Chester Rachel, Costa Matthew L, Shepstone Lee, Donell Simon T
School of Allied Health Professions, University of East Anglia, Norwich, Norfolk, UK.
Foot Ankle Int. 2003 Dec;24(12):909-15. doi: 10.1177/107110070302401207.
Research investigating the most effective management of Achilles tendon injury has been limited by a lack of reliable outcome measurements. Calf strength may be a valid outcome measure, not only in terms of identifying possible risk factors for reoccurrence of rupture, but also as an indicator of recovery. Isokinetic dynamometry has been suggested as an effective tool for measuring the torque of the calf muscles. Such measurements have demonstrated high reliability for the assessment of calf muscle torque in healthy subjects. However, there are no published data to demonstrate the reliability of isokinetic dynamometry in subjects with pathology in the Achilles tendon. The purpose of this study was to assess the inter- and intraobserver reliability of isokinetic dynamometry for assessing plantarflexion torque following Achilles tendon rupture.
Two independent observers used the Kin-com Dynamometer to measure the torque of the plantarflexors in 22 subjects 6 months after unilateral rupture of the Achilles tendon. Twelve subjects had been managed operatively and 10 nonoperatively. Subjects were placed in the prone position with the knee extended. Measurements of peak torque, average torque, and total work were made for both concentric and eccentric plantarflexion movements at 60 degrees per second.
Intraclass correlation coefficients were used to calculate reliability of measurements both within and between observers. Reliability was slightly greater on the healthy side (0.74-0.92 ICC) in comparison with the injured side (0.74-0.89 ICC).
The results of this study suggest that isokinetic dynamometry provides a reliable method of measuring the torque of the plantarflexors following rupture of the Achilles tendon, with levels of reliability comparable with those from healthy subjects. The study concludes that this would be a valuable and reliable outcome measure for use in clinical trials.
由于缺乏可靠的疗效评估指标，关于跟腱损伤最有效治疗方法的研究受到限制。小腿力量可能是一个有效的疗效评估指标，不仅可用于识别再次断裂的可能风险因素，还能作为恢复的指标。等速测力法已被认为是测量小腿肌肉扭矩的有效工具。此类测量已证明在评估健康受试者小腿肌肉扭矩方面具有高可靠性。然而，尚无已发表的数据证明等速测力法在跟腱病变受试者中的可靠性。本研究的目的是评估等速测力法在评估跟腱断裂后跖屈扭矩时观察者间和观察者内的可靠性。
两名独立观察者使用Kin-com测力计测量22名单侧跟腱断裂6个月后的受试者的跖屈肌扭矩。12名受试者接受了手术治疗，10名接受了非手术治疗。受试者处于俯卧位，膝关节伸直。在每秒60度的速度下，对向心和离心跖屈运动的峰值扭矩、平均扭矩和总功进行测量。
组内相关系数用于计算观察者内和观察者间测量的可靠性。与患侧（组内相关系数0.74 - 0.89）相比，健侧的可靠性略高（组内相关系数0.74 - 0.92）。
本研究结果表明，等速测力法为测量跟腱断裂后跖屈肌扭矩提供了一种可靠的方法，其可靠性水平与健康受试者相当。该研究得出结论，这将是用于临床试验中的一项有价值且可靠的疗效评估指标。
