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Clinical significance and reliability of two common grip strength measures

University of British Columbia

This study surveyed therapist's use of grip strength measures in clinical practice and determined the test-retest reliability of two common grip strength tests to elucidate what drives clinical decision making with respect to grip strength measurements and to determine an effective measurement strategy to detect clinically important change. Survey responses were obtained from 120 facilities across Canada. Results indicated that the Jamar dynamometer was the instrument most commonly used to measure grip strength (87%), and the Standard Grip Strength Test (SGST) (3 trials at position #2) and the 5-Position Grip Strength Test (5PGST) (1 trial at each of 5 positions) were the most common tests used. A normative database for comparison of test results is not consistently used in clinical practice. From our survey results, there was considerable variation in what clinicians deemed a clinically important change in grip strength measurements. Fourteen healthy males (mean age 25.4 years) were involved in a test-retest reliability study of the SGST and the 5PGST using the Jamar dynamometer. Generalizability coefficients (R) were used to determine test-retest reliability. Generalizability coefficients for the SGST were greater for the mean of 3 trials (R =.67 for the right hand and R=.70 for the left). Handle position of the 5PGST was reliable for the left hand only at position 1(R=.87) and position 2 (R=.83). The greatest source of error was seen between subjects across test occasions. Grip strength fluctuations were between 2.8 to 6.6 kgf (6.4 to 12.8%) in the right hand and 2.8 to 5.9 kgf (5.1-10.8%) in the left over 2 test occasions. It appears that clinicians may be stating a true change in grip strength scores when changes in measurement may be due to error alone. From our study, it is recommended that a standardized test protocol be used consistently for grip strength measurements. The clinician needs to determine normal variability for their patients using the standard error of measurement (SEM) and confidence intervals. True grip strength may best be evaluated by taking multiple measurements over a number of test occasions. The use of a normative database should only be compared to when the same test protocol, sample population and instrument used by the clinician has been used to develop the normative data.

Thesis/Dissertation

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2009-05-20

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http://hdl.handle.net/2429/8009

Rehabilitation Sciences

University of British Columbia

UBCV

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