Test-retest reliability of lower limb isokinetic endurance in COPD: A comparison of angular velocities

Fernanda Ribeiro, Pierre-Alexis Lépine, Corine Garceau-Bolduc, Valérie Coats, Étienne Allard, François Maltais, Didier Saey, Fernanda Ribeiro, Pierre-Alexis Lépine, Corine Garceau-Bolduc, Valérie Coats, Étienne Allard, François Maltais, Didier Saey

Abstract

Background: The purpose of this study was to determine and compare the test-retest reliability of quadriceps isokinetic endurance testing at two knee angular velocities in patients with chronic obstructive pulmonary disease (COPD).

Methods: After one familiarization session, 14 patients with moderate to severe COPD (mean age 65±4 years; forced expiratory volume in 1 second (FEV1) 55%±18% predicted) performed two quadriceps isokinetic endurance tests on two separate occasions within a 5-7-day interval. Quadriceps isokinetic endurance tests consisted of 30 maximal knee extensions at angular velocities of 90° and 180° per second, performed in random order. Test-retest reliability was assessed for peak torque, muscle endurance, work slope, work fatigue index, and changes in FEV1 for dyspnea and leg fatigue from rest to the end of the test. The intraclass correlation coefficient, minimal detectable change, and limits of agreement were calculated.

Results: High test-retest reliability was identified for peak torque and muscle total work at both velocities. Work fatigue index was considered reliable at 90° per second but not at 180° per second. A lower reliability was identified for dyspnea and leg fatigue scores at both angular velocities.

Conclusion: Despite a limited sample size, our findings support the use of a 30-maximal repetition isokinetic muscle testing procedure at angular velocities of 90° and 180° per second in patients with moderate to severe COPD. Endurance measurement (total isokinetic work) at 90° per second was highly reliable, with a minimal detectable change at the 95% confidence level of 10%. Peak torque and fatigue index could also be assessed reliably at 90° per second. Evaluation of dyspnea and leg fatigue using the modified Borg scale of perceived exertion was poorly reliable and its clinical usefulness is questionable. These results should be useful in the design and interpretation of future interventions aimed at improving muscle endurance in COPD.

Keywords: chronic obstructive pulmonary disease; isokinetic endurance; lower limb; test-retest reliability.

Figures

Figure 1
Figure 1
Experimental design. Note: *Randomized order. Abbreviation: PFT, pulmonary function tests.
Figure 2
Figure 2
Bland-Altman plots. Notes: llustration by Bland-Altman plots of means differences (solid lines) and 95% confidence intervals (dotted lines) of a 30-maximal repetition isokinetic muscle endurance procedure performed on two separate occasions for peak torque, total work, work slope, work fatigue, dyspnea perception, and leg fatigue perception. Left panels illustrate means differences and 95% confidence intervals for peak torque (A), total work (C), work slope (E), work fatigue (G), dyspnea perception (I), and leg fatigue perception (K) during isokinetic leg extension performed at 90°/s. The right panels illustrate means differences and 95% confidence intervals for peak torque (B), total work (D), work slope (F), work fatigue (H), dyspnea perception (J), and leg fatigue perception (L) during isokinetic leg extension performed at 180°/s. Abbreviation: SD, standard deviation.
Figure 2
Figure 2
Bland-Altman plots. Notes: llustration by Bland-Altman plots of means differences (solid lines) and 95% confidence intervals (dotted lines) of a 30-maximal repetition isokinetic muscle endurance procedure performed on two separate occasions for peak torque, total work, work slope, work fatigue, dyspnea perception, and leg fatigue perception. Left panels illustrate means differences and 95% confidence intervals for peak torque (A), total work (C), work slope (E), work fatigue (G), dyspnea perception (I), and leg fatigue perception (K) during isokinetic leg extension performed at 90°/s. The right panels illustrate means differences and 95% confidence intervals for peak torque (B), total work (D), work slope (F), work fatigue (H), dyspnea perception (J), and leg fatigue perception (L) during isokinetic leg extension performed at 180°/s. Abbreviation: SD, standard deviation.

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