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Article

Evaluation of Hand Muscle Strength Using Manual Dynamometry: A Reliability and Validity Study of the Activ5 Instrument

by
José Pino-Ortega
1,*,
Rafael Carvajal-Espinoza
2 and
Boryi A. Becerra-Patiño
3
1
BioVetMed & SportSci Research Group, Faculty of Sport Sciences, University of Murcia, 30720 San Javier, Spain
2
School of Physical Education and Sports, University of Costa Rica, San José 11501-2060, Costa Rica
3
Physical Activity and Sport Management and Pedagogy Group (GPAFD), Faculty of Physical Education, National Pedagogical University, Bogotá 480100, Colombia
*
Author to whom correspondence should be addressed.
Appl. Sci. 2024, 14(19), 8775; https://doi.org/10.3390/app14198775 (registering DOI)
Submission received: 9 August 2024 / Revised: 20 September 2024 / Accepted: 25 September 2024 / Published: 28 September 2024
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Abstract

:
Manual dynamometry (HHD) allows for the assessment of musculature because its use has been supported as an indicator of health in different population groups. The objective of this study was to examine the reliability and validity of the Activ5 dynamometer for assessing grip strength in a population of adults. A total of 106 individuals with an age of 20.38 ± 1.64, body mass of 71.52 ± 11.32 kg, and height of 1.70 ± 0.11 m were evaluated during two sessions. A cross-sectional agreement study was conducted on Sports Science students from a university community, and 106 individuals were evaluated during two sessions. Statistical analysis of reliability and validity was performed using intraclass correlation coefficients (ICCs), Pearson correlations, and Lin’s coefficient. According to Lin’s coefficient, both instruments measure grip strength for both conditions, either for the right hand or the left hand. The correlation coefficient to determine the linear relationship between both instruments determined that between the Jamar right-hand dynamometer and the right-hand Activ5, a coefficient R2 = 0.580, p = 0.00, was obtained. In contrast, the correlation between the Jamar left-hand dynamometer and the left-hand Activ5 had a coefficient R2 = 0.543, p = 0.001. Both intraclass correlation coefficients and Cronbach’s alpha presented high values, indicating that both instruments have good reproducibility in their measurements. The Activ5 dynamometer cannot be used interchangeably with the Jamar dynamometer; however, the close values reported make it a reliable tool in grip strength assessment. The different characteristics of the Activ5 instrument, such as its ergonomics, weight, portability, wireless connection, dimensions, and applications, make it a promising daily- use tool for assessing, monitoring, and the prescription of physical activity and exercise.

