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Letter to the Editor

Hébert, Luc J. PT, PhD, CD; Maltais, Désirée PT, PhD

Pediatric Physical Therapy: October 2016 - Volume 28 - Issue 3 - p 362
doi: 10.1097/PEP.0000000000000274

CIRRIS-IRDPQ, Quebec, Canada

The authors declare no conflicts of interest.

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Dear Editor:

We read with interest the commentary on our article “Hand-Held Dynamometry Isometric Torque Reference Values for Children and Adolescents.”1 provided by Drs Masaracchia and Comet.2 They make a good point regarding how our reference values might be used. We would suggest, however, that muscle strength is not unique in being “only one piece of the puzzle.” Modern clinical reasoning theory in physical therapy suggests that outcome measure data in general should be treated as such.3 That is, context and various sources of information about the client or patient are required for meaningful clinical decision making. As well, although we agree with the suggestion of Drs Masaracchia and Comet that clinicians use a standardized protocol for muscle strength testing, we would also like to point out that our study did not “develop a mechanism for objectively measuring muscle strength in children” as stated by the authors. The validation of the measurement protocol was part of a previous study.4 Our main objective for the present study was to “establish hand-held dynamometry maximal isometric muscle torque reference values for children and adolescents who are developing typically.”1 We would also like to add that the optimal use of the reference values published in our recent study1 implies that the clinician has had sufficient training and practice to apply the protocol correctly and consistently. This training should be seen as an integral component of employing a standardized muscle strength testing protocol.

Luc J. Hébert, PT, PhD, CD

Désirée Maltais, PT, PhD

CIRRIS-IRDPQ, Quebec, Canada

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1. Hebert LJ, Maltais DB, Lepage C, Saulnier J, Crete M. Hand-held dynamometry isometric torque reference values for children and adolescents. Pediatr Phys Ther. 2015;27(4):414–423.
2. Masaracchio M, Comet S. Commentary on “hand-held dynamometry isometric torque reference values for children and adolescents.” Pediatr Phys Ther. 2015;27(4):424.
3. Jensen GM, Gwyer J, Hack LM, Shepard KF. Expertise in Physical Therapy Practice. 2nd ed. Philadelphia, PA: WB Saunders Company; 2007.
4. Hebert LJ, Maltais DB, Lepage C, Saulnier J, Crete M, Perron M. Isometric muscle strength in youth assessed by hand-held dynamometry: a feasibility, reliability, and validity study. Pediatr Phys Ther. 2011;23(3):289–299.
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