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PubMed1996

Which setting of the dynamometer provides maximal grip strength?

The purpose of this study was to determine which setting of the clinical dynamometer produced maximal grip strength and to correlate that setting with characteristics of the individual. Using a computerized isometric dynamometer, the maximal grip strength was determined in 288 normal asymptomatic hands in 4- to 78-year-old individuals at five dynamometer size settings. The majority of hands (256, or 89%) had a maximal grip strength at setting II. Mean body weight and mean height were lower in the group that had a maximal strength at or equal to setting I than in those individuals with maximal setting II and above. However, no clear significant correlation between body mass or hand size and maximal setting was evident. Those with a maximal grip at setting III or IV did not have larger hands or other features that differed from those with maximal settings at II. If measured at setting II only, maximal grip strength would have been underestimated in about 10% of individuals, but the error was small, ranging from 2% to 24%. Since no feature was identified that predicted maximal grip strength setting, it is recommended that grip strength of all patients should be routinely measured at setting II, irrespective of age, weight, or hand dimensions.

Adolescent↗
PubMed2006

Age trajectories of grip strength: cross-sectional and longitudinal data among 8,342 Danes aged 46 to 102.

PURPOSE: The purpose is to study the age trajectory of hand-grip strength after the age of 45 years. METHODS: In this study, we use data from three large nationwide population-based surveys of Danes aged 45 to 102 years with a total of 8342 participants with grip-strength measurements and up to 4 years of follow-up. Grip strength was measured by using a portable hand dynamometer. RESULTS: Grip strength declines throughout life for both males and females, but among the oldest women, the longitudinal curve reaches a horizontal plateau. The course of the decline is estimated by using full information in the longitudinal data and is found to be almost linear in the age span of 50 to 85 years. In this age span, mean annual grip-strength loss is estimated to be 0.59 (0.02) (SE) kg for men and 0.31 (0.01) kg for women. CONCLUSION: This study confirms the previously reported grip-strength decline with increasing age. Estimates were obtained by using full-information methods from large population-representative studies. Equations of expected grip strength, as well as tables with sex-, age-, and height-stratified reference data, provide an opportunity to include grip-strength measurement in clinical care in similar populations.

Aged↗
PubMed1998

Grip strength changes over 27 yr in Japanese-American men.

The aim of this study was to describe changes in grip strength over a follow-up period of approximately 27 yr and to study the associations of rate of strength decline with weight change and chronic conditions. The data are from the Honolulu Heart Program, a prospective population-based study established in 1965. Participants at exam 1 were 8,006 men (ages 45-68 yr) who were of Japanese ancestry and living in Hawaii. At follow-up, 3,741 men (age range, 71-96 yr) participated. Those who died before the follow-up showed significantly lower grip-strength values at baseline than did the survivors. The average annualized strength change among the survivors was -1.0%. Steeper decline (>1.5%/yr) was associated with older age at baseline, greater weight decrease, and chronic conditions such as stroke, diabetes, arthritis, coronary heart disease, and chronic obstructive pulmonary disease. The risk factors for having very low hand-grip strength at follow-up, here termed grip-strength disability (</=21 kg, the lowest 10th percentile), were largely same as those for steep strength decline. However, the age-adjusted correlation between baseline and follow-up strength was strong (r = 0.557, P < 0.001); i.e., those who showed greater grip strength at baseline were also likely to do so 27 yr later. Consequently, those in the lowest grip-strength tertile at baseline had about eight times greater risk of grip-strength disability than those in the highest tertile because of their lower reserve of strength. In old age, maintenance of optimal body mass may help prevent steep strength decrease and poor absolute strength.

Aged↗
PubMed2001

Dynamometer measurements of hand-grip strength predict multiple outcomes.

Hand-grip strength, which can be measured easily and objectively using a dynamometer, is predictive of multiple outcomes among a variety of subjects. Although the literature is not fully consistent, it tends to support grip strength as a predictor of postoperative complications, mortality, and functional decline. Hand-grip dynamometry may merit broader application as a screening procedure.

Chronic Disease↗
PubMed2001

Relationship among grip strength, functional outcomes, and work performance following hand trauma.