1. Introduction

Muscle weakness has been widely investigated in various clinical and educational populations, revealing that impaired muscle function affects physical function [1,2]. Many factors can trigger strength deficits at some point in people’s lives, including aging, injuries [3], physical inactivity [4], or sedentary behaviors [5]. Various methods have been used for strength assessment, including fixed dynamometry based in the laboratory; however, the main limitation of these dynamometers is their cost and cumbersome nature, making their daily use in people’s evaluations difficult [6,7,8]. Therefore, other devices have been used because they allow for daily assessment. These portable, low-cost devices have emerged as suitable methods for assessing the isometric muscle strength of the limbs, particularly hand dynamometers [6]. The results of this study demonstrate that the Nicholas Manual Muscle Tester is valid and highly reliable for testing between trials and days. Clinicians should be diligent in ensuring that their HHD instruments are clearly marked so that the same device is used consistently to evaluate a given patient [9]. Meanwhile, the study developed by Bohannon [10] affirms that manual dynamometry is a good portable alternative that allows objective measurements of muscle strength to be obtained where measurements must be reliable and valid.
According to Mentiplay [11], manual dynamometry is a reliable tool for isometric muscle assessment, providing valuable information in different population groups, especially those characterized by physical inactivity, sedentary lifestyle, and low grip strength [12,13]. In the scientific community, grip strength assesses people’s physical function based on muscle strength measurement, frailty [14], sarcopenia [15], and cardiovascular risk [16,17]. Grip strength assessment has also been a determining variable in the physical condition of healthy populations, especially as a predictor of mortality risk and to monitor the rehabilitation process [18,19,20]. Although various instruments have been developed to assess grip strength, including fixed dynamometers and manual grip dynamometers, the Jamar hand dynamometer (Lafayette Instrument, Lafayette, IN, USA)) is the most widely used for clinical contexts and research [21]. This is because the Jamar dynamometer guarantees excellent reliability and is considered the gold standard in grip strength assessment [22,23].
However, manual grip as a health indicator demands appropriate reference values and cutoff points aiming to classify grip strength to adjust these parameters to the specificities of each context [24,25]. Here, grip strength assessment using the Jamar dynamometer has allowed for the establishment of reference values for various age groups to make future clinical decisions [26,27]. In the same vein, manual grip assessment responds to a specific methodology for its evaluation. The American Society of Hand Therapists (ASHT) has designed a protocol, and it was replicated in various research studies [28,29,30].
For the protocols, three repetitions with 15 s of rest between each one are recommended [31]. Although the Jamar dynamometer is considered the gold standard, various technological advances have allowed other instruments aimed at grip strength assessment to exist, including portable, smaller, lighter, and easier-to-grip devices which can be useful in various contexts, such as the K-force grip dynamometer (Kinvent, Montpellier, France), which is lighter (0.2 kg) compared to the Jamar (1.4 kg) [21]. However, although the K-force dynamometer has shown high reliability, various studies have reported lower grip strength evaluations when compared to the Jamar dynamometer [32,33].
Similarly, the Activ5 instrument, which has a curved pattern to improve control, grip, and force application, has recently been designed. The Activ5 has several sensors that can absorb more than 100 pounds of pressure and can be connected to a smartphone via Bluetooth, displaying real-time data. It assists in isometric strength assessment with different tests, such as lying shoulder flexion, half-knee flexion, hook, triceps French press, front shoulder elevation, and standing chest press, among others. However, to date, no study has reported comparing the reliability and validity of the Activ5 dynamometer with the Jamar dynamometer.
In response, Sullivan [34] mentions that reliability refers to whether the same instrument used in the same environment and with the same subjects reproduces the same data; therefore, reliability is an integral part of validity assessment. Validity, on the other hand, refers to the accuracy of the measurement of what is specifically intended to be measured [34]. Other studies have sought to evaluate the validity and reliability of other dynamometers compared to the gold standard, Jamar. Among them, it has been highlighted that the DynEx dynamometer is a reliable and valid instrument when compared to the second handle position of the Jamar dynamometer [35]. Similarly, the smart dynamometer and hand trainer Squegg™ also demonstrates good concurrent validity and test–retest reliability ranging from good to excellent when compared to the Jamar dynamometer [36]. However, to date, no study seeking to evaluate the validity and reliability of the Activ5 dynamometer in comparison to the Jamar has been reported.
It has been reported in a study that the Activbody Activ5 load sensor was mechanically tested to evaluate its validity and the reliability of its measurements. It was determined that it has excellent repeatability and agreement when compared to a standard universal testing machine (UTM), Instron ElectroPuls E10000 (Instron, Norwood, MA, USA), which used an Instron Dynacell 2527-202 (Instron, Norwood, MA, USA) load cell (10 kN capacity) [37].
Based on the above discussion, this study aims to examine the reliability and validity of the Activ5 dynamometer for grip strength assessment.

2. Method

2.1. Study Design

This study examined the reliability and concurrent validity of the portable Activ5® dynamometer (Activbody Inc., San Diego, CA, USA) using the hydraulic manual Jamar dynamometer as the gold standard. The present study followed the guidelines for reporting reliability and agreement studies (GRRAS) [38]. This study received approval from our institution’s research ethics committee (ID: 3495/2021) and adhered to the ethical recommendations for research involving human participants, as outlined in the Declaration of Helsinki [39].

2.2. Instruments

The Activ5 instrument (Figure 1) is a digital grip dynamometer that measures generated grip strength and sends the results to a smartphone via Bluetooth technology to an application (Activ5 application) for Android/iOS devices. The instrument has dimensions (length × width × height) [mm] of 95 × 78 × 33, a sampling frequency of 10 Hz, a maximum load design/production at full scale (FS) of 90 kg, and an accuracy of (0.635 kg + 5% of applied force) [37]. Meanwhile, the Jamar dynamometer is an analog instrument that is easily calibrated with a specific weight. This dynamometer has been widely used in various research studies due to the availability of normative data [26,27].
Activ5 is designed for measuring compressive forces up to 90 kg/200 lbs by applying pressure to Activ5’s exterior gray surfaces when placed between two body parts, such as your palms. Pressing on or near the orange belt will result in an inaccurate force measurement. The grip strength test with the Activ5 instrument was performed with the participant seated, feet flat on the floor, the unsupported arm in a neutral position, the shoulder in adduction, the elbow flexed at 90°, and the wrist and forearm in a neutral position, with the wrist supported between 0 and 30° of dorsiflexion and 0 to 10° of ulnar deviation; this guideline was developed in other studies to ensure the quality of the assessment [16]. Additionally, for accurate evaluation, protocols involving three repetitions (trials) with a 15 s rest between each were suggested.

