Measurement Properties of the Hand Grip Strength Assessment: A Systematic Review With Meta-analysis

The Association Between Grip Strength, Upper Body Power, and Limb Dominance in a Military Population

INTRODUCTION

Military service members rely on upper body strength and power to accomplish tasks such as carrying heavy weapons and gear, rappelling, combat grappling, and marksmanship. Early identification of the factors that lead to reduced upper body strength and power would enable leadership to predict and mitigate aspects that decrease military operational readiness and increase injury risk. The purpose of this study was to investigate the relationship between grip strength and upper body power in U.S. Infantry Marines. We hypothesized that dominant arm grip strength would show a strong positive correlation with upper body power and that the dominant arm would be more powerful than the non-dominant arm.

MATERIALS AND METHODS

A total of 120 U.S. Marines completed 3 maximum effort isometric grip strength trials with their dominant hand and 3 maximum effort ballistic pushups on a ForceDecks force plate system. Force plate data were used to estimate pushup height and peak power. Maximum grip strength, pushup height, and peak power across the 3 trials were used for analysis. Pearson's correlation was used to test for associations between peak power, pushup height, and grip strength. Paired t-tests were used to test for differences in peak power between the dominant and non-dominant arms.

RESULTS

A very weak correlation was found between grip strength and upper body power, but there was no relationship between grip strength and pushup height. Additionally, there were no significant differences in upper body power between the dominant and non-dominant arms.

CONCLUSIONS

The results of this study suggest that grip strength is not predictive of upper body power and cannot be used as a stand-alone measure of physical readiness in a military unit. These findings do not, however, degrade the potential of both measures to predict and inform health status and physical readiness. Future prospective research should be conducted to determine if either of these measures can be used as indicators of performance and/or injury susceptibility and if limb dominance plays a role in injury incidence within the upper extremity.

Impact of the Combination of Anamorelin and Rehabilitation on Functional and Nutritional Outcomes in Patients with Cancer Cachexia

Cancer cachexia, characterized by the progressive loss of skeletal muscle mass, leads to functional impairment and poor prognosis. Anamorelin is approved for treating cancer cachexia in Japan; however, the factors influencing its discontinuation and the impact of combining anamorelin with rehabilitation remain unclear. Therefore, we retrospectively analyzed 82 patients with cancer cachexia to identify factors associated with anamorelin discontinuation and assess changes in nutritional status and motor function using non-dominant handgrip strength after 12 wk. Patients received outpatient rehabilitation, combining resistance and aerobic training every two weeks, alongside anamorelin therapy. Our findings indicate that patients with an ECOG performance status of 1 or 2 were less likely to continue anamorelin therapy for 12 wk compared to those with a performance status of 0 (odds ratio 2.71; 95% CI 1.05 - 7.00; p = 0.040). Significant improvements were observed in body weight (48.8 to 53.7 kg, p < 0.001), skeletal muscle mass (6.4 to 6.9 kg/m2, p < 0.001), FAACT score (11.5 to 18.0, p < 0.001), and non-dominant handgrip strength (20.5 to 21.7 kg, p = 0.018) after 12 wk. Early initiation of anamorelin with regular rehabilitation is recommended to enhance nutritional status and motor function in patients with cancer cachexia.

A cross-sectional study evaluating grip strength and associated factors in Turkish nurses and nursing students

BACKGROUND

Grip strength is an important indicator of muscle strength. Nursing job demands physical power, which is related to their muscle strength. However, studies on nurses' grip strength remains lacking.

OBJECTIVE

This study aims to examine the differences in grip strength between staff nurses and nursing students and to identify factors associated with grip strength in nursing sample.

METHOD

This study was designed as descriptive and analytical. Data collected from nursing students and staff nurses in Turkiye, from May 1 to September 30, 2022. A total of 200 staff nurses and 200 nursing students participated. Data tool included a participant information form, the Perceived Stress Scale-4 (PSS-4), and the Nordic Musculoskeletal Questionnaire (NMQ). Moreover, researchers assessed the anthropometric measurements using the same scale and grip strength using a digital hand dynamometer.

RESULTS

There was no significant difference in grip strength of staff and student nurses. 48.8% of participants met or exceeded Turkish normative values. 79.5% of staff nurses and 66.0% of nursing students reported musculoskeletal issues in the last 12 months. Height, waist-to-hip ratio, and neck circumference was found to be significant predictors of grip strength, explaining 57% of the variance.

CONCLUSION

Grip strength was similar between staff nurses and nursing students, despite differences in age, BMI, and musculoskeletal issues. Height, waist-to-hip ratio, and neck circumference are key predictors of grip strength in this Turkish nursing sample. Understanding the factors influencing grip strength can help in designing targeted interventions to maintain and improve muscle strength in nursing professionals.

