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The grip strength of 110 patients with end stage renal disease was measured. Their grip strength tended to be low compared with published norms. Significant correlations were found between the patients' grip strength and their gender, height, weight, and diabetic status. A regression equation including gender, height, and diabetic status as independent variables explained more than 40% of the variance in patients' grip strength.
Grip strength is considered to be a good indicator of upper limb strength. The Jamar dynamometer and the Martin vigorimeter are two instruments frequently used to assess grip strength in clinical and research settings. The purpose of this study was to compare these instruments for assessing grip strength in 360 people aged 60 to 94 years, randomly selected from the electoral list. Anthropometric data were also collected. Data analyses were done using the maximum value on 3 trials with each instrument. Although the Martin vigorimeter is a pressure measure implying a dynamic movement as opposed to the static strength measure of the Jamar dynamometer, results indicate a very high correlation between the two measures. Grip strength measured by the Jamar dynamometer is even more dependent on hand anthropometry than measurements with the Martin vigorimeter.
OBJECTIVES: Grip strength has been reported to be associated with bone mass locally at the forearm and also at distant skeletal sites, including the spine and hip. Less is known about the association between low grip strength and risk of vertebral fracture. The aim of this study was to examine the association between low grip strength, bone mineral density at the hip and spine, and vertebral fracture in middle-aged and elderly European men and women. METHODS: Men and women aged 50 yr and over were recruited for participation in a screening survey of vertebral osteoporosis across Europe. Subjects who agreed to take part had an interviewer-administered questionnaire and lateral spinal radiographs performed. Subjects were assessed also for grip strength using a handgrip dynamometer (range 0-300 mmHg). A subsample of those recruited had bone mineral density measurements performed at the spine and femoral neck. Subjects had repeat lateral spine radiographs performed a mean of 3.8 yr following the baseline survey. Linear regression analysis was used to determine the association between low grip strength and bone mineral density at the hip and spine. Logistic regression was used to determine the association between grip strength and both prevalent and incident vertebral fracture. RESULTS: One thousand two hundred and sixty-five men and 1380 women with data concerning grip strength and bone mineral density were included in the analysis. In women, after age adjustment, compared with those with 'normal' grip, those with 'impaired' (231-299 mmHg) and low grip (<231 mmHg) had significantly lower bone mass at the spine and femoral neck. In men, those with low grip strength had a lower BMD at the spine and hip than those in the normal group. However, because of the small numbers with submaximal grip strength, the confidence intervals around all estimates included zero. Adjustment for body size and levels of physical activity had little effect on the results. In addition, among women, after adjustment for age, body mass index and physical activity levels, compared with those with normal grip, those with low grip strength had an increased risk of developing incident vertebral fracture (odds ratio = 2.67; 95% confidence interval 1.13, 6.30). Further adjustment for spine bone density had little influence on the association (odds ratio = 2.60). CONCLUSIONS: In women, low grip strength is associated with low bone mineral density at both the spine and hip and an increased risk of incident vertebral fracture. These associations cannot be explained by differences in body size or lifestyle.