2.3. Participants

The sample consisted of undergraduate students in Sports Science from a university institution (n = 106). The inclusion criteria were as follows: (i) signing of informed consent forms, where all participants agreed to participate voluntarily; (ii) being an undergraduate student in Sports Science; (iii) not having current or recent hand injuries, nor having had hand surgeries in the last 6 months; (iv) not experiencing any discomfort at the time of performing the tests. Each of the students filled out the PAR-Q instrument to determine that they were healthy. Before the test, an informative meeting was held during which the purposes and scope of this study, as well as the tests to be performed, the procedure, and the protocol, were explained to the participants. Before the test, all participants were familiarized with the protocol. All procedures were established based on the guidelines of the Declaration of Helsinki [39]. Table 1 shows the main characteristics of the sample used in this study.

2.4. Procedure

Procedure measurements were taken during a Sports Science undergraduate class at a university community in Murcia. The measurements were always conducted under the same conditions (morning hours) and at room temperature (22–27 °C). The evaluations were conducted at two different time points, with a 5-day interval between each.
The materials used, the adequacy of space, administration time, and data processing methods were kept consistent for the different measurements. The procedure used followed the description by Magni et al. [21], where the participants performed the test seated on a chair, with their feet resting on the floor, their shoulders in a neutral position, their elbow flexed at 90° and without any support, their forearm in a neutral position, and their wrist in dorsiflexion between 0° and 30° with ulnar deviation between 0° and 15°. Each of the participants performed a maximal contraction for 5 s, repeated three times with 30 s rest intervals. Once the work was completed with one hand, they performed the same procedure with the other hand. If they were randomly assigned to perform the first test with the digital dynamometer, they had to repeat the contractions with the Jamar dynamometer in the opposite direction. The tests of both instruments were performed on the same day with an interval of 12 min between the two devices [21]. Additionally, for accurate evaluation, protocols involving three repetitions (trials) with a 15 s rest between each were suggested [31].
The Activ5 dynamometer (Paterson Medical, Green Bay, WI, USA) was placed in the right and left hands, with the evaluator holding it lightly to prevent it from falling, as recommended in other studies [40]. Three maximum contractions (trials) were recorded for each hand, and the best result for each was considered for the analysis. Finally, all participants were evaluated in a seated position without exception to ensure result homogenization [41].

2.5. Statistical Analysis

Pearson correlation analysis was conducted to identify the correlation between the Jamar dynamometer and the Activ5 device. The Lin coefficient was obtained for the same purpose [42]. Likewise, the test–retest technique was used to determine the instrument’s reliability, with ICC (intraclass correlation coefficient) [43] analysis of the three measurements for each participant. To provide a graphical representation of the agreement between the average Activ5 and Jamar measurements, Bland–Altman plots were created. Using the G*power 3.1.9.7 software, the alpha level was set to 0.05 and the power to 0.80. The hypothesis was set to one-tail. With these parameters, the required sample size was 106 participants. The level of significance was set to p < 0.05. All analyses were performed using the Statistical Package for the Social Sciences (SPSS) version 25 (SPSS Inc., Chicago, IL, USA).

