TO THE EDITOR:

I was quite concerned with the conclusions posited by McCarthy et al. in “Correlation between the Measures of Impairment, According to the Modified System of the American Medical Association, and Function” (80-A: 1034–1042, July 1998). They stated that the correlations were highest when measures of impairment were based on muscle strength rather than on range of motion. Muscle strength was measured by a physical therapist with use of a force-gauge. Approximately one-third of the study group did not show this positive correlation, and yet recommendations were made that undoubtedly will be cited as being authoritative.

My objections are twofold. A physical therapist often cannot distinguish between true muscle weakness and feigned or nonorganic muscular dysfunction. The sensation of giving-way or cogwheel resistance that an experienced orthopaedist evaluates as psychological dysfunction is not properly evaluated by lesser-trained personnel or a machine. Strength-testing evokes a subjective response by the patient and is not an objective manifestation as proposed in this article. If secondary gains are manifest, strength-testing is an inappropriate …


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