Scientific Article|Articles in Press

Test–retest Reliability and Precision of the Rotterdam Intrinsic Hand Myometer

Published:March 10, 2023DOI:


      The purpose of this study was to determine the test–retest reliability and precision of Rotterdam Intrinsic Hand Myometer (RIHM) in healthy adults.


      Twenty-nine participants originally recruited via convenience sampling at a Midwestern state fair returned approximately 8 days later for retest. An average of three trials for each of the five intrinsic hand strength measurements were collected using the same technique that was used during initial testing. Test–retest reliability was assessed using the intraclass correlation coefficient or ICC(2,3) and precision was evaluated using the standard error of measurement (SEM), and the minimal detectable change (MDC90)/MDC%.


      Across all measures of intrinsic strength, the RIHM and its standardized procedures had excellent test–retest reliability. Index finger metacarpophalangeal flexion demonstrated the lowest reliability, and right small finger abduction, left thumb carpometacarpal abduction, and index finger metacarpophalangeal abduction tests had the highest reliability. Precision, as evidenced by SEM and MDC values, was excellent for tests of left index and bilateral small finger abduction strength and acceptable for all other measurements.


      Test–retest reliability and precision of RIHM across all measurements was excellent.

      Clinical Relevance

      These findings indicate that RIHM is a reliable and precise tool in measuring intrinsic strength of hands of healthy adults, although further research is needed in clinical populations.