OBJECTIVE: An ability to predict accurately 'normal' grip strength in rheumatoid arthritis (RA) patients would facilitate a more accurate assessment of the degree of their functional loss. This, in turn, would allow the setting of more meaningful treatment goals aimed at restoring hand function towards normal. This study carefully measures three modalities of hand grip strength and their correlation with multiple simple anthropometric parameters in normal subjects. We aim to determine which of these parameters are best correlated to grip strength, and whether this correlation is strong enough to allow the accurate prediction of what normal grip strength should be in RA patients. METHODS: In 81 normal subjects (67 female), power, pinch and tripod grip strength measurements were made using an MIE digital pinch grip analyser. These strength data were correlated with specific local forearm anthropometric measurements: forearm circumference, forearm length, forearm volume, hand circumference, hand length, hand volume, hand and forearm volume, and various general anthropometric parameters (weight, height and age). These normal subjects had been chosen so as to be age and sex matched with 83 RA patients (67 female) in whom the same strength and anthropometric parameters were assessed and correlated. In patients, the grip strength results were additionally correlated with two markers of disease activity: a modified Ritchie Articular Index local to the hand and forearm (mRAI) and a visual analogue scale (VAS) assessing subjective pain severity. RESULTS: In normal subjects, clear correlations were demonstrated between hand grip strengths and all specific anthropometric variables, the strongest correlation being with forearm and hand volume (r = 0.729 and 0.638 for dominant and non-dominant hands, respectively; P < 0.01 for both). The patients were considerably weaker than normal subjects. Markers of disease activity showed a negative correlation with grip strength. In normal subjects, the dominant hand was significantly stronger than the non-dominant hand, and on average by 8%, while the opposite was true in patients, who were 20% weaker on the dominant side. CONCLUSION: Simple anthropometric measurements, and forearm and hand volume in particular, would be useful at baseline for predicting 'normal' hand grip strength in RA patients, both in the clinical setting and in research trials aimed at improving grip strength and hand function.
UNLABELLED: The aim of this study was to provide norms for grip strength in children. A total of 530 Swedish 4-16-y-olds was tested with the instrument Grippit. The instrument estimates peak grip strength over a 10s period, and sustained grip strength averaged across the 10s. The increase in grip strength with age was approximately parallel for boys and girls until 10 y of age, after which boys were significantly stronger than girls. Strong correlations existed between grip strength and the anthropometric measures weight, height and, in particular, hand length. Right-handed children were significantly stronger in their dominant hand, while left-handers did not show any strength difference between the hands. It is therefore suggested that when evaluating grip strength in left-handed children both hands should be assumed to be about equally strong, while right-handed children are expected to be up to 10% stronger with their right hand. Sustained grip strength was consistently about 80-85% of peak grip strength, with somewhat lower values in younger children. The present normative data for peak grip strength were slightly lower than 1980s' data from the USA and Australia, probably because of divergences in age grouping and in instruments used. CONCLUSION: Norms for grip strength including estimates of variation were provided for children aged 4-16 y. These data will enable therapists and physicians to compare a patient's score with the scores of normally developed children according to age, gender, handedness and body measures.
The purposes of this study were to develop normative maximum grip strength (GRIP) data for men and women aged 20 to 64 years, separated into nine five-year age groups, and to develop prediction equations for GRIP using gender, age, height, weight, and hand dominance. A total of 1,182 volunteers (553 men and 629 women) participated in the study. Maximum hand grips were obtained using the Jamar dynamometer with standardized positioning and instructions. The hand to be tested first was chosen randomly. Each hand was then tested alternately. Three trials were performed on each hand. The highest GRIP for each hand was used for analysis. Two-way analyses of variance showed significant differences between the right and left hands and across the age groups for both genders. Follow-up analyses showed that significant decreases occurred between the age groups of 50-54 and 55-59 years in men and between the age groups of 50-54 and 60-64 years in women. The data also indicated that right and left GRIPs were highly correlated with each other (r = 0.93). Gender, height, and weight moderately correlated with both GRIPS (r = 0.52-0.73. Age correlated weakly with both GRIPs (r = -0.17). If either the right or the left GRIP was known, the other GRIP could be predicted easily from the known GRIP, with 87% of variance accounted for. Without the knowledge of the other GRIP, either GRIP could be predicted through gender, height, weight, age, and hand dominance, with 61% to 62% of the explained variance. The norms and prediction equations of GRIP developed in this study for men and women aged 20 to 64 years will help clinicians with decision making regarding grip strength.
