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Maximum Voluntary Isometric Contraction (MVIC)
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Supplemental-Highly Recommended: Facioscapulohumeral Muscular Dystrophy (FSHD)
Supplemental: Amyotrophic Lateral Sclerosis, (ALS), Cerebral Palsy (CP), Congenital Muscular Dystrophy (CMD), Duchenne Muscular Dystrophy (DMD), Mitochondrial Disease (Mito), Myotonic Dystrophy (DM), Neuromuscular Disease (NMD), Spinal Muscular Atrophy (SMA)
Short Description of Instrument
Maximum Voluntary Isometric Contraction (MVIC) is a standardized method for measurement of muscle strength in patients with neuromuscular disease. (Cudkowicz et al., 2004) Along with the Manual Muscle Test, the MVIC is a common measurement techniques used in the clinical setting. (Meldrum et al., 2003)
Derived from the Tufts Quantitative Neuromuscular Exam (Andres et al., 1986), the MVIC measures the strength of 20 muscle groups by asking the individual to exert maximal isometric force against a strap attached to a strain gauge, using standard positions (flexion, dorsiflexion, extension) and stabilization procedures (National Isometric Muscle Strength (NIMS) Database Consortium, 1996).
Comments/Special Instructions
For strength measurement, the MVIC is the simplest method of accurately measuring the force-producing capabilities of a muscle group, mainly because isometric testing holds constant the variables of velocity of joint motion and muscle length. (Smidt et al, 1982) Measurement of MVIC using a fixed strain-gauge tensiometer has become the standard method of strength measurement in research studies of neuromuscular disease. (National Isometric Muscle Strength (NIMS) Database Consortium, 1996; Potvin et al., 1981)
Methodologies vary on the number of trials of MVIC utilized to give the final value. Some authors suggest that the maximum of two or three values should be used in keeping with the definition of MVIC, (Brinkman et al., 1997; Hoagland et al., 1997); others suggest taking the average value of three (Fillyaw et al., 1987; Mathiowetz, 1990), and one group used the median of five values. (Tawil et al., 1997)
Scoring and Psychometric Properties
Scoring: Each muscle is tested twice while the patient is encouraged by the evaluator to exert maximal effort. The maximum force generated by the patient is recorded for each trial, and the maximum over the two trials is used as the final measurement for each muscle.
MVIC tested values can be measured in Newtons, kilogram-force or pounds-force.
Psychometric Properties: In a study by Andre et al., (1986) "the mean intrarater test-retest correlation for isometric strength was r = 0.96 for normal contrls and r = 0.98 for ALS patients." Meldrum and collegues (2003) reported the MVIC generating very good inter- and intratester reliability levels for all muscle groups tested.
Strengths: MVIC using strain-gauge tensiometers eliminates muscle-length and velocity of variables. Strain-guage measurements produce valid and reliable interval data. (Andre et al., 1986)
Weaknesses: MVIC requires digital technology with supportive equipment, additional technical expertise for maintenance, and a significant time commitment from examiners. (Great Lakes ALS Study Group, 2003) In a study by Meldrum et al. (2003), it was demonstrated that a learning effect in new users of the system, suggesting that "extensive training, standardization and serial testing are necessary to reduce error when measuring MVIC." The test must be performed at a fixed joint angle to avoid strength curve differences.
Key References:
Andres PL, Hedlund W, Finison L, Conlon T, Felmus M, Munsat TL. Quantitative motor assessment in amyotrophic lateral sclerosis. Neurology. 1986 Jul;36(7):937-41.
National Isometric Muscle Strength (NIMS) Database Consortium. Muscular weakness assessment: use of normal isometric strength data. Arch Phys Med Rehabil 1996; 77:1251-1255.
Additional References:
de Boer A, Boukes RJ, Sterk JC. Reliability of dynamometry in patients with a neuromuscular disorder. Eng Med. 1982 Oct;11(4):169-74.
Brinkmann JR, Andres P, Mendoza M, Sanjak M. Guidelines for the use and performance of quantitative outcome measures in ALS clinical trials. J Neurol Sci. 1997 Mar 20;147(1):97-111.
Cudkowicz M, Zhang H, Qureshi M, Schoenfeld D. Maximum voluntary isometric contraction (MVIC). Amyotroph Lateral Scler Other Motor Neuron Disord. 2004 Sep;5 Suppl 1:84-5.
Fillyaw MJ, Tandan R, Bradley WG. Serial evaluation of neuromuscular function in management of chronic inflammatory demyelinating polyneuropathy. A case report. Phys Ther. 1987 Nov;67(11):1708-11.
