LIRN PAPER
fix LIRN paper
Reliability of Ankle Isometric, Isotonic,
and Isokinetic Strength and Power
Testing in Older Women
Sandra C. Webber, Michelle M. Porter
Background. Ankle strength (force-generating capacity) and power (work pro-
duced per unit of time or product of strength and speed) capabilities influence
physical function (eg, walking, balance) in older adults. Although strength and power
parameters frequently are measured with dynamometers, few studies have examined
the reliability of measurements of different types of contractions.
Objective. The purpose of this study was to examine relative and absolute
intrarater reliability of isometric, isotonic, and isokinetic ankle measures in older
women.
Design. This was a prospective, descriptive methodological study.
Methods. The following dorsiflexion (DF) and plantar-flexion (PF) measures were
assessed twice (7 days apart) by the same examiner in 30 older women (mean
age�73.3 years, SD�4.7): isometric peak torque and rate of torque development
(RTD), isotonic peak velocity, average acceleration and peak power, and isokinetic
peak torque and peak power (30°/s and 90°/s). Several statistical methods were used
to examine relative and absolute reliability.
Results. Intraclass correlation coefficients (ICCs) for the DF tests (ICC�.76–.97)
were generally higher than ICCs for matched PF tests (ICC�.58–.93). Measures of
absolute reliability (eg, coefficient of variation of the typical error [CVTE]) also
demonstrated more reliable values for DF tests (5%–18%) compared with PF tests
(7%–37%). Isotonic peak velocity tests at minimal loads were associated with the
lowest CVTE and ratio limits of agreement values for both DF (5% and 14%, respec-
tively) and PF (7% and 18%, respectively). Isometric RTD variables were the least
reliable (CVTE�16%–37%).
Limitations. This study was limited to a relatively homogeneous sample of older
women.
Conclusions. Test-retest reliability was adequate for determining changes at the
group level for all strength and power variables except isometric RTD. Minimal
detectable change scores were determined to assist clinicians in assessing meaningful
change over time in ankle strength and power measurements within individuals.
S.C. Webber, MSc, BMR(PT), is a
PhD candidate, Department of
Physiology, Faculty of Medicine,
University of Manitoba, Winnipeg,
Manitoba, Canada.
M.M. Porter, BPHE, MSc, PhD, is
Professor, Faculty of Kinesiology
and Recreation Management and
the Department of Physiology,
University of Manitoba, 207 Max
Bell Centre, Winnipeg, Manitoba,
Canada R3T 2N2. Address all cor-
respondence to Dr Porter at:
portermm@ms.umanitoba.ca.
[Webber SC, Porter MM. Reliabil-
ity of ankle isometric, isotonic,
and isokinetic strength and power
testing in older women. Phys Ther.
2010;90:1165–1175.]
© 2010 American Physical Therapy
Association
Research Report
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Loss of neuromuscular mass,strength (force-generating capac-ity), and power (work produced
per unit of time or product of
strength and speed) are closely asso-
ciated with functional decline, loss
of independence, and mortality in
older adults.1 Some studies suggest
that the rate of loss of neuromuscu-
lar power exceeds the rate of loss of
strength with age.2,3 Cross-sectional
studies also have demonstrated that
functional capabilities such as the
ability to get up and down from a
chair, climb stairs, and walk quickly
may be more closely associated with
power than strength4–6 and that loss
of power may be more related to the
etiology of falls.7 In order to deter-
mine the true nature of the relation-
ships among changes in strength and
power with age and changes in func-
tion, reliable testing techniques are
required.
Isokinetic dynamometers frequently
are used to assess neuromuscular
function because they provide de-
tailed torque, velocity, and position
data with high mechanical reliabili-
ty.8 Although researchers have in-
vestigated the reliability of dyna-
mometer strength assessment in
older adults, the focus has largely
been on the knee.9–14 However, the
distal leg muscles exhibit reductions
in strength and power with ag-
ing15,16 and are important for walk-
ing,17,18 maintaining balance, avoid-
ing falls,7,19 and braking a vehicle.
Greater limitations in ankle strength
(as opposed to knee strength) have
been associated with falls in nurs-
ing home residents.20,21
Dorsiflexion
(DF) power has been found to be
closely associated with function in
community-dwelling older women
in terms of their ability to get up and
down from a chair and climb stairs.4
Plantar-flexion (PF) strength has been
shown to be positively related to
both habitual gait speed and fast gait
speed.4,18 Despite the important role
that ankle function plays in mobility,
there have been only a few evalua-
tions of the reliability of ankle
strength protocols11,12,22 and only
one assessment concerned with reli-
ability associated with measures of
ankle power in this population.11
Because power is defined as work
(force � distance) divided by time,
it is influenced by both strength and
speed. Peak or average power
(watts�newton-meters � radians/s)
can be measured using either the iso-
kinetic or isotonic mode on a dyna-
mometer. Other indirect measures
that may be associated with the abil-
ity of the neuromuscular system to
generate force or torque rapidly can
be evaluated using either the isomet-
ric mode (rate of torque develop-
ment [RTD]) or the isotonic mode
(velocity, acceleration).2,16,23,24 Hart-
mann et al11 reported reliability
scores for ankle average isokinetic
power tests, but reliability of iso-
tonic and isometric measures related
to power has not been investigated
previously in older adults. Prelimi-
nary findings suggest that isokinetic
evaluations of power may not be as
reliable as strength measures9,11 and
that RTD averaged over a specified
range (eg, from 30% to 60% of peak
torque) may yield more consistent
results compared with peak RTD.24
Further research is needed to com-
pare reliability of strength and
power measures and to determine
which measures are associated with
lower levels of measurement error
for use in research and clinical
situations.