Clinically, the measurement of grip strength is a static measure. It is performed in a standardized posture with the arm at the side, elbow flexed to 90 degrees, and the wrist-forearm positioned in neutral. Many functional activities require dynamic grip strength when an individual moves the wrist-forearm while simultaneously gripping an object. This preliminary study investigated dynamic forearm rotation with isometric grip strength over real time. Thirty wrists from 15 normal subjects were measured with a tilt sensor attached to a strain gauge dynamometer. Each subject underwent randomized trials of maximally gripping the dynamometer while rotating the forearm over a 10-second period. A multiple-regression model was fit for the parameters of extremity, forearm rotation order, fatigue, and loss of strength with supination and pronation. For each parameter, the mean and standard error of its estimate were computed and compared with zero. The significant effects (p = 0.05) of interest were for fatigue and the loss of grip strength from 70 degrees of supination to the end range of supination. Comparisons to existing static grip strength literature were made. We concluded that there is a decrease in grip strength over time as a result of fatigue, there is a decrease in grip strength at supination angles greater than 70 degrees. There is no decrease in grip strength resulting from supination angles less than 70 degrees, nor is there a decrease in grip strength with pronation when measured dynamically. It is suggested that there may be a difference in static and dynamic GS measurements related to forearm rotation.
Age-associated loss of muscle strength is attributed to decreasing muscle mass. Both strength and mass are dependent on peripheral innervation. However, the association between nerve function and age-associated strength loss has not been studied directly. The median nerve contribution to grip strength was estimated using nerve conduction velocity (NCV). Grip strength and NCV were measured in 197 male participants of the Baltimore Longitudinal Study of Aging (age 59.0 +/- 13.9 years). Multiple regression and path analyses were used separately to examine the association between median NCV and grip strength. Grip strength showed a negative quadratic relationship with increasing age (r2 = 0.32, p < 0.001) with a major change in slope occurring after 64.7 years of age. Median NCV (r2 = 0.14, p < 0.001) declined linearly with age. Median NCV significantly contributed to grip strength (p < 0.001) while controlling for forearm muscle mass (forearm circumference), self-reported 24-hour caloric expenditures, and age. The median nerve has an independent contribution to age-associated levels of muscle strength. The level of the effect was smaller than what could be attributed to forearm muscle mass or age.
This preliminary study indicates the proportion of patients with lateral epicondylalgia that demonstrate a favourable initial response to a manual therapy technique - the mobilization with movement (MWM) for tennis elbow. Twenty-five subjects with lateral epicondylalgia participated. In a one-group pretest - post-test design, we measured (1) pain with active motion, (2) pain-free grip strength and, (3) maximum grip strength before and after a single intervention of MWM. Results of the study indicate that MWM was effective in allowing 92% of subjects to perform previously painful movements pain-free, and improving grip strength immediately afterwards. Significant differences were found between the grip strength of the affected and unaffected limbs prior to the intervention. Both pain-free grip strength and maximum grip strength of the affected limb increased significantly following the intervention. Pain-free grip strength increased by a greater magnitude than maximum grip strength. It can be concluded that MWM is a promising intervention modality for the treatment of patients with Lateral Epicondylalgia. Pain-free grip strength is a more responsive measure of outcome than maximum grip strength for patients with Lateral Epicondylalgia. Further research is warranted to investigate the long-term effectiveness of MWM in the treatment of impairment and disability resulting from Lateral Epicondylalgia.
OBJECTIVE: Several studies have indicated that changing body positions results in altered grip strengths. Although one might expect that grip strength would be influenced by the position of the forearm during gripping due to the biomechanical properties of the forearm and hand muscles, no investigations of this variable have been undertaken. METHOD: This study examined the effect on grip strength of moving the forearm among supinated, neutral, and pronated positions while maintaining the standard position recommended by the American Society of Hand Therapists. The mean of three grip trials in each position was recorded for each of 106 subjects. RESULTS: Grips in forearm supination were the strongest, followed by grips in the neutral position. Grips in pronation were the weakest. CONCLUSIONS: The changes in grip strength observed with variations in forearm position further support the necessity of a standard position for testing grip strength. The knowledge of how changes in body position affect the strength of the grip can be used to design environments and tools to maximize biomechanical abilities.