This study examined the relationship among the recovery grip strength, functional outcomes, and work performance following occupational therapy intervention for hand trauma. This study had a sample size of 15 participants whose recovery grip strength was measured using a Jamar dynamometer, whose satisfaction with outcomes was measured by the Michigan Hand Outcomes Questionnaire (MHQ), and whose compliance with the home therapy program was measured by a visual analog scale (VAS). A Pearson r correlation demonstrated a significant relationship between recovery grip strength and two MHQ subset scores: overall hand function (r = 0.59, p = 0.019) and activities of daily living (ADL) performance (r = 0.61, p = 0.016). The participants' self-rating of compliance did not predict or influence either recovery grip strength or MHQ scores. A moderate positive correlation approaching significance (r = 0.51, p = 0.052) was found between grip strength and overall MHQ scores. The researchers concluded that a recovery grip strength measure should be used along with functional measures to appropriately assess overall hand function following hand trauma.

Journal Article↗
PubMed1992

The relationship between elbow position and grip strength.

Forty-six graduate students participated in a study to investigate the effect of elbow position on grip-strength measurements. Sixteen males and 30 females, aged 21 to 46 years, participated in the study. Data collection procedures followed standardized grip-strength testing guidelines established by the American Society of Hand Therapists, with the exception of elbow position. Grip-strength measurements were taken with the elbow positioned at 0 degree, 45 degrees, 90 degrees, and 135 degrees of flexion. The results showed a significantly stronger grip-strength measurement at 0 degree of flexion and the weakest grip-strength measurement at 135 degrees of flexion. This study supports the use of a standardized method for hand-strength testing. The knowledge that grip-strength measurement is highest when the elbow is fully extended could affect treatment planning.

Adult↗
PubMed1989

Generalizability of grip strength measurements in patients with tennis elbow.

The purpose of this study was to determine the interrepetition and interoccasion generalizability of grip strength measurements in patients with the diagnosis of proximal extensor carpi radialis brevis tendinitis. Thirty-five consecutive patients (mean age = 44.5 +/- 8.6 years; mean duration of symptoms = 3.9 +/- 3.5 months) fulfilling the eligibility criteria participated in the study. Measurements of pain-free grip strength and maximum grip strength for the involved limb and maximum grip strength for the uninvolved limb were taken on two test dates within seven days of each other. We calculated the variation between measurements within a test session and the variation from one session to the next using generalizability coefficients based on the mean of the six measurements. The coefficients for interrepetition, interoccasion, and overall generalizability were .99, .97, and .96, respectively. The clinical implication of these findings is that the overall generalizability can best be enhanced by averaging grip strength measurements recorded from multiple test sessions rather than by increasing the number of repetitions during a single test session.

Adult↗
PubMed2006

Is grip strength associated with health-related quality of life? Findings from the Hertfordshire Cohort Study.

OBJECTIVE: to investigate the relationship between grip strength and health-related quality of life (HRQoL). DESIGN: cross-sectional survey within a cohort study design. SETTING: the county of Hertfordshire in the UK. PARTICIPANTS: a total of 2,987 community-dwelling men and women aged 59-73 years of age. MEASUREMENTS: grip strength was used as a marker of sarcopaenia and measured using a Jamar dynamometer. HRQoL was assessed using the eight domain scores of the Short Form-36 (SF-36) questionnaire, and subjects in the lowest sex-specific fifth of the distribution were classified as having 'poor' status for each domain. RESULTS: men and women with lower grip strength were significantly more likely to report a poor as opposed to excellent to fair overall opinion of their general health (GH) [odds ratio (OR) per kilogram decrease in grip strength = 1.13, 95% CI = 1.06-1.19, P < 0.001 in men, 1.13, 95% CI = 1.07-1.20, P < 0.001 in women]. Among men, after adjustment for age, size, physical activity and known co-morbidity, decreased grip strength was associated with increased prevalence of poor SF-36 scores for the physical functioning (PF) (OR per kilogram decrease in grip strength = 1.03, 95% CI = 1.01-1.06, P = 0.007) and GH domains (OR = 1.03, 95% CI = 1.01-1.05, P = 0.01). Similar associations were seen in women. CONCLUSIONS: our findings suggest that lower grip strength is associated with reduced HRQoL in older men and women. This does not appear to be explained by age, size, physical activity or co-morbidity and may reflect the link between sarcopaenia and generalised frailty. Individuals with sarcopaenia may benefit from interventions to improve muscle mass and strength before the onset of chronic disorders usually associated with impaired HRQoL.

