Scientific Investigation of the Calf Raise Test Using the Calf Raise Mobile Application to Inform Test Administration and Interpretation
Permanent link to Research Commons versionhttps://hdl.handle.net/10289/16307
The Calf Raise Test (CRT) is a widely used functional assessment of triceps surae muscle-tendon unit function. While it exhibits acceptable reliability, administration inconsistencies and test parameter variations likely contribute to observed normative value discrepancies in the literature. Additionally, devices employed in research for standardisation and quantification of outcomes beyond the number of repetitions are often inaccessible in clinics. This Thesis addresses these gaps by conducting an evidence-based assessment of the CRT and examining how changes in test parameters affect outcomes. The overarching aims of this Thesis were to: (1) develop a valid and reliable method to assess the CRT in clinical practice that provides research-grade outcomes, and (2) examine the influence of changing CRT parameters on outcomes and triceps surae muscle function. To achieve these overarching aims, two literature reviews and three experimental studies were conducted. The first literature review, aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, provides an overview of CRT devices used in research. Thirty-five studies were included, identifying seven CRT devices. The linear encoder emerged as the most used, quantifying all three main CRT outcomes (repetitions, peak height, and total work). However, its limited clinical use is attributed to hardware costs and need for programming skills. Chapter 3 introduces the Calf Raise application (CRapp), a smartphone application designed to aid standardise CRT procedures and automate outcomes. Thirteen individuals underwent single-leg CRT on both legs across three occasions. CRapp outcomes (i.e., repetitions, total work, total height, peak height, fatigue index, and peak power) were validated against 3D motion capture and force plate data, demonstrating excellent concurrent validity and agreement levels. The CRapp proved valid, reliable, and suitable for both research and clinical practice. Chapter 4 explores the impact of varying ankle starting positions on CRT outcomes in 49 healthy individuals, accounting for gender, age, body mass index (BMI), and physical activity levels. Participants performed single-leg CRT in three randomised conditions on three occasions: flat (0°), incline (10° dorsiflexion), and step (full dorsiflexion). Analysis of CRapp data indicate significant effects of ankle starting position on all CRT outcomes, emphasising the importance of ankle start position for CRT administration and interpreting test outcomes. Chapter 5 investigates the effects of varying cadence on CRT outcomes in 36 healthy individuals, considering gender, age, BMI, and physical activity levels. Participants performed single-leg CRT in three randomised conditions on three occasions: 30, 60, and 120 beats per minute. Significant cadence effects were observed on CRapp outcomes, hence this study confirmed that cadence does matter when administering the CRT and interpreting its outcomes. Chapter 6, a systematic review following PRISMA guidelines, examines changes in standing CRT parameters on triceps surae surface electromyography (EMG) activity and fatigue measures. Seven studies were included, indicating increased activity in medial gastrocnemius increased with feet externally rotated, knees straight, and added load; lateral gastrocnemius with feet internally rotated, knees straight, and added load; and soleus with knees bent, whole-body vibration, and added load. These findings can inform evidence-based practices, though further training studies are recommended. Overall, this Thesis introduces the CRapp, an innovative, valid, and reliable method of quantifying key CRT outcomes. Also, this Thesis provides a better understanding of the influence of varying CRT parameters on outcomes. The evidence-base generated from this Thesis may be used to inform best practice use and interpretation of the CRT and guide future research.
The University of Waikato
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