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Reliability and Measurement Error of Instrument-Based Methods to Assess Ankle Evertor Strength: A Systematic Review.

Aude Aguilaniu1,2, Stéphanie Grosdent1, Cédric Schwartz1,2

  • 1Department of Physical Activity and Rehabilitation Sciences, University of Liège, Liège, Belgium.

Journal of Sport Rehabilitation
|April 4, 2026
PubMed
Summary
This summary is machine-generated.

Accurate ankle evertor strength testing is crucial for ankle sprain recovery. Isokinetic dynamometry offers the best reliability and lowest measurement error, with hand-held dynamometers as a viable alternative.

Keywords:
ankle sprainhand-held dynamometerisokinetic dynamometermuscle strengthsports medicine

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Area of Science:

  • Biomechanics and Sports Medicine
  • Rehabilitation Science
  • Clinical Assessment Tools

Background:

  • Ankle evertor strength assessment is vital for rehabilitation and return-to-sport decisions after lateral ankle sprain.
  • The reliability and measurement error of common assessment instruments are not well-established.

Purpose of the Study:

  • To systematically review and synthesize existing literature on the reliability and measurement error of instruments used for assessing ankle evertor strength.

Main Methods:

  • A systematic literature search was performed across major databases (MEDLINE, Embase, Scopus, DiTA).
  • Studies measuring voluntary ankle evertor strength were included and assessed for risk of bias using the COSMIN tool.
  • Data on reliability (ICC or Pearson r) and measurement error (MDC, LoA, CV) were extracted, with predefined thresholds for sufficiency (reliability ≥ .70, measurement error ≤20%).

Main Results:

  • 23 studies were included from 4047 records, utilizing isokinetic dynamometers, hand-held dynamometers, and other custom instruments.
  • Reliability was sufficient in 83% of assessed values, but measurement error was only sufficient in 34% of cases.
  • While protocol parameters minimally impacted test-retest reliability, they significantly influenced measurement error and interrater reliability.

Conclusions:

  • Isokinetic dynamometry, particularly for isometric testing, shows the most consistent reliability and lowest measurement error for ankle evertor strength.
  • Hand-held dynamometers serve as a reliable field alternative for isometric assessments when isokinetic devices are unavailable.
  • Standardizing protocol parameters is essential to enhance measurement reproducibility and clinical utility.