Inter-rater reliability of baseline push-pull dynamometer for shoulder and scapular muscle strength testing among healthy individuals

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The objective of this study is to evaluate the inter-rater reliability of the Baseline® PPD in testing shoulder and scapular muscle strength among healthy individuals. This study included 35 healthy individuals who underwent standardized independent shoulder and scapular muscle strength testing by two raters using Baseline® PPD. Inter-rater reliability for muscle strength measurements ranged from moderate to good (ICC = 0.53–0.90). The SEMs for the push and pull muscle strength tests ranged from 2.2 to 5.8 N and 3.1 to 4.9 N, respectively. The MDC (95% CI) ranged from 6.09 to 15.06 for the push strength tests and 8.58 to 13.57 for the pull strength tests. Bland‒Altman plots revealed no systematic bias for most PPD tests, except for the push muscle strength of the serratus anterior, upper trapezius, and external rotators. The Baseline® PPD demonstrated acceptable inter-rater reliability and agreement for assessing shoulder and scapular muscle strength among healthy individuals. Further studies are warranted to evaluate its reliability in athletes and individuals with shoulder disorders to expand its clinical and research applications. Clinical Trial Registry of India number :(CTRI/2023/07/055409) Health sciences/Anatomy Health sciences/Health care Health sciences/Medical research Baseline push/pull dynamometer isometric strength reliability scapular muscles shoulder test-retest Figures Figure 1 1. Introduction Muscle strength assessment is crucial for analysing an individual's health, physical well-being and treatment planning in rehabilitation settings (1). There are several methods for measuring muscular strength, including manual muscle testing, handheld dynamometers (HHD), handgrip strength and isokinetic dynamometers (2). The Medical Research Council (MRC) offers a five-point scale to assess manual muscle strength. Despite its widespread use, the validity and reliability of the MRC scale are debatable (3). Isokinetic dynamometers are the gold standard for objective muscular strength measurement. It measures the muscle power of a joint over its whole range of motion by applying resistance to a standardized contraction velocity. This method also provides a highly reproducible means of measuring neuromuscular performance in both healthy and diseased states (4). Compared with isokinetic dynamometry, HHD is gaining popularity in clinical practice because of its portability and easy application (5). HHD is a reliable alternative for MRC testing and isokinetic dynamometers, and it can measure strength in various muscle groups, is relatively inexpensive and can be used in a clinical setting (2). HHDs are broadly classified into two types: push and pull. According to a systematic review by Stark et al., compared with isokinetic devices, HHD is a reliable and valid technique for testing muscle strength in a clinical setting. Many analogue, digital, and mechanical quantitative devices, such as universal digital, hydraulic, and electronic push‒pull dynamometers, have been designed for both research and clinical purposes (1,3,6,7). We found that all of these dynamometers have been tested and found to be reliable across multiple muscle groups(8–10). Although the reliability of these dynamometers seems to be very high, they are typically limited to research settings and large institutions due to their cost. Comparatively, Baseline® Push Pull Dynamometer (PPD) would be much cheaper and easy to assess the muscle strength. Shoulder girdle motion is the synchronized movement of the scapula and humerus, with the scapula acting as a platform for humeral motion. The scapula position and control of the thorax are crucial for optimal shoulder function. Functional upper extremity use is required for individuals to conduct a wide array of jobs necessary for day-to-day life (11). To our knowledge, no previous study has evaluated the reliability of the Baseline® PPD for shoulder and scapular muscle strength testing. Given the clinical need for simple and objective strength assessment of the shoulder and scapular muscles, it is imperative to evaluate the reliability of push and pull dynamometric measurements via the Baseline® PPD before it is implemented in clinical scenarios. The aim of this study was to determine the inter-rater reliability of the Baseline® PPD in measuring shoulder and scapular muscular strength in healthy individuals. 2. Materials and methods 2.1. Study design, setting, and ethics approval A cross-sectional study was conducted at the Department of Physical Medicine and Rehabilitation, PSG Hospitals, in Tamil Nadu, India. This study has been registered on 20th July 2023 in Clinical Trial Registry of India. [Registration No. CTRI/2023/07/055409]. The Institutional Ethics Committee at the PSG Institute of Medical Sciences and Research approved the study protocol (Project No. 23/141). All participants provided written informed consent after reading the information sheet explaining the study. This study adhered to the Guidelines for Reporting Reliability and Agreement Studies (GRRAS) (12). 2.2. Sample size calculation With a minimal acceptable reliability of 0.7, an expected reliability of 0.9, a level of significance of 99%, and a power of 80%, 37 individuals (including dropouts) were deemed appropriate for the study (13). 2.3. Study participants A convenience sample of 37 healthy adult male and female physiotherapists aged between 20 and 45 years with full and pain-free shoulder range of motion was included in the study. Participants were excluded if they had one or more of the following conditions: upper extremity deformities, a medical history of neurological disease (e.g., stroke or Parkinson's disease), medical instability, or a history of recent upper limb or trunk injury/surgery within the previous six months. 2.4. Instrument: The Baseline® PPD (Fabrication Enterprises, Inc., PO Box 1500, White Plains, New York 10602, USA) has a capacity of 0–66 lbs./30 kg and comes with nine accessories. This device has two functional ends: one designed for push measurements and the other for pull measurements. It has a zero button, which ensures that measurements begin at zero. The two-inch-wide digital screen displays the strength measurement in pounds or kilograms, depending on the option selected. The Baseline® PPD has replaceable handles and accessories, including three push pads, three push circular tips, one open pull hook, and one snap-close pull hook with an adaptor and gauge (Fig. 1 ). 2.5. Procedure A detailed description of the study's nature and information on the eligibility criteria were advertised on the department notice board. The volunteers who agreed to participate in the study were screened for eligibility criteria. Initially, the hand dominance of the participants was assessed via the Edinburgh Handedness Inventory (14). The selected participants were asked to remove all hand jewellery and wash and dry their dominant hand prior to being tested. Before the isometric tests were started, each individual's anthropometric measurements were recorded, and warm-up activities (self-stretching) for the shoulder and scapular muscular groups were performed. Kendell’s muscle testing protocol has been used for isometric strength assessments of the shoulder and scapular muscles (15). Two raters, both with good clinical experience and with a master’s degree in physiotherapy, underwent two-hour training sessions on how to assess the pull and push strength of the shoulder and scapular muscles via the Baseline® PPD. After training, they assessed muscle strength via equipment for five healthy volunteers. The order of testing muscles were randomly selected by the raters. Isometric tests for shoulder flexors (pectoralis major), abductors (middle fibres of the deltoid), external and internal rotators, the upper trapezius, the serratus anterior, and the latissimus dorsi were performed on each participant before the real assessment. Muscle strength assessment was performed by two raters on alternate weeks. Push muscle strength was assessed by Rater 1 (MV) and 2 (DV) using the push Baseline® PPD during the first and second weeks, respectively. Similarly, Rater 1 and Rater 2, assessed the pull muscle strength using the Baseline® PPD at the third and fourth weeks, respectively. Participants were asked not to get involved in any resisted exercise programs that might alter the strength of these muscles’ groups. Muscle testing was performed in a well-lit environment. Before testing the muscle strength, the pointer of the Baseline® PPD was ensured to be zero. Each muscle group received two measurements with a 30-second rest period in between. The raters were blinded to the measurements while the third investigator (PA) recorded the results on the dynamometer during all time periods. The mean values of two readings were calculated, and the data were statistically analysed. 