Physical therapists and other health
care providers need to be able to
properly interpret measurement
change to determine the relative ef-
fectiveness of different interventions.
Test-retest studies provide informa-
tion about relative reliability, that is,
the degree to which repeated mea-
surements reveal consistent ranking
of individuals’ scores within a group.
Measures of absolute reliability de-
scribe individual variability and mea-
surement error and, therefore, are
important in determining levels for
clinically significant change. Although
the literature suggests that power
may be more important than
strength in terms of function in older
adults, very little is known about the
reliability of different measures of
power or power-related variables
(eg, velocity during isotonic move-
ments). The objective of this study
was to determine the relative and
absolute intrarater reliability for an-
kle strength and power measure-
ments obtained using isometric, iso-
tonic, and isokinetic tests on a
dynamometer in older women.
Method
Participants
Thirty older women (mean age�
73.3 years, SD�4.7) were recruited
to take part in this study. This sam-
ple size was consistent with those
traditionally chosen for studying
dynamometer measures in older
adults.9 –12,14,25 A convenience sam-
ple consisting of women who had
expressed an interest or participated
in previous research in our labora-
tory was used. However, none of the
women had been tested previously
on an isokinetic dynamometer or
participated in an exercise-related
study. Exclusion criteria included
acute or unstable chronic disease
and neurological or musculoskeletal
impairment that would interfere with
testing. In addition to the 30 women
who participated, another 22 women
were approached to be involved in the
study but either did not meet the in-
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Ankle Measures in Older Women
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clusion and exclusion criteria or
were not interested in participating.
Participant characteristics are pre-
sented in Table 1. A physician’s signed
Physical Activity Readiness Medical
Examination (PARmed-X) form was re-
quired when potential contraindica-
tions to exercise (eg, history of cardiac
disease, uncontrolled hypertension,
hernia, detached retina) were identi-
fied. All testing took place in a univer-
sity research laboratory over the sum-
mer of 2008. At the initial evaluation
session, participants provided their
written informed consent.
The median number of comorbidi-
ties reported by participants was 2
(range�0–3). Arthritis (18), hyper-
tension (14), previous cancer diag-
nosis (5), and diabetes (4) were most
commonly reported. Seven partici-
pants reported that they had fallen in
the past year, and 1 participant reg-
ularly used a cane. The median num-
ber of medications prescribed was 1
(range�0–3). None of the partici-
pants changed their medications dur-
ing their testing week.
Procedure
Upon admission to the study, partic-
ipants completed a health/demo-
graphic questionnaire. All other tests
were conducted twice, by the same
physical therapist, exactly 1 week
apart, at the same time of day. Infor-
mation on the isokinetic dynamome-
ter setup from session 1 was used
for session 2, but the examiner was
blinded to the results from session 1
until after session 2 was conducted.
Resting blood pressure, heart rate,
body mass, and height were mea-
sured using standard procedures. Ac-
tive range of motion was measured
for both DF and PF (right ankle) with
the participant in a seated position
with the knee supported in exten-
sion. Two measurements were taken
in each direction and then averaged
to determine active range of motion.
A universal goniometer was used for
the measurements, with the axis of
the goniometer aligned with the lat-
eral malleolus of the ankle, the prox-
imal arm aligned with the head of
the fibula, and the distal arm parallel
to the lateral border of the fifth meta-
tarsal. Ankle range of motion was
measured to ensure that participants
had adequate range of motion to
tolerate the starting positions used
for dynamometer testing. No partic-
ipants were excluded because they
lacked sufficient range of motion.
Dynamometer Tests
Dorsiflexion and PF torque, position,
and velocity were measured using a
Biodex System 3 Pro dynamometer.*
The mechanical reliability of this dy-
namometer has been shown to be
excellent.8 Calibration of the dyna-
mometer was verified each day prior
to testing. Participants warmed up
by walking for 4 minutes on a tread-
mill before being seated on the Bio-
dex dynamometer (right lateral mal-
leolus aligned with the axis of
rotation, right knee flexed 45°–55°,
trunk reclined 5° from vertical).
Only the dominant leg (defined as
the leg that would be used to kick a
ball) was tested. All participants re-
ported right leg dominance. Each
participant kept her arms folded
across her chest during testing, and
belts provided stabilization around
the waist and over the right thigh.
The end limits of range of motion
were set at 10 degrees of DF and 30
degrees of PF for all tests. Partici-
pants performed isometric tests,
concentric isotonic tests, and con-
centric isokinetic tests, always in
that order, with DF contractions pre-
ceding PF contractions. Standard-
ized, consistent verbal encourage-
ment was provided for all tests using
a script.
Isometric Tests
Following 3 practice trials, 3 maxi-
mal voluntary isometric contractions
were performed for DF (at 25° of PF)
and then for PF (at 0°). Test angles
were chosen based on previous liter-
ature2,12,16,26 to correspond approxi-
mately to the angles at which maxi-
mum isometric torques can be
produced. Participants were strongly
encouraged to contract “fast” and to
hold each contraction for 3 to 5 sec-
onds. They were given 90 seconds of
rest between trials.
