Use of the modified sphygmomanometer test to assess muscle strength in children and adolescents: a systematic review

Martins, Júlia Caetano; Matos, João Osmar Teixeira; Alves, Taluane Vívian Gomes; Andrade, Alice Caroline Arnaldo; Aquino, Cecília Ferreira de

doi:10.1590/1809-2950/e23004523en

Brasil

Fisioterapia e Pesquisa

Sumário Anterior Atual Seguinte

Sumário

SYSTEMATIC REVIEW • Fisioter. Pesqui. 31 • 2024 • https://doi.org/10.1590/1809-2950/e23004523en linkcopy

Use of the modified sphygmomanometer test to assess muscle strength in children and adolescents: a systematic review

Aplicación de la prueba del esfigmomanómetro modificada en la evaluación de la fuerza muscular en niños y en adolescentes: una revisión sistemática

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT:

Evaluating muscle strength in the pediatric population allows comparing healthy and affected individuals, establishing recovery goals, tracking the results of interventions and the evolution over time due to health conditions, as well as monitoring load progression and level of training. The Modified Sphygmomanometer Test (MST) is a technique used to measure isometric muscle strength in this population. The objective of the study is to gather and synthesize studies that used MST to measure the muscular strength of children and adolescents, identifying the muscle groups, measurement properties investigated, and the applied protocols. Bibliographic search was conducted on the MEDLINE, Embase, PEDro, SciELO, and LILACS databases. Original, peer-reviewed studies published up to September 2021 that evaluated isometric muscle strength using MST in children and adolescents aged 0 to 19 years were selected. A total of 1,610 studies were identified, and 17 were considered eligible. Of these, 12 studies (70.6%) were conducted with a mixed population and five (29.4%) with only children and adolescents. The most evaluated muscle groups were hip adductors (47.5%) and handgrip (29.4%) with a predominance of the non-adapted sphygmomanometer (47.1%) and 20mmHg pre-insufflation (47.1%). Only six studies (35.3%) evaluated MST measurement properties . In conclusion, there are few studies aimed at the pediatric population, which hinders the standardization of MST application in clinical practice, despite being easy to access and handle.

Keywords
adolescents; children; muscle strength

RESUMO:

A avaliação da força muscular na população pediátrica possibilita comparar indivíduos saudáveis e com alguma condição de saúde, estabelecer metas de recuperação, acompanhar os resultados das intervenções e a evolução ao longo do tempo, além de permitir monitorar a progressão de carga e o nível de treinamento. O teste do esfigmomanômetro modificado (TEM) é uma técnica que pode ser usada para mensurar a força muscular isométrica dessa população. O objetivo do estudo foi reunir e produzir uma síntese dos estudos que utilizaram o TEM para mensuração da força muscular de crianças e adolescentes, identificando os grupos musculares e as propriedades de medida investigados e os protocolos aplicados. A busca foi realizada nas bases de dados MEDLINE, EMBASE, PEDro, SciELO e LILACS. Foram selecionados estudos originais, revisados por pares, publicados até setembro de 2021, que avaliaram a força muscular isométrica com o uso do TEM em crianças e adolescentes com idade entre 0 e 19 anos. Um total de 1.610 estudos foram obtidos na busca, sendo 17 elegíveis. Destes, 12 estudos (70,6%) foram realizados com população mista, e cinco (29,4%), somente com crianças e adolescentes. Os grupos musculares mais avaliados foram os adutores de quadril (47,1%) e preensão palmar (29,4%), com predominância do esfigmomanômetro não adaptado (47,1%) e pré-insuflação de 20mmHg (47,1%). Apenas seis estudos (35,3%) avaliaram as propriedades de medida do TEM. Conclui-se que existem poucos estudos voltados à população pediátrica, o que dificulta padronizar a aplicação do TEM na prática clínica, apesar de o instrumento ser de fácil acesso e manuseio.

Descritores
Adolescentes; Crianças; Força muscular

RESUMEN:

La evaluación de la fuerza muscular en la población pediátrica permite comparar a individuos sanos con alguna condición de salud, establecer metas de recuperación, monitorear los resultados de las intervenciones y la evolución en el tiempo, además de monitorear la progresión de la carga y el nivel de entrenamiento. La prueba del esfigmomanómetro modificado (TEM) es una técnica que se puede utilizar para medir la fuerza muscular isométrica de esta población. El objetivo de este estudio fue recopilar y producir una síntesis de los estudios que utilizaron la TEM para medir la fuerza muscular en niños y en adolescentes, identificando los grupos musculares, las propiedades de medición investigadas y los protocolos aplicados. La búsqueda se realizó en las bases de datos MEDLINE, EMBASE, PEDro, SciELO y LILACS. Se seleccionaron estudios originales, revisados por pares, publicados hasta septiembre de 2021, que evaluaron la fuerza muscular isométrica con el uso de TEM en niños y en adolescentes de entre 0 y 19 años de edad. Se obtuvieron un total de 1.610 estudios en la búsqueda, de los cuales 17 fueron elegibles. De estos, 12 estudios (70,6%) se realizaron con una población mixta, y cinco (29,4%) solo con niños y adolescentes. Los grupos musculares más evaluados fueron los aductores de la cadera (47,1%) y agarre de palma (29,4%), con predominio del esfigmomanómetro no adaptado (47,1%) y preinflado de 20mmHg (47,1%). Solo seis estudios (35,3%) evaluaron las propiedades de medición de TEM. Se concluye que existen pocos estudios centrados en la población pediátrica, lo que dificulta la estandarización de la aplicación de TEM en la práctica clínica, a pesar de que el instrumento es de fácil acceso y manejo.

Palabras clave
Adolescentes; Niños; Fuerza muscular

INTRODUCTION

Muscle strength is directly related to one’s quality of life and functionality¹. Deficits in muscle strength can limit activities of daily living and restrict social participation since this physical attribute is necessary for the proper performance of various activities, e.g., reaching and manipulating objects, walking, self-care, and work activities². In children and adolescents, muscle strength is indispensable for adequate motor development and is directly related to a good health prognosis³. Hence, evaluating muscle strength in the pediatric population is essential for the functional diagnosis and prescription of an adequate intervention plan in physiotherapy rehabilitation⁴.

To assist in strength training and rehabilitation, it is essential to use appropriate and accessible instruments to perform assessments. By assessing muscle strength we can compare healthy and affected individuals, establish recovery and rehabilitation goals, track the results of interventions and evolution over time, as well as monitor load progression and training level⁵. It is therefore necessary to know the evidence on the use of a muscle strength assessment instrument so that it can be used in clinical practice.

Currently, the modified sphygmomanometer test (MST) is an alternative method being used to measure muscle strength. It encompasses the advantages of manual muscle testing and the portable dynamometer, providing objective measurements at low cost⁶. MST measures isometric muscle strength using a conventional aneroid sphygmomanometer⁷. It is portable, easy to handle and maintain, and often accessible to healthcare providers⁶. MST has already demonstrated adequate measurement properties when used to evaluate muscle strength in healthy adults and older adults, individuals with rheumatoid arthritis, post-stroke, and Parkinson’s disease⁸^-¹³.

Two reviews on sphygmomanometer use to measure muscle strength have already been described in the literature⁶^,¹⁴. Souza et al.⁶ investigated MST use to assess muscle strength in different muscle groups and populations and mentioned previously studied measurement properties. The authors identified only two studies that used MST to assess grip strength in children¹⁵^-¹⁶. Toohey et al.¹⁴ investigated MST measurement properties in measuring the isometric strength of hip muscles among different populations, such as hospitalized older adults, soccer athletes, and healthy students. The authors identified only three studies that used MST to assess hip muscle strength in adolescents¹⁷^-¹⁹. Consequently, the results obtained in these two reviews do not allow us to extract precise information on MST use in children and adolescents, as they did not focus on the pediatric population and did not involve the terms in which this population is referred to in the search strategies. Moreover, the body of knowledge regarding MST must be updated since the last available review was published in 2015. Considering the importance of measuring muscle strength in the pediatric population and the advantages of using MST in clinical practice³^,²^,⁸, an in-depth study on MST use to assess muscle strength in children and adolescents is necessary. Thus, this study gathered and produced a synthesis of studies that used MST to measure muscle strength in children and adolescents. As such, we identified the muscle groups already studied, the protocols used for MST use, the measurement properties investigated in this population and the existing gaps on the topic to guide new research in rehabilitation.

METHODOLOGY

Study design

This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations and was registered in Prospero under CRD protocol 42018106702.

Eligible studies

We included original, peer-reviewed studies conducted with children and adolescents aged 0 to 19 years that assessed isometric muscle strength with MST. Studies that included part of this population in their sample were also included. Studies that used MST to measure blood pressure and not muscle strength, as well as gray literature (abstracts published in events, theses, dissertations, etc.) were excluded. There was no restriction regarding study design, date, or language of publication.

Data sources and search strategies

Bibliographical search was conducted on the MEDLINE (via PubMed), Embase, PEDro, SciELO, and LILACS databases. A search strategy was developed for MEDLINE involving descriptors related to the instrument used (sphygmomanometer) and the population (children and adolescents) (see Appendix). This strategy was adapted for the other databases.

Selection of studies

After searching the electronic databases, two independent evaluators selected the studies published up to September 2021. After excluding duplicates, study selection was divided into three stages. First, the evaluators analyzed the titles of all the studies identified and excluded those that did not meet the established inclusion criteria. Next, the abstracts of the previously selected studies were read and analyzed, and those that did not meet the eligibility criteria were excluded. Finally, the evaluators read the remaining studies in full.