Accidental Falls↗
PubMed1995

Spherical grip strength in children 3 to 6 years of age.

OBJECTIVE: The purpose of this study was to establish normative data on spherical grip strength of children 3 to 6 years of age with the Martin Vigorimeter. METHOD: Two hundred twenty-five preschoolers in the Kalamazoo, Michigan, area were tested with standardized positioning and instructions. The mean of three trials for each hand was used as the grip-strength score. A repeated measure design was used and the right and left hands were alternated during testing to allow a 20-sec rest period between trials. Hand width also was measured in inches from the head of the second metacarpal to the head of the fifth metacarpal. RESULTS: Hand width and grip strength were significantly correlated for both the right (p < .0001) and the left hands (p < .001). Grip strength increased linearly across all of the age groups (p < .001). The results of paired t tests did not show a significant difference in grip strength between the right and left hands or between boys and girls. A table of mean grip-strength scores and hand width measurements along with their standard deviations is presented for clinical use. CONCLUSION: The vigorimeter could be used to assess the grip strength of children with rheumatic disorders without putting excessive pressure on the joints or skin of the hand.

Anthropometry↗
PubMedDate not supplied

Grip strength testing reliability.

The purpose of this study was to investigate the test-retest reliability of isometric grip strength testing using the Jamar dynamometer. Thirty-three subjects, 16 men (mean age = 37.4 years) and 17 women (mean age = 35.5 years), were assessed on two separate occasions using four methods to determine grip strength score. The methods used were (1) the score of one trial, (2) the mean score of two trials, (3) the mean score of three trials, and (4) the highest score of three trials. All five handle positions of the Jamar dynamometer were used during testing. Although still within the limits of acceptability, position 1 was significantly less reliable when compared with the other handle positions. Because the four methods of determining grip strength score were not significantly different in reliability, it was not possible to recommend any method as being more accurate. To analyze curve shape further, grip strength curves for the strongest and weakest men and women were compared by transforming points on the curves into percentages of the maximum value. Transformed curves for both strong and weak subjects were almost identical, indicating that, for this sample, "flattening" of the grip strength curves was a function of weak grip. The present data do not support the use of raw score curve shape as an indicator of sincerity of effort during grip strength testing.

Adult↗
PubMed1991

Grip strength: effects of testing posture and elbow position.

This study was designed to determine the effect of testing posture and elbow position on grip strength. A hand dynamometer was used to measure the grip strength of 61 subjects (26 female and 35 male) in four positions: (1) sitting with elbow in 90 degree flexion, (2) sitting with elbow in full extension, (3) standing with elbow in 90 degree flexion, and (4) standing with elbow in full extension. The four experimental conditions were randomized, and standardized instructions were followed. A two-factor (gender and treatment) repeated measures ANOVA was used to determine any significant difference in grip strength between the sexes and the experimental (treatment) conditions. The result of the ANOVA revealed a significant F-ratio for gender and treatment main effects. Scheffé post hoc analysis revealed that males had higher (p less than .01) grip strength than females at all the testing postures and elbow joint angles, and that there was a significant (p less than .05) difference between the grip strength measured in subjects sitting with the elbow in 90 degree flexion and standing with the elbow in full extension. The findings suggest the need for clinicians to maintain standard testing conditions while measuring grip strength.

Adolescent↗
PubMed1995

Relation between grip strength and radial bone mineral density in young athletes.

In this study, we evaluated the relationship between bone mineral density (BMD) and muscle strength in young athletes who had not yet experienced age-related bone loss. Radial BMD and grip strength were measured in 10 male college wrestlers, 16 female college basketball players, and 12 female college tennis players. Radial BMD was measured in the distal and middle radius by dual energy x-ray absorptiometry (DEXA). Isometric grip strength was assessed with a hand-held dynamometer. The dominant forearm was examined in the amateur wrestlers and basketball players for grip strength and BMD. Both forearms were examined in the tennis players. A significant positive correlation was found between radial BMD and grip strength in the dominant forearm, and between radial BMD and body weight. Moreover, to eliminate a possible effect of body weight on radial BMD, we compared radial BMD with grip strength in both the dominant and nondominant arm of 12 college tennis players. Grip strength in the dominant forearm was significantly greater than in the nondominant forearm. The midradial BMD of the dominant forearm was also significantly higher than in the nondominant forearm. Based on these findings, we conclude that grip strength is one of the determinant factors of radial BMD in the dominant forearm of young college athletes.