Isotonic Tests
The dynamometer then was
switched to the isotonic mode. The
DF and PF movements were each
performed against 2 set resistance
levels: (1) a minimal resistance level
(DF�1 N�m, PF�15 N�m) and (2) a
load equal to 50% of isometric peak
torque. These resistance levels rep-
resent the boundaries of those previ-
ously published for the dorsiflexors.2
Isotonic DF trials were initiated from
30 degrees of PF, and PF trials were
initiated from 10 degrees of DF.
Again, participants were strongly en-
couraged to move “fast.” Two prac-
tice trials preceded 5 test trials for
each of the 4 conditions (DF and PF,
2 loads each). Thirty seconds of rest
was provided between all repetitions.
Isokinetic Tests
Maximal-effort isokinetic concentric
DF and PF tests were performed at
30°/s and 90°/s (in that order).
These velocities were chosen be-
cause they are within the range of
velocities typically studied for mea-
* Biodex Medical Systems Inc, 20 Ramsey Rd,
Shirley, NY 11967.
Table 1.
Participant Characteristics
Characteristic Mean (SD)
Age (y) 73.3 (4.7)
Body mass (kg) 73.8 (11.9)
Height (cm) 159.9 (4.8)
Body mass index (kg/m2) 28.8 (4.1)
Active dorsiflexion range of
motion (°)
11 (5)
Active plantar-flexion range
of motion (°)
53 (6)
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surements about the ankle in older
adults.4,25,27,28 In addition, restricting
the highest velocity to 90°/s allowed
for constant velocity to be main-
tained over approximately one third
(12°) of the total 40-degree range of
motion excursion (once acceleration
and deceleration were accounted
for). The passive mode on the dyna-
mometer was used for these con-
stant velocity tests because it pro-
vided a passive return to the start
position after each concentric con-
traction; therefore, all concentric DF
contractions were completed before
PF testing began (ie, DF and PF con-
tractions were not performed imme-
diately back-to-back). Furthermore,
many participants would not be able
to generate enough DF torque to
overcome the torque related to the
combined mass of the foot and foot-
plate to initiate DF movement.
Matching concentric contractions
with the onset of passive movement
avoided this difficulty. Participants
were given 3 to 5 submaximal prac-
tice trials for familiarization before 5
test trials were conducted for each
movement, at each velocity. A
2-minute rest period was provided
between velocities. One participant
was unable to generate torque in the
DF direction at the higher velocity;
therefore, DF peak torque and peak
power values were recorded at 90°/s
for 29 participants.
Data Analysis
Biodex data were collected at a fre-
quency of 100 Hz and exported for
analyses in SigmaPlot (version
11.0).† All variables used in the anal-
yses were means of the repetitions
performed (isometric measures�
mean of 3 repetitions, isotonic and
isokinetic measures�mean of 5 rep-
etitions). Because all scores inher-
ently include some random error
(which either adds to or subtracts
from the true score), using mean
scores may reduce the magnitude of
the error component contributing to
the total score.29
For each isometric contraction, peak
torque (in newton-meters) was iden-
tified and RTD (in newton-meters
per second) was calculated by 2
methods. Change in newton-meters/
time was first determined from 0% to
50% of peak torque and then from
40% to 80% of peak torque (Fig. 1).
Calculating RTD over a specified
range has been shown to be more
reliable than determining peak
RTD.24 These specific ranges were
chosen to allow comparison of RTD
reliability between relatively steep
sections of the isometric torque
curve (0%–50% of peak torque) and
less steep sections (40%–80% of
peak torque).
For each isotonic contraction, peak
velocity (in degrees per second),
average acceleration (peak velocity/
time to reach peak velocity, mea-
sured in degrees per second
squared), and peak power (watts�
newton-meters � radians/s) were
determined (Fig. 2). Although the dy-
namometer was set to the isotonic
mode for these tests, torque is not
held absolutely constant throughout
the range of motion on this setting
(Fig. 2). As has been noted previous-
ly,30,31 the sampling rate (100 Hz) of
the dynamometer does not permit
adjustments in speed to occur fast
enough to result in a continuous
torque level. For each isokinetic con-
traction, peak torque (in newton-
meters) and peak power (watts�N�m
� radians/s) were analyzed.
Statistical analyses were conducted
using SPSS (version 15.0)‡ and Sig-
maPlot. Means and standard devia-
tions were calculated for each vari-
able tested at time 1 and time 2.
Paired t tests were conducted to look
† Systat Software Inc, 1735 Technology Dr, Ste
430, San Jose, CA 95110.
‡ SPSS Inc, 233 S Wacker Dr, Chicago, IL
60606.
Figure 1.
Torque recorded during one repetition of isometric dorsiflexion for one representative
participant. Rate of torque development was calculated as the change in newton-
meters/change in time from 0% to 50% of peak torque and from 40% to 80% of peak
torque. Torque is designated as negative in the dorsiflexion direction.
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for significant bias between test ses-
sions (P�.05). The intraclass corre-
lation coefficient (ICC [2,k]) was
used to evaluate both systematic and
random errors that may affect rela-
tive test-retest reliability.32 Specifi-
cally, ICC [2,3] was used for all iso-
metric measures because they were
based on the mean of 3 repetitions,
and ICC [2,5] was used for all iso-
kinetic and isotonic measures that
were scored as the mean of 5 repe-
titions. Normality of the difference
scores was assessed using the
Shapiro-Wilk test. Data were
checked visually with Bland-Altman
plots for the presence of heterosce-
dasticity, and Pearson correlation co-
efficients were calculated between
absolute differences and the means
of the 2 tests.