Exploring heterogeneity: a dive into preclinical models of cancer cachexia

Cancer cachexia (CC) is a multifactorial and complex syndrome experienced by up to 80% of patients with cancer and implicated in ∼40% of cancer-related deaths. Given its significant impact on patients' quality of life and prognosis, there has been a growing emphasis on elucidating the underlying mechanisms of CC using preclinical models. However, the mechanisms of cachexia appear to differ across several variables including tumor type and model and biologic variables such as sex. These differences may be exacerbated by variance in experimental approaches and data reporting. This review examines literature spanning from 2011 to March 2024, focusing on common preclinical models of CC, including Lewis Lung Carcinoma, pancreatic KPC, and colorectal colon-26 and Apcmin/+ models. Our analysis reveals considerable heterogeneity in phenotypic outcomes, and investigated mechanisms within each model, with particular attention to sex differences that may be exacerbated through methodological differences. Although searching for unified mechanisms is critical, we posit that effective treatment approaches are likely to leverage the heterogeneity presented by the tumor and pertinent biological variables to direct specific interventions. In exploring this heterogeneity, it becomes critical to consider methodological and data reporting approaches to best inform further research.

Comparison of wrist range of motion and muscle strength in assembly workers with and without lateral epicondylitis

BACKGROUND

Lateral epicondylitis (LE), also called tennis elbow, is a common musculoskeletal disorder that causes pain in the elbow area and is highly prevalent in assembly workers who repeatedly move their wrists.

OBJECTIVE

The purpose of this study was to compare the wrist ROM and muscle strength of assembly workers with and without LE.

METHODS

Forty-five male assembly line workers (23 with LE) participated in the study. Participants had their wrist range of motion (flexion, extension, ulnar deviation, and radial deviation) and strength (wrist flexors, extensors, and hand grip) measured using Smart KEMA sensors.

RESULTS

Workers with LE showed significantly reduced wrist extension and radial deviation ROM compared to workers without LE, with no significant differences in wrist flexion and ulnar deviation ROM between groups. Workers with LE had significantly lower wrist extensor strength compared to workers without LE, and there was no significant difference in wrist flexor and grip strength between the two groups.

CONCLUSIONS

For workers with LE, the difference in wrist ROM and muscle strength will be useful for planning intervention and evaluating treatment outcomes for assembly workers with LE.

Reliability, validity, and responsiveness of pinch strength assessment: a systematic review

PURPOSE

To summarize and critically appraise the quality of studies investigating psychometric properties of pinch strength assessment.

METHODS

Medical literature up to February 2024 was searched for studies reporting on at least one measurement property of pinch strength assessment. The quality of the evidence and the risk of bias were rated using COSMIN 2018 guidelines.

RESULTS

Thirty-three studies (1962 participants) were included. The majority (16/19) of reliability studies were of adequate to very good quality. Seven of 12 studies of validity were rated as adequate or very good. The quality of the eight responsiveness studies was adequate. Reliability was good to excellent (ICC > 0.75) for neurological conditions, and excellent (ICC > 0.90) for musculoskeletal disorders and healthy participants. Pinch strength showed strong to very strong correlations with grip strength (r = 0.72-0.92), moderate to strong correlations with assessments of dexterity (r = 0.78-0.80), and weak to moderate correlation with patient-reported outcome measures (r = 0.03-0.50). Varied results were found for pinch strength responsiveness in a small number of studies.

CONCLUSIONS

Pinch strength assessment is reliable. Validity and responsiveness are less reported, but there is a strong correlation between pinch and grip strength, and a moderate correlation with dexterity.

High-intensity interval training improves bone remodeling, lipid profile, and physical function in multiple sclerosis patients