3. Statistical analysis Descriptive data are presented as the mean ± standard deviation (SD). The muscle strength, assessed in kg, was converted into newtons (N) and analysed for reliability. The following reliability measures were assessed: 1. relative reliability via the intraclass correlation coefficient [two-way mixed effects, consistency, multiple raters/measurements model ICC (3,2)] (16) with 95% confidence intervals and 2. absolute reliability via the calculation of the standard error of measurement (SEM) and coefficient of variation (CV). ICCs were analysed via IBM SPSS Statistics version 16 (IBM Corp., Armonk, NY, USA). The reliability was rated as excellent (ICC > 0.90), good (ICC = 0.76–0.90), moderate (ICC = 0.51–0.75), or poor (ICC < 0.50). SEM (calculated as the product of standard deviation and √ (1 – ICC)) measures the precision of individual scores, whereas CV% (calculated as SD/Mean × 100) reflects the extent of variability in the population mean. The average of the repetitions was used to conduct the analysis. The MDC was estimated via a 95% confidence interval via the formula, MDC = SEM × 1.96 × √2, where 1.96 is determined via the 95% CI (17). According to the literature, an SEM of less than 10% is clinically acceptable. SEM results below 5% are characterized as good (SEM < 5.0%), moderate (SEM 5.0–9.9%), or poor (SEM ≥ 10.0%) (7,18). Bland‒Altman plots were used to determine the level of agreement (LOA) between force outputs from two raters (see Appendix 1 – Fig. 2 – 13 ). The Bland‒Altman plots display the mean values versus differences in the rater 1 and rater 2 measurements. The plots had 95% limits of agreement (mean ± [1.96 * SD], where the mean and SD are obtained from the discrepancies between rater 1 and rater 2 observations, respectively). Linear regression analysis was used to assess proportional bias in the data by comparing the difference and mean ratings of two raters. All analyses were performed with a significance level of p < 0.05. 3. Results Two participants dropped out of the study owing to personal reasons unrelated to the dynamometer examination. Both raters assessed a total of 35 participants (young adults; 12 men and 23 women) with a normal BMI. (Table 1 ). Table 1 Demographic characteristics of the participants (n = 35) Characteristics Mean (standard deviation) Age (years) 27 (2.83) Gender Man Woman 12 (34) $ 23 (66) $ Height (m) 1.72 (0.11) Weight (kg) 62 (4.24) BMI (kg/m 2 ) 21.03 (1.38) $ number of participants (%); BMI- Body mass index; kg-Kilogram; m- meter The inter-rater reliability of the Baseline® via the ICC with 95% confidence intervals for all the muscle strength tests was good (ICC = 0.73–0.90), except for the push muscle strength of the external rotators and the pull muscle strength of the deltoid, which was moderate (ICC = 0.53–0.68). SEM of the push and pull muscle strength tests revealed values ranging from 2.2 to 5.8 N and 3.1 to 4.9 N, respectively, for all muscle groups tested. The MDCs (95% CIs) of push and pull muscle strength ranged from 6.09 to 15.06 and 8.58to 13.57, respectively, for all target muscle groups (Tables 2 and 3 ). Table 2 Interrater reliability of the push dynamometer Muscles assessed using the push strength test Mean ± SD Rater 1 measurements (n = 35) Mean ± SD Rater 2 measurements (n = 35) ICC 95% Confidence Interval SEM (N) CV% MDC 95 (N) p value Upper bound Lower bound Pectoralis major 51.45 ± 10.4 52.85 ± 12.09 0.78 0.57 0.89 5.2 21.53 14.40 0.001 Deltoid 55.58 ± 8.27 54.74 ± 10.38 0.79 0.59 0.89 4.2 16.92 11.63 0.001 Internal rotator 55.30 ± 6.83 54.39 ± 7.10 0.89 0.78 0.94 2.3 12.70 6.37 0.001 External rotator 53.13 ± 7.14 56.07 ± 10.04 0.53 0.10 0.76 5.8 15.67 16.06 0.011 Upper trapezius 63.56 ± 5.91 64.12 ± 7.85 0.89 0.79 0.94 2.2 10.77 6.09 0.001 Serratus anterior 61.25 ± 6.4 61.81 ± 11.12 0.73 0.46 0.86 4.5 14.22 12.46 0.001 Latissimus dorsi 42.35 ± 10.87 46.13 ± 12.67 0.87 0.70 0.94 4.1 25.56 11.35 0.001 CI = confidence interval; CV – coefficient of variance; ICC = intraclass correlation; MDC-minimal detectable change; SD = standard deviation; SEM = standard error of measurement Table 3 Inter-rater reliability of the pull dynamometer Muscles assessed using the pull strength test Mean ± SD Mean ± SD ICC 95% Confidence Interval SEM (N) CV% MDC 95 (N) p value Upper bound Lower bound Pectoralis major 73.78 ± 10.65 72.94 ± 9.24 0.90 0.81 0.95 3.1 13.56 8.58 0.001 Deltoid 69.65 ± 7.86 68.32 ± 8.60 0.68 0.38 0.84 4.6 11.95 12.74 0.001 Internal rotator 69.16 ± 10.84 67.55 ± 10.99 0.79 0.60 0.89 4.9 15.97 13.57 0.001 External rotator 67.83 ± 10.06 66.36 ± 10.10 0.80 0.61 0.90 4.5 15.03 12.46 0.011 Upper trapezius 73.36 ± 7.94 77.14 ± 8.17 0.80 0.48 0.91 3.6 10.72 9.97 0.001 Serratus anterior 72.59 ± 11.4 73.22 ± 12.79 0.90 0.80 0.95 3.9 16.59 10.80 0.001 Latissimus dorsi 63.14 ± 8.85 68.25 ± 10.20 0.81 0.36 0.92 4.1 14.48 11.35 0.001 CI = confidence interval; CV – coefficient of variance; ICC = intraclass correlation; MDC-minimal detectable change; SD = standard deviation; SEM = standard error of measurement Table 4 Testing positions of the shoulder and scapular muscles using a baseline push dynamometer Name of the muscle group Participant position Push pad placement by the rater Application of resistance by the rater Pectoralis major Supine lying with the shoulder in 90° flexion Internal aspect of upper arm Against shoulder flexion and adduction Middle fibres of deltoid Sitting with the shoulder in 90° abduction and elbow in 90° flexion Dorsal surface of the distal end of the humerus Against shoulder abduction Internal rotators Prone lying with shoulder abduction and elbow flexion in 90° Volar aspect of distal forearm Against external rotation of the shoulder External rotators Prone lying with shoulder abduction and elbow flexion in 90° Dorsal aspect of distal forearm Against internal rotation of the shoulder Upper trapezius Sitting without back support Above the clavicle Against elevation of shoulder Serratus anterior Supine lying with elbow in extension, shoulder in 90° flexion and fingers are made into fist On the fist. Rater's force directed downwards, against participant’s fist, through the upper limb to the scapula Latissimus dorsi Prone lying with shoulder in 30° extension and elbow in extension Posterior aspect of upper arm just superior to elbow Against shoulder extension and adduction Table 5 Testing positions of the shoulder and scapular muscles via a baseline pull dynamometer Name of the muscle group Participant position Pull – application closed the Velcro strap Application of pull force by the assessor rater Pectoralis major Supine lying with shoulder in 90° flexion Around the mid forearm Externally against flexion and adduction Middle fibres of deltoid Sitting with shoulder in 90° of abduction Around the mid arm Pulling down as if adducting the shoulder. Internal rotators Prone lying with shoulder 90°abduction and elbow 90-degree flexion Strap around the mid forearm Pulling externally against Internal rotation External rotators Prone lying with shoulder abduction and elbow flexion in 90° Strap around the mid forearm Pulling Internally against external rotation Upper trapezius Sitting without back support Participant holding strap in the hand and trying to shrug the shoulder Pulling down as if depressing the shoulder Serratus anterior Supine lying with elbow and shoulder in 90° and hand in fist Participant holding strap in the hand and trying to pull upwards Pulling force directing downwards through the extremity to the scapula Latissimus dorsi Prone lying with shoulder in 30°extension and elbow in extension Around the mid forearm Pulling externally against extension and adduction The regression model revealed a systematic bias in push muscle strength for the serratus anterior, upper trapezius, and external rotator (Appendix 1 - Fig. 8 , 10 , and 12 ). The regression lines demonstrated that all other plots had no systematic bias, with a propensity to decline in difference scores. When the mean scores of the two raters increased, the exception was pectoralis major pull muscular strength (Fig. 3 ), which was the opposite. Discussion This study evaluated the reliability of the Baseline® PPD for measuring the strength of the shoulder and scapular muscles among healthy individuals. The study results revealed moderate to good reliability of the Baseline® PPD for measuring both the push and pull muscle strengths of the pectoralis major, middle deltoid, shoulder internal and external rotators, upper trapezius, serratus anterior and latissimus dorsi. Previous studies have revealed that muscle strength assessment with HHD for shoulder flexors, abductors, and rotators has excellent reliability (1),(9,19). Celik et al. reported that the ICC values for shoulder and scapular push muscle strength (trapezius, serratus anterior, supraspinatus, anterior deltoid, and latissimus dorsi) using HHD ranged between 0.77 and 0.99 for all muscles tested, indicating excellent reliability except for the upper trapezius, for which the values were much lower (ICC = 0.45 to 0.60) (6). In contrast, in our study, the