Muscle Study Group. Randomized pilot trial of high-dose betaINF-1a in patients with inclusion body myositis. Neurology. 2004 Aug 24;63(4):718-20.
Great Lakes ALS Study Group. A comparison of muscle strength testing techniques in amyotrophic lateral sclerosis. Neurology. 2003 Dec 9;61(11):1503-7.
Hoagland RJ, Mendoza M, Armon C, Barohn RJ, Bryan WW, Goodpasture JC, Miller RG, Parry GJ, Petajan JH, Ross MA. Reliability of maximal voluntary isometric contraction testing in a multicenter study of patients with amyotrophic lateral sclerosis. Syntex/Synergen Neuroscience Joint Venture rhCNTF ALS Study Group. Muscle Nerve. 1997 Jun;20(6):691-5.
Mathiowetz V. Grip and pinch strength measurements. In: Amundsen LR (ed) Muscle strength testing: instrumented and non-instrumented systems. Churchill Livingstone. Edinburgh 1990. Chapter 7, p 163-177.
Meldrum D, Cahalane E, Keogan F, Hardiman O. Maximum voluntary isometric contraction: investigation of reliability and learning effect. Amyotroph Lateral Scler Other Motor Neuron Disord. 2003 Apr;4(1):36-44.
Personius KE, Pandya S, King WM, Tawil R, McDermott MP. Facioscapulohumeral dystrophy natural history study: standardization of testing procedures and reliability of measurements. The FSH DY Group. Phys Ther. 1994 Mar;74(3):253-63.
Potvin AR, Tourtellotte WW, Syndulko K, Potvin J. Quantitative methods in assessment of neurologic function. Crit Rev Bioeng. 1981;6(3):177-224.
Scott OM, Hyde SA, Goddard C, Dubowitz V. Quantitation of muscle function in children: a prospective study in Duchenne muscular dystrophy. Muscle Nerve. 1982 Apr;5(4):291-301.
Smidt GL, Rogers MW. Factors contributing to the regulation and clinical assessment of muscular strength. Phys Ther. 1982 Sep;62(9):1283-90.
Tawil R, McDermott MP, Pandya S, King W, Kissel J, Mendell JR, Griggs RC. A pilot trial of prednisone in facioscapulohumeral muscular dystrophy. FSH-DY Group. Neurology. 1997 Jan;48(1):46-9.
van der Woude DR, Ruyten T, Bartels B. Reliability of Muscle Strength and Muscle Power Assessments Using Isokinetic Dynamometry in Neuromuscular Diseases: A Systematic Review. Phys Ther. 2022 Oct 6;102(10):pzac099.
Wiles CM, Karni Y. The measurement of muscle strength in patients with peripheral neuromuscular disorders. J Neurol Neurosurg Psychiatry. 1983 Nov;46(11):1006-13.
MVIC Observational Study in FSHD:
A prospective, quantitative study of the natural history of facioscapulohumeral muscular dystrophy (FSHD): implications for therapeutic trials. The FSH-DY Group. Neurology. 1997 Jan;48(1):38-46.
MVIC in Clinical Trials:
Kissel JT, McDermott MP, Mendell JR, King WM, Pandya S, Griggs RC, Tawil R; FSH-DY Group. Randomized, double-blind, placebo-controlled trial of albuterol in facioscapulohumeral dystrophy. Neurology. 2001 Oct 23;57(8):1434-40.
Payan CA, Hogrel JY, Hammouda EH, Lacomblez L, Ollivier G, Doppler V, Eymard B, Attarian S, Pouget J, Desnuelle C, Laforet P. Periodic salbutamol in facioscapulohumeral muscular dystrophy: a randomized controlled trial. Arch Phys Med Rehabil. 2009 Jul;90(7):1094-101.
van der Kooi EL, Vogels OJ, van Asseldonk RJ, Lindeman E, Hendriks JC, Wohlgemuth M, van der Maarel SM, Padberg GW. Strength training and albuterol in facioscapulohumeral muscular dystrophy. Neurology. 2004 Aug 24;63(4):702-8.
Wagner KR, Fleckenstein JL, Amato AA, Barohn RJ, Bushby K, Escolar DM, Flanigan KM, Pestronk A, Tawil R, Wolfe GI, Eagle M, Florence JM, King WM, Pandya S, Straub V, Juneau P, Meyers K, Csimma C, Araujo T, Allen R, Parsons SA, Wozney JM, Lavallie ER, Mendell JR. A phase I/IItrial of MYO-029 in adult subjects with muscular dystrophy. Ann Neurol. 2008 May;63(5):561-71.
Document last updated March 2024