Measurement Properties of Hand-Held Dynamometry for Ankle Strength Assessment: A COSMIN-Based Systematic Review and Meta-Analysis.
6 affiliations
- 1Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
- 2Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil.
- 3Universidade Paulista (UNIP), São Paulo, SP, Brazil.
- 4Departamento de Pós-Graduação em Saúde Baseada em Evidências, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
- 5Faculdade de Sete Lagoas (FACSETE), Sete Lagoas, MG, Brazil.
- 6Faculdade Ciências Médicas de Minas Gerais (FCM-MG), Belo Horizonte, MG, Brazil.
Abstract
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.
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BibTeX
@article{ferreira2026measurement,
title = {{Measurement Properties of Hand-Held Dynamometry for Ankle Strength Assessment: A COSMIN-Based Systematic Review and Meta-Analysis.}},
author = {Matheus Hissa Lourenço Ferreira and João Victor Völker Oliveira and Nelson Carvas Junior and Túlio Medina Dutra de Oliveira and Guilherme Augusto Santos Araujo and José Elias Filho and George Schayer Sabino and Carla Malaguti and Diogo Carvalho Felício},
journal = {Musculoskeletal care},
year = {2026},
month = oct,
doi = {10.1002/msc.70285},
url = {https://europepmc.org/article/MED/42920374},
note = {CC BY},
}
RIS
TY - JOUR
TI - Measurement Properties of Hand-Held Dynamometry for Ankle Strength Assessment: A COSMIN-Based Systematic Review and Meta-Analysis.
AU - Matheus Hissa Lourenço Ferreira
AU - João Victor Völker Oliveira
AU - Nelson Carvas Junior
AU - Túlio Medina Dutra de Oliveira
AU - Guilherme Augusto Santos Araujo
AU - José Elias Filho
AU - George Schayer Sabino
AU - Carla Malaguti
AU - Diogo Carvalho Felício
PY - 2026
DA - 2026/10/30
JO - Musculoskeletal care
DO - 10.1002/msc.70285
UR - https://europepmc.org/article/MED/42920374
AB - 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.
SN - 1478-2189
SN - 1557-0681
ER -