push and pull muscle strengths of the upper trapezius showed good reliability, with ICC values of 0.80 and 0.89, respectively (8,17). The strength of the serratus anterior push strength, assessed at 90° of shoulder flexion, was moderate (ICC = 0.73), which is evident in a previous study, where a similar position of assessment reported good reliability for serratus anterior push muscle strength when the HHD ICC = 0.79 (3). The SEM and MDC values reported in this study were acceptable and correlated with those of a previous study in which small values of SEM (< 5.0 N) and MDC (< 13.9) were reported for assessing the isometric strength of shoulder muscles via a force meter (20). In this study, the SEM values of shoulder flexor and abductor push muscle strength were similar, at 5.2 N and 4.2 N, respectively. The MDCs (95% CIs) of shoulder flexor and abductor push muscle strength in our study were 14.4 N and 11.63 N, respectively. Similar results were evident in previous studies, with SEM values for shoulder abductors measured via HHD of 14.6 and 19.53 for the right and left sides, respectively (1) The SEM values for the push muscle strength of the internal rotator in this study were lower (2.3 N) than those in a previous study, which reported an SEM of 3.45 N for the same muscle strength measured with HHD. Moreover, this study revealed slightly high SEM and MDC (95% CI) values for external rotator push muscle strength of 5.8 N and 16.06, respectively. This result coincides with a previous study, which suggested that internal rotation movement is more common in day-to-day activities involving the shoulder joint than is external rotation (10). The arm elevated to 90° for determining peak eccentric muscle torque in both internal and external rotators has a greater ICC and lower MDC% (8). The position of the assessment (90° of shoulder abduction) used to assess the isometric muscle strength of the rotators in our study was similar to that used in previous studies. With respect to rotator muscle strength, the internal and external rotator strengths of the shoulder were found to be almost equal in our study, which supports the concept stated in the literature that an adequate balance between the strength of the internal and external rotator is needed to maintain dynamic stabilization of the shoulder (21). With respect to the scapular muscles, the push strength assessment of the serratus anterior resulted in a lower SEM (4.5 N) and MDC (95% CI; 12.46 N). Very few studies have reported the normative values for muscle strength assessment although dynamometers. It is evident from the literature that the normative values of the shoulder external rotator, internal rotator and serratus anterior muscle strength determined via the Kendall and Kendall MMT test parameters with a push-pull hydraulic dynamometer are 4.75 Kg (~ 46.99 N), 5.2 Kg (~ 50.96 N) and 9.7 kg (~ 95.06 N) respectively (22). Although there were more female participants than male participants in our study (66% female and only 34% male), the mean muscle strength values for the external and internal rotators were similar to those reported in previous studies [5.6 kg (~ 54.88 N) and 5.55 kg (~ 54.39 N), respectively), and the strength of the serratus anterior was lower [6.3 kg (~ 61.74 N)] than previously reported. In this study, shoulder and scapular muscle strength were assessed only on the dominant side in healthy individuals. The ambiguity of the variation in strength between the dominant and nondominant limbs was clarified in a previous study, which reported that scapulohumeral muscle strength and endurance were not clinically different for the dominant and nondominant limbs in a middle-aged healthy population recorded with a hand-held dynamometer (23). Strengths, limitations, and future recommendations The Baseline® PPD is a portable, cost-effective instrument for measuring the isometric strength of muscles, which is the major strength of this study. Given its cost-effectiveness, clinicians can purchase and use the Baseline® PPD as the primary outcome-assessing equipment for shoulder and scapular muscle strength in their clinical settings. Most studies have presented push isometric assessment methods using hand-held dynamometers. This study explains the procedure of assessing both the push strength and the pull strength of the shoulder and scapular muscles. A limitation of the study is that the strengths of the assessors may have influenced the strengths of the participants. Although two raters were used to assess interrater reliability in our study, future studies could consider including three or more raters. We recommend analysing reliability in athletes as well as persons with shoulder issues, as sex, age, and weight can influence the results of shoulder strength tests. Conclusion Shoulder and scapular push and pull muscle strength assessment via the Baseline® PPD among healthy individuals revealed good to excellent reliability and acceptable agreement between the two raters. Furthermore, strength assessments with the Baseline® PPD, the pull dynamometer, yielded relatively greater agreement between the raters than did the push dynamometer. Clinicians could reliably use the Baseline® PPD to assess the isometric strength of the shoulder and scapular muscles in clinical practice. Declarations Acknowledgements: Authors sincerely thank all the participants for their valuable time, cooperation, and contribution to this study. Their involvement was essential to the successful completion of this research. Authors' contributions: DV contributed to conceptualization, methodology, data Collection, manuscript review and editing; MV contributed to conceptualization, methodology, data collection, data analysis, original draft writing; AA contributed to data analysis, manuscript editing, overall project Supervision; RV contributed to data collection and manuscript review; PA contributed to data collection and manuscript review and SD contributed on expert input on the topic area, and approved the final version of the manuscript. All authors have read and approved the final version of the manuscript and agree with the order of the presentation of the authors. Availability of data and materials: The datasets generated and analysed during the current study are available from the corresponding author on reasonable request. Competing interests: All the authors declare no competing interests. Ethical approval and consent to participant: This study was conducted in accordance with the Declaration of Helsinki, ensuring the ethical treatment of all participants involved. Ethical approval given by the PSG Institute of Human Ethics Committee, Project no: 23/141. All the participants provided written informed consent for the study. Consent for publication: Consent was received from the participant who agreed to display their picture in the manuscript by blocking the identity. Funding: The authors gratefully acknowledge the financial support by the SRM College of Physiotherapy, Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology (SRM IST), Kattankulathur, Chengalpattu – 603 203, India for bearing the defrayed costs of publishing this article. References Ferraro E, Trajkovi´ctrajkovi´c N, Kozinc Ž, Smajla D, Šarabon N. Interrater and Intrarater Reliability of the EasyForce Dynamometer for Assessment of Maximal Shoulder, Knee and Hip Strength. 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Wałecka J, Lubiatowski P, Bręborowicz E, Kaczmarek P, Grygorowicz M, Romanowski L. Isometric Shoulder Testing Using a Forcemeter Is a Reliable Method of Strength Evaluation. Sensors. 2023 Nov 1;23(22). Bradley H, Pierpoint L. Normative Values of Isometric Shoulder Strength Among Healthy Adults. Int J Sports Phys Ther. 2023;18(4):977–88. Senthil P, Radhakrishnan R. Normative Data and Intra-Rater Reliability of Scapula-Humeral Muscle Strength Using Push-Pull Hydraulic Type Hand Held Dynamometer in Healthy College Students. International Journal of Health Sciences & Research . 2016 Jun;6(6):177. Day JM, Bush H, Nitz AJ, Uhl TL. Arm dominance does not influence measures of scapular muscle strength and endurance in healthy individuals. Physiother Pract Res. 2015 Jul 7;36(2):87–95. Additional Declarations No competing interests reported. Supplementary Files Appendix1and2.