3. Results

Participants and grip strength measurement reliability. The averages of the test results obtained for both devices are shown in Table 2.
The correlation coefficient to determine the linear relationship between both instruments determined that between the Jamar right-hand dynamometer and the right-hand Activ5, a coefficient R2 = 0.580, p = 0.00, was obtained. In contrast, the correlation between the Jamar left-hand and the Activ5 left-hand dynamometers had a coefficient R2 = 0.543, p = 0.001. Table 1 shares the main characteristics of the sample used in this study. Both correlations were positive and significant, indicating that if a value increased in one instrument, the value of the other instrument also increased, and vice versa (Figure 2 and Figure 3).
Bland–Altman plots were constructed to quantify the mean difference between both methods [44]. In both cases, for both the right hand and the left hand, we found a discrepancy regarding the accuracy of the Activ5 method, which underestimated the result provided by the Jamar dynamometer. For the right-hand condition, the Activ5 method underestimated an average of 7.14 units compared to the value generated by the Jamar dynamometer. In the case of the left hand, the value obtained by the Activ5 was underestimated by an average of 4.65 units compared to the result of the Jamar dynamometer (Figure 4 and Figure 5).
The other objective of this analysis was to obtain the Lin coefficient, which yielded the following results: for the comparison of the Jamar right-hand dynamometer with the right-hand Activ5, a coefficient of 0.506 was obtained with 95% confidence limits (CLs), LI = 0.411, LS = 0.601. The results for the left hand were as follows: Lin coefficient = 0.601, with 95% confidence limits, LI = 0.502, LS = 0.700. It is assumed that both instruments measure grip strength for both conditions, whether it is the right hand or the left hand.
The second objective was to assess the reliability of the instruments used. For this purpose, the intraclass correlation coefficient (ICC) was calculated. Three measurements were taken for both instruments under both conditions (right hand and left hand). The results are presented in Table 3. The instruments used in this study demonstrate high reliability in measurements. Both the ICC and Cronbach’s alpha scores are high, indicating good reproducibility in their measurements.

4. Discussion

The objective of this study was to examine the reliability and validity of the Activ5 dynamometer for assessing grip strength in a population of adults. The results of this study reveal that both the Jamar dynamometer and the Activ5 are reliable in assessing grip strength. Manual dynamometry showed good to excellent reliability in assessing the isometric muscle strength of the arm musculature in a healthy population. Our findings are consistent with scientific evidence reporting that the Jamar dynamometer has high levels of reliability (ICC) [26,31]. Thus, ICC values and the 95% confidence interval for both devices were above 0.91, indicating excellent intratest reliability. To the best of our knowledge, this is the first study evaluating the reliability and validity of the Activ5 dynamometer by comparing it with the gold-standard instrument.
Similarly, the present study, to evaluate the reliability of the Activ5 instrument in grip strength assessment, considered the sample size references for determining instrument reliability elaborated by the Consensus for the Selection of Health Measurement Instruments (COSMIN) [45]. There, it is reported that to determine whether the sample size included in the analysis is adequate, the sample size must be (≥100) to achieve an excellent category. The present study considered the evaluation of 106 individuals. Regarding reliability, highly positive correlations were found through Pearson’s test, revealing that if the assessment with one instrument increased, so did the other instrument [32,46].
These findings correspond to those reported in other studies using other instruments. Following the findings reported by Bittmann et al. [47], the use of objective measures for determining manual muscle testing (MMT) is a line of research that needs to be developed, as is the establishment of other possible issues, beyond muscle weakness, that are commonly determined by dynamometry usage. This is why the validation of a dynamometer like the Activ5 could help understand this issue: this instrument and its application were designed to perform real-time monitoring and evaluation of different postures in different populations. Another important aspect of the validation process of other portable instruments lies in how weight generates ease or difficulty in maneuvering the instrument, which can cause different efforts due to the position of the joints when generating force [48,49]. This is in response to the variety of portable dynamometers available, where their different grips require different validation and reliability studies to be performed [48].
These issues should be solved in the form of longitudinal studies, which can be conducted using instruments that allow for feedback on the produced force, as Activ5 does. The Activ5 dynamometer allows for the instantaneous recording of grip strength assessment through projection on a mobile phone screen, which can help the individual to regulate his or her muscle control and generate rapid feedback. Given the above, and comparing the results obtained, it can be assumed that the difference in force measurement between both dynamometers is small and that the upper–lower limits are narrow, which can lead to the belief that the Activ5 dynamometer is optimal for use in grip strength assessment in healthy populations or individual monitoring. This is closely related to other studies in the Colombian population between the Camry and Jamar instruments [49], MyoGrip and Jamar [50], and K-force and Jamar [21], which have sought to compare the reliability and validity of two dynamometers, including the gold standard. It should be mentioned that, regarding the accuracy of the measurements obtained by the Activ5 for both the right and left hand, we found that the Activ5 underestimated the result provided by the Jamar dynamometer.
However, both the Activ5 and the Jamar dynamometer show high reliability in measurements; both ICC and Cronbach’s alpha present high scores, indicating that the instruments have good reproducibility in their measurements. For this reason, and considering that both dynamometers compared in this study differ in their precision, structure, ergonomics, weight, and characteristics, it is necessary to develop future research that replicates the validity of the Activ5 dynamometer, as well as future applications in the monitoring of rehabilitation processes and promotion of physical activity, among others. For this reason, future research should carry out investigations using the Activ5 dynamometer in other contexts and ages to favor its reproducibility and to compare the validity according to the results shown by the instrument, the grip structure, and the influence of other protocols different from the one used in the present study.
This could have practical utility for both health and sports sciences professionals, primarily for children and elderly populations [51]. However, it is necessary to clarify that in clinical evaluations, the Activ5 dynamometer should be used with caution, considering the estimation reached in the present study and other research suggesting the same with other dynamometers [21]. There is a challenge for health and sports science professionals, which lies in understanding technological advances and putting them at the service of society.
There are increasingly more portable instruments with connectivity to mobile devices that provide opportunities to monitor people’s recovery, making the rehabilitation process more interactive. This is the case with instruments such as the point of care (POC) in medicine, which can help obtain faster results and help make decisions or develop more efficient therapeutic interventions [52]. All this is because there are smartphone sensors aimed at monitoring and diagnosing health [53], portable devices for balance assessment in stroke patients [54], as well as wireless mobile grip devices that measure both isometric and elastic grip force to assess and help program training [55]. Although there are multiple portable dynamometers available today, determining their interchangeability remains unknown, which can make reading, analyzing, and comparing normative data difficult.
In response, the study conducted by Du [56] sought variability among six dynamometers available on the market to determine the assessment of isometric muscle strength in four muscle groups in healthy individuals. It was proven that the percentage differences between the dynamometers were in the ranges of 0.2% and 16%, concluding that portable dynamometers (Citec, MicroFET2, Jamar Plus, and Baseline Hydraulic) can be used for strength assessment [56]. These findings somewhat relate to those of the present study, which confirmed that the Activ5 dynamometer allows for assessing the isometric strength of the musculature by reporting similar data when compared to the Jamar dynamometer (gold standard). The correlation coefficient to determine the linear relationship between both instruments determined that between the Jamar right-hand dynamometer and the right-hand Activ5, a coefficient R2 = 0.580, p = 0.00, was obtained. In contrast, the correlation between the Jamar left-hand dynamometer and left-hand Activ5 had a coefficient R2 = 0.543, p = 0.00.

