objectively present the benefits to be gained from the use of other methods and also state the efficacy of these alternative methods. In their analysis of other methods, Cuthbert & Goodheart (2007), also state possible limitations relative to the use of other muscle testing strategies:

“…There also exists a large body of data demonstrating how electromyographic signals are used as an objective representation of neuromuscular activity in patients. The EMG is a valid index of motor unit recruitment and reflects the extent to which the muscle is active; however there are some difficulties with the sensitivity and specificity of electrodiagnosis” (p.12).

The objective of this research holds implicit significance for the field chiropractic and medical field as a whole because applied kinesiology chiropractic technique (AK) is one of the oldest methods and MMT is the most commonly used method for documenting impairments in muscle strength (Cuthbert & Goodheart, 2007). The limited muscle testing methods taught in chiropractic schools around the world and the growing number of clinicians that use AK techniques warrants definitive confirmation regarding the true benefits and limitations associated with these methods of treatment (Cuthbert & Goodheart, 2007). Although the methodologies explored in the study are appropriate, many of the methods discussed are not described in any detail, only referenced. The procedures are mentioned in passing, as demonstrated in the statement “The early years of the AK method are related elsewhere in detail” (Cuthbert & Goodheart, 2007, p.3). However, the designs used by the authors to gather and analyze the data are appropriate for the purposes of the study since “The skills of the examiners conducting studies on MMT and their skills in interpreting the derived information will affect the usefulness of MMT data” (Cuthbert & Goodheart, 2007, p.8).

The objectives of the study are clearly identified and the study method used is appropriately applied to provide reliable results in this study. Reliability and validity are defined as the extent to which an experiment, test, or measuring procedure yields the same results on repeated trials and valid meaning well-grounded or justifiable results are produced, being at once relevant and meaningful (Reliability, 2012). Subjective validity is relative to the conditions of the thinking subject either to the universal limitations of human experience and knowledge or to personal limitations, such as ignorance, or circumstances of individual judgment. The authors cite numerous correlating studies supporting the method of statistical analysis that they used to interpret the findings of their study and were similar to the technique used in parallel muscular studies (Reiman, Krier, Nelson, Rogers, Stuke, & Smith, 2010). The authors have comprised multiple visual accoutrements, such as tables, to reflect the details found through the research (Cuthbert & Goodheart, 2007).

The research is extensive and includes studies dating as far back as 1912 and validity is discussed in abundance, demonstrating how construct and content validity are confirmed through reasonable argument as opposed to experimental study (Cuthbert & Goodheart, 2007). The calculations and determinations appear valid and correct, as indicated by the presentation of the data. The authors conclude with definitive statements regarding the limitations of their research, including “…problems with the actual forces measured by a hand-held dynamometer (HHD) and in providing the stabilization that is essential for controlling variables and for standardization of the testing technique; as even a slight tipping of the devise during testing can alter its results” (Cuthbert & Goodheart, 2007, pg. 12). Although this narrative literature review offers considerable evidence about the reliability and validity of MMT as an examination tool, most of the research retrieved has developed within the past 30 years (Cuthbert & Goodheart, 2007, pp. 14-15). Furthermore, the study cites limitations in the search method used to compile the data used in the study.

References

Barrett, S. (2010, September 13). Applied kinesiology: Phony muscle-testing for “Allergies” and “Nutrient Deficiencies”. Retrieved from www.quackwatch.org.

Cuthbert, S.C. & Goodheart, G.J. Jr. 2007On the reliability and validity of manual muscle testing: a literature review. Chiropractic & Osteopathy, 15(4). Retrieved from BoiMed Center. (10.1186/1746-1340-15-4)

Lu, Y., Lin, J., Hsiao, S., Liu, M., Chen, S., & Lue, Y.. (2011). The relative and absolute reliability of leg muscle strength testing by a handheld dyanometer. Journal of Strength and Conditioning Research, 25(4), 1065-1071. Retrieved from ProQuest Health and Medical Complete. (2331247681)

Reiman, M., Krier, A., Nelson, J., Rogers, M., Stuke, Z., & Smith, B.. (2010). Reliability of alternative trunk endurance testing procedures using clinician stabilization vs. traditional methods. Journal of Strength and Conditioning Research, 24(3), 730-6. Retrieved from ProQuest Health and Medical Complete. (2004756221)

Reliability. (2012). The Free On-line Dictionary of Computing. Retrieved from Dictionary.com website: http://dictionary.reference.com/browse/Reliability

Shimon, J., Darden, G., Martinez, R., & Clouse-Snell, J.. (2010). Initial reliability and validity of the lift-and-release hamstring test. Journal of Strength and Conditioning Research, 24(2), 517-21. Retrieved from ProQuest Health and Medical Complete. (1980065041)