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Measurement Properties of Hand-Held Dynamometry for Ankle Strength Assessment: A COSMIN-Based Systematic Review and
Matheus Hissa Lourenço Ferreira1, João Victor Völker Oliveira1,2, Nelson Carvas Junior3,4
1Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
Objective:
This systematic review and meta-analysis evaluated the measurement properties of handheld dynamometry (HHD) for assessing isometric ankle muscle strength in healthy individuals.
Methods:
A comprehensive search was conducted in PubMed, EMBASE, CINAHL, Web of Science, SPORTDiscus, PsycINFO, Scopus, and the Virtual Health Library, with no language or date restrictions. Observational and methodological studies assessing dorsiflexors, plantar flexors, invertors, or evertors using HHD were eligible if they reported reliability, measurement error, or construct validity against isokinetic dynamometry. Random-effects meta-analyses were performed by measurement property and testing configuration, following COSMIN guidance.
Results:
Twenty-four studies were included. Inter-rater reliability was good for dorsiflexors (ICC = 0.89, 95% CI 0.80-0.94), plantar flexors (ICC = 0.86, 95% CI 0.72-0.93), invertors (ICC = 0.79, 95% CI 0.66-0.87), and evertors (ICC = 0.75, 95% CI 0.46-0.90). Intra-rater reliability ranged from good to excellent (ICC = 0.88-0.91). External fixation was associated with numerically higher inter-rater ICCs for dorsiflexors and plantar flexors although subgroup differences were not statistically significant. Construct validity was strong for dorsiflexors (r = 0.87, 95% CI 0.42-0.98) but uncertain for plantar flexors (r = 0.72, 95% CI -0.20-0.96). Measurement error remained indeterminate due to the absence of an established minimal important change. Certainty of evidence was high for reliability and low for construct validity; measurement error was not graded.
Conclusion:
HHD provides reliable assessment of isometric ankle strength, including without external fixation. Evidence for construct validity, particularly for plantar flexors, and for measurement error remains limited.
