Teste de elevação do calcanhar bipodal cadenciado externamente: reprodutibilidade e valores de referência em adultos saudáveis

Abstract

Introduction. The heel rise test (HRT) supports the comprehension of musculotendinous limitations, peripheral vascular complications, and resistance in muscle contraction of the triceps surae. However, considerable protocols in literature with great variability, differing in cadence and execution parameters, as well as reference values deficit in the adult population, limiting comparison in clinical practice. An elaboration of a protocol with external cadence (HRTEC) that intensifies muscle contraction can be a reliable instrument to identify functional limitations. Objectives. The present study aims to elaborate an HRTEC protocol with bipedal support in healthy adults, the predictive values, besides to evaluate intra-rater reliability. Secondly, to determine the reference values of the bipedal HRTEC and to propose prediction equations for the healthy population. Methods. The study was characterized as observational and transversal, with healthy adults of both sexes, aged between 20 and 59 years, with a body mass index (BMI) < 30 kg/m2 . The participants included in the study were submitted to a protocol with a cadence of 60 elevations/minute, starting from 10º of dorsiflexion on non-slip board, with subjective evaluation of pain perception and effort by the visual analog scale (VAS) and Borg, respectively. For reproducibility analysis, we used an interval of one week between the tests. The analysis of the measurement properties was performed with the data collected in a subgroup of the Natal/RN metropolitan region and for the reference values, the application was multicentric (Natal/RN, Curitiba/PR, and Belo Horizonte/MG). For statistical analysis, Kolmogorov-Smirnov and Shapiro-Wilk tests were used for data normality, MannWhitney test and the Kruskal-Wallis test with Dunn post-hoc for comparisons between the variables and intra-rater reliability analysis, the intraclass correlation coefficient (ICC) and Bland-Altman for agreement, in addition to the Pearson correlation between the tests. Results. A total of 112 (52 male) volunteers, aged 26 (22.2-34.7) years for men and 25 (23.2-34) years for women, were analyzed from 140 healthy adults from the metropolitan region of Natal/RN with BMI<25.0 kg/m2 . Higher performance with the number of elevations 52.5 (45-89) vs 47 (41-57) p<0.02, in men vs women, with no change in the execution time 53 (45.2-87.2) seconds vs 46 (48-55.1) seconds, p>0.05. The main symptoms reported were burning sensation (54.5%) and fatigue (22.3%), with pain and tiredness at the end of the moderate intensity test (VAS and Borg, respectively). For reproducibility analysis, 21 adults performed a test and retest with an ICC of 0.98, excellent reliability, r=0.98 and coefficient of determination r 2 =0.96 (p<0.0001). The Bland-Altman dispersion model showed a bias of - 0.76, with 95% agreement limits. Conclusions. The HRTEC protocol with bipedal support was easy to perform, the predictive values were found and the test showed excellent intra-rater reproducibility. The reference values could not yet be determined with the total sample collected so far.