Validity and reliability of hand-held dynamometers in hip, knee, and ankle strength testing in healthy adults: A systematic review and meta-analysis.
Reil Vinard S Espino, Consuelo G Suarez, Donald G Manlapaz and 1 others
Hand-held dynamometers give reliable and valid hip and knee strength readings in healthy adults.
Ankle evidence is weaker. All participants were healthy, so the findings do not extend to clinical populations.
Key findings
1Pooled reliability for hip strength was high (ICC = 0.86, 95% CI 0.76 to 0.96) and for knee extension was very high (ICC = 0.94, 95% CI 0.76 to 0.96), based on four studies using the Lafayette HHD.
2Pooled validity showed a very large positive correlation between HHD and isokinetic dynamometry for hip flexion (r = 0.92, 95% CI 0.88 to 0.95) and knee extension (r = 0.94, 95% CI 0.88 to 0.95).
3The level of evidence was rated strong for hip and knee assessments but only moderate for the ankle.
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What it does not show
Every participant in every included study was a healthy adult. The review excluded people with musculoskeletal disorders, post-surgical patients, and anyone with a lower-extremity condition, so the findings cannot be assumed to hold in the clinical populations a physiotherapist actually sees. Only four studies contributed to the meta-analysis, and the two validity studies were both rated very low certainty under GRADE. All ten validity studies showed some risk of bias on QUADAS-2, and eight of the ten had a high risk of bias for the index test. The search was limited to English-language publications, and no unpublished studies or doctoral theses were sought. Individual study samples were small, ranging from 11 to 50 participants. The ankle evidence is rated only moderate, so confidence in ankle HHD readings is lower than for the hip and knee.
Declared interests
The authors declare no conflict of interest. The research was funded by DOST-SEI (Department of Science and Technology, Science and Technology Information Institute).
The easy way to misread this
Do not read this as evidence that a hand-held dynamometer can replace isokinetic dynamometry in your clinical patients. Every participant in every included study was a healthy adult, the two validity studies were both rated very low certainty, and all ten validity studies carried some risk of bias. The findings describe how well the device works in a research setting with healthy people, not how well it will track a post-stroke patient's hip flexors or a post-ACL-reconstruction patient's knee.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →