Development and testing of reduced versions of the MMT-8 in juvenile dermatomyositis

Objective To develop and test shortened versions of Manual Muscle Testing-8 (MMT-8) in juvenile dermatomyositis (JDM). Methods Construction of reduced tools was based on retrospective analysis of individual scores of MMT-8 muscle groups in three multinational datasets. The 4 and 6 most frequently impaired muscle groups were included in MMT-4 and MMT-6, respectively. Metrologic properties of reduced tools were assessed by evaluating construct validity, internal consistency, discriminant ability, and responsiveness to change. Results Neck flexors, hip extensors, hip abductors and shoulder abductors were included in MMT-4, whereas MMT-6 also included elbow flexors and hip flexors. Both shortened tools revealed strong correlations with MMT-8 and other muscle strength measures. Correlations with other JDM outcome measures were in line with predictions. Internal consistency was good (0.88-0.96) for both MMT-4 and MMT-6. Both reduced tools showed strong ability to discriminate between disease activity states, assessed by the caring physician or a parent (p < 0.001), and between patients whose parents were satisfied or not satisfied with illness course (p < 0.001). Responsiveness to change (assessed by both standardized response mean and relative efficiency) of MMT-4 and, to a lesser degree, MMT-6, was slightly superior to that of MMT-8. Conclusion The metrologic performance of MMT-4 and MMT-6 was overall comparable to that of the other established muscle strength tools, which indicate that they may be suitable for use in clinical practice and research, including clinical trials. The measurement properties of these tools should be further tested in other patient populations evaluated prospectively.