Measures of absolute reliability were
expressed using standard error of
the measurement (SEM), coefficients
of variation of the typical error
(CVTE), limits of agreement (LOA),
ratio limits of agreement (RLOA),
and the minimal detectable change
(MDC). Absolute reliability describes
within-subject variation and the de-
gree to which observed scores will
vary with repeated measurements.33
Generally, CVTE and RLOA are used
to describe heteroscedastic data, and
SEM and LOA are used to describe
homoscedastic data.34 The majority
of the strength and power variables
studied did not demonstrate het-
eroscedasticity (greater measure-
ment error when measured values
were larger) and, therefore, could be
adequately described using SEM and
LOA.34 However, because a few vari-
ables demonstrated a positive rela-
tionship between the degree of mea-
surement error and the magnitude of
the measured value, CVTE and RLOA
statistics also are included.
The SEM was determined as the
square root of the residual mean
square error term from the analysis
of variance table.35 The SEM de-
scribes (in units of the actual mea-
sure) the limits for change required
to indicate a real increase or de-
crease for a group of individuals fol-
lowing some sort of intervention.25
Whereas SEM values express typical
error in original units, CVTE ex-
presses typical error as a percentage,
making it useful for comparing reli-
ability among different measures and
across different studies. Typical error
was calculated as the standard devi-
ation of the differences scores be-
tween sessions, divided by �2.33 Co-
efficient of variation of the typical
error is defined as typical error di-
vided by the mean of all trials from
both sessions, multiplied by 100.36
The LOA was calculated as the sys-
tematic bias: (mean difference be-
tween 2 test sessions) � the random
error component (1.96 � standard
deviation of the difference between
the 2 test sessions), which is identi-
cal to systematic bias � MDC9534
(MDC95�1.96 � �2 � SEM37,38).
The MDC95 values provide informa-
tion about the confidence limits as-
sociated with measurement error so
that, for example, it can be stated
with 95% confidence that an individ-
ual’s change score that exceeds the
LOA represents a true change. The
MDC95 values also were expressed
as a percentage in order to allow for
comparisons among measures and
across studies (RLOA�MDC95/mean
of all observations � 100).
Role of the Funding Source
Ms Webber was supported by a Ca-
nadian Institutes of Health Research,
Institute of Aging fellowship.
Results
Means and standard deviations for
the isometric, isotonic, and isoki-
netic strength and power variables
are presented in Table 2. There were
no significant differences between
session 1 and session 2 for almost
all of the variables; however, PF iso-
metric torque and RTD increased
(P�.05). In addition, changes in DF
Figure 2.
Torque, angle, velocity, and power measurements during one repetition of isotonic
plantar flexion (against 50% of isometric peak torque) for one representative
participant.
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Table 2.
Means and Standard Deviations for Isometric, Isotonic, and Isokinetic Tests
Measure Test 1 Test 2 P a
Dorsiflexion
Isometric results
Peak torque (N�m) 21.6 (5.1) 21.2 (5.5) .28
RTDb (to 50% of peak torque, N�m/s) 97.8 (28.6) 95.3 (34.9) .55
RTD (40%–80% of peak torque, N�m/s) 62.3 (18.6) 59.3 (23.1) .30
Isotonic results
Peak velocity (1-N�m load, °/s) 160.9 (31.0) 158.5 (28.9) .24
Average acceleration (1-N�m load, °/s2) 685.5 (183.0) 662.0 (176.7) .05
Peak power (1-N�m load, W) 14.7 (6.1) 13.8 (5.6) .18
Peak velocity (50% of maximum isometric load, °/s) 78.2 (18.5) 80.0 (15.0) .53
Average acceleration (50% of maximum isometric load, °/s2) 345.2 (95.3) 350.9 (81.9) .57
Peak power (50% of maximum isometric load, W) 15.7 (6.3) 15.5 (6.2) .64
Isokinetic results
Peak torque (30°/s, N�m) 14.0 (4.6) 13.9 (4.8) .68
Peak torque (90°/s, N�m) 10.5 (4.2) 10.6 (4.1) .68
Peak power (30°/s, N�m) 7.2 (2.3) 7.1 (2.5) .76
Peak power (90°/s, N�m) 11.2 (4.5) 10.9 (4.4) .35
Plantar flexion
Isometric results
Peak torque (N�m) 71.0 (21.5) 77.5 (24.0) .03
RTD (to 50% of peak torque, N�m/s) 113.5 (60.1) 142.0 (65.3) .02
RTD (40%–80% of peak torque, N�m/s) 68.9 (30.1) 90.3 (48.8) .02
Isotonic results
Peak velocity (15-N�m load, °/s) 275.2 (47.8) 274.8 (50.1) .93
Average acceleration (15-N�m load, °/s2) 1,686.4 (477.2) 1,698.3 (460.5) .79
Peak power (15-N�m load, W) 171.3 (73.0) 180.0 (71.2) .24
Peak velocity (50% of maximum isometric load, °/s) 224.6 (44.2) 217.9 (43.6) .34
Average acceleration (50% of maximum isometric load, °/s2) 1,304.7 (334.8) 1,235.6 (318.5) .17
Peak power (50% of maximum isometric load, W) 158.9 (59.1) 162.7 (57.0) .51
Isokinetic results
Peak torque (30°/s, N�m) 66.7 (20.0) 69.7 (20.2) .11
Peak torque (90°/s, N�m) 61.4 (15.8) 62.0 (18.5) .82
Peak power (30°/s, N�m) 35.0 (10.3) 37.1 (10.6) .06
Peak power (90°/s, N�m) 76.2 (18.0) 77.8 (21.2) .54
a P values from paired t tests, except dorsiflexion isotonic peak power (1-N�m load) and plantar-flexion isometric peak torque, which were analyzed with the
signed rank test.
b RTD�rate of torque development.