      Key words

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        • Allen M.D.
        • Doherty T.J.
        Assessing weakness in patients with ulnar neuropathy: comparison between a custom hand muscle dynamometer and a pinch dynamometer.
        Am J Phys Med Rehabil. 2011; 90: 923-929
        • Bell S.W.
        • Brown M.J.
        • Hems T.J.
        Refinement of myotome values in the upper limb: evidence from brachial plexus injuries.
        Surgeon. 2017; 15: 1-6
        • Sapienza A.
        • Green S.
        Correction of the claw hand.
        Hand Clin. 2012; 28: 53-66
        • Brand P.W.
        • Yancey P.
        Chingleput Detour.
        in: Brand P.W. The Gift of Pain: Why We Hurt and What We Can Do About It. Zondervan, Grand Rapids, MI1993: 87-102
        • Arthur-Farraj P.J.
        • Murphy S.M.
        • Laura M.
        • et al.
        Hand weakness in Charcot-Marie-Tooth disease 1X.
        Neuromuscul Disord. 2012; 22: 622-626
        • Li L.
        • Shin H.
        • Stampas A.
        • Li X.
        • Zhou P.
        Electrical impedance myography changes after incomplete cervical spinal cord injury: an examination of hand muscles.
        Clin Neurophysiol. 2017; 128: 2242-2247
        • Lai C.
        • Kenney D.
        • Kerkhof F.
        • et al.
        Ultrasound of thumb muscles and grasp strength in early thumb carpometacarpal osteoarthritis.
        J Hand Surg Am. 2022; 47: 898-e1
        • Kozin S.H.
        • Porter S.
        • Clark P.
        • Thoder J.J.
        The contribution of the intrinsic muscles to grip and pinch strength.
        J Hand Surg Am. 1999; 24: 64-72
        • Schreuders T.A.
        • Selles R.W.
        • Roebroeck M.E.
        • Stam H.J.
        Strength measurements of the intrinsic hand muscles: a review of the development and evaluation of the Rotterdam intrinsic hand myometer.
        J Hand Ther. 2006; 19: 393-401
        • Van Harlinger W.
        • Blalock L.
        • Merritt J.L.
        Upper limb strength: study providing normative data for a clinical handheld dynamometer.
        PM&R. 2015; 7: 135-140
        • McGee C.
        • Hoehn A.
        • Hoenshell C.
        • McIlrath S.
        • Sterling H.
        • Swan H.
        Age- and gender-stratified adult myometric reference values of isometric intrinsic hand strength.
        J Hand Ther. 2020; 33: 402-410.e2
        • Chen C.Y.
        • McGee C.W.
        • Rich T.L.
        • Prudente C.N.
        • Gillick B.T.
        Reference values of intrinsic muscle strength of the hand of adolescents and young adults.
        J Hand Ther. 2018; 31: 348-356
        • McGee C.
        Measuring intrinsic hand strength in healthy adults: the accuracy, intra-rater, and inter-rater reliability of the Rotterdam intrinsic Hand Myometer.
        J Hand Ther. 2018; 31: 530-537
        • Molenaar H.M.T.
        • Selles R.W.
        • Schreuders T.A.R.
        • Hovius S.E.R.
        • Stam H.J.
        Reliability of hand strength measurements using the Rotterdam intrinsic Hand Myometer in children.
        J Hand Surg Am. 2008; 33: 1796-1801
        • Schreuders T.A.
        • Roebroeck M.E.
        • Jaquet J.B.
        • Hovius S.E.
        • Stam H.J.
        • et al.
        Measuring the strength of the intrinsic muscles of the hand in patients with ulnar and median nerve injuries: reliability of the Rotterdam Intrinsic Hand Myometer (RIHM).
        J Hand Surg Am. 2004; 29: 318-324
        • Keller J.L.
        • Henderson J.P.
        • Landrieu K.W.
        • Dimick M.P.
        • Walsh J.M.
        The 2019 practice analysis of hand therapy and the use of orthoses by certified hand therapists.
        J Hand Ther. 2021; (S0894-1130(21)00055-7)
        • Mackenzie D.J.
        • Hainer R.
        • Wheatley M.J.
        Early recovery after endoscopic vs. short-incision open carpal tunnel release.
        Ann Plast Surg. 2000; 44: 601-604
        • Trumble T.E.
        • Diao E.
        • Abrams R.A.
        • Gilbert-Anderson M.M.
        Single-portal endoscopic carpal tunnel release compared with open release: a prospective, randomized trial.
        J Bone Joint Surg Am. 2002; 84: 1107-1115
        • Macdermid J.C.
        • Richards R.S.
        • Roth J.H.
        • Ross D.C.
        • King G.J.W.
        Endoscopic versus open carpal tunnel release: a randomized trial.
        J Hand Surg Am. 2003; 28: 475-480
        • Burke J.
        • Buchberger D.J.
        • Carey-Loghmani M.T.
        • Dougherty P.E.
        • Greco D.S.
        • Dishman J.D.
        A pilot study comparing two manual therapy interventions for carpal tunnel syndrome.
        J Manipulative Physiol Ther. 2007; 30: 50-61
        • Li L.
        • Li Y.
        • Wu C.
        • Zhang X.
        Test-retest reliability of tip, key, and palmar pinch force sense in healthy adults.
        BMC Musculoskelet Disord. 2020; 21: 189
        • Bulut T.
        • Tahta M.
        • Sener U.
        • Sener M.
        Inter- and intra-tester reliability of sensibility testing in healthy individuals.
        J Plast Surg Hand Surg. 2018; 52: 189-192
        • Den Ouden A.H.
        • Den Ouden R.H.
        User’s Manual RIHM (Version 1.3). St. Annaland: Last Mile Solutions. 2005.
        • Fleiss J.L.
        • Levin B.
        • Paik M.C.
        Statistical Methods for Rates and Proportions.
        3rd ed. John Wiley & Sons Inc, 2003
        • Chiu E.C.
        • Wu W.C.
        • Chou C.X.
        • Yu M.Y.
        • Hung J.W.
        Test-retest reliability and minimal detectable change of the test of visual perceptual skills-third edition in patients with stroke.
        Arch Phys Med Rehabil. 2016; 97: 1917-1923
        • von Elm E.
        • Altman D.G.
        • Egger M.
        • et al.
        The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies.
        Int J Surg. 2014; 12: 1495-1499
        • Walter S.D.
        • Eliasziw M.
        • Donner A.
        Sample size and optimal designs for reliability studies.
        Stat Med. 1998; 17: 101-110<101::aid-sim727>;2-e
        • Baschung Pfister P.
        • de Bruin E.D.
        • Sterkele I.
        • Maurer B.
        • de Bie R.A.
        • Knols R.H.
        Manual muscle testing and hand-held dynamometry in people with inflammatory myopathy: an intra- and interrater reliability and validity study.
        PLOS ONE. 2018; 13e0194531
        • Madhanagopal J.
        • Singh O.P.
        • Mohan V.
        • Sathasivam K.V.
        • Omar A.H.
        • Abdul Kadir M.R.
        New device for intrinsic hand muscle strength measurement: an alternative to strain gauge handheld dynamometer.
        Eval Health Prof. 2019; 42: 103-113
        • Pataky T.C.
        • Savescu A.V.
        • Latash M.L.
        • Zatsiorsky V.M.
        A device for testing the intrinsic muscles of the hand.
        J Hand Ther. 2007; 20: 345-350
        • Portney L.
        • Watkins M.
        Foundations of Clinical Research.
        3rd ed. Pearson Health Science, 2009
        • Med.engineers
        Rotterdam Intrinsic Hand Myometer.