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 29 Mar, 2026 Reviewers agreed at journal 28 Mar, 2026 Reviewers invited by journal 28 Mar, 2026 Editor assigned by journal 23 Mar, 2026 Editor invited by journal 30 Jan, 2026 Submission checks completed at journal 29 Jan, 2026 First submitted to journal 29 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8598257","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":614851269,"identity":"c285f9b9-9f8a-4e34-8065-11ab0854e32f","order_by":0,"name":"Divya varshini Ravikumar","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABE0lEQVRIiWNgGAWjYDCCwxCKsYGB+fiHDxU2IHbjASK1sKUxzjiTBmbj13IAroXHjJm35TCyIHbAd5zHTOJnm51s/4wEs8e8Deft1rYfBtpSYxONS4vkYR4zyd62ZOMZNxLSDefuuJ287UwiUMuxtNwGHFoMDrOlSfC2MSc2nDlwQOLtmdvJZgeAWhgbDuPVIvm3rT5x/pmDDUC955LNzj8kpIX5mDRv2+HEDceb2SR52w7Ymd0gYIvkYebD1jLnjhtvPN7GbDjjTHKC2Q2gLQl4/MJ3/mDjzTdl1bLzDvN/fPChws7e7Hz6wwcfamxwagECFglGNgQvEawyAbdyEGD+wPAHwbPHr3gUjIJRMApGIgAAGh5u8DeEOlMAAAAASUVORK5CYII=","orcid":"","institution":"SRM Institute of Science and Technology (SRMIST)","correspondingAuthor":true,"prefix":"","firstName":"Divya","middleName":"varshini","lastName":"Ravikumar","suffix":""},{"id":614851270,"identity":"827b666e-da06-410f-8257-26937403baa9","order_by":1,"name":"Mahalakshmi Venugopalan","email":"","orcid":"","institution":"Government Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mahalakshmi","middleName":"","lastName":"Venugopalan","suffix":""},{"id":614851271,"identity":"cc1c4995-5c06-46aa-b6eb-639dc5ed7851","order_by":2,"name":"Ashokan Arumugam","email":"","orcid":"","institution":"University of Sharjah","correspondingAuthor":false,"prefix":"","firstName":"Ashokan","middleName":"","lastName":"Arumugam","suffix":""},{"id":614851272,"identity":"4341635d-51cc-44f4-9967-0c27ad928a9a","order_by":3,"name":"Ramamoorthy V","email":"","orcid":"","institution":"PSG Institute of Medical Sciences and Research","correspondingAuthor":false,"prefix":"","firstName":"Ramamoorthy","middleName":"","lastName":"V","suffix":""},{"id":614851273,"identity":"2e6fb25b-d6fb-4e07-af18-edcb5cc495a7","order_by":4,"name":"Parthiban Alagappan","email":"","orcid":"","institution":"PSG Institute of Medical Sciences and Research","correspondingAuthor":false,"prefix":"","firstName":"Parthiban","middleName":"","lastName":"Alagappan","suffix":""},{"id":614851274,"identity":"d6e2a5f4-fab2-466c-ad9f-cc57f3ba7c5f","order_by":5,"name":"Senthil Kumaran D","email":"","orcid":"","institution":"Manipal Academy of Higher Education","correspondingAuthor":false,"prefix":"","firstName":"Senthil","middleName":"Kumaran","lastName":"D","suffix":""}],"badges":[],"createdAt":"2026-01-14 06:38:46","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8598257/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8598257/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106402853,"identity":"591a08df-64b2-46fa-8a61-b5606ab6c061","added_by":"auto","created_at":"2026-04-08 09:13:02","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":403727,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eBaseline push-pull dynamometer with its accessories\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8598257/v1/5eac94b59e554fc5ca1cd8c7.png"},{"id":106959585,"identity":"7698a7c0-0bfb-4e50-8fb8-a0ae940daf86","added_by":"auto","created_at":"2026-04-15 09:11:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1459885,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8598257/v1/03f069b0-728b-4838-8dd9-290a70f7bd62.pdf"},{"id":106212811,"identity":"f39ab30b-1efd-4e19-a846-4c2b161d5752","added_by":"auto","created_at":"2026-04-06 07:49:28","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":98015,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix1and2.docx","url":"https://assets-eu.researchsquare.com/files/rs-8598257/v1/21ebc19e84ba10445b3e32f9.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Inter-rater reliability of baseline push-pull dynamometer for shoulder and scapular muscle strength testing among healthy individuals","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eMuscle strength assessment is crucial for analysing an individual's health, physical well-being and treatment planning in rehabilitation settings (1). There are several methods for measuring muscular strength, including manual muscle testing, handheld dynamometers (HHD), handgrip strength and isokinetic dynamometers (2). The Medical Research Council (MRC) offers a five-point scale to assess manual muscle strength. Despite its widespread use, the validity and reliability of the MRC scale are debatable (3).\u003c/p\u003e \u003cp\u003eIsokinetic dynamometers are the gold standard for objective muscular strength measurement. It measures the muscle power of a joint over its whole range of motion by applying resistance to a standardized contraction velocity. This method also provides a highly reproducible means of measuring neuromuscular performance in both healthy and diseased states (4). Compared with isokinetic dynamometry, HHD is gaining popularity in clinical practice because of its portability and easy application (5). HHD is a reliable alternative for MRC testing and isokinetic dynamometers, and it can measure strength in various muscle groups, is relatively inexpensive and can be used in a clinical setting (2). HHDs are broadly classified into two types: push and pull.\u003c/p\u003e \u003cp\u003eAccording to a systematic review by Stark et al., compared with isokinetic devices, HHD is a reliable and valid technique for testing muscle strength in a clinical setting. Many analogue, digital, and mechanical quantitative devices, such as universal digital, hydraulic, and electronic push‒pull dynamometers, have been designed for both research and clinical purposes (1,3,6,7). We found that all of these dynamometers have been tested and found to be reliable across multiple muscle groups(8\u0026ndash;10). Although the reliability of these dynamometers seems to be very high, they are typically limited to research settings and large institutions due to their cost. Comparatively, Baseline\u0026reg; Push Pull Dynamometer (PPD) would be much cheaper and easy to assess the muscle strength.\u003c/p\u003e \u003cp\u003eShoulder girdle motion is the synchronized movement of the scapula and humerus, with the scapula acting as a platform for humeral motion. The scapula position and control of the thorax are crucial for optimal shoulder function. Functional upper extremity use is required for individuals to conduct a wide array of jobs necessary for day-to-day life (11). To our knowledge, no previous study has evaluated the reliability of the Baseline\u0026reg; PPD for shoulder and scapular muscle strength testing. Given the clinical need for simple and objective strength assessment of the shoulder and scapular muscles, it is imperative to evaluate the reliability of push and pull dynamometric measurements via the Baseline\u0026reg; PPD before it is implemented in clinical scenarios. The aim of this study was to determine the inter-rater reliability of the Baseline\u0026reg; PPD in measuring shoulder and scapular muscular strength in healthy individuals.\u003c/p\u003e"},{"header":"2. Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Study design, setting, and ethics approval\u003c/h2\u003e \u003cp\u003eA cross-sectional study was conducted at the Department of Physical Medicine and Rehabilitation, PSG Hospitals, in Tamil Nadu, India. This study has been registered on 20th July 2023 in Clinical Trial Registry of India. [Registration No. CTRI/2023/07/055409]. The Institutional Ethics Committee at the PSG Institute of Medical Sciences and Research approved the study protocol (Project No. 23/141). All participants provided written informed consent after reading the information sheet explaining the study. This study adhered to the Guidelines for Reporting Reliability and Agreement Studies (GRRAS) (12).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Sample size calculation\u003c/h2\u003e \u003cp\u003eWith a minimal acceptable reliability of 0.7, an expected reliability of 0.9, a level of significance of 99%, and a power of 80%, 37 individuals (including dropouts) were deemed appropriate for the study (13).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Study participants\u003c/h2\u003e \u003cp\u003eA convenience sample of 37 healthy adult male and female physiotherapists aged between 20 and 45 years with full and pain-free shoulder range of motion was included in the study. Participants were excluded if they had one or more of the following conditions: upper extremity deformities, a medical history of neurological disease (e.g., stroke or Parkinson's disease), medical instability, or a history of recent upper limb or trunk injury/surgery within the previous six months.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Instrument:\u003c/h2\u003e \u003cp\u003eThe Baseline\u0026reg; PPD (Fabrication Enterprises, Inc., PO Box 1500, White Plains, New York 10602, USA) has a capacity of 0\u0026ndash;66 lbs./30 kg and comes with nine accessories. This device has two functional ends: one designed for push measurements and the other for pull measurements. It has a zero button, which ensures that measurements begin at zero. The two-inch-wide digital screen displays the strength measurement in pounds or kilograms, depending on the option selected. The Baseline\u0026reg; PPD has replaceable handles and accessories, including three push pads, three push circular tips, one open pull hook, and one snap-close pull hook with an adaptor and gauge (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5. Procedure\u003c/h2\u003e \u003cp\u003eA detailed description of the study's nature and information on the eligibility criteria were advertised on the department notice board. The volunteers who agreed to participate in the study were screened for eligibility criteria. Initially, the hand dominance of the participants was assessed via the Edinburgh Handedness Inventory (14). The selected participants were asked to remove all hand jewellery and wash and dry their dominant hand prior to being tested. Before the isometric tests were started, each individual's anthropometric measurements were recorded, and warm-up activities (self-stretching) for the shoulder and scapular muscular groups were performed. Kendell\u0026rsquo;s muscle testing protocol has been used for isometric strength assessments of the shoulder and scapular muscles (15).