Myotonometry for the evaluation of Achilles tendon mechanical properties: a reliability and construct validity study

Alessandro Schneebeli, Deborah Falla, Ron Clijsen, Marco Barbero, Alessandro Schneebeli, Deborah Falla, Ron Clijsen, Marco Barbero

Abstract

Objective: This study evaluates the intra-rater and inter-rater reliability of the MyotonPRO and its construct validity for the assessment of Achilles tendon stiffness.

Design: Reliability and construct validity study.

Methods: Forty healthy participants were assessed using the MyotonPRO by two raters on two different occasions. Tendon was evaluated in three different positions (relaxed, 0° plantarflexion and standing) and during different isometric contractions (range 0-3 kg). Reliability was calculated using intraclass correlation coefficient (ICC and 95% CI) standard error of measurement and minimal detectable change. Construct validity was evaluated between the different positions and the different contraction intensities using Friedman test.

Results: Intra-rater reliability was very high ICC2,k 0.87-0.98. The reliability of the 0.5 kg contraction was moderate with an ICC2,k of 0.59. Inter-rater reliability ranged from high to very high with an ICC2,k of 0.76-0.86. The reliability of the 0.5 kg, 1 kg contraction and the standing position was moderate with an ICC2,k of 0.55, 0.54 and 0.56 respectively. Inter-session reliability ranged from high to very high with an ICC2,k of 0.70-0.89. The reliability of the 0.5 kg contraction was moderate with an ICC2,k of 0.54. Construct validity was demonstrated between different contraction levels and different positions.

Conclusion: MyotonPRO is a reliable tool for the evaluation of Achilles tendon stiffness during different contraction levels and in different positions. Construct validity was supported by changes of tendon stiffness during the explored conditions. MyotonPRO can be implemented, as a ready to use device, in the evaluation of tendon tissue mechanical properties.

Keywords: achilles; ankle; tendon.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Schematic of the experimental setup. (A) Isometric contractions: the foot was securely attached to a dynamometer with a wooden board at a fixed angle of 0° of dorsiflexion. The force measured by the load cell was proportional to the torque exerted at the ankle level. (B) Standing position: participants were asked to stand on a Wii balance board (Nintendo, Kyoto, Japan) with the centre of mass centred on the centre of board with the feet equally spaced. (C) Relaxed position: the feet were hanging freely over the edge of the examination bed. MyotonPRO was applied to the most central point of the tendon at the level of the medial malleolus.
Figure 2
Figure 2
Construct validity. Box plot showing the stiffness median and IQR values of the entire sample for the different contraction levels (A) and for the different positions (B). *p

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