The grip strength in both hands of thirty-two heavy vehicle drivers and twenty-two nondrivers ranging from 30 to 60 years of age was investigated. Blood pressure, heart rate and other physical parameters were also investigated. The subjects were drawn at random from the employees of the North Bengal State Transport Corporation and Civil Aviation. Heavy vehicle drivers perform their duties 8 hr per day with an average speed of 60-70 km hour for 4-5 hr of continuous driving at a time. The only significant difference in the physical characteristics of heavy vehicle drivers and nondrivers was their body weight (p less than 0.05). The right and left wrist power of heavy vehicle drivers was respectively 6% and 3% higher than that of nondrivers. The mean blood pressure, heart rate and wrist width were found to be almost same in heavy vehicle drivers and nondrivers. From our studies we concluded that vibrating steering probably has no influence on the grip strength and that performing 8 hr of driving daily does not affect the blood pressure and heart rate in heavy vehicle drivers. However, further studies are needed to determine the influence of vibrating steering on grip strength.
Change in grip strength over 30 trials was documented in two samples of junior college tennis players to assess possible fatigue. Eight men and eight women performed 30 maximum-grip strength tests with 25-sec. rests between trials. Significant positive correlations (.38 and .53 for men and women) were observed between grip strength and trials. In practical terms, grip strength did not change over 30 trials in these tennis players. The data suggested that the repetitive gripping patterns used by these players in tennis play resulted in consistent maximum-grip strengths across 30 trials.
This study investigated the effect of shoulder position on grip strength in 80 men and 80 women. A Jamar dynamometer was used to measure the grip strength in the four testing positions. The four hand strength tests consisted of three positions in which the elbow was maintained in full extension combined with varying degrees of shoulder flexion (ie, 0 degrees, 90 degrees, and 180 degrees) and of one position in which the elbow was flexed at 90 degrees with the shoulder in 0 degrees of flexion. Only the dominant hand was tested. The highest mean grip strength measurement was recorded when the shoulder was positioned at 180 degrees of flexion with elbow in full extension; whereas the position of 90 degrees elbow flexion with shoulder in 0 degrees of flexion had the lowest grip strength score. In addition, the grip strength measured with the elbow in extension, regardless of shoulder position (ie, 0 degrees, 90 degrees, and 180 degrees of flexion), was significantly higher than when the elbow was flexed at 90 degrees with the shoulder positioned at 0 degrees of flexion. Finally, grip strength differed significantly for both sexes and for each age group. The grip values of the standardized 90 degrees elbow flexed position were further analyzed to determine the average performances in the study population. For men, grip strength peaked within the 20 to 39 years age group and gradually declined thereafter. For women, the highest mean grip strength measurement was recorded in the 40- to 49-year-old age group and then deteriorated with age.(ABSTRACT TRUNCATED AT 250 WORDS)
Are walk time and grip strength measures of disease activity or functional ability? Ninety-two patients with rheumatoid arthritis were examined initially and 12 months later for clinical measures including joint deformity, and answered a functional status questionnaire. Walk time and grip strength were strongly related to joint deformity and functional questionnaire measures, and appeared insensitive in showing changes in disease activity over time. They could serve as objective functional measures in studies primarily directed towards changing functional ability, but appeared to be poor major outcome measures for trials aimed at altering disease activity.
PURPOSE: To measure the hand grip strength of Malaysians aged 18 to 65 years. METHODS: Between January and April 2003, 412 subjects (200 women and 212 men) were recruited from staff, students, and visitors of the University of Malaya Medical Centre. Socioeconomic, general health, and lifestyle data were collected from each subject using a standard questionnaire. Weight and height were measured prior to testing. Standardised positioning and instructions based on several hand grip protocols were used. Data were collected using the LIDO kinetic work set. RESULTS: 93% of the subjects were right-hand dominant and 7% were left-hand dominant. Hand grip strength was significantly correlated with hand dominance, gender, occupation, height, and weight, but not body mass index. No significant differences in grip strength were noted with regard to race or level of income. Men were stronger than women in all age-groups, with a ratio of 1.75:1. In both right- and left-hand dominant groups, the dominant hand was consistently stronger than the non-dominant side, with a ratio of 1.12:1 in the right-hand dominant group and 1.05:1 in the left-hand dominant group. The strongest hand grip strength in the right-hand dominant group occurred in the age-group of 25 to 34 years; in the left-hand dominant group it was in the age-group of 18 to 24 years. In western populations, the mean grip strength can be as much as 1.5 times greater than in the Malaysian population. CONCLUSION: Data derived from western populations cannot be applied to a comparable Malaysian population. Gender, hand dominance, age, occupation, weight, and height must be considered when establishing normal values for grip strength.