\u003c/p\u003e \u003cp\u003eTwo raters, both with good clinical experience and with a master\u0026rsquo;s degree in physiotherapy, underwent two-hour training sessions on how to assess the pull and push strength of the shoulder and scapular muscles via the Baseline\u0026reg; PPD. After training, they assessed muscle strength via equipment for five healthy volunteers. The order of testing muscles were randomly selected by the raters. Isometric tests for shoulder flexors (pectoralis major), abductors (middle fibres of the deltoid), external and internal rotators, the upper trapezius, the serratus anterior, and the latissimus dorsi were performed on each participant before the real assessment. Muscle strength assessment was performed by two raters on alternate weeks. Push muscle strength was assessed by Rater 1 (MV) and 2 (DV) using the push Baseline\u0026reg; PPD during the first and second weeks, respectively. Similarly, Rater 1 and Rater 2, assessed the pull muscle strength using the Baseline\u0026reg; PPD at the third and fourth weeks, respectively. Participants were asked not to get involved in any resisted exercise programs that might alter the strength of these muscles\u0026rsquo; groups. Muscle testing was performed in a well-lit environment. Before testing the muscle strength, the pointer of the Baseline\u0026reg; PPD was ensured to be zero. Each muscle group received two measurements with a 30-second rest period in between. The raters were blinded to the measurements while the third investigator (PA) recorded the results on the dynamometer during all time periods. The mean values of two readings were calculated, and the data were statistically analysed.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e3. Statistical analysis\u003c/h3\u003e\n\u003cp\u003eDescriptive data are presented as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD). The muscle strength, assessed in kg, was converted into newtons (N) and analysed for reliability. The following reliability measures were assessed: 1. relative reliability via the intraclass correlation coefficient [two-way mixed effects, consistency, multiple raters/measurements model ICC (3,2)] (16) with 95% confidence intervals and 2. absolute reliability via the calculation of the standard error of measurement (SEM) and coefficient of variation (CV). ICCs were analysed via IBM SPSS Statistics version 16 (IBM Corp., Armonk, NY, USA). The reliability was rated as excellent (ICC\u0026thinsp;\u0026gt;\u0026thinsp;0.90), good (ICC\u0026thinsp;=\u0026thinsp;0.76\u0026ndash;0.90), moderate (ICC\u0026thinsp;=\u0026thinsp;0.51\u0026ndash;0.75), or poor (ICC\u0026thinsp;\u0026lt;\u0026thinsp;0.50). SEM (calculated as the product of standard deviation and \u0026radic; (1 \u0026ndash; ICC)) measures the precision of individual scores, whereas CV% (calculated as SD/Mean \u0026times; 100) reflects the extent of variability in the population mean. The average of the repetitions was used to conduct the analysis. The MDC was estimated via a 95% confidence interval via the formula, MDC\u0026thinsp;=\u0026thinsp;SEM \u0026times; 1.96 \u0026times; \u0026radic;2, where 1.96 is determined via the 95% CI (17). According to the literature, an SEM of less than 10% is clinically acceptable. SEM results below 5% are characterized as good (SEM\u0026thinsp;\u0026lt;\u0026thinsp;5.0%), moderate (SEM 5.0\u0026ndash;9.9%), or poor (SEM\u0026thinsp;\u0026ge;\u0026thinsp;10.0%) (7,18).\u003c/p\u003e \u003cp\u003eBland‒Altman plots were used to determine the level of agreement (LOA) between force outputs from two raters (see Appendix 1 \u0026ndash; Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Fig13\" class=\"InternalRef\"\u003e13\u003c/span\u003e). The Bland‒Altman plots display the mean values versus differences in the rater 1 and rater 2 measurements. The plots had 95% limits of agreement (mean \u0026plusmn; [1.96 * SD], where the mean and SD are obtained from the discrepancies between rater 1 and rater 2 observations, respectively). Linear regression analysis was used to assess proportional bias in the data by comparing the difference and mean ratings of two raters. All analyses were performed with a significance level of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003eTwo participants dropped out of the study owing to personal reasons unrelated to the dynamometer examination. Both raters assessed a total of 35 participants (young adults; 12 men and 23 women) with a normal BMI. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of the participants (n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean (standard deviation)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27 (2.83)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eMan\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eWoman\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (34) \u003csup\u003e$\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e23 (66) \u003csup\u003e$\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHeight (m)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.72 (0.11)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWeight (kg)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e62 (4.24)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI (kg/m\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21.03 (1.38)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003e\u003csup\u003e$\u003c/sup\u003enumber of participants (%); BMI- Body mass index; kg-Kilogram; m- meter\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe inter-rater reliability of the Baseline\u0026reg; via the ICC with 95% confidence intervals for all the muscle strength tests was good (ICC\u0026thinsp;=\u0026thinsp;0.73\u0026ndash;0.90), except for the push muscle strength of the external rotators and the pull muscle strength of the deltoid, which was moderate (ICC\u0026thinsp;=\u0026thinsp;0.53\u0026ndash;0.68). SEM of the push and pull muscle strength tests revealed values ranging from 2.2 to 5.8 N and 3.1 to 4.9 N, respectively, for all muscle groups tested. The MDCs (95% CIs) of push and pull muscle strength ranged from 6.09 to 15.06 and 8.58to 13.57, respectively, for all target muscle groups (Tables\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInterrater reliability of the push dynamometer\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMuscles assessed using the push strength test\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003cp\u003eRater 1 measurements (n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003cp\u003eRater 2 measurements (n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eICC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e95% Confidence Interval\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSEM (N)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCV%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMDC\u003csub\u003e95\u003c/sub\u003e (N)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUpper bound\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLower bound\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePectoralis major\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e51.45\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;10.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e52.85\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;12.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e5.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e21.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e14.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDeltoid\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e55.58\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;8.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e54.74\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;10.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e16.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e11.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInternal rotator\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e55.30\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;6.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e54.39\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;7.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e12.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e6.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExternal rotator\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e53.13\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;7.