Oncology EDGE Task Force on Colorectal Cancer Outcomes: A Systematic Review of Clinical Measures of Strength and Muscular Endurance

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Background:Weakness and decreased muscular strength are a common morbidities following treatment for colorectal cancer. Accurate clinical assessment of strength and muscular endurance following colorectal cancer treatments is essential to identify deficits and plan effective physical therapy interventions.Purpose:To identify strength and muscular endurance outcome measures that have strong psychometric properties and are clinically useful for examination of individuals treated for colorectal cancer.Methods:Multiple electronic databases were searched between December 13, 2014, and March 4, 2015. Studies of tools used to assess strength and muscular endurance were included if they were peer-reviewed publications from 1995 to March of 2014 in English, reported psychometric properties, clinically feasible methods, and were conducted on adults. Each outcome measure was independently reviewed and rated by 2 reviewers. If there was disagreement, a third reviewer rated the measure. A single Cancer Evaluation Database to Guide Effectiveness (EDGE) Task Force Outcome Measure Rating Form was completed for each tool, and a recommendation was made using the 4-point Cancer EDGE Task Force Rating Scale.Results:Of the original 4922 articles identified, 21 were reviewed. Five clinical measures of strength were identified: hand grip strength, hand-held dynamometry, isometric strength, manual muscle testing, and trunk flexion strength/lower extremity (LE) dynamometry, along with muscle endurance. Hand-held dynamometry and hand grip strength and using dynamometry were rated a 3 (recommended for clinical use). Manual muscle testing, isometric strength testing, and trunk flexion/LE dynamometry were rated a 2B (unable to recommend at this time because of poor psychometric properties). Muscular endurance testing was rated 1 (unable to recommend at this time because of a lack of psychometric support). Isokinetic testing for muscle strength and endurance has been reported in pilot testing in patients with colorectal cancer; however, sample size was small (n = 4) and the clinical utility is poor.Conclusions:Using objective hand-held dynamometry for muscle strength testing provides precise measurement to assess baseline status and monitor change among those being treated for colorectal cancer. No measures for muscle endurance in the colorectal cancer population with adequate psychometrics were identified.

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