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Myotonometry for the evaluation of Achilles tendon mechanical properties: a reliability and construct validity study
  1. Alessandro Schneebeli1,2,
  2. Deborah Falla2,
  3. Ron Clijsen1,3,
  4. Marco Barbero1
  1. 1Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno/Landquart, Switzerland
  2. 2Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise Rehabilitation Sciences, College of Life Environmental Sciences, University of Birmingham, Birmingham, UK
  3. 3University College Physiotherapy, Thim van der Laan AG, Landquart, Switzerland
  1. Correspondence to Alessandro Schneebeli; alessandro.schneebeli{at}


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.

  • ankle
  • tendon
  • achilles

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  • Contributors AS, DF, RC and MB designed and planned the study. AS and MB collected the data. All authors were involved in the drafting and revision of the manuscript and approved the final version of the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Ethics Committee of Canton Ticino (ID:2018–01483/CE3391) and written informed consent was provided by the participants.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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