The references of the included articles and previous reviews were analyzed and used as an additional source to identify other studies of interest. The inclusion of studies in the review was made after discussion and consensus between the two evaluators.

Data extraction

We extracted from each selected study the following information: date of publication; study design; number of participants, together with sample characterization (age, sex and body mass index); muscle groups evaluated; protocol used to assess muscle strength; type of sphygmomanometer used (adapted or not adapted); and measurement properties investigated (validity, reliability, and responsiveness).

Magnitude of the intraclass correlation coefficient and Pearson’s correlation coefficient was evaluated using the Munro et al.²⁰ classification. In the case of significant correlations between variables, the magnitude of the correlation was classified as very low≤0.25, low=0.26-0.49, moderate=0.50-0.69, high=0.70-0.89, and very high=0.90-1.00.

Quality assessment of studies

The methodological quality of the studies was assessed using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN), which aims to improve the selection of instruments for measuring results, both in research and in clinical practice, developing tools for selecting the most appropriate instrument. COSMIN evaluates nine measurement properties grouped into three domains: reliability, validity, and responsiveness²¹^,²². Reliability evaluates internal consistency, test-retest, intra- and inter-rater reliability, and measurement error²¹^,²². Validity assesses construct validity (structural validity and hypothesis testing), criterion validity, and content validity²¹^,²². Each measurement property has four to 18 items to be evaluated and scored on a four-point rating scale²². The lowest score received on an item consists of the overall classification of the methodological quality of the measure property analyzed. The methodological quality of each measurement property was then classified as excellent, good, moderate, or poor, following the COSMIN criteria²³.

RESULTS

The electronic searches identified a total of 3,284 studies. After removing duplicates (n=555), 2,729 studies remained. Next, the selection based on titles and abstracts considered 51 studies as potentially eligible. After full text analysis, only 11 studies met the eligibility criteria, whereas the others were excluded for using MST to measure blood pressure instead of measuring muscle strength. Active manual search performed on the reference list of included studies identified other six articles, totaling 17 studies. Figure 1 shows the flowchart for search and studies selection.

Figure 1.
Flowchart for search and studies selection

Of the 17 studies included, 12 (70.6%)¹⁰^,¹⁷^-¹⁹^,²⁴^-³¹ were conducted with mixed population (children/adolescents and adults) and five (29.4%)¹⁵^-¹⁶^,³²^-³⁴ only with children and adolescents (0 to 19 years old). Overall, the age of the samples ranged from 6 to 65 years. In the studies that reported participant gender (n=15), male subjects predominated (n=12; 80%). Thirteen studies (76.5%) were conducted with healthy subjects ¹⁶^-¹⁹^,²⁴^-²⁵^,²⁷^-³²^,³⁴, five (n=5; 38.5%) included rugby or basketball and volleyball athletes, and the others were non-athletes (n=8; 61.5%). Three studies (17.6%) involved individuals with different health conditions: patients with spinal muscular atrophy (n=1; 33.3%)³³ and rheumatoid arthritis (n=2; 66.7%)¹⁵^-¹⁶. Table 1 presents the characteristics of the included studies.

Thumbnail

Table 1.
Characteristics of reviewed studies that used the modified sphygmomanometer test (MST) to assess muscle strength in children and adolescents (n=17)

To assess muscle strength, eight studies (47.1%)¹⁷^-¹⁹^,²⁷^-²⁸^,³⁰^,³²^,³⁴ used MST without any adaptation, four studies (23.5%) ¹⁰^,¹⁶^,²⁴^-²⁵ used bag adaptation, and another four (23.5%)¹⁰^,²⁶^,²⁹^,³¹ the cuff method. Only Soares & Riedel²⁵ reported the use of a neonatal sphygmomanometer (bag method). Two studies (11.8%)¹⁵^,³³ did not provide information about equipment adaptations. Regarding sphygmomanometer pre-inflation, seven studies (41.2%)¹⁷^-¹⁸^,²⁷^,²⁹^-³⁰^,³²^,³⁴ used an initial pressure of 10 mmHg, eight studies (47.1%)¹⁰^,¹⁶^,¹⁹^,²⁴^-²⁶^,²⁸^,³¹ 20mmHg, and two studies (11.8%)¹⁵^,³³ did not provide this information.

The muscle groups evaluated were: hip adductors (n=8; 47.1%)¹⁷^-¹⁸^,²⁷^-³⁰^,³²^,³⁴; handgrip (n=5; 29.4%)¹⁵^-¹⁶^,²⁴^,²⁶^,³¹; hip abductors (n=2; 11.8%)¹⁹^,²⁹; palmar and lateral pinch (n=2; 11.8%)²⁵^-²⁶; hip flexors and extensors (n=1; 5.9%)¹⁹; knee extensors (n=1; 5.9%)¹⁰; flexors, extensors, abductors, internal and external rotators of the shoulder (n=1; 5.9%)¹⁹; and three-point pinch (n=1; 5.9%)²⁵.

MST protocols for muscle strength assessment in this population varied greatly. Eleven studies (64.7%)¹⁰^,¹⁵^-¹⁷^,²⁴^,²⁶^-²⁷^,³⁰^-³²^,³⁴ reported the number of repetitions which ranged from one to three. Rest time between repetitions was reported in eight studies (47.1%)¹⁶^-¹⁷^,¹⁹^,²⁴^,²⁹^,³²^,³¹^,³⁴ and ranged from 15 seconds to five minutes. Contraction time during the test was reported in seven studies (41.2%)¹⁰^,¹⁵^,²⁴^,²⁷^-³⁰ and ranged from two to ten seconds. Eleven studies (64.7%)¹⁰^,¹⁶^-¹⁹^,²⁴^,²⁶^-²⁸^,³⁰^,³² reported participants’ familiarity with the test, and only two (11.8%)¹⁶^,²⁶ described the verbal stimulus provided during the test.

Of the 17 studies included, six (35.3%)¹⁰^,¹⁷^,¹⁸^,¹⁹^,²⁴^,²⁹ evaluated some MST measurement property. Three (17.6%) studies evaluated concurrent criterion validity, comparing MST measurements with those provided by a loading method¹⁰ and by portable dynamometry²⁴^,²⁹. All three studies (100%) reported that MST has adequate concurrent criterion validity with magnitude ranging from high to very high. Five studies (29.4%)¹⁷^,¹⁸^,¹⁹^,²⁴^,²⁹ evaluated MST intra-rater reliability and reported adequate results, with magnitude ranging from moderate to very high. Three studies (17.6%)¹⁰^,¹⁸^,²⁹ evaluated MST inter-rater reliability and reported adequate results, with magnitude ranging from high to very high. Table 2 presents the results of studies that investigated MST measurement properties.

Thumbnail

Table 2.
Results of studies investigating the measurement properties of the modified sphygmomanometer test (n=6)

Table 3 summarizes the COSMIN evaluation of the methodological quality of studies. The methodological quality of studies investigating MST measurement properties ranged from poor to excellent¹⁰^,²⁴^,²⁹^,¹⁷^,¹⁸^,¹⁹.

Thumbnail

Table 3.
COSMIN evaluation of the methodological quality of studies (n=6)

DISCUSSION

Our literature review showed the scarcity of studies investigating MST use to assess muscle strength in children and adolescents. Hip adductors and handgrips were the most evaluated muscle groups. MST protocols for use in this population varied greatly. We observed significant intraclass correlation coefficients among the studies that investigated MST measurement properties, with magnitudes ranging from moderate to very high. However, when investigating their methodological quality, we noted that most were classified as weak to moderate.

Most of the reviewed studies used MST in healthy, typical children and adolescents. Investigating MST use in pediatric populations that present deficits in muscle strength, such as children with neurological diseases (cerebral palsy, Down syndrome, neuromuscular diseases, among others) can be useful for clinical decision-making and monitoring of treatment evolution. Moreover, muscle strength is fundamental in children and adolescents who practice or intend to enter some sport or physical activity, playing a key role in sports performance. Muscle strength determines the speed of execution of technical skills and provides joint stabilization in various sports activities, helping to prevent injuries³⁵. Thus, muscle strength tests have been commonly used in sports to provide normative values (athletic profile), talent detection, distinguish between different levels of performance or evaluate adaptations to training³^,³⁶. Additionally, the load progression recommended in strength training programs for children and adolescents³⁷ can be more assertive when guided by the results of strength tests. As such, a better understanding of MST use as an instrument for assessing strength in the pediatric population for this purpose would be greatly beneficial.

Only two studies were conducted with a sample involving exclusively children¹⁵^,¹⁶. Published more than 20 years ago, they did not evaluate any MST measurement properties for this population, which reveals a gap in the literature regarding MST use in children and the investigation of its measurement properties in this group. Assessing children’s muscle strength is an important health marker and is fundamental for adequate motor development and execution of functional activities³. Thus, future studies should be conducted on using MST to assess muscle strength in this population.

As for MST adaptation, most studies made no sphygmomanometer adaptation. The absence of adaptation increases its clinical applicability, as it reduces costs and application time. Studies with adult individuals have already shown that MST can be used as is, or with bag or cuff adaptation³⁸. For children, the adapted sphygmomanometer may be an easier alternative to stabilize the equipment, given its small size and application to small limbs³⁹. However, no study investigated the best MST adaptation to assess children and adolescents.

