title: Are repeated single-limb heel raises and manual muscle testing associated with peak plantar-flexor force in people with inclusion body myositis?
abstract: BACKGROUND
  Repeated heel raises have been proposed as a method of ankle plantar-flexor strength testing that circumvents the limitations of manual muscle testing (MMT).
  
  
  OBJECTIVE
  The study objective was to examine the relationships among ankle plantar-flexion isometric maximum voluntary contraction (MVC), repeated single-limb heel raises (SLHRs), and MMT in people with myositis.
  
  
  METHODS
  This was a cross-sectional study with a between-group design. The ability to complete 1 SLHR determined group assignment (SLHR group, n=24; no-SLHR group, n=19).
  
  
  METHODS
  Forty-three participants with myositis (13 women; median age=64.9 years) participated. Outcome measures included MVC, predicted MVC, Kendall MMT, and Daniels-Worthingham MMT.
  
  
  RESULTS
  The Kendall MMT was unable to detect significant ankle plantar-flexor weakness established by quantitative methods and was unable to discriminate between participants who could and those who could not perform the SLHR task. Ankle plantar-flexion MVC was not associated with the number of heel-raise repetitions in the SLHR group (pseudo R(2)=.13). No significant relationship was observed between MVC values and MMT grades in the SLHR and no-SLHR groups. However, a moderate relationship between MVC values and MMT grades was evident in a combined-group analysis (ρ=.50-.67).
  
  
  CONCLUSIONS
  The lower half of both MMT grading scales was not represented in the study despite the profound weakness of the participants.
  
  
  CONCLUSIONS
  Both Kendall MMT and Daniels-Worthingham MMT had limited utility in the assessment of ankle plantar-flexor strength. Repeated SLHRs should not be used as a proxy measure of ankle plantar-flexion MVC in people with myositis.
authors.affiliation: M.O. Harris-Love, PT, DSc, Research Service/Geriatrics and Extended Care Service, Washington DC Veterans Affairs Medical Center, Department of Veterans Affairs, Washington, DC; Department of Exercise Science, School of Public Health and Health Services, George Washington University, Washington, DC; and Rehabilitation Medicine Department, National Institutes of Health, Bethesda, Maryland. Mailing address: Research Service/Geriatrics and Extended Care Service, Washington DC Veterans Affairs Medical Center, Department of Veterans Affairs, 50 Irving St NW, Room 11G, Washington, DC 20422.
authors.forename: Michael O
authors.initials: MO
authors.lastname: Harris-Love
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Shrader
authors.forename: Todd E
authors.initials: TE
authors.lastname: Davenport
authors.forename: Galen
authors.initials: G
authors.lastname: Joe
authors.forename: Goran
authors.initials: G
authors.lastname: Rakocevic
authors.forename: Beverly
authors.initials: B
authors.lastname: McElroy
authors.forename: Marinos
authors.initials: M
authors.lastname: Dalakas
mesh_terms: D000368:Aged; D000842:Ankle / Q000502:physiology*; D003430:Cross-Sectional Studies; D005081:Exercise Therapy; D005260:Female; D006365:Heel / Q000502:physiology*; D006801:Humans; D007537:Isometric Contraction / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology*; D018482:Muscle, Skeletal / Q000502:physiology; D018979:Myositis, Inclusion Body / Q000503:physiopathology* / Q000534:rehabilitation; D011237:Predictive Value of Tests