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e56.07\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;10.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e5.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e15.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e16.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUpper trapezius\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e63.56\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;5.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e64.12\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;7.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e6.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSerratus anterior\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e61.25\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;6.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e61.81\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;11.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e14.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e12.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLatissimus dorsi\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e42.35\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;10.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e46.13\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;12.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e4.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e25.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e11.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003eCI\u0026thinsp;=\u0026thinsp;confidence interval; CV \u0026ndash; coefficient of variance; ICC\u0026thinsp;=\u0026thinsp;intraclass correlation; MDC-minimal detectable change; SD\u0026thinsp;=\u0026thinsp;standard deviation; SEM\u0026thinsp;=\u0026thinsp;standard error of measurement\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInter-rater reliability of the pull dynamometer\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMuscles assessed using the pull strength test\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eICC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e95% Confidence Interval\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSEM (N)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCV%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMDC\u003csub\u003e95\u003c/sub\u003e (N)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUpper bound\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLower bound\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePectoralis major\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e73.78\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;10.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e72.94\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;9.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e13.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e8.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDeltoid\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e69.65\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;7.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e68.32\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;8.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e4.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e11.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e12.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInternal rotator\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e69.16\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;10.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e67.55\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;10.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e4.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e15.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e13.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExternal rotator\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e67.83\u0026thinsp;\u0026plusmn;\u0026thinsp;10.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e66.36\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;10.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e15.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e12.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUpper trapezius\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e73.36\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;7.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e77.14\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;8.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e9.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSerratus anterior\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e72.59\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;11.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e73.22\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;12.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e16.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e10.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLatissimus dorsi\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e63.14\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;8.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e68.25\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;10.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e4.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e14.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e11.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003eCI\u0026thinsp;=\u0026thinsp;confidence interval; CV \u0026ndash; coefficient of variance; ICC\u0026thinsp;=\u0026thinsp;intraclass correlation; MDC-minimal detectable change; SD\u0026thinsp;=\u0026thinsp;standard deviation; SEM\u0026thinsp;=\u0026thinsp;standard error of measurement\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTesting positions of the shoulder and scapular muscles using a baseline push dynamometer\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eName of the muscle group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParticipant position\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePush pad placement by the rater\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eApplication of resistance by the rater\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePectoralis major\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSupine lying with the shoulder in 90\u0026deg; flexion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInternal aspect of upper arm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAgainst shoulder flexion and adduction\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle fibres of deltoid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSitting with the shoulder in 90\u0026deg; abduction and elbow in 90\u0026deg; flexion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDorsal surface of the distal end of the humerus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAgainst shoulder abduction\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInternal rotators\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProne lying with shoulder abduction and elbow flexion in 90\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVolar aspect of distal forearm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAgainst external rotation of the shoulder\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExternal rotators\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProne lying with shoulder abduction and elbow flexion in 90\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDorsal aspect of distal forearm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAgainst internal rotation of the shoulder\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUpper trapezius\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSitting without back support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAbove the clavicle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAgainst elevation of shoulder\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerratus anterior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSupine lying with elbow in extension, shoulder in 90\u0026deg; flexion and fingers are made into fist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOn the fist.