Five lower limb muscle groups were evaluated: knee extensors¹⁰; hip flexors and extensors¹⁹; hip abductors¹⁹^,²⁹; and hip adductors¹⁷^,¹⁸^,²⁷^,²⁸^-³⁰^,³²^,³⁴. These are important muscle groups for sports performance and functional activities such as walking, going up and down stairs, running, and jumping⁴⁰. However, other LL muscle groups considered essential for one’s functionality—e.g., plantar flexors, dorsiflexors, knee flexors, and external hip rotators—lacked evaluation. Plantar flexors (soleus and medial and lateral gastrocnemius) are associated with speed and joint force generation during gait⁴¹. Thus, these muscle groups need greater focus and, consequently, a more appropriate evaluation method which the selected studies lacked, highlighting the need for further research in this area.

Seven upper limb muscle groups were evaluated: grip muscles¹⁵^-¹⁶^,²⁴^,²⁶^,³¹^,³³, pinch²⁵^-²⁶, shoulder flexors and extensors, shoulder abductors, and internal and external shoulder rotators¹⁹. These are important muscle groups in the execution of activities of daily living. Measuring grip strength provides an objective index of UL functional integrity and is important in the clinical application of disability assessment, treatment response, and assessment of individuals’ ability to perform activities of daily living like reaching and manipulating objects⁴². Performing an adequate evaluation of this musculature is essential and can be used in the clinical environment as a tool to establish a functional prognosis, evolution, and treatment efficacy⁴. Priosti et al.⁴³ correlated functional performance and manual dexterity with grip strength in children with Down syndrome. They also showed that self-care activities (handling cutlery, brushing teeth, untangling hair, using the bathroom, bathing, etc.) are related to grip strength.

Our review noted the absence of studies investigating MST use to evaluate other upper limb muscle groups, such as elbow and wrist flexors and extensors. According to Carvalho⁴⁴, muscle strength of the elbow flexors and extensors is important for daily activities, such as supporting one’s own body weight, feeding, and personal hygiene, contributing to the development and maintenance of children’s quality of life. The studies by Evans et al.⁴⁵ and Lacourse⁴⁶ address the importance of elbow extensor strength in the functional independence of wheelchair users with neurological impairments, showing that this muscle is essential for lifting and moving in wheelchairs. Studies on the evaluation of muscle strength in this body segment using MST are therefore also important.

We identified no studies that evaluated trunk muscle strength in children and adolescents. Strength deficit of the trunk muscles can prevent individuals from performing various functional activities like sitting, reaching for objects, standing up, among others⁴⁷. The trunk muscles are critical for anticipatory postural control and create a stable foundation for limb movement in children⁴⁸. Studies on the evaluation of muscle strength in this body segment using MST are therefore also important.

The MST protocols for evaluating children and adolescents lacked standardization. Differences were observed in positioning, stabilization sites, contraction time, and number of repetitions used to obtain measurements. Studies with post-stroke adult individuals have already identified that a single repetition, after familiarization, is enough to obtain muscle strength measurements using MST⁸^,¹¹^-¹². However, no study has investigated the recommended number of repetitions when assessing muscle strength in children and adolescents. Investigating the best MST protocol to be used in the evaluation of this population is essential to guide clinical practice.

Studies that investigated MST measurement properties showed adequate test validity and reliability when used to evaluate adolescents. However, the COSMIN analysis revealed a low methodological quality of said studies; thus, the MST validity and reliability results for this population should be analyzed with caution. This poor classification can be explained by the small sample size. New studies should be conducted with larger samples to investigate MST measurement properties in children and adolescents.

Although bibliographical search was conducted in five electronic databases, and additional references were included by active manual search, some relevant study on the topic may have escaped our notice. Moreover, the inclusion of only original, peer-reviewed articles may have excluded other studies on MST in the population of interest. Among them, Drumond’s³⁹ study conducted with children and adolescents aged 6 to 19 years investigated MST measurement properties for evaluating LL muscle strength and found adequate reliability, with magnitudes ranging from moderate to very high. As it is a master’s thesis, its results were not included in the present review.

As most of the included studies involved mixed populations (children/adolescents and adults), caution is needed when analyzing the results regarding the measurement properties investigated. Given the variability in the MST protocols used with the pediatric population, it was not possible to establish a technique standardization. Nonetheless, the information gathered can serve as a guide for new studies in the area.

CONCLUSION

Studies on MST in the pediatric population are scarce. Moreover, the great variability of protocols employed hinder standardizing MST use. Few studies have investigated the properties of MST measurements among children and adolescents, and most present low methodological quality. Although MST is easy to access and perform, its use in the pediatric population needs further exploration.

APPENDIX

Search strategy elaborated for MEDLINE (Pubmed)

[INSTRUMENT]

1. sphygmomanometer

2. “modified sphygmomanometer”

3. “sphygmomanometer modified”

4. “adapted sphygmomanometer”

5. “manometer method”

6. “modified manual sphygmomanometer”

7. “modified sphygmomanometer dynamometer”

8. #1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7

[POPULATION]

9. children

10. child

11. childhood

12. kids

13. boys

14. girls

15. infant

16. young

17. adolescent

18. teenager

19. teen

20. youth

21. student

22. “high school”

23. “secondary school”

24. “middle school”

25. “elementary school”

26. “primary school”

27. #10 OR #11 OR #12 OR #13 OR #14 OR #15 OR #16 OR #17 OR #18 OR #19 OR #20 OR #21 OR #22 OR #23 OR #24 OR #25 OR #26

28. #8 AND #27

REFERENCES

1. Kendall FP, McCreary EK, Provance PG, Rodgers MM, Romani WA. Músculos, provas e funções. 5th ed. Barueri: Manole; 2007.
2. Silva BBC, Lacerda CSA, Roza EA, Junqueira, DP, Costa PHV, Polese JC. Confiabilidade interexaminadores do teste e re-teste do esfigmomanômetro modificado em indivíduos saudáveis. Conexão Ci. 2017;12(1):38-45. doi: 10.24862/cco.v12i1.522
» https://doi.org/10.24862/cco.v12i1.522
3. Lima TR, Moraes MS, Martins PC, Silva VS, Silva DAS. Diversity of parameters in the muscle strength evaluation of Brazilian school children. Rev. bras. cineantropom. desempenho hum. 2018; 20(4):497-516. doi: 10.5007/1980-0037.2018v20n4p497
» https://doi.org/10.5007/1980-0037.2018v20n4p497
4. Ferreira ACC, Shimano AC, Mazzer N, Barbieri CH, Elui VMC, Fonseca MCR. Força de preensão palmar e pinças em indivíduos sadios entre 6 e 19 anos. Acta Ortop Bras. 2011;19(2):92-7. doi: 10.1590/S1413-78522011000200006
» https://doi.org/10.1590/S1413-78522011000200006
5. Bermejo L, Gómez JP, Manzano F, Collado-Mateo D, Villafaina S, Adsuar JC. Reliability of isokinetic knee strength measurements in children: a systematic review and meta-analysis. Plos One. 2019;14(12):226-74. doi: 10.1371/journal.pone.0226274
» https://doi.org/10.1371/journal.pone.0226274
6. Souza LAC, Martins JC, Teixeira-Salamela LF, Godoy MR, Aguiar LTA, Faria CDCM. Evaluation of muscular strength with the modified sphygmomanometer test: a review of the literature. Fisioter Mov. 2013;26(2):437-52. doi: 10.1590/S0103-51502013000200021
» https://doi.org/10.1590/S0103-51502013000200021
7. Helewa A, Goldsmith CH, Smythe HA. Patient, observer and instrument variation in the measurement of strength of shoulder abductor muscles in patients with rheumatoid arthritis using a modified sphygmomanometer. J Rheumatol. 1986;13(6):1044-9. doi: 10.1136/jrheum.13.6.1044
» https://doi.org/10.1136/jrheum.13.6.1044
8. Souza LAC, Martins JC, Moura JB, Teixeira-Salamela LF, De Paula FVR, Faria CDCM. Avaliação da força muscular com o teste do esfigmomanômetro modificado: qual o melhor método e forma de operacionalização para sua utilização? Braz J Phys Ther. 2014;19(2):191-200. doi: 10.1590/S1413-35552012005000149
» https://doi.org/10.1590/S1413-35552012005000149
9. Brito SAF, Santana MM, Amaral PB, Aguiar LT, Gomes GC, Faria CDCM. The modified sphygmomanometer test for assessment of muscle strength of community-dwelling older adults in clinical practice: reliability and validity. Disabil Rehabil. 2020;44(1):1-8. doi: 10.1080/09638288.2020.1758804
» https://doi.org/10.1080/09638288.2020.1758804
10. Helewa A, Goldsmith CH, Smythe HA. The modified sphygmomanometer–an instrument to measure muscle strength: a validation study. J Chronic Dis. 1981;34(7):353-61. doi: 10.1016/0021-9681(81)90073-4
» https://doi.org/10.1016/0021-9681(81)90073-4
11. Aguiar LT, Lara EM, Martins JC, Teixeira-Salmela LF, Quintino LF, Christo PP, et al. Modified sphygmomanometer test for the assessment of strength of the trunk, upper and lower limbs muscles in subjects with subacute stroke: reliability and validity. Eur J Phys Rehabil Med. 2016;52(5):637-49. doi: 10.23736/S1973-9087.16.04376-2
» https://doi.org/10.23736/S1973-9087.16.04376-2
12. Martins JC, Souza LAC, Teixeira-Salamela LF, Aguiar LTA, Lara EM, Moura JB, et al. Reliability and validity of the modified sphygmomanometer test for the assessment of strength of upper limb muscles after stroke. J Rehabil Med. 2015;47(8):697-705. doi: 10.2340/16501977-1978
» https://doi.org/10.2340/16501977-1978
13. Silva SM, Corrêia FI, Silva PFC, Silva DFT, Lucareli PRG, Corrêa JCF. Validation and reliability of a modified sphygmomanometer for the assessment of handgrip strength in Parkinson’s disease. Braz J Phys Ther. 2015;19(2):137-45. doi: 10.1590/bjpt-rbf.2014.0081
» https://doi.org/10.1590/bjpt-rbf.2014.0081
14. Toohey LA, Noronha M, Taylor C, Thomas J. Is a sphygmomanometer a valid and reliable tool to measure the isometric strength of hip muscles? A systematic review. Physiother Theory Pract. 2015; 31(2):1-6. doi: 10.3109/09593985.2014.963905
» https://doi.org/10.3109/09593985.2014.963905
15. Barden W, Brooks D, Ayling-Campos A. Physical therapy management of the subluxated wrist in children with arthritis. Phys Ther. 1995;75(10):879-85. doi: 10.1093/ptj/75.10.879
» https://doi.org/10.1093/ptj/75.10.879
16. Dunn W. Grip strength of children aged 3 to 7 years using a modified sphygmomanon1eter: comparison of typical children and children with rheumatic disorders. Am J Occup Ther. 1993;47(5):421-8. doi: 10.5014/ajot.47.5.421
» https://doi.org/10.5014/ajot.47.5.421
17. Delahunt E, McEntee BL, Kennelly C, Green BS, Coughlan GF. Intrarater reliability of the adductor squeeze test in Gaelic Games athletes. J Athl Train. 2011; 46(3):241-5. doi: 10.4085/1062-6050-46.3.241
» https://doi.org/10.4085/1062-6050-46.3.241
18. Malliaras P, Hogan A, Nawrocki A, Crossley K, Schache A. Hip flexibility and strength measures: reliability and association with athletic groin pain. Br J Sports Med. 2009;43(10):739-44. doi: 10.1136/bjsm.2008.055749
» https://doi.org/10.1136/bjsm.2008.055749
19. Perossa DR, Dziak M, Vernon HT, Hayashita T. The intra-examiner reliability of manual muscle testing of the hip and shoulder with a modified sphygomomanometer: a preliminary study of normal subjects [Internet]. J Can Chiropr Assoc. 1998;42(2):73-82 [cited 2024 Dec 18]. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC2485202/pdf/jcca00022-0011.pdf
» https://pmc.ncbi.nlm.nih.gov/articles/PMC2485202/pdf/jcca00022-0011.pdf
20. Munro BH, Plichta SB, Kelvin EA. Statistical methods for health care research. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2005.
21. Echevarría-Guanilo ME, Gonçalves N, Romanoski PJ. Propriedades psicométricas de instrumentos de medida: bases conceituais e métodos de avaliação – parte I. Texto contexto enferm. 2017;26(4):e1600017. doi: 10.1590/0104-07072017001600017
» https://doi.org/10.1590/0104-07072017001600017
22. Mokking LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, et al. The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study. Qual Life Res. 2010; 19(4):539-49. doi: 10.1007/s11136-010-9606-8
» https://doi.org/10.1007/s11136-010-9606-8
23. Terwee CB, Bot SDM, Boer MR, van der Windt DAWM, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60(1):34-42. doi: 10.1016/j.jclinepi.2006.03.012
» https://doi.org/10.1016/j.jclinepi.2006.03.012
24. Balogun JA, Akomolafe CT, Amusa LO. Reproducibility and criterion-related validity of the modified sphygmomanometer for isometric testing of grip strength. Physiother Can. 1990:42(6):290-9.
25. Soares D, Riedel A. A simple and inexpensive pinch meter to detect subclinical weakness among leprosy patients. Lepr Rev. 1997;68(1):55-60. doi: 10.5935/0305-7518.19970009
» https://doi.org/10.5935/0305-7518.19970009
26. Suresh M, Nicholls PG, Das L, Brakel WHV. Voluntary muscle testing and dynamometry in diagnosis of motor impairment in leprosy: a comparative study within the INFIR Cohort Study. Lepr Rev. 2008;79(3):277-94.
27. Delahunt E, Kennelly C, McEntee BL, Coughlan GF, Green BS. The thigh adductor squeeze test: 45 of hip flexion as the optimal test position for eliciting adductor muscle activity and maximum pressure values. Man Ther. 2011;16(5):476-80. doi: 10.1016/j.math.2011.02.014
» https://doi.org/10.1016/j.math.2011.02.014
28. Hodgson L, Hignett T, Edwards K. Normative adductor squeeze tests scores in rugby. PhysTher Sport. 2014;16(2):93-7. doi: 10.1016/j.ptsp.2014.08.010
» https://doi.org/10.1016/j.ptsp.2014.08.010
29. Toohey LA, Noronha M, Taylor C, Thomas J. The validity and reliability of the sphygmomanometer for hip strength assessment in Australian football players. Physiother Theory Pract. 2018;34(2):131-6. doi: 10.1080/09593985.2017.1374492
» https://doi.org/10.1080/09593985.2017.1374492
30. Tiernan C, Lyons M, Comyns T, Nevill AM, Warrington G. The relationship between adductor squeeze strength, subjective markers of recovery and training load in elite rugby players. J Strength Cond Res. 2019; 33(11):2926-31. doi: 10.1519/JSC.0000000000003370
» https://doi.org/10.1519/JSC.0000000000003370
31. Vishesh S, Panda S, Singh TI, Gaurav K. Association of anthropometric measurements of hand and forearm with grip strength in basketball and volleyball players. Eur J Mol Clin Med. 2020;7(7):4722-37. doi: 10.31838/ejmcm.07.07.586
» https://doi.org/10.31838/ejmcm.07.07.586
32. Coughlan GF, Delahunt E, Caulfield BM, Forde C, Green BS. Normative adductor squeeze test values in elite junior rugby union players. Clin J Sport Med. 2014;24(4):315-9. doi: 10.1097/JSM.0000000000000046
» https://doi.org/10.1097/JSM.0000000000000046
33. Koch BM, Simenson RL. Upper extremity strength and function in children with spinal muscular atrophy type II. Arch Phys Med Rehabil. 1992; 73(3): 241-245. doi: 10.1016/0003-9993(92)90107-7
» https://doi.org/10.1016/0003-9993(92)90107-7
34. Roe GAB, Phibbs PJ, Till K, Jones BL, Read DB, Weakley JJ, et al. Changes in adductor strength after competition in academy rugby union players. J Strength Cond Res. 2016;30(2):344-50. doi: 10.1519/JSC.0000000000001024
» https://doi.org/10.1519/JSC.0000000000001024
35. Laurensen JB, Bertelsen DM, Andersen LB. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med. 2018; 48(11): 871-7. doi: 10.1136/bjsports-2013-092538
» https://doi.org/10.1136/bjsports-2013-092538
36. Cunha GS, Vaz MA, Oliveira AR, Reischak A. Normalization of muscle strength and torque in children and adolescents. Rev. Bras. Cineantropom. Desempenho Hum. 2011; 13(6): 468-76. doi: 10.5007/1980-0037.2011v13n6p468
» https://doi.org/10.5007/1980-0037.2011v13n6p468
37. Dahab KS, McCambridge TM. Strength training in children and adolescents: raising the bar for youth athletes? Sports Health. 2009;1(3):223-6. doi: 10.1177/1941738109334215
» https://doi.org/10.1177/1941738109334215
38. Souza LAC, Martins JC, Teixeira-Salmela LF, Lara EM, Moura JB, Aguiar LT, et al. Validity and reliability of the modified sphygmomanometer test to assess strength of the lower limbs and trunk muscles after stroke. J Rehabil Med. 2014;46(7):620-8. doi: 10.2340/16501977-1823
» https://doi.org/10.2340/16501977-1823
39. Drumond CM. Confiabilidade do teste do esfigmomanômetro modificado e não modificado para avaliação de força muscular dos membros inferiores de crianças e adolescentes [dissertação]. Juiz de Fora: Faculdade Federal de Juiz de Fora; 2020.
40. Magalhães J, Oliveira J, Ascensão A, Soares, JMC. Avaliação isocinética da força muscular de atletas em função do desporto praticado, idade, sexo e posições específicas. Rev Port Cien Desp. 2001;1(2):13-21. doi: 10.5628/rpcd.01.02.13
» https://doi.org/10.5628/rpcd.01.02.13
41. Mentiplay BF, Williams G, Tan D, Adair B, Pua YH, Bok CW, et al. Gait velocity and joint power generation after stroke: contribution of strength and balance. Am J Phys Med Rehabil. 2019;98(10):841-9. doi: 10.1097/PHM.0000000000001122
» https://doi.org/10.1097/PHM.0000000000001122
42. Moura PMLS, Moreira D, Caixeta APL. Força de preensão palmar em crianças e adolescentes saudáveis. Rev paul. pediatr. 2008;26(3):290-4. doi: 10.1590/S0103-05822008000300014
» https://doi.org/10.1590/S0103-05822008000300014
43. Priosti PA, Assis SMB, Cymrot R, Vianna DL, Caromano FA. Força de preensão e destreza manual na criança com Síndrome de Down. Fisioter Pesqui. 2013; 20(3):275-8. doi: 10.1590/S1809-29502013000300013
» https://doi.org/10.1590/S1809-29502013000300013
44. Carvalho C. Força em crianças e jovens: seu desenvolvimento e treinabilidade. Lisboa: Horizonte; 1996.
45. Evans N, Wingo B, Sasso E, Hicks A, Gorgey AS, Harness E. Exercise recommendations and considerations for persons with spinal cord injury. Arch Phys Med Rehabil. 2015;96(9):1749-50. doi: 10.1016/j.apmr.2015.02.005
» https://doi.org/10.1016/j.apmr.2015.02.005
46. Lacourse MG. Lesão da medula espinhal. In: Walter R, Dawson DM, Slovik DM. Exercício físico e reabilitação. Porto Alegre: Artmed; 2001. p. 246-263.
47. Paz GA, Lima VP, Miranda H, Oliveira CG, Dantas HM. Atividade eletromiográfica dos músculos extensores do tronco durante exercícios de estabilização lombar do método Pilates [Internet]. Rev Andal Med Deporte. 2014;7(2):72-7 [cited 2024 Dec 18]. Available from: https://www.elsevier.es/es-revista-revista-andaluza-medicina-del-deporte-284-pdf-X1888754614324445
» https://www.elsevier.es/es-revista-revista-andaluza-medicina-del-deporte-284-pdf-X1888754614324445
48. Kane K, Barden J. Contributions of trunk muscles to anticipatory postural control in children with and without developmental coordination disorder. Hum Mov Sci. 2012; 31(3):707-20. doi: 10.1016/j.humov.2011.08.004
» https://doi.org/10.1016/j.humov.2011.08.004