4.1. Limitations

It must not be forgotten that the instrument was validated under a specific context and in a sample population with specific characteristics. Therefore, caution should be exercised when interpreting the results found, as it has been reported that HHD reliability tends to be lower in healthy population groups compared to clinical samples [57].
It would also be important to consider the characteristics of the population, given that it was a physically active population, without health problems, and that they were young adults.

4.2. Future Perspectives and Practical Applications

Although the sample evaluated in this study consisted of healthy and physically active young individuals, more data are needed for such population groups; many of the findings may not be extrapolatable to clinical populations. There is a justified need to validate an instrument that can be portable and that would help solve grip strength assessment in different contexts. Such wireless and easy-to-carry instruments could become a daily-use tool for populations with low levels of physical activity or even for active populations. Finally, with the validation of the instrument, new research scenarios open; studies with longitudinal designs will allow for the recognition of the usefulness of the Activ5 instrument. There is also the opportunity to develop other studies to validate the instrument in other ages and contexts. Further research is needed to provide information on how the Activ5 dynamometer can be used for the long-term monitoring of handgrip strength in different population groups.

5. Conclusions

Manual dynamometry has become a reliable and valid tool for assessing the isometric strength of the musculature of the upper extremities; this information can be valuable for both health and sports sciences professionals. It has been proven that, although the Activ5 dynamometer cannot be used interchangeably with the Jamar dynamometer, it reports close values to the Jamar, which makes it a reliable tool for use in grip strength assessment in healthy populations. The different characteristics of the Activ5 instrument, such as its ergonomics, weight, portability, wireless connection, dimensions, and applications, make it a promising daily-use tool for assessing, monitoring, and the prescription of physical activity and exercise.

Author Contributions

Conceptualization, B.A.B.-P. and J.P.-O.; methodology, J.P.-O. and R.C.-E.; software, R.C.-E.; validation, R.C.-E. and J.P.-O.; formal analysis, R.C.-E.; investigation, J.P.-O.; resources, B.A.B.-P. and J.P.-O.; data curation, R.C.-E. and J.P.-O.; writing—original draft preparation, B.A.B.-P. and J.P.-O.; writing—review and editing, B.A.B.-P. and J.P.-O.; visualization, J.P.-O.; R.C.-E. and B.A.B.-P.; supervision, B.A.B.-P. and J.P.-O.; project administration, J.P.-O. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki and approved by Ethics Committee of Murcia University (ID: 3495/2021).