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Table 3.
Relative and Absolute Reliability Scores for Isometric, Isotonic, and Isokinetic Testsa
Measure ICCb
95% CI
for ICC
SEM
(Units)
95% CI for SEM
(Units)
CVTE
(%)
Systematic Biasc � MDC95
(Units)
Ratio LOA
(% of Mean)
Dorsiflexion
Isometric results
Peak torque (N�m) .97 0.94–0.99 1.3 �2.4 6 0.4�3.5 16
RTD (0%–50%, N�m/s) .86 0.71–0.94 15.8 �31.0 16 2.5�43.8 45
RTD (40%–80%, N�m/s) .84 0.67–0.92 11.0 �21.5 18 3.0�30.4 50
Isotonic results
Peak velocity (1-N�m load, °/s) .96 0.92–0.98 8.0 �15.8 5 2.5�22.3 14
Average acceleration (1-N�m load, °/s2) .97 0.93–0.98 43.7 �85.6 6 23.5�121.1 18
Peak power (1-N�m load, W) .90 0.79–0.95 2.5 �4.9 17 0.9�6.9 48
Peak velocity (50%,°/s) .76 0.50–0.89 10.6 �20.7 13 �1.7�29.2 37
Average acceleration (50%, °/s2) .90 0.79–0.95 37.9 �74.3 11 �5.7�105.1 30
Peak power (50%, W) .95 0.90–0.98 1.9 �3.7 12 0.2�5.3 34
Isokinetic results
Peak torque (30°/s, N�m) .95 0.89–0.98 1.5 �3.0 11 0.2�4.2 30
Peak torque (90°/s, N�m) .96 0.92–0.98 1.2 �2.3 11 �0.1�3.2 31
Peak power (30°/s, N�m) .94 0.88–0.97 0.8 �1.6 11 0.1�2.3 32
Peak power (90°/s, N�m) .97 0.94–0.99 1.0 �2.0 9 0.3�2.9 26
Plantar flexion
Isometric results
Peak torque (N�m) .90 0.74–0.95 9.2 �18.0 12 �6.5�25.4 34
RTD (0–50%, N�m/s) .63 0.20–0.82 44.7 �87.6 35 �28.4�123.8 97
RTD (40–80%, N�m/s) .58 0.12–0.80 29.9 �58.6 37 �19.5�82.9 104
Isotonic results
Peak velocity (15-N�m load, °/s) .93 0.85–0.97 18.2 �35.6 7 0.4�50.4 18
Average acceleration (15-N�m load, °/s2) .93 0.86–0.97 168.2 �329.6 10 �11.9�466.1 28
Peak power (15-N�m load, W) .92 0.83–0.96 27.6 �54.1 16 �8.6�76.5 44
Peak velocity (50%, °/s) .77 0.51–0.89 27.0 �53.0 12 6.7�74.9 34
Average acceleration (50%, °/s2) .79 0.56–0.90 192.0 �376.2 15 69.1�532.1 42
Peak power (50%, W) .92 0.68–0.93 22.2 �43.5 14 �13.8�61.5 40
Isokinetic results
Peak torque (30°/s, N�m) .89 0.77–0.95 8.7 �17.1 13 �3.8�24.2 36
Peak torque (90°/s, N�m) .85 0.68–0.93 8.9 �17.5 14 �0.5�24.7 40
Peak power (30°/s, N�m) .88 0.75–0.95 4.6 �9.0 13 �2.4�12.8 35
Peak power (90°/s, N�m) .86 0.71–0.93 9.8 �19.2 13 �1.6�27.1 35
a ICC�intraclass correlation coefficient, CI�confidence interval, SEM�standard error of measurement, CVTE�coefficient of variation of typical error,
MDC95�minimal detectable change with 95% confidence.
b ICC (2,3) for isometric results and ICC (2,5) for isotonic and isokinetic results.
c Systematic bias�average difference between the 2 tests (time1�time2).
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isotonic average acceleration (1-N�m
load) and PF isokinetic peak power
at 30°/s were very close to being
statistically significant (P�.05 and
P�.06, respectively).