Partial results were presented on the 22º Seminário de Pesquisa e Extensão at UEMG, held on November 2020.
Financing source:
Nothing to declare
Project registered at PROSPERO under protocol CRD42021230195.

Publication Dates

Publication in this collection
10 Mar 2025
Date of issue
2024

History

Received
17 Aug 2023
Accepted
29 Apr 2024

This is an open access article distributed under the terms of the Creative Commons License

Study(study design)	Objectives	Sample	Sphygmomanometer fitting and calibration	Protocol
Helewa et al., 198110 (cross-sectional)	To evaluate the concurrent criterion validity and inter-rater reliability of the sphygmomanometer and a weight measurement method for measuring knee EXT strength in individuals with rheumatoid arthritis	Population: individuals with rheumatoid arthritis	Adaptation: bag and cuff	Muscle group: knee EXT
Database/source		N=5	Equipment preparation: 20mmHg pre-inflation	Familiarization with the test: the methods were explained to each individual and pre-tested on the opposite leg
(MEDLINE)		Age: 18 to 65 years	Calibration: Yes	Number of repetitions: 1
Ethical approval NR		Gender: F: 3 (66%)		Contraction time: 5s
		M: 2 (34%)		Resting time: NR
		BMI: NR		Verbal stimulus: NR
				Participant positioning: SP, upper limbs at the side of the body, thighs supported, hip joint flexed at 45° and knee flexed at 90°;
				The examiner passively positioned the subject’s MI to maintain a 90° angle at the knee joint; the individual was asked to maintain the position while the examiner applied resistance gradually (with open hands on the equipment).
				Position of the equipment: placed above the ankle, longitudinally
Balogun et al., 199024	To evaluate the modified sphygmomanometer reproducibility during HG force measurement; determine the relations between the modified sphygmomanometer and dynamometer readings, derive a linear regression equation to predict HG strength from modified sphygmomanometer measurements and to determine the relative contribution of age, body, weight, and height to predicting HG strength	Population: healthy adolescents and adults	Adaptation: bag	Muscle group: HG
(cross-sectional)		N=34	Equipment preparation: 20mmHg pre-inflation	Familiarization with the test: each individual underwent two experimental sessions
Database/source		Age: 16 to 28 years	Calibration: NR	Number of repetitions: 2, considering the higher value
(retrieved from Toohey et al., 2018)29		Gender: F: 6 (18%)		Contraction time: 5 s + 2 s for reading
Ethical approval NR		M: 28 (82%)		Resting time: 5 min
		BMI: NR		Verbal stimulus: NR
				Participant positioning: standing with the shoulder adducted and rotated neutral, elbow joint kept in full extension and the forearm in a neutral position
				Equipment Position: palm
Dunn, 199316	To gather data on HG strength of typical children aged 3 to 7 years using MST, and to compare the HG strength of a preliminary sample of children with rheumatic disorders with the HG strength of typical children	Population: children with rheumatic disorders and typical children	Adaptation: bag	Muscle group: HG
(cross-sectional)		N=273	Equipment preparation: 20mmHg pre-inflation	Familiarization with the test: the position was explained verbally and demonstrated as many times as necessary
Database/source		Age: 3 to 7 years	Calibration: Yes	Number of repetitions: 3, analysis with arithmetic mean
(MEDLINE)		Gender: F: 132 (48%);		Contraction time: NR
Ethical approval NR		M: 141 (52%)		Resting time: 15s
		BMI: NR		Verbal stimulus: Yes
				Participant positioning: child seated in a chair, hip joint flexed at 90° bilaterally, both feet resting on the floor before the chair. upper limbs adducted, elbows flexed at 90°, forearm supinated and wrist in neutral position
				Equipment position: palm
Koch and Simenson, 199233	To document how the muscles of the distal extremities of upper limbs may function as a primary resource for hand function, ADLs, and mobility in children with spinal muscular atrophy type II and to describe the natural history of the disease	Population: children with spinal muscular atrophy type II	Adaptation: NR	Muscle group: HG
(prospective cohort)		N=10	Equipment preparation: NR	Familiarization with the test: NR
Database/source		Age: NR	Calibration: NR	Number of repetitions: NR
(MEDLINE)		Gender: NR		Contraction time: NR
Ethical approval NR		BMI: NR		Resting time: NR
				Verbal stimulus: NR
				Participant positioning: NR
				Equipment Position: NR
Barden et al., 199515	To describe a physical therapy protocol for treating wrist subluxation in children with arthritis	Population: children with arthritis	Adaptation: NR	Muscle group: HG
(case report)		N=2	Equipment preparation: NR	Familiarization with the test: NR
Database/source		Age: 5 and 17 years	Calibration: NR	Number of repetitions: 3 (analysis with the highest value)
(MEDLINE)		Gender: F: 1 (50%);		Contraction time: 10s
Ethical approval NR		M: 1 (50%)		Resting time: NR
		BMI: NR		Verbal stimulus: NR
				Participant positioning: NR
				Equipment Position: NR
Soares & Riedel, 199725	To compare the manual forceps of individuals affected by leprosy with healthy individuals using a neonatal sphygmomanometer	Population: individuals with leprosy and unaffected	Adaptation: bag (neonatal sphygmomanometer)	Muscle group: palmar pinch, tree-point pinch, and lateral pinch
(cross-sectional)		N=78	Equipment preparation: 20mmHg pre-inflation	Familiarization with the test: NR
Database/source		Age: 15 to 55 years	Calibration: NR	Number of repetitions: NR
(MEDLINE)		Gender: NR		Contraction time: NR
Ethical approval NR		BMI: NR		Resting time: NR
				Verbal stimulus: NR
				Participant positioning: NR
				Position of the equipment: palmar pinch: between the thumb and each of the fingers; lateral pinch: between the thumb and the side of the index finger; and three-point pinch: between the index and middle fingers, middle and ring fingers, ring and little fingers
Perossa et al., 199819	To investigate the intra-examiner reliability of manual shoulder and hip muscle assessment using MST	Population: typical student volunteers	Adaptation: none	Muscle group: FLX, EXT, ABD, shoulder RI and RE, EXT, hip FLX and ABD
(cross-sectional)		N=80	Equipment preparation: 20mmHg pre-inflation	Familiarization with the test: the participant was allowed to practice the movements before performing the test
Database/source		Age: 19 to 22 years	Calibration: NR	Number of repetitions: NR
(retrieved from Souza et al., 2013)6		Gender: F: 40 (50%);		Contraction time: NR
Ethical approval NR		M: 40 (50%)		Resting time: 30 to 35s
		BMI: NR		Verbal stimulus: NR
				Participant positioning: Shoulder FLX: seated, shoulder flexed at 30°;
				Shoulder EXT: seated, shoulder extended at 20°;
				Shoulder ABD: seated, shoulder abducted at approximately 35°;
				RI: seated, elbow flexed at 90°;
				RE: seated, elbow flexed at 90°;
				Hip EXT: prone position, equipment behind the knee. Participant bent their leg at 90º and raised their thigh 15º to 20º from the table;
				Hip FLX: supine position, with thigh and knee bent at 90º. Equipment positioned in the anterior region near the knee;
				Hip ABD: LD, equipment on the side of the knee, instructed to initiate the action by pushing upwards
				Equipment Position: Shoulder FLX: on the forearm above the elbow;
				EXT of shoulder: on the inside of the forearm;
				Shoulder ABD: in the middle of the forearm;
				Shoulder RI: NR;
				Shoulder RE: above the outside of the wrist;
				Hip EXT: behind the knee;
				Hip FLX: in front of the knee;
				Hip ABD: on the side of the knee
Suresh et al., 200826	To evaluate hand muscle weakness using dynamometry as an indicator of alteration in motor nerve function detected by the voluntary test of muscles innervated by the ulnar and median nerves	Population: individuals newly diagnosed with multibacillary leprosy	Adaptation: cuff	Muscle group: HG, palmar pinch, and lateral pinch
(prospective cohort)		N=303	Equipment preparation: 20mmHg pre-inflation	Familiarization with the test: all test procedures were described in detail in a procedure manual
Database/source		Age: 12 to 60 years old (mean of 32.8)	Calibration: NR	Number of repetitions: 3, analysis with arithmetic mean
(MEDLINE)		Gender: F: 83 (27%)		Contraction time: NR
Ethical approval		M: 220 (73%)		Resting time: NR
Indian Council of Medical Research and the Research Ethics Committee of the JALMA Central Institute of Leprosy in Agra		BMI: NR		Verbal stimulus: Yes
				Participant positioning: seated in a chair whose arms served as support for the upper limbs, feet resting on the floor. Palmar pinch: forearm in neutral position, wrist slightly extended, finger joints slightly flexed, thumb between flexion and opposition, interphalangeal joint extended; lateral pinch: UL close to the trunk, elbow flexed, forearm pronated, wrist extended, metacarpophalangeal joint of the index finger flexed, interphalangeal joints extended, thumb in opposition. HG: shoulder abducted, elbow flexed at 90°, forearm in neutral position, wrist extended
				Equipment Position: NR
Malliaras et al., 200918	To identify reliable hip flexibility and strength measures among junior elite soccer players with and without groin pain	Population: soccer players	Adaptation: none	Muscle group: Hip ABD
