Measuring Motor Fatigability in the Upper Limbs in Individuals With Neurologic Disorders: A Systematic Review

  • Lieke Brauers
    Corresponding author Lieke Brauers, MSc, REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, BMO-A103 Campus Diepenbeek, Agoralaan Gebouw A, BE 3590 Diepenbeek, Belgium.
    REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium

    Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, the Netherlands
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  • Eugene Rameckers
    REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium

    Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, the Netherlands

    Center of Expertise, Adelante Rehabilitation Center, Valkenburg, the Netherlands
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  • Deborah Severijns
    REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
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  • Peter Feys
    REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
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  • Rob Smeets
    Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, the Netherlands
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  • Katrijn Klingels
    REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
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Published:December 28, 2019DOI:



      To summarize the literature on definitions, assessment protocols, and outcome measures for motor fatigability in patients with neurologic problems and investigates the known clinimetric properties according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria.

      Data Sources

      Two databases were consulted for studies published between January 2003 and November 2018 using the terms “motor fatigability,” “nervous system disease,” and “upper limb.”

      Study Selection

      Studies were included if they were (1) not older than 15 years; (2) written in English, German, or Dutch; (3) involved upper limbs of patients with neurologic disease; and (4) adequately described protocols using maximum voluntary contractions.

      Data Extraction

      Thirty-three studies were included, describing 14 definitions, 37 assessment protocols, and 9 outcome measures. The following data were obtained: (1) author and publication year; (2) aim; (3) fatigability definition; (4) sample characteristics; (5) fatigability protocol; (8) measurement system; and (9) outcome measure.

      Data Synthesis

      Protocols relating to body function level of the International Classification of Functioning (ICF) were most often performed in patients with multiple sclerosis (MS) including maximal or submaximal, isometric or concentric, and eccentric contractions of variable duration. For ICF activities level, most protocols included wheelchair-related tasks. Clinimetric properties were known in 2 included protocols. Test-retest reliability in patients with MS were moderate to excellent for the static fatigue index and moderate for the dynamic fatigue index.


      Based on physiology, recommendations are made for protocols and outcome measures for motor fatigability at the ICF body function level. For the ICF activities level, too little is known to make sound statements on the use of protocols in populations with neurologic disease. Clinimetric properties should be further investigated for populations with neurologic problems.


      List of abbreviations:

      ADL (activities of daily living), (H)AUC ((hypothetical) area under the curve), CP (cerebral palsy), COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments), DFI (dynamic fatigue index), ICC (intraclass correlation coefficient), ICF (International Classification of Functioning, Disability and Health), MS (multiple sclerosis), MVC (maximum voluntary contraction), NOS (Newcastle-Ottawa Scale), RoB (risk of bias), ROBINS-I (Risk of Bias in Nonrandomized Studies), SCI (spinal cord injury), SFI (static fatigue index)
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