Table 3 reports the reliability data for
all DF and PF tests. The ICC values
for DF tests (ICC�.76–.97) were
higher (signed rank test, P�.001)
than ICC values for matched PF tests
(ICC�.58–.93), with the exception
of 2 isotonic values (peak power
against minimal load and peak veloc-
ity against 50% of maximum isomet-
ric load). Measures of absolute reli-
ability (CVTE) also demonstrated
more reliable values for all DF tests
(5%–18%) compared with PF tests
(7%–37%), except for the same 2 iso-
tonic measures (signed rank test,
P�.001). Isotonic peak velocity tests
at minimal loads were associated
with the lowest CVTE and RLOA val-
ues for both DF (5% and 14%, respec-
tively) and PF (7% and 18%, respec-
tively). Isometric RTD0%–50% and
RTD40%–80% demonstrated the high-
est levels of variability between test
sessions for both DF (CVTE�16% and
18%, respectively, and RLOA�45%
and 50%, respectively) and PF
(CVTE�35% and 37%, respectively,
and RLOA�97% and 104%, respec-
tively). The MDC values, considered
to be the minimal amount of change
in an outcome measure that can be
measured for an individual that is not
due to systematic or chance variation
in measurement,37,39 are included for
all variables. Specifically, MDC95 val-
ues indicate that a person can be
95% confident in the true nature of
changes that exceed these levels.
The LOA were equal to the system-
atic bias � the MDC95 value.
Bland-Altman plots (individual par-
ticipant differences plotted against
the mean for both test sessions)
were created for all outcome vari-
ables to look for systematic bias,
outliers, and the presence of het-
eroscedasticity. Pearson correlation
coefficients were not significant for
heteroscedasticity for 23 of the 26
tests, but isotonic PF peak velocity
(against 50% of isometric peak
torque), PF RTD0%–50%, and PF
RTD40%–80% did demonstrate signifi-
cant positive correlations (r�.45–
.65, P�.01). Reliability statistics as-
sociated with the RTD and peak
isotonic velocity (against 50% of iso-
metric peak torque) variables were
relatively poor; therefore, other
strength or power variables should
be chosen in test-retest situations. No
data transformations were conducted.
Discussion
This study was conducted to estab-
lish relative and absolute reliability
scores for isometric, isotonic, and
isokinetic strength- and power-
related measures about the ankle in
older women. Although the reliabil-
ity of some of these measures (eg,
isokinetic tests) has been investi-
gated previously, other parameters
(eg, isotonic values) have been re-
ported infrequently in the literature
with no associated reliability infor-
mation provided. Results demon-
strated that isometric, isotonic, and
isokinetic measures of strength and
power were associated with good
relative reliability (all ICCs�.75,
with the exception of PF RTD)29 and
measures of absolute reliability were
similar to previously published re-
sults involving both younger and
older individuals.11,24,25,36
Virtually all isometric, isotonic, and
isokinetic DF and PF measures dem-
onstrated good relative reliability, in-
dicating that these measures gener-
ally exhibited consistency for repeated
measurements at the group level.
With the exception of PF RTD0%–50%
(ICC [2,k]�.63) and PF RTD40%–80%
(ICC [2,k]�.58), all ICC values ex-
ceeded .75, and more than half of
the values reached .90 or greater.
The 95% confidence intervals associ-
ated with the ICCs (Tab. 3) provide a
more thorough understanding of the
reliability of these measurements. In
the majority of cases (18/26), the
lower confidence interval did not fall
below 0.70; however, at the worst
extreme, PF RTD measurements
demonstrated lower confidence lim-
its of 0.20 and 0.12, indicating very
poor test-retest reliability.
In terms of strength, women in this
study obtained DF and PF isokinetic
peak torque values similar to those
previously reported.11,12,16,40 The
ICC values associated with isokinetic
DF and PF peak torque and peak
power (ICC�.85–.97) also were very
similar to those reported in a previ-
ous study (ICC�.92–.98) of older
women and men tested at 60°/s.11
The current study is the first to re-
port reliability statistics associated
with isometric and isotonic tests
about the ankle in older women;
therefore, no comparisons of these
variables could be made.
Clinically, SEM values (expressed in
absolute units) and CVTE values (ex-
pressed as a percentage) can be
used to determine whether signifi-
cant change has occurred in a group
over time. The SEM and CVTE results
were similar to those reported in
other ankle strength and power stud-
ies for isokinetic parameters11,25,36
and isometric RTD.24 The CVTE val-
ues for DF and PF isometric peak
torque were relatively low in this
study (6% and 12%, respectively),
whereas CVTE results were slightly
higher for isokinetic peak torque and
peak power results, ranging from 9%
to 14%.
Clinicians can use MDC95 and RLOA
values to determine whether true
change has occurred over time in
individual patients. Based on our
results, changes in isokinetic peak
torques in individual patients would
need to exceed the following
thresholds to exceed measurement
error: 4.2 N�m (DF�30°/s), 3.2 N�m
(DF�90°/s), 24.2 N�m (PF�30°/s),
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and 24.7 N�m (PF�90°/s). Isometric
peak torques would need to exceed
3.5 N�m (DF) and 25.4 N�m (PF). The
MDC95, LOA (systematic bias �
MDC95), and RLOA results in this
study were similar to those previ-
ously reported.11,12,25 Small differ-
ences among study results may be
attributed to differences in the par-
ticipants (eg, sex, age), the raters,
or the test protocol itself (eg, test
velocities, measurement of peak ver-
sus average power, and participant
positioning).
The older women in our study
reached peak isotonic velocities of
275°/s for PF and 161°/s for DF
when testing was conducted against
minimal loads. Only one previous
study has reported peak isotonic ve-
locities about the ankle in older
adults.2 The current study adds to
the literature by providing detailed
information about relative and abso-
lute reliability associated with differ-
ent isotonic parameters that have
been measured infrequently to date.