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRater's force directed downwards, against participant\u0026rsquo;s fist, through the upper limb to the scapula\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLatissimus dorsi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProne lying with shoulder in 30\u0026deg; extension and elbow in extension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePosterior aspect of upper arm just superior to elbow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAgainst shoulder extension and adduction\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTesting positions of the shoulder and scapular muscles via a baseline pull dynamometer\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eName of the muscle group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParticipant position\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePull \u0026ndash; application closed the Velcro strap\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eApplication of pull force by the assessor rater\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePectoralis major\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSupine lying with shoulder in 90\u0026deg; flexion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAround the mid forearm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eExternally against flexion and adduction\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle fibres of deltoid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSitting with shoulder in 90\u0026deg; of abduction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAround the mid arm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePulling down as if adducting the shoulder.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInternal rotators\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProne lying with shoulder 90\u0026deg;abduction and elbow 90-degree flexion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStrap around the mid forearm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePulling externally against Internal rotation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExternal rotators\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProne lying with shoulder abduction and elbow flexion in 90\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStrap around the mid forearm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePulling Internally against external rotation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUpper trapezius\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSitting without back support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eParticipant holding strap in the hand and trying to shrug the shoulder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePulling down as if depressing the shoulder\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerratus anterior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSupine lying with elbow and shoulder in 90\u0026deg; and hand in fist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eParticipant holding strap in the hand and trying to pull upwards\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePulling force directing downwards through the extremity to the scapula\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLatissimus dorsi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProne lying with shoulder in 30\u0026deg;extension and elbow in extension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAround the mid forearm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePulling externally against extension and adduction\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe regression model revealed a systematic bias in push muscle strength for the serratus anterior, upper trapezius, and external rotator (Appendix 1 - Fig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003e, \u003cspan refid=\"Fig10\" class=\"InternalRef\"\u003e10\u003c/span\u003e, and \u003cspan refid=\"Fig12\" class=\"InternalRef\"\u003e12\u003c/span\u003e). The regression lines demonstrated that all other plots had no systematic bias, with a propensity to decline in difference scores. When the mean scores of the two raters increased, the exception was pectoralis major pull muscular strength (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), which was the opposite.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study evaluated the reliability of the Baseline\u0026reg; PPD for measuring the strength of the shoulder and scapular muscles among healthy individuals. The study results revealed moderate to good reliability of the Baseline\u0026reg; PPD for measuring both the push and pull muscle strengths of the pectoralis major, middle deltoid, shoulder internal and external rotators, upper trapezius, serratus anterior and latissimus dorsi.\u003c/p\u003e \u003cp\u003ePrevious studies have revealed that muscle strength assessment with HHD for shoulder flexors, abductors, and rotators has excellent reliability (1),(9,19). Celik et al. reported that the ICC values for shoulder and scapular push muscle strength (trapezius, serratus anterior, supraspinatus, anterior deltoid, and latissimus dorsi) using HHD ranged between 0.77 and 0.99 for all muscles tested, indicating excellent reliability except for the upper trapezius, for which the values were much lower (ICC\u0026thinsp;=\u0026thinsp;0.45 to 0.60) (6). In contrast, in our study, the push and pull muscle strengths of the upper trapezius showed good reliability, with ICC values of 0.80 and 0.89, respectively (8,17). The strength of the serratus anterior push strength, assessed at 90\u0026deg; of shoulder flexion, was moderate (ICC\u0026thinsp;=\u0026thinsp;0.73), which is evident in a previous study, where a similar position of assessment reported good reliability for serratus anterior push muscle strength when the HHD ICC\u0026thinsp;=\u0026thinsp;0.79 (3).\u003c/p\u003e \u003cp\u003eThe SEM and MDC values reported in this study were acceptable and correlated with those of a previous study in which small values of SEM (\u0026lt;\u0026thinsp;5.0 N) and MDC (\u0026lt;\u0026thinsp;13.9) were reported for assessing the isometric strength of shoulder muscles via a force meter (20). In this study, the SEM values of shoulder flexor and abductor push muscle strength were similar, at 5.2 N and 4.2 N, respectively. The MDCs (95% CIs) of shoulder flexor and abductor push muscle strength in our study were 14.4 N and 11.63 N, respectively. Similar results were evident in previous studies, with SEM values for shoulder abductors measured via HHD of 14.6 and 19.53 for the right and left sides, respectively (1)\u003c/p\u003e \u003cp\u003eThe SEM values for the push muscle strength of the internal rotator in this study were lower (2.3 N) than those in a previous study, which reported an SEM of 3.45 N for the same muscle strength measured with HHD. Moreover, this study revealed slightly high SEM and MDC (95% CI) values for external rotator push muscle strength of 5.8 N and 16.06, respectively. This result coincides with a previous study, which suggested that internal rotation movement is more common in day-to-day activities involving the shoulder joint than is external rotation (10). The arm elevated to 90\u0026deg; for determining peak eccentric muscle torque in both internal and external rotators has a greater ICC and lower MDC% (8).\u003c/p\u003e \u003cp\u003eThe position of the assessment (90\u0026deg; of shoulder abduction) used to assess the isometric muscle strength of the rotators in our study was similar to that used in previous studies. With respect to rotator muscle strength, the internal and external rotator strengths of the shoulder were found to be almost equal in our study, which supports the concept stated in the literature that an adequate balance between the strength of the internal and external rotator is needed to maintain dynamic stabilization of the shoulder (21). With respect to the scapular muscles, the push strength assessment of the serratus anterior resulted in a lower SEM (4.5 N) and MDC (95% CI; 12.46 N).\u003c/p\u003e \u003cp\u003eVery few studies have reported the normative values for muscle strength assessment although dynamometers. It is evident from the literature that the normative values of the shoulder external rotator, internal rotator and serratus anterior muscle strength determined via the Kendall and Kendall MMT test parameters with a push-pull hydraulic dynamometer are 4.75 Kg (~\u0026thinsp;46.99 N), 5.2 Kg (~\u0026thinsp;50.96 N) and 9.7 kg (~\u0026thinsp;95.06 N) respectively (22). Although there were more female participants than male participants in our study (66% female and only 34% male), the mean muscle strength values for the external and internal rotators were similar to those reported in previous studies [5.6 kg (~\u0026thinsp;54.88 N) and 5.55 kg (~\u0026thinsp;54.39 N), respectively), and the strength of the serratus anterior was lower [6.3 kg (~\u0026thinsp;61.74 N)] than previously reported.\u003c/p\u003e \u003cp\u003eIn this study, shoulder and scapular muscle strength were assessed only on the dominant side in healthy individuals. The ambiguity of the variation in strength between the dominant and nondominant limbs was clarified in a previous study, which reported that scapulohumeral muscle strength and endurance were not clinically different for the dominant and nondominant limbs in a middle-aged healthy population recorded with a hand-held dynamometer (23).