(prospective cohort)		N=29	Equipment preparation: 10mmHg pre-inflation	Familiarization with the test: measurements were taken after a trial, for familiarization
Database/source		Age: 15 to 21 years	Calibration: NR	Number of repetitions: NR
(retrieved from Toohey et al., 201514)29		Gender: M: 29 (100%)		Contraction time: NR
Ethical approval		BMI: NR		Resting time: NR
La Trobe University, Melbourne, Australia				Verbal stimulus: NR
				Participant positioning: supine position, three angles of hip flexion: 0°, 30° and 45°
				Equipment position: between the player’s knees
Delahunt et al., 201127	To evaluate the intra-rater reliability of a commercially available sphygmomanometer to measure ADD compression values in Irish soccer athletes and to determine if different compression values are associated with the three commonly used test positions	Population: Irish soccer athletes	Adaptation: none	Muscle group: Hip ABD
(cross-sectional)		N=18	Equipment preparation: 10mmHg pre-inflation	Familiarization with the test: 3 practical trials were allowed in each test position for familiarization with the protocol
Database/source (retrieved from Hodgson et al., 201428)		Age: 21.11±2.53 years	Calibration: NR	Number of repetitions: 3, considering the higher value
Ethical approval		Gender: M: 18 (100%)		Contraction time: NR
College Dublin University		BMI: NR		Resting time: 2 min
				Verbal stimulus: NR
				Participant positioning: supine position with arms crossed and head resting on a cushion. Hip joints were kept in neutral rotation in each of the test positions. Three angles: 0º, 45º and 90º hip flexion
				Position of the equipment: between the knees at the most prominent point of the medial femoral condyles
Delahunt et al., 201127	To investigate adductor muscle activity and concomitant pressure values while performing hip ADD compression test at 0°, 45° and 90° hip flexion of Irish soccer athletes without any history of groin injury	Population: Irish soccer athletes	Adaptation: none	Muscle group: Hip ABD
(cross-sectional)		N=18	Equipment preparation: 10mmHg pre-inflation	Familiarization with the test: three attempts at submaximal practice were allowed in each test position for familiarization with the procedures.
Database/source		Age: 21.11±2.53 years	Calibration: NR	Number of repetitions: 3, considering the higher value
(MEDLINE)		Gender: M: 18 (100%)		Contraction time: 5s
Ethical approval College Dublin University		BMI: NR		Resting time: NR
				Verbal stimulus: NR
				Participant positioning: at 0° the hip joint was kept in a neutral rotation position. For the 45° and 90° hip flexion test positions, the knee joint was held at 90° flexion
				Equipment position: the sphygmomanometer cuff was placed between the knees
Coughlan et al., 201432	To establish normative values of the ADD compression test in asymptomatic junior elite rugby players and to investigate whether there are differences between the player’s position on the field and the category	Population: asymptomatic rugby players	Adaptation: none	Muscle group: Hip ABD
(cross-sectional)		N=104	Equipment preparation: 10mmHg pre-inflation	Familiarization with the test: before the validity test, each participant became familiar with the protocol, was informed about the test procedure and allowed to perform three submaximal efforts in each of the test positions
Database/source		Age: 17.56±0.54 years	Calibration: NR	Number of repetitions: 3, considering the higher value
(retrieved from Souza et al., 201634)6		Gender: M: 104 (100%)		Contraction time: NR
Ethical approval		BMI: NR		Resting time: 15s between each rep and a 45s rest between each test position
College Dublin University				Verbal stimulus: NR
				Participant positioning: supine position, with the head resting on the stretcher and the arms on the chest. Three angles: 0º, 45º and 90º hip flexion
				Equipment position: the cuff was positioned so that the middle third rested at the most prominent point of the medial femoral condyles
Hodgson et al., 201428	To determine the normative values of hip ADD strength in professional rugby players using a sphygmomanometer cuff in different test positions	Population: rugby players	Adaptation: none	Muscle group: Hip ABD
(cross-sectional)		N=81	Equipment preparation: 20mmHg pre-inflation	Familiarization with the test: all participants were familiar with the tests and had received training in their use to improve inter-rater reliability
Database/source (Embase)		Age: <18 to >30 years	Calibration: NR	Number of repetitions: NR
Ethical approval NR		Gender: M: 81 (100%)		Contraction time: 2 to 3s
		BMI: 29.0kg/m2 (3.0kg/m2)		Resting time: NR
				Verbal stimulus: NR
				Participant positioning: 0° test: athlete in SP on the pedestal with the ankles together. 60° test: athlete in SP and then flexing the knee and hip until the heel of the foot aligned with the medial joint line of the opposite knee, the other foot was brought to mirror this position, providing approximately 60° of hip flexion. 90° test with support, the athletes were instructed to place their legs in 90° hip and knee flexion and the examiner made the corrections relevant to the position while resting their arms under the athletes’ knees and instructing them to relax to perform the test. For the 90° test without support, the athlete maintained this position without support of the examiner
				Equipment Position: NR
Roe et al., 201634	Firstly, to investigate the magnitude of the change in ADD strength after a match in rugby players using the ADD compression test. Secondly, to examine the relation between game displacement demands and changes in ADD strength	Population: rugby players	Adaptation: none	Muscle group: Hip ABD
(prospective cohort)		N=14	Equipment preparation: 10mmHg pre-inflation	Familiarization with the test: NR
Database/source		Age: 17.4±0.8 years	Calibration: NR	Number of repetitions: 3, considering the higher value
(retrieved from Tiernan et al., 201930)		Gender: M: 14 (100%)		Contraction time: NR
Ethical approval		BMI: NR		Resting time: 30s
Leeds Beckett University				Verbal stimulus: NR
				Participant positioning: SP with hip joints positioned in neutral rotation
				Equipment position: between the knees at the most prominent point of the medial condyles
Toohey et al., 201829	To investigate sphygmomanometer intra- and inter-rater reliability for assessing ADD compression test and isometric strength of the hip ABD muscles and to establish its concurrent validity for evaluating the same measurements compared with the reference standard of portable dynamometry	Population: soccer players	Adaptation: cuff	Muscle group: Hip ADD and ABD
(prospective cohort)		N=32	Equipment preparation: 10mmHg pre-inflation	Familiarization with the test: NR
Database/source		Age: 23.9±4.5 years	Calibration: Yes	Number of repetitions: NR
(MEDLINE)		Gender: M: 32 (100%)		Contraction time: 5s
Ethical approval		BMI: NR		Resting time: 60s
La Trobe University (FHEC13/064)				Verbal stimulus: NR
				Participant positioning: LD with the tested LL positioned superiorly at 0° flexion and abduction at the hip and full knee extension. Knee of the LL positioned inferiorly was flexed at 90° to provide stability
				Equipment position: the center of the device was placed 5cm proximal to the lateral malleolus
Tiernan et al., 201930	To investigate the relation between ADD compression force values, subjective markers of recovery, and training load in elite rugby players	Population: elite rugby players	Adaptation: none	Muscle group: Hip ABD
(prospective cohort)		N=19	Equipment preparation: 10mmHg pre-inflation	Familiarization with the test: players were familiar with all testing protocols as a result of previous years of monitoring
Database/source		Age: 19.7±1.1 years	Calibration: NR	Number of repetitions: 1
(MEDLINE)		Gender: M: 19 (100%)		Contraction time: 2 to 3s.
Ethical approval		BMI: NR		Resting time: NR
University of Limerick				Verbal stimulus: NR
				Participant positioning: players lay on the floor with their hips held in a neutral position, knees bent at 90°, and hips flexed at 45°
				Equipment position: between the knees with the middle third of the cuff located at the most prominent point of the medial femoral condyles
Vishesh et al., 202031	To measure dominant HG strength with a modified sphygmomanometer and Its association with various hand and forearm anthropometric measurements in basketball and volleyball players	Population: basketball and volleyball players	Adaptation: cuff	Muscle group: HG
(cross-sectional)		N=60	Equipment preparation: 20mmHg pre-inflation	Familiarization with the test: NR
Database/source		Age: 15 to 20 years	Calibration: NR	Number of repetitions: 3
(Embase)		Gender: F: 16 (27%)		Contraction time: NR
Ethical approval NR		M: 44 (73%)		Resting time: 5s
		BMI: 18.57±2.33		Verbal stimulus: NR
				Participant positioning: players were positioned in a straight-backed chair, with both feet fully supported on the floor. Each player was instructed to place their left hand on the right thigh and assume the position with adducted shoulders in neutral rotation. For the arm tested, the elbow was flexed up to 90°, the forearm and wrist were in a neutral position, and the fingers were flexed
				Equipment Position: NR