In the present study, isotonic peak
velocity and average acceleration
were associated with low CVTE val-
ues when the load was minimal
(CVTE for DF�5% and 6% for peak
velocity and average acceleration, re-
spectively, CVTE for PF�7% and 10%,
respectively) and slightly higher
CVTE values (DF�13% and 11%, re-
spectively, and PF�12% and 15%, re-
spectively) when the load was equal
to 50% of isometric peak torque. Iso-
tonic peak velocity measured against
low loads was associated with less
variation compared with other iso-
tonic and isokinetic variables. Fur-
ther research involving other joint
movements and different populations
is needed to determine whether
peak velocity is consistently more re-
liable than other more traditionally
measured parameters. This informa-
tion may be important clinically, as
the isotonic setting allows for evalu-
ation of contractions in which veloc-
ity is not constrained, and results,
therefore, may be more functionally
relevant compared with isokinetic
tests.
In all but 2 instances (isotonic peak
power against minimal load and iso-
tonic peak velocity against 50% of
maximum isometric load), DF scores
demonstrated better reliability com-
pared with PF scores. This result is
in agreement with the findings re-
ported by Hartmann et al.11 In both
studies, participants were positioned
with the knee flexed for PF tests.
Although the upper body and thigh
were well stabilized with straps, it is
conceivable that attempts to extend
the knee or hip may have occurred
during PF movements, adding vari-
ability to these PF measurements
that did not occur with DF move-
ments. Reliability of ankle PF mea-
sures may be improved with differ-
ent positioning during testing (eg,
hip in neutral and knee extended
with the individual in a prone
position).
It has been suggested that from a
functional perspective, increases in
RTD may represent one of the most
important adaptations that occurs
in response to resistance training in
older adults.41 That is, the ability to
generate moderate forces quickly
may be more important than being
able to generate high forces, espe-
cially when quick action is required
(eg, to regain balance and avoid a
fall). Improvements in RTD are likely
associated with a greater capacity to
generate power. Although RTD may
be a functionally important variable,
our study demonstrated that it had
the lowest absolute reliability of all
the power-related variables studied
about the ankle. The PF results were
especially variable. Positioning used
in this study (sitting with the hip
and knee partially flexed) and the
longer duration associated with iso-
metric testing (3 seconds) likely con-
tributed to some of this variability
(greater potential contributions of
hip or knee extension accompanying
isometric PF attempts). It should be
noted that isokinetic dynamometers
may not be as reliable for isometric
tests as other devices that are inher-
ently more stable (eg, custom-made
isometric rigs). It is recommended
that the reliability of measurements
of RTD about the ankle be examined
in future studies using different joint
and body positions and possibly us-
ing different types of strength testing
equipment.
In this study, a familiarization session
on the dynamometer was not pro-
vided before the 2 test sessions. This
lack of a familiarization session may
represent a limitation of the study if
learning had an effect on the scores
during the second testing session.
However, familiarization sessions are
rarely provided in clinical situations
and may not always be feasible in
research circumstances because of
time constraints, associated costs,
and availability of equipment. For
these reasons, we elected to omit a
familiarization session. Measured lev-
els of systematic bias were minimal
for most variables, indicating that
there was no substantial learning
effect.
This study involved a relatively ho-
mogeneous sample of community-
dwelling older women. Future stud-
ies should continue to investigate
the reliability of strength and power
measurements attained using differ-
ent modes on the dynamometer
about different joints and in other
segments of the older population
(eg, older men, individuals who are
more frail).
Conclusions
Interpreting and setting threshold
levels for acceptable reliability re-
sults depends on the particular test-
ing circumstance.29 In this study,
many variables demonstrated good
ICC results and CVTE values in the
range of 6% to 13%, which are com-
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parable to previous strength and
power assessments in younger and
older people.9,10,25,36 These levels
are likely adequate to determine
gross changes in strength- and
power-related parameters among
groups over the course of a training
period; but ideally, more reliable
measures would provide greater
confidence in interpreting clinically
meaningful change within individu-
als. Further research is needed to
examine the reliability of isotonic
variables that have been studied in-
frequently using dynamometers.
These measures may prove to be
more reliable and relevant to func-
tion in older adults than the more
commonly reported isometric and
isokinetic strength and power pa-
rameters. In the meantime, MDC95
scores have been presented for all
DF and PF isometric, isotonic, and
isokinetic variables to provide mean-
ingful thresholds for clinicians and
researchers to identify changes in in-
dividuals beyond those expected by
measurement error.
Both authors provided concept/idea/re-
search design, data collection, and project
management. Ms Webber provided writing
and data analysis. Dr Porter provided fund
procurement, facilities/equipment, and con-
sultation (including review of manuscript be-
fore submission).
Ethical approval for this study was granted
by the Education/Nursing Research Ethics
Board of the University of Manitoba.
Some of the results specific to isotonic tests
were presented orally at the Canadian Soci-
ety for Exercise Physiology meeting; Novem-
ber 11–14, 2009; Vancouver, British Colum-
bia, Canada.
Ms Webber was supported by a Canadian
Institutes of Health Research, Institute of Ag-
ing fellowship.
This article was submitted November 30,
2009, and was accepted April 10, 2010.