Absorptiometry, Photon↗
PubMedDate not supplied

Hand grip strength--a simple prognostic indicator in surgical patients.

This study evaluates hand grip strength as an indicator of nutritional status and a predictor of postoperative complications. Hand grip strength and other parameters of nutritional status, namely, midarm muscle circumference, forearm muscle circumference, triceps skinfold, percentage ideal body weight, serum albumin, and percent usual weight were determined preoperatively in 205 patients. Complications occurred in 28 patients (14%). Patients with at least one abnormal nutritional parameter had a higher incidence of postoperative complications. Their length of total and postoperative hospitalization was greater by 6.2 and 4.6 days, respectively (p less than 0.01). Grip strength was the most sensitive single parameter, but forearm muscle circumference and percentage ideal body weight were the most specific indices. Hand grip strength is a simple measure of nutritional status and an accurate prognostic indicator that requires further clinical evaluation.

Adult↗
PubMed1989

The effect of grip strength on radial bone in postmenopausal women.

This communication explores the correlation in 255 postmenopausal women of grip strength to bone tissue density (BTD) and cross-sectional area (CSArea) of the radius. While grip strength correlated cross-sectionally with the baseline measures of both BTD and CSArea, grip strength affected differentially the changes that transpired in the two bone parameters over the 3 years of the study. Thus, the increases in the CSArea of the radius were significantly enhanced by higher grip strength, while BTD losses were not. Since the power of muscle contraction is a factor in the mechanical loading of a bone, it is argued that the differential effects of grip strength on the two bone parameters of the radius suggest that moderate loading can effect favorable changes in the geometry of the bone, without necessarily affecting changes in BTD.

Aged↗
PubMed1999

Midlife hand grip strength as a predictor of old age disability.

CONTEXT: Poor muscle strength, functional limitations, and disability often coexist, but whether muscle strength during midlife predicts old age functional ability is not known. OBJECTIVE: To determine whether hand grip strength measured during midlife predicts old age functional limitations and disability in initially healthy men. DESIGN AND SETTING: A 25-year prospective cohort study, the Honolulu Heart Program, which began in 1965 among Japanese-American men living on Oahu, Hawaii. PARTICIPANTS: A total of 608945- to 68-year-old men who were healthy at baseline and whose maximal hand grip strength was measured from 1965 through 1970. Altogether, 2259 men died over the follow-up period and 3218 survivors participated in the disability assessment in 1991 through 1993. MAIN OUTCOME MEASURES: Functional limitations including slow customary walking speed (< or =0.4 m/s) and inability to rise from a seated position without using the arms, and multiple self-reported upper extremity, mobility, and self-care disability outcomes. RESULTS: After adjustment for multiple potential confounders, risk of functional limitations and disability 25 years later increased as baseline hand grip strength, divided into tertiles, declined. The odds ratio (OR) of walking speed of 0.4 m/s or slower was 2.87 (95% confidence interval [CI], 1.76-4.67) in those in the lowest third and 1.79 (95% CI, 1.14-2.81) in the middle third of grip strength vs those in the highest third. The risk of self-care disability was more than 2 times greater in the lowest vs the highest grip strength tertile. Adding chronic conditions identified at follow-up to the models predicting disability reduced the ORs related to grip strength only minimally. CONCLUSIONS: Among healthy 45- to 68-year-old men, hand grip strength was highly predictive of functional limitations and disability 25 years later. Good muscle strength in midlife may protect people from old age disability by providing a greater safety margin above the threshold of disability.

Activities of Daily Living↗
PubMed2003

Is grip strength a useful single marker of frailty?

