manual muscle testing ( mmt ) is simple and quick , and can be performed without specific 
 tools . however , mmt only has 5 grades based on a gravity standard . therefore , it is 
 difficult to assess muscle strength at a grade higher than fair , which is any grade of 
 muscle strength in excess of gravity . since the evaluations are determined subjectively by 
 therapists , there is a high likelihood of error1 , 
 2 . it is easy to use , shows high 
 reliability , and measures force as a unit of pressure3 , 4 . two methods are used to measure muscle strength using a hand - held dynamometer : the break 
 test and make test5 . the examiner and the subject applies a maximal force against 
 the examiner and the position is maintained by the examiner during the make test . during the 
 break test , the subject holds a position and the examiner pushes until the subject s maximal 
 force is overcome and the joint gives way5 . the 2 methods apply force in different ways ; the dynamometer receives 
 different amounts of force , and should generate different results6 . however , few studies about reliability have specified 
 whether they used a make test or break test3 , 4 . in addition , previous make tests were only 
 conducted with caucasians or black people and those conducted with asian people should show 
 different results2 , 5,6,7,8 . therefore , this study aimed to analyze intra - rater and 
 inter - rater reliabilities of the make test , an mmt measurement method using a hand - held 
 dynamometer . a total of 42 students ( 6 males and 36 females ) at u university in gyeongsangnam - do , south 
 korea , participated in this study . the mean ages , heights , and weights of the participants 
 were 21.4  0.5  years , 162.6  6.8  cm , and 55.6  11.6  kg , respectively . the selection 
 criteria were as follows : no disease that might affect the test ; and no visual impairment , 
 hearing damage , or nervous system or vestibular organ disorder . information about the study was 
 provided to the subjects before participation , in accordance with the ethical principles of 
 the declaration of helsinki , and all agreed to participate in the project by providing 
 written informed consent . a hand - held dynamometer ( commander muscle tester , jtech , usa ) was used for mmt of elbow 
 flexor strength . the subjects were in a supine position with elbow flexion at 90 during the 
 test to eliminate the effect of gravity and to enable movement parallel to the ground . a dynamometer was placed just proximal to the wrist joint on the 
 radial surface of the forearm1 . two examiners sequentially measured elbow flexor muscle strength of a subject to determine 
 inter - rater reliability . the elbow flexor muscle strength was measured by a single examiner 
 once a day for 2 days to determine the intra - rater reliability . the subjects had sufficient 
 rest before the test and were informed about the measurement procedure before the test . ibm spss statistics for windows ( version 22.0 ) was used to analyze the data . the 
 intra - class correlation coefficient ( icc ) was used to examine the intra - rater and 
 inter - rater reliabilities . the intra - rater reliability results of the make test for elbow flexor muscle strength of in 
 the first test were 30.88  10.78 lbs , and 31.48  10.63 lbs in the second test ( icc=0.992 ) . the inter - rater reliability result for the first examiner was 31.48  10.63 lbs , and 30.76  
 10.96 lbs for the second examiner ( icc=0.949 ) . both reliabilities were excellent , with 
 values over 0.9 ( p<0.05 ) ( table 1table 1.intra-rater and inter - rater reliabilities of mmt using the make testmeasurement ( lbs)icc ( 95% ci)intra - rater1st2nd0.992 ( 0.980.99)*30.88  10.7831.48 10.63inter - raterexaminer 1examiner 20.949 ( 0.900.97)*31.48  10.6330.76  10.96mean  sd , * p<0.05 , icc : intraclass correlation coefficient , ci : confidence 
 interval , mmt : manual muscle test ) . mean  sd , * p<0.05 , icc : intraclass correlation coefficient , ci : confidence 
 interval , mmt : manual muscle test two methods for evaluating muscle strength using a hand - held dynamometer are the make test 
 and break test . the subject flexes the muscles , but is stabilized by an examiner during the 
 make test . the examiner pushes the dynamometer against the subject s limb until the 
 subject s joint gives way during the break test5 . a previous study reported that the break test showed larger numbers 
 than the make test6 . this study analyzed intra - rater and inter - rater reliabilities for the make test using a 
 hand - held dynamometer for the elbow flexors in young adults . this study showed excellent 
 reliabilities , with icc=0.992 ( intra - rater reliability ) and icc=0.949 ( inter - rater 
 reliability ) . previous studies also showed that the make test usually had greater 
 reliability than the break test , and that its reliability level was very high5 . a study by phillips et al . analyzed the 
 reliabilities of the make test in 200 subjects aged 20 to 69 and showed that the icc of the 
 make test was over 0.85 : the intra - rater reliability showed icc=0.988 , and the inter - rater 
 reliability showed icc=0.934 in the same joint as in this study8 . the muscle strength level was 30 lbs ( 13  kg ) in this study , and a study by bohannon 
 conducted with adults aged 2079 showed 11  kg of elbow flexion1 . another study by 
 bohannon conducted among young women showed that the make test value was 19  kg in the 
 1329  kg range . this amount is slightly greater than the amount in this study , but the 
 present result was still in the 1329  kg range7 . in addition , a study by stratford and balsor conducted among adults in their twenties 
 showed 173 n of elbow flexion , which was similar to the result in this study . the results of 
 the make test using a hand - held dynamometer were computer - analyzed ; there was no difference 
 in reliabilities compared with the kin - com , which is large and fixes the body in a 
 machine5 . these results indicated that the make test using a hand - held dynamometer had high 
 intra - rater and inter - rater reliabilities . therefore , this is a useful method for 
 measurement of muscle strength at a grade higher than fair . a limitation of this study was 
 that the break test was not conducted ; reliability analysis for the break test should be 
 investigated in future .
[ purpose ] the purpose of this study was to analyze intra - rater and inter - rater 
 reliabilities of the make test , a manual muscle testing measurement method , using a 
 hand - held dynamometer in korean young adults . 
 [ subjects and methods ] a total of 42 
 university students participated in this study . 
 the make test , a manual muscle testing 
 method , was conducted . 
 a hand - held dynamometer was used to measure elbow joint flexion 
 during the make test . 
 [ results ] both intra - rater ( the intraclass correlation 
 coefficient=0.992 ) and inter - rater reliabilities ( the intraclass correlation 
 coefficient=0.949 ) were excellent , with values over 0.9 . 
 [ conclusion ] the make test is a 
 useful manual muscle testing method with high intra - rater and inter - rater reliability .