DOI: 10.2522/ptj.20090394
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SABER College
Physical Therapist Assistant Program
PTA 1401: Applied Anatomy and Kinesiology with Lab
L.I.R.N. Annotated Bibliography Assignment
Assignment: Students will be assigned a body region. Each student will then be responsible for choosing
one article from a peer reviewed journal using the virtual library in relation to applied anatomy and
kinesiology for the assigned body region. Students must have the article approved by the instructor prior
to submission of the annotated bibliography. The instructor will approve the article based on a peer
reviewed journal not content or relevance to topic. Students will then be required to write an annotated
bibliography on the approved article.
Date: Students need to email a copy of the complete research article for approval on no later than
Tuesday 10/16/2020 email at: gbarditch@sabercollege.edu
The Final assignment is DUE ON November 17, 2020 . Assignment will
be submitted on google classroom.
Instructions: Students will construct an annotated bibliography. An annotated bibliography is a list of
citations of articles, books, and other publications on a particular topic. Each citation is followed by a
relatively brief paragraph that summarizes the source’s argument and other relevant material including its
intended audience, sources of evidence, and methodology. The assignment will be completed individually
and out of class.
The annotated bibliography consists of two elements:
1. The citation in current AMA style format
2. The Annotation – The annotation should consist of one paragraph using whole complete
sentences in the third person and should be approximately 150-200 words in length. The assignment
should be typed, double spaced, in Times New Roman 12 font, 1” margin.
The annotation should include most, if not all, of the following:
Explanation of main purpose
Description of content
Focus of article
Relevance of topic
Type of intended audience
Evaluate its method, conclusion and/or reliability
Strengths / weaknesses or biases
Your own brief impression of the work
Assessment: The assignment will be assessed according to the criteria identified in the grading rubric on
the attached page.
*Once all of the annotated bibliographies are turned in the instructor will be responsible for compiling a comprehensive
annotated bibliography, which will be given to the students.
SABER College
Physical Therapist Assistant Program
PTA 1401: Applied Anatomy and Kinesiology with Lab
Student Name
PTA 1401: Applied Anatomy and Kinesiology with Lab
L.I.R.N. assignment: annotated bibliography
Sample
This is a sample of an annotated bibliography.
1. Waters, Eric. Suggestions From the Field for Return to Sports Participation Following
Anterior Cruciate Ligament Reconstruction. J Orthop Sports Phys Ther. 2012; 42.4. 326-
36. Retrieved From http://www.jospt.org/issues/articleID.2737,type.2/article_detail.asp
Eric Waters’s, in his 2012 article “Suggestions From the Field for Return to Sports
Participation Following Anterior Cruciate Ligament Reconstruction” concentrates on the
treatment of ACL injuries. He supports this by setting examples of specific exercises that treat or
prevent ACL injuries. His purpose is to show how treatment works with an ACL injury and
explain how to prevent it, in order for others to educate themselves with the study that he has
done. His intended audience is physical therapists, doctors, physicians, and athletes.
Water’s article is relevant to my topic because he focuses on rehabilitation of athletes.
Stating, “Preparing a basketball player for an effective return to play requires that the final and
most functional phase of the rehabilitation program encompass a thorough protocol based on
exercises that maintain proper lower extremity alignment throughout all the conceivable
scenarios of a basketball game,” (333) he exemplifies that it is important to perform certain
exercises in order to compete at the best ability.
http://www.jospt.org/issues/articleID.2737,type.2/article_detail.asp
- Assignment: Students will be assigned a body region. Each student will then be responsible for choosing one article from a peer reviewed journal using the virtual library in relation to applied anatomy and kinesiology for the assigned body region. Students must have the article approved by the instructor prior to submission of the annotated bibliography. The instructor will approve the article based on a peer reviewed journal not content or relevance to topic. Students will then be required to write an annotated bibliography on the approved article.
SABER College
Physical Therapist Assistant Program
PTA 1401: Applied Anatomy and Kinesiology with Lab
* If students score is ever in the 3rd column ( 1 point) , the student needs to make the appropriate improvements to the annotated
bibliography and turn-in again. The student will receive the original number of points for the document. In doing this the class
document that your instructor is complying together will be more accurate and helpful.
3
2 1
Annotation
Clear and concise summary of the
source including the author’s main
point and arguments that support
his/her conclusion. Relevance to
topic is identified and addressed
clearly. Personal evaluation or
critique demonstrates
understanding, discrimination and
insight.
Discussed topic but
summary is too brief Still
includes author’s main
point and conclusions.
Relevance to topic is not
identified clearly.
Personal evaluation or
critique is included but
lacks depth of
understanding.
Summary is based solely
from the abstract – no
evidence that the article
has been read. Relevance
to topic is not identified
or addressed clearly.
Personal evaluation or
critique is not addressed
clearly.
Citation
AMA style
Student cites their source using the
correct citation format.
Follows correct citation
format with minimal errors
(1-2 errors)
Does not follow correct
citation format or
contains frequent errors
(3 or more errors)
Mechanics,
Grammar
and Spelling
Occasional minor errors
mechanical, grammatical,
punctuation and spelling errors.
Demonstrates sentence fluency.
Minor errors (3 errors)
however do not distract the
reader. Demonstrates
minimal sentence fluency
(sentence transitions are
present however thought
process is unorganized.)
Errors are distracting (4
or more errors), to the
extent that the meaning is
unclear. Sentence
fluency is lacking.
TOTAL POINTS /9
- L.I.R.N. assignment Grading Rubric: Annotated Bibliography