BACKGROUND: Several studies in older people have shown that grip strength predicts all-cause mortality. The mechanisms are unclear. Muscle strength declines with age, accompanied by a loss of muscle mass and an increase in fat, but the role that body composition plays in the association between grip strength and mortality has been little explored. We investigated the relation between grip strength, body composition, and cause-specific and total mortality in 800 men and women aged 65 and over. METHODS: During 197374 the UK Department of Health and Social Security surveyed random samples of men and women aged 65 and over living in eight areas of Britain to assess the nutritional state of the elderly population. The survey included a clinical examination by a geriatrician who assessed grip strength and anthropometry. We used Cox proportional hazards models to examine mortality over 24 years of follow-up. RESULTS: Poorer grip strength was associated with increased mortality from all-causes, from cardiovascular disease, and from cancer in men, though not in women. After adjustment for potential confounding factors, including arm muscle area and BMI, the relative risk of death in men was 0.81 (95% CI 0.700.95) from all-causes, 0.73 (95% CI 0.600.89) from cardiovascular disease, and 0.81 (95% CI 0.660.98) from cancer per SD increase in grip strength. These associations remained statistically significant after further adjustment for fat-free mass or % body fat. CONCLUSION: Grip strength is a long-term predictor of mortality from all-causes, cardiovascular disease, and cancer in men. Muscle size and other indicators of body composition did not explain these associations.
Isolated finger flexion force and hand grip strength were measured in a group of patients with flexor tendon lacerations treated by primary tendon repair. The results show that reduced isolated finger flexion force is much more common than reduced hand grip strength (66% and 26% respectively). Reduced finger flexion force is strongly correlated to elongation in tendon repair, to the range of motion in the distal interphalangeal joint, and to reduced hand grip strength in patients with lesions of both flexor tendons in one finger. Range of motion in the distal interphalangeal joint and hand grip strength in the individual patient are of little value for prediction of isolated finger flexion force, however. Hand grip strength is sufficient for evaluation of strength in many cases, but knowledge of finger flexion force is a valuable adjunct in analyzing patients with subjective and/or objective weakness in their hands after flexor tendon surgery.
OBJECTIVE: To explore the relationship of impairment types to grip strength in the live-at-home frail elderly. DESIGN: All data in this cross-sectional study were collected in face-to-face interviews in subjects' homes by a nurse or occupational therapist. A total of 832 elders with activity limitations, as determined by the FIM instrument, participated in the study. Subjects were divided into three age groups (60-69, 70-79, and 80+ yrs) and four impairment groups: (1) minimally impaired, (2) visually impaired, (3) motor impaired, and (4) cognitively impaired. The outcome measures included the average (in kilograms) of three grip-strength trials per hand measured with the Jamar dynamometer at the second handle setting. RESULTS: There were significant differences in grip strength scores among all age groups, indicating that grip strength decreased with age. Among impairment groups, the minimally impaired and visually impaired groups had significantly greater grip strength scores than the motor-impaired and the cognitively impaired groups. There were no significant differences between the minimally impaired and visually impaired groups or between the motor-impaired and the cognitively impaired groups. CONCLUSIONS: Age and sex are not the only determining factors of grip strength in the frail elderly. The type of impairment affects grip strength as well. Thus, age-based norms may not be the only basis for interpreting evaluation data and establishing treatment goals with this population.