\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStrengths, limitations, and future recommendations\u003c/strong\u003e \u003cp\u003eThe Baseline\u0026reg; PPD is a portable, cost-effective instrument for measuring the isometric strength of muscles, which is the major strength of this study. Given its cost-effectiveness, clinicians can purchase and use the Baseline\u0026reg; PPD as the primary outcome-assessing equipment for shoulder and scapular muscle strength in their clinical settings. Most studies have presented push isometric assessment methods using hand-held dynamometers. This study explains the procedure of assessing both the push strength and the pull strength of the shoulder and scapular muscles.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eA limitation of the study is that the strengths of the assessors may have influenced the strengths of the participants. Although two raters were used to assess interrater reliability in our study, future studies could consider including three or more raters. We recommend analysing reliability in athletes as well as persons with shoulder issues, as sex, age, and weight can influence the results of shoulder strength tests.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eShoulder and scapular push and pull muscle strength assessment via the Baseline\u0026reg; PPD among healthy individuals revealed good to excellent reliability and acceptable agreement between the two raters. Furthermore, strength assessments with the Baseline\u0026reg; PPD, the pull dynamometer, yielded relatively greater agreement between the raters than did the push dynamometer. Clinicians could reliably use the Baseline\u0026reg; PPD to assess the isometric strength of the shoulder and scapular muscles in clinical practice.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eAuthors sincerely thank all the participants for their valuable time, cooperation, and contribution to this study. Their involvement was essential to the successful completion of this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u0026nbsp;\u003c/strong\u003eDV contributed to conceptualization, methodology, data Collection, manuscript review and editing; MV contributed to conceptualization, methodology, data collection, data analysis, original draft writing; AA contributed to data analysis, manuscript editing, overall project Supervision; RV contributed to data collection and manuscript review; PA contributed to data collection and manuscript review and SD contributed on expert input on the topic area, and approved the final version of the manuscript. All authors have read and approved the final version of the manuscript and agree with the order of the presentation of the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eThe datasets generated and analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eAll the authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participant:\u0026nbsp;\u003c/strong\u003eThis study was conducted in accordance with the Declaration of Helsinki, ensuring the ethical treatment of all participants involved.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eEthical approval given by the PSG Institute of Human Ethics Committee, Project no: 23/141. All the participants provided written informed consent for the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e Consent was received from the participant who agreed to display their picture in the manuscript by blocking the identity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThe authors gratefully acknowledge the financial support by the SRM College of Physiotherapy, Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology (SRM IST), Kattankulathur, Chengalpattu \u0026ndash; 603 203, India for bearing the defrayed costs of publishing this article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eFerraro E, Trajkovi\u0026acute;ctrajkovi\u0026acute;c N, Kozinc Ž, Smajla D, \u0026Scaron;arabon N. Interrater and Intrarater Reliability of the EasyForce Dynamometer for Assessment of Maximal Shoulder, Knee and Hip Strength. 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J Chiropr Med. 2016 Jun 1;15(2):155\u0026ndash;63. \u003c/li\u003e\n\u003cli\u003eMorin M, H\u0026eacute;bert LJ, Perron M, Petitclerc \u0026Eacute;, Lake SR, Duchesne E. Psychometric properties of a standardized protocol of muscle strength assessment by hand-held dynamometry in healthy adults: a reliability study. BMC Musculoskelet Disord. 2023 Dec 1;24(1). \u003c/li\u003e\n\u003cli\u003eClaudino JG, Cardoso Filho CA, Boullosa D, Lima-Alves A, Carrion GR, Gianoni RL da S, et al. The role of veracity on the load monitoring of professional soccer players: A systematic review in the face of the big data era. Applied Sciences (Switzerland). 2021 Jul 2;11(14). \u003c/li\u003e\n\u003cli\u003eKaragiannopoulos C, Griech S, Leggin B. Reliability and Validity of the ActivForce Digital Dynamometer in Assessing Shoulder Muscle Force across Different User Experience Levels. Int J Sports Phys Ther. 2022;17(4):669\u0026ndash;76. \u003c/li\u003e\n\u003cli\u003eWałecka J, Lubiatowski P, Bręborowicz E, Kaczmarek P, Grygorowicz M, Romanowski L. Isometric Shoulder Testing Using a Forcemeter Is a Reliable Method of Strength Evaluation. Sensors. 2023 Nov 1;23(22). \u003c/li\u003e\n\u003cli\u003eBradley H, Pierpoint L. Normative Values of Isometric Shoulder Strength Among Healthy Adults. Int J Sports Phys Ther. 2023;18(4):977\u0026ndash;88. \u003c/li\u003e\n\u003cli\u003eSenthil P, Radhakrishnan R. Normative Data and Intra-Rater Reliability of Scapula-Humeral Muscle Strength Using Push-Pull Hydraulic Type Hand Held Dynamometer in Healthy College Students. International Journal of Health Sciences \u0026amp; Research . 2016 Jun;6(6):177. \u003c/li\u003e\n\u003cli\u003eDay JM, Bush H, Nitz AJ, Uhl TL. Arm dominance does not influence measures of scapular muscle strength and endurance in healthy individuals. Physiother Pract Res. 2015 Jul 7;36(2):87\u0026ndash;95. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Baseline push/pull dynamometer, isometric strength, reliability, scapular muscles, shoulder, test-retest","lastPublishedDoi":"10.21203/rs.3.rs-8598257/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8598257/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eInter -rater reliability of push‒pull dynamometers (PPDs) are essential to ensure consistent and accurate measurements in laboratory and clinical settings. The objective of this study is to evaluate the inter-rater reliability of the Baseline\u0026reg; PPD in testing shoulder and scapular muscle strength among healthy individuals. This study included 35 healthy individuals who underwent standardized independent shoulder and scapular muscle strength testing by two raters using Baseline\u0026reg; PPD. Inter-rater reliability for muscle strength measurements ranged from moderate to good (ICC\u0026thinsp;=\u0026thinsp;0.53\u0026ndash;0.90). The SEMs for the push and pull muscle strength tests ranged from 2.2 to 5.8 N and 3.1 to 4.9 N, respectively. The MDC (95% CI) ranged from 6.09 to 15.06 for the push strength tests and 8.58 to 13.57 for the pull strength tests. Bland‒Altman plots revealed no systematic bias for most PPD tests, except for the push muscle strength of the serratus anterior, upper trapezius, and external rotators. The Baseline\u0026reg; PPD demonstrated acceptable inter-rater reliability and agreement for assessing shoulder and scapular muscle strength among healthy individuals. Further studies are warranted to evaluate its reliability in athletes and individuals with shoulder disorders to expand its clinical and research applications.\u003c/p\u003e \u003cp\u003e \u003cb\u003eClinical Trial Registry of India number\u003c/b\u003e:(CTRI/2023/07/055409)\u003c/p\u003e","manuscriptTitle":"Inter-rater reliability of baseline push-pull dynamometer for shoulder and scapular muscle strength testing among healthy individuals","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-06 07:49:24","doi":"10.21203/rs.3.rs-8598257/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"18453604547955395838821230586745118796","date":"2026-03-30T01:39:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"173326315570943609384236562754932076615","date":"2026-03-28T09:23:13+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-28T09:20:31+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-23T08:41:57+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-30T13:07:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-29T08:42:06+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2026-01-29T08:12:06+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d3c18313-1c72-462a-a2d7-a13c5e9ceaf1","owner":[],"postedDate":"April 6th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":65423794,"name":"Health sciences/Anatomy"},{"id":65423795,"name":"Health sciences/Health care"},{"id":65423796,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2026-04-06T07:49:25+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-06 07:49:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8598257","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8598257","identity":"rs-8598257","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}