Study (study design)	Measurement properties	Muscle groups	Results
Helewa et al., 198110 (cross-sectional)	Concurrent criterion validity	Knee extensors	r=0.92 to 0.94
Balogun et al., 199024	Concurrent criterion validity	Handgrip	r=0.84 to 0.99
(cross-sectional)	Intra-rater reliability	Handgrip	r=0.84 to 0.99
Perossa et al., 199819 (cross-sectional)	Intra-rater reliability	Shoulder flexors, extensors, abductors, and internal and external rotators; flexors, extensors, hip abductors	ICC=0.86 to 0.97
Malliaras et al., 200918 (prospective cohort)	Intra-rater reliability	Hip adductors	ICC=0.81 to 0.94
Malliaras et al., 200918 (prospective cohort)	Inter-rater reliability	Hip adductors	ICC=0.80 to 0.83
Delahunt et al., 201127 (cross-sectional)	Intra-rater reliability	Hip adductors	ICC=0.89 to 0.92
Toohey et al., 201829 (prospective cohort)	Intra-rater reliability	Hip adductors and abductors	ICC=0.61 to 0.92
	Inter-rater reliability	Hip adductors and abductors	ICC=0.77 to 0.91
	Concurrent criterion validity	Hip adductors and abductors	r=0.77 to 0.91

Author	Validity of concurrent criteria	Intra-rater reliability	Inter-rater reliability
Helewa et al., 198110 (cross-sectional)	Excellent	NE	NE
Balogun et al., 199024 (cross-sectional)	Moderate	Excellent	NE
Perossa et al., 199819 (cross-sectional)	NE	Weak	NE
Malliaras et al., 200918	NE	Moderate	Moderate
(prospective cohort)	NE	Moderate	Moderate
Delahunt et al., 201127 (cross-sectional)	NE	Weak	NE
Toohey et al., 201829 (prospective cohort)	Weak	Weak	Weak

location_on

Universidade de São Paulo Rua Ovídio Pires de Campos, 225 2° andar. , 05403-010 São Paulo SP / Brasil, Tel: 55 11 2661-7703, Fax 55 11 3743-7462 - São Paulo - SP - Brazil
E-mail: revfisio@usp.br

rss_feed Acompanhe os números deste periódico no seu leitor de RSS

Reportar erro

[1] 1. Kendall FP, McCreary EK, Provance PG, Rodgers MM, Romani WA. Músculos, provas e funções. 5th ed. Barueri: Manole; 2007.

[2] 2. Silva BBC, Lacerda CSA, Roza EA, Junqueira, DP, Costa PHV, Polese JC. Confiabilidade interexaminadores do teste e re-teste do esfigmomanômetro modificado em indivíduos saudáveis. Conexão Ci. 2017;12(1):38-45. doi: 10.24862/cco.v12i1.522
» https://doi.org/10.24862/cco.v12i1.522

[3] 3. Lima TR, Moraes MS, Martins PC, Silva VS, Silva DAS. Diversity of parameters in the muscle strength evaluation of Brazilian school children. Rev. bras. cineantropom. desempenho hum. 2018; 20(4):497-516. doi: 10.5007/1980-0037.2018v20n4p497
» https://doi.org/10.5007/1980-0037.2018v20n4p497

[4] 4. Ferreira ACC, Shimano AC, Mazzer N, Barbieri CH, Elui VMC, Fonseca MCR. Força de preensão palmar e pinças em indivíduos sadios entre 6 e 19 anos. Acta Ortop Bras. 2011;19(2):92-7. doi: 10.1590/S1413-78522011000200006
» https://doi.org/10.1590/S1413-78522011000200006

[5] 5. Bermejo L, Gómez JP, Manzano F, Collado-Mateo D, Villafaina S, Adsuar JC. Reliability of isokinetic knee strength measurements in children: a systematic review and meta-analysis. Plos One. 2019;14(12):226-74. doi: 10.1371/journal.pone.0226274
» https://doi.org/10.1371/journal.pone.0226274

[6] 6. Souza LAC, Martins JC, Teixeira-Salamela LF, Godoy MR, Aguiar LTA, Faria CDCM. Evaluation of muscular strength with the modified sphygmomanometer test: a review of the literature. Fisioter Mov. 2013;26(2):437-52. doi: 10.1590/S0103-51502013000200021
» https://doi.org/10.1590/S0103-51502013000200021

[7] 7. Helewa A, Goldsmith CH, Smythe HA. Patient, observer and instrument variation in the measurement of strength of shoulder abductor muscles in patients with rheumatoid arthritis using a modified sphygmomanometer. J Rheumatol. 1986;13(6):1044-9. doi: 10.1136/jrheum.13.6.1044
» https://doi.org/10.1136/jrheum.13.6.1044

[8] 8. Souza LAC, Martins JC, Moura JB, Teixeira-Salamela LF, De Paula FVR, Faria CDCM. Avaliação da força muscular com o teste do esfigmomanômetro modificado: qual o melhor método e forma de operacionalização para sua utilização? Braz J Phys Ther. 2014;19(2):191-200. doi: 10.1590/S1413-35552012005000149
» https://doi.org/10.1590/S1413-35552012005000149

[9] 9. Brito SAF, Santana MM, Amaral PB, Aguiar LT, Gomes GC, Faria CDCM. The modified sphygmomanometer test for assessment of muscle strength of community-dwelling older adults in clinical practice: reliability and validity. Disabil Rehabil. 2020;44(1):1-8. doi: 10.1080/09638288.2020.1758804
» https://doi.org/10.1080/09638288.2020.1758804

[10] 10. Helewa A, Goldsmith CH, Smythe HA. The modified sphygmomanometer–an instrument to measure muscle strength: a validation study. J Chronic Dis. 1981;34(7):353-61. doi: 10.1016/0021-9681(81)90073-4
» https://doi.org/10.1016/0021-9681(81)90073-4

[11] 11. Aguiar LT, Lara EM, Martins JC, Teixeira-Salmela LF, Quintino LF, Christo PP, et al. Modified sphygmomanometer test for the assessment of strength of the trunk, upper and lower limbs muscles in subjects with subacute stroke: reliability and validity. Eur J Phys Rehabil Med. 2016;52(5):637-49. doi: 10.23736/S1973-9087.16.04376-2
» https://doi.org/10.23736/S1973-9087.16.04376-2

[12] 12. Martins JC, Souza LAC, Teixeira-Salamela LF, Aguiar LTA, Lara EM, Moura JB, et al. Reliability and validity of the modified sphygmomanometer test for the assessment of strength of upper limb muscles after stroke. J Rehabil Med. 2015;47(8):697-705. doi: 10.2340/16501977-1978
» https://doi.org/10.2340/16501977-1978

[13] 13. Silva SM, Corrêia FI, Silva PFC, Silva DFT, Lucareli PRG, Corrêa JCF. Validation and reliability of a modified sphygmomanometer for the assessment of handgrip strength in Parkinson’s disease. Braz J Phys Ther. 2015;19(2):137-45. doi: 10.1590/bjpt-rbf.2014.0081
» https://doi.org/10.1590/bjpt-rbf.2014.0081

[14] 14. Toohey LA, Noronha M, Taylor C, Thomas J. Is a sphygmomanometer a valid and reliable tool to measure the isometric strength of hip muscles? A systematic review. Physiother Theory Pract. 2015; 31(2):1-6. doi: 10.3109/09593985.2014.963905
» https://doi.org/10.3109/09593985.2014.963905

[15] 15. Barden W, Brooks D, Ayling-Campos A. Physical therapy management of the subluxated wrist in children with arthritis. Phys Ther. 1995;75(10):879-85. doi: 10.1093/ptj/75.10.879
» https://doi.org/10.1093/ptj/75.10.879

[16] 16. Dunn W. Grip strength of children aged 3 to 7 years using a modified sphygmomanon1eter: comparison of typical children and children with rheumatic disorders. Am J Occup Ther. 1993;47(5):421-8. doi: 10.5014/ajot.47.5.421
» https://doi.org/10.5014/ajot.47.5.421

[17] 17. Delahunt E, McEntee BL, Kennelly C, Green BS, Coughlan GF. Intrarater reliability of the adductor squeeze test in Gaelic Games athletes. J Athl Train. 2011; 46(3):241-5. doi: 10.4085/1062-6050-46.3.241
» https://doi.org/10.4085/1062-6050-46.3.241

[18] 18. Malliaras P, Hogan A, Nawrocki A, Crossley K, Schache A. Hip flexibility and strength measures: reliability and association with athletic groin pain. Br J Sports Med. 2009;43(10):739-44. doi: 10.1136/bjsm.2008.055749
» https://doi.org/10.1136/bjsm.2008.055749

[19] 19. Perossa DR, Dziak M, Vernon HT, Hayashita T. The intra-examiner reliability of manual muscle testing of the hip and shoulder with a modified sphygomomanometer: a preliminary study of normal subjects [Internet]. J Can Chiropr Assoc. 1998;42(2):73-82 [cited 2024 Dec 18]. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC2485202/pdf/jcca00022-0011.pdf
» https://pmc.ncbi.nlm.nih.gov/articles/PMC2485202/pdf/jcca00022-0011.pdf

[20] 20. Munro BH, Plichta SB, Kelvin EA. Statistical methods for health care research. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2005.