BACKGROUND: chronological age is widely used as a marker of frailty in clinical practice. However there can be wide variation in frailty between individuals of a similar age. Grip strength is a powerful predictor of disability, morbidity and mortality which has been used in a number of frailty scores but not as a single marker of frailty. OBJECTIVE: to investigate the potential of grip strength as a single marker of frailty in older people of similar chronological age. DESIGN: cross-sectional study with prospective collection of mortality data. SETTING: North Hertfordshire, UK. SUBJECTS: 717 men and women, aged 64-74, born and still living in North Hertfordshire, who took part in a previous study to investigate the relationship between size at birth and ageing processes in later life. METHODS: the number of significant associations between grip strength and the ageing markers was compared with numbers between chronological age and the ageing markers. RESULTS: in men, lower grip strength correlated significantly with ten ageing markers compared to chronological age which was significantly associated with seven. In women, there were six significant relationships for grip compared to three for age. The greater number of relationships between grip strength and ageing markers was not explained by the association between grip strength and age, and remained after adjustment for adult size. CONCLUSIONS: grip strength was associated with more markers of frailty than chronological age within the narrow age range studied. Grip strength may prove a more useful single marker of frailty for older people of similar age than chronological age alone. Its validity in a clinical setting needs to be tested.

Aged↗
PubMedDate not supplied

Grip strength asymmetry in depressed boys.

OBJECTIVE: The purpose of this experiment was to investigate the influence of depressed mood on functional motor asymmetry among school-aged boys. Thus, left- and right-hand grip strength as well as fatigue across successive trials was examined among 38 right-handed school-aged boys, half of whom had been classified as depressed (n = 19) and the other half as nondepressed (n = 19). BACKGROUND: There is support in the literature that depressed individuals experience relative right anterior activation, and previous reports of functional motor asymmetries among depressed adults are generally supportive of this notion. To date, however, little is known regarding the neuropsychology of depression as it may pertain to children; in particular, the possibility of functional motor asymmetry within this population has yet to be explored. METHOD: Participants were asked to squeeze a hand dynamometer four times successively with each hand. The order of hand presentation was counterbalanced, and the dependent measure was in kilograms. RESULTS: As hypothesized, depressed boys failed to demonstrate asymmetry for grip strength, although nondepressed boys exhibited right-hand grip strength. In addition, based on trend, right-hand grip strength for depressed boys fatigued more rapidly across successive trials than did right-hand grip strength for nondepressed boys. In contrast, depressed boys maintained left-hand grip strength longer across successive trials than did nondepressed boys. CONCLUSIONS: The data are interpreted as consistent with current neuropsychological theories of emotion, particularly depression, and suggest that the functional motor asymmetries (i.e., failure to demonstrate asymmetric grip strength) observed in depressed adults are also present among depressed children. Implications for increased right hemisphere activation, decreased left hemisphere activation, or a combination of both are discussed.

Brain↗
PubMedDate not supplied

Associations between pain, grip strength, and manual tests in the treatment evaluation of chronic tennis elbow.

OBJECTIVE: The objective was to assess the associations between changes in pain and grip strength and manual tests among patients with chronic tennis elbow. DESIGN: Measurements for 45 consecutive patients with unilateral tennis elbow were made before and after an exercise intervention. SETTING: The setting was a physiatric outpatient clinic. PATIENTS: The patients were 45 persons with chronic unilateral tennis elbow: 32 women and 13 men. The mean age was 44 (31-54) years; mean duration of symptoms was 35 (10-66) weeks. OUTCOME MEASURES: Manual tests, pressure pain thresholds at three cubital points, a pain questionnaire, a pain drawing, and grip strength measurements were assessed. RESULTS: Grip strength became normal during the treatment. Pressure pain thresholds reached 66% of that of the healthy arm. Lowered pain thresholds and changes in pain thresholds of the lateral epicondyle were strongly associated with the findings in the manual tests. Mills test and resisted wrist extension tests were associated with perceived pain, and resisted wrist extension tests also were associated with decreased grip strength. Pain on palpation was associated with lowered pain thresholds at the lateral epicondylus and with perceived pain under physical load. After the treatment, for 13 patients all 4 manual tests were still positive; for 17 patients, 3 were still positive; and for 5 patients, all were negative. Positive clinical tests were associated with lowered pain thresholds, decreased grip strength, and high perceived pain scores. CONCLUSIONS: Pain thresholds at the lateral epicondyles are strongly associated with pain on palpation and with a positive Mills test. Resisted wrist extension test results reflect decreased grip strength. Impaired function of the hand is associated with the number of positive clinical tests. Pain threshold evaluation is a simple, easy, inexpensive method that provides useful additional quantitative data on pain and disability among patients with chronic tennis elbow.

Adult↗