Informed Consent Statement

Informed consent was obtained from all subjects involved in this study.

Data Availability Statement

The raw data supporting the conclusions of this article will be made available by the authors without undue reservation.

Conflicts of Interest

The authors declare no conflicts of interest.

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Figure 1. Activ5 force dynamometer. Source: https://activ5.com/.
Figure 1. Activ5 force dynamometer. Source: https://activ5.com/.
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Figure 2. Correlation between Jamar dynamometer and Activ5 for the right hand.
Figure 2. Correlation between Jamar dynamometer and Activ5 for the right hand.
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Figure 3. Correlation between Jamar dynamometer and Activ5 for the left hand. Note: The gray points are the measurements of each of the pairs of measurements, it is a scatter plot, so each pair of measurements of each variable for each data. The dashed line is the trend line that graphically shows the relationship between the variables. If the line is increasing, the relationship is positive.
Figure 3. Correlation between Jamar dynamometer and Activ5 for the left hand. Note: The gray points are the measurements of each of the pairs of measurements, it is a scatter plot, so each pair of measurements of each variable for each data. The dashed line is the trend line that graphically shows the relationship between the variables. If the line is increasing, the relationship is positive.
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Figure 4. Bland–Altman plot of the differences for the right hand.
Figure 4. Bland–Altman plot of the differences for the right hand.
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Figure 5. Bland–Altman plot of the differences for the left hand.
Figure 5. Bland–Altman plot of the differences for the left hand.
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Table 1. Simple variables. Values are expressed as mean ± SD.
Table 1. Simple variables. Values are expressed as mean ± SD.
nAge (y)Weight (kg)Height (m)BMI (kg/m2)
10620.38 ± 1.6471.52 ± 11.321.70 ± 0.1124.7 ± 3.2
Note: n: number of participants; y: years; kg: kilograms; m: meters; BMI: body mass index; SD: standard deviation.
Table 2. Mean and standard deviation of grip strength results for Jamar and Activ5 dynamometers ( x ¯  ± SD).
Table 2. Mean and standard deviation of grip strength results for Jamar and Activ5 dynamometers ( x ¯  ± SD).
nJamar Dynamometer Right HandActiv5
Right Hand		Delta
(Δ)		ESJamar Dynamometer Left HandActiv5 Left HandDelta (Δ)ES
10639 ± 8.731.8 ± 6.47.14 ± 5.630.935.9 ± 8.631.2 ± 8.74.65 ± 5.810.6
Note: ES = effect size.
Table 3. Intraclass correlation coefficient (ICC) for Jamar dynamometer and Activ5 under two conditions.
Table 3. Intraclass correlation coefficient (ICC) for Jamar dynamometer and Activ5 under two conditions.
InstrumentConditionICCLower LimitUpper LimitCronbach’s Alpha
Jamar dynamometerRight0.9550.9360.9680.957
Left0.9590.9380.9730.965
Activ5Right0.9300.8950.9530.938
Left0.9130.8750.9400.920
Note: ICC: intraclass correlation coefficient.
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Pino-Ortega, J.; Carvajal-Espinoza, R.; Becerra-Patiño, B.A. Evaluation of Hand Muscle Strength Using Manual Dynamometry: A Reliability and Validity Study of the Activ5 Instrument. Appl. Sci. 2024, 14, 8775. https://doi.org/10.3390/app14198775

AMA Style

Pino-Ortega J, Carvajal-Espinoza R, Becerra-Patiño BA. Evaluation of Hand Muscle Strength Using Manual Dynamometry: A Reliability and Validity Study of the Activ5 Instrument. Applied Sciences. 2024; 14(19):8775. https://doi.org/10.3390/app14198775

Chicago/Turabian Style

Pino-Ortega, José, Rafael Carvajal-Espinoza, and Boryi A. Becerra-Patiño. 2024. "Evaluation of Hand Muscle Strength Using Manual Dynamometry: A Reliability and Validity Study of the Activ5 Instrument" Applied Sciences 14, no. 19: 8775. https://doi.org/10.3390/app14198775

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