[21] 21. Echevarría-Guanilo ME, Gonçalves N, Romanoski PJ. Propriedades psicométricas de instrumentos de medida: bases conceituais e métodos de avaliação – parte I. Texto contexto enferm. 2017;26(4):e1600017. doi: 10.1590/0104-07072017001600017
» https://doi.org/10.1590/0104-07072017001600017

[22] 22. Mokking LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, et al. The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study. Qual Life Res. 2010; 19(4):539-49. doi: 10.1007/s11136-010-9606-8
» https://doi.org/10.1007/s11136-010-9606-8

[23] 23. Terwee CB, Bot SDM, Boer MR, van der Windt DAWM, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60(1):34-42. doi: 10.1016/j.jclinepi.2006.03.012
» https://doi.org/10.1016/j.jclinepi.2006.03.012

[24] 24. Balogun JA, Akomolafe CT, Amusa LO. Reproducibility and criterion-related validity of the modified sphygmomanometer for isometric testing of grip strength. Physiother Can. 1990:42(6):290-9.

[25] 25. Soares D, Riedel A. A simple and inexpensive pinch meter to detect subclinical weakness among leprosy patients. Lepr Rev. 1997;68(1):55-60. doi: 10.5935/0305-7518.19970009
» https://doi.org/10.5935/0305-7518.19970009

[26] 26. Suresh M, Nicholls PG, Das L, Brakel WHV. Voluntary muscle testing and dynamometry in diagnosis of motor impairment in leprosy: a comparative study within the INFIR Cohort Study. Lepr Rev. 2008;79(3):277-94.

[27] 27. Delahunt E, Kennelly C, McEntee BL, Coughlan GF, Green BS. The thigh adductor squeeze test: 45 of hip flexion as the optimal test position for eliciting adductor muscle activity and maximum pressure values. Man Ther. 2011;16(5):476-80. doi: 10.1016/j.math.2011.02.014
» https://doi.org/10.1016/j.math.2011.02.014

[28] 28. Hodgson L, Hignett T, Edwards K. Normative adductor squeeze tests scores in rugby. PhysTher Sport. 2014;16(2):93-7. doi: 10.1016/j.ptsp.2014.08.010
» https://doi.org/10.1016/j.ptsp.2014.08.010

[29] 29. Toohey LA, Noronha M, Taylor C, Thomas J. The validity and reliability of the sphygmomanometer for hip strength assessment in Australian football players. Physiother Theory Pract. 2018;34(2):131-6. doi: 10.1080/09593985.2017.1374492
» https://doi.org/10.1080/09593985.2017.1374492

[30] 30. Tiernan C, Lyons M, Comyns T, Nevill AM, Warrington G. The relationship between adductor squeeze strength, subjective markers of recovery and training load in elite rugby players. J Strength Cond Res. 2019; 33(11):2926-31. doi: 10.1519/JSC.0000000000003370
» https://doi.org/10.1519/JSC.0000000000003370

[31] 31. Vishesh S, Panda S, Singh TI, Gaurav K. Association of anthropometric measurements of hand and forearm with grip strength in basketball and volleyball players. Eur J Mol Clin Med. 2020;7(7):4722-37. doi: 10.31838/ejmcm.07.07.586
» https://doi.org/10.31838/ejmcm.07.07.586

[32] 32. Coughlan GF, Delahunt E, Caulfield BM, Forde C, Green BS. Normative adductor squeeze test values in elite junior rugby union players. Clin J Sport Med. 2014;24(4):315-9. doi: 10.1097/JSM.0000000000000046
» https://doi.org/10.1097/JSM.0000000000000046

[33] 33. Koch BM, Simenson RL. Upper extremity strength and function in children with spinal muscular atrophy type II. Arch Phys Med Rehabil. 1992; 73(3): 241-245. doi: 10.1016/0003-9993(92)90107-7
» https://doi.org/10.1016/0003-9993(92)90107-7

[34] 34. Roe GAB, Phibbs PJ, Till K, Jones BL, Read DB, Weakley JJ, et al. Changes in adductor strength after competition in academy rugby union players. J Strength Cond Res. 2016;30(2):344-50. doi: 10.1519/JSC.0000000000001024
» https://doi.org/10.1519/JSC.0000000000001024

[35] 35. Laurensen JB, Bertelsen DM, Andersen LB. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med. 2018; 48(11): 871-7. doi: 10.1136/bjsports-2013-092538
» https://doi.org/10.1136/bjsports-2013-092538

[36] 36. Cunha GS, Vaz MA, Oliveira AR, Reischak A. Normalization of muscle strength and torque in children and adolescents. Rev. Bras. Cineantropom. Desempenho Hum. 2011; 13(6): 468-76. doi: 10.5007/1980-0037.2011v13n6p468
» https://doi.org/10.5007/1980-0037.2011v13n6p468

[37] 37. Dahab KS, McCambridge TM. Strength training in children and adolescents: raising the bar for youth athletes? Sports Health. 2009;1(3):223-6. doi: 10.1177/1941738109334215
» https://doi.org/10.1177/1941738109334215

[38] 38. Souza LAC, Martins JC, Teixeira-Salmela LF, Lara EM, Moura JB, Aguiar LT, et al. Validity and reliability of the modified sphygmomanometer test to assess strength of the lower limbs and trunk muscles after stroke. J Rehabil Med. 2014;46(7):620-8. doi: 10.2340/16501977-1823
» https://doi.org/10.2340/16501977-1823

[39] 39. Drumond CM. Confiabilidade do teste do esfigmomanômetro modificado e não modificado para avaliação de força muscular dos membros inferiores de crianças e adolescentes [dissertação]. Juiz de Fora: Faculdade Federal de Juiz de Fora; 2020.

[40] 40. Magalhães J, Oliveira J, Ascensão A, Soares, JMC. Avaliação isocinética da força muscular de atletas em função do desporto praticado, idade, sexo e posições específicas. Rev Port Cien Desp. 2001;1(2):13-21. doi: 10.5628/rpcd.01.02.13
» https://doi.org/10.5628/rpcd.01.02.13

[41] 41. Mentiplay BF, Williams G, Tan D, Adair B, Pua YH, Bok CW, et al. Gait velocity and joint power generation after stroke: contribution of strength and balance. Am J Phys Med Rehabil. 2019;98(10):841-9. doi: 10.1097/PHM.0000000000001122
» https://doi.org/10.1097/PHM.0000000000001122

[42] 42. Moura PMLS, Moreira D, Caixeta APL. Força de preensão palmar em crianças e adolescentes saudáveis. Rev paul. pediatr. 2008;26(3):290-4. doi: 10.1590/S0103-05822008000300014
» https://doi.org/10.1590/S0103-05822008000300014

[43] 43. Priosti PA, Assis SMB, Cymrot R, Vianna DL, Caromano FA. Força de preensão e destreza manual na criança com Síndrome de Down. Fisioter Pesqui. 2013; 20(3):275-8. doi: 10.1590/S1809-29502013000300013
» https://doi.org/10.1590/S1809-29502013000300013

[44] 44. Carvalho C. Força em crianças e jovens: seu desenvolvimento e treinabilidade. Lisboa: Horizonte; 1996.

[45] 45. Evans N, Wingo B, Sasso E, Hicks A, Gorgey AS, Harness E. Exercise recommendations and considerations for persons with spinal cord injury. Arch Phys Med Rehabil. 2015;96(9):1749-50. doi: 10.1016/j.apmr.2015.02.005
» https://doi.org/10.1016/j.apmr.2015.02.005

[46] 46. Lacourse MG. Lesão da medula espinhal. In: Walter R, Dawson DM, Slovik DM. Exercício físico e reabilitação. Porto Alegre: Artmed; 2001. p. 246-263.

[47] 47. Paz GA, Lima VP, Miranda H, Oliveira CG, Dantas HM. Atividade eletromiográfica dos músculos extensores do tronco durante exercícios de estabilização lombar do método Pilates [Internet]. Rev Andal Med Deporte. 2014;7(2):72-7 [cited 2024 Dec 18]. Available from: https://www.elsevier.es/es-revista-revista-andaluza-medicina-del-deporte-284-pdf-X1888754614324445
» https://www.elsevier.es/es-revista-revista-andaluza-medicina-del-deporte-284-pdf-X1888754614324445

[48] 48. Kane K, Barden J. Contributions of trunk muscles to anticipatory postural control in children with and without developmental coordination disorder. Hum Mov Sci. 2012; 31(3):707-20. doi: 10.1016/j.humov.2011.08.004
» https://doi.org/10.1016/j.humov.2011.08.004