Multiple sclerosis (MS) is a demyelinating and neurodegenerative disease due to an autoimmune chronic inflammatory response, yet the etiology is currently not completely understood. It is already known that physical activity plays an essential role in improving quality of life, especially in neuropathological conditions. The study was aimed to investigate the possible benefits of high-intensity interval training (HIIT) in bone and lipid metabolism markers, and neuromotor abilities in MS patients. 130 participants were recruited; 16 subjects with MS met the inclusion criteria and were included in the data analysis. The patients were randomly assigned to two groups: a Control group (CG) (34.88 ± 4.45 yrs) that didn't perform any physical activity and the Exercise group (EG) (36.20 ± 7.80 yrs) that performed HIIT protocol. The training program was conducted remotely by a kinesiologist. It was performed three times a week for 8 weeks. At the beginning (T0) and the end of the study (T1) physical function tests, bone remodelling markers, and lipid markers analyses were performed. After 8 weeks of training the wall squat (s) (T0 = 27.18  ±  4.21; T1 = 41.68 ± 5.38, p ≤ 0.01) and Time Up and Go test (s) (T0 = 7.65 ± 0.43; T1 = 6.34 ± 0.38 p ≤ 0.01) performances improved; lipid markers analysis showed a decrease in Total (mg/dl) (T0 = 187.22 ± 15.73; T1 = 173.44 ± 13.03, p ≤ 0.05) and LDL (mg/dl) (T0 = 108 ± 21.08; T1 = 95.02 ± 17.99, p < 0.05) cholesterol levels. Additionally, the levels of osteocalcin (µg/L), a marker of bone formation increased (T0 = 20.88 ± 4.22; T1 = 23.66 ± 6.24, p < 0.05), 25-OH Vitamin D (µg/L) improved after 8 weeks (T0 = 21.11 ± 7.11; T1 = 27.66 ± 7.59, p < 0.05). HIIT had an effect on lower limb strength and gait control, improved bone formation, and lipid management, in MS patients.

Therapy effect on hand function after home use of a wearable assistive soft-robotic glove supporting grip strength

BACKGROUND

Soft-robotic gloves with an assist-as-needed control have the ability to assist daily activities where needed, while stimulating active and highly functional movements within the user's possibilities. Employment of hand activities with glove support might act as training for unsupported hand function.

OBJECTIVE

To evaluate the therapeutic effect of a grip-supporting soft-robotic glove as an assistive device at home during daily activities.

METHODS

This multicentre intervention trial consisted of 3 pre-assessments (averaged if steady state = PRE), one post-assessment (POST), and one follow-up assessment (FU). Participants with chronic hand function limitations were included. Participants used the Carbonhand glove during six weeks in their home environment on their most affected hand. They were free to choose which activities to use the glove with and for how long. The primary outcome measure was grip strength, secondary outcome measures were pinch strength, hand function and glove use time.

RESULTS

63 patients with limitations in hand function resulting from various disorders were included. Significant improvements (difference PRE-POST) were found for grip strength (+1.9 kg, CI 0.8 to 3.1; p = 0.002) and hand function, as measured by Jebson-Taylor Hand Function Test (-7.7 s, CI -13.4 to -1.9; p = 0.002) and Action Research Arm Test (+1.0 point, IQR 2.0; p≤0.001). Improvements persisted at FU. Pinch strength improved slightly in all fingers over six-week glove use, however these differences didn't achieve significance. Participants used the soft-robotic glove for a total average of 33.0 hours (SD 35.3), equivalent to 330 min/week (SD 354) or 47 min/day (SD 51). No serious adverse events occurred.

CONCLUSION

The present findings showed that six weeks use of a grip-supporting soft-robotic glove as an assistive device at home resulted in a therapeutic effect on unsupported grip strength and hand function. The glove use time also showed that this wearable, lightweight glove was able to assist participants with the performance of daily tasks for prolonged periods.

Instruments for measuring the neuromuscular function domain of vitality capacity in older persons: an umbrella review

PURPOSE

Recently, handgrip, knee extensor and respiratory muscle strength were proposed as candidate biomarkers to assess the neuromuscular function of vitality capacity in older persons. This umbrella review aims to provide an overview of the available instruments and their measurement properties to assess these biomarkers.

METHODS

The databases PubMed, Web of Science and Embase were systematically screened for systematic reviews and meta-analyses reporting on handgrip, knee extensor or respiratory muscle strength assessments, resulting in 7,555 articles. The COSMIN checklist was used to appraise psychometric properties and the AMSTAR for assessing methodological quality.

RESULTS

Twenty-seven systematic reviews were included in this study. Some of the identified reviews described the psychometric properties of the assessment tools. We found five assessment tools that can be used to measure neuromuscular function in the context of healthy ageing. Those are the handheld dynamometer for handgrip strength, the dynamometer for knee extensor strength and regarding respiratory muscle strength, the sniff nasal inspiratory pressure, maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP).

CONCLUSION

The handheld dynamometer for hand grip strength, the dynamometer for knee extensor strength, sniff nasal inspiratory pressure, MIP and MEP were identified. Therefore, these assessments could be used to identify community-dwelling older adults at risk for a declined neuromuscular function in the context of vitality capacity.

Efficacy of personalized rTMS to enhance upper limb function in subacute stroke patients: a protocol for a multi-center, randomized controlled study

Background

Repetitive transcranial magnetic stimulation (rTMS) is widely used therapy to enhance motor deficit in stroke patients. To date, rTMS protocols used in stroke patients are relatively unified. However, as the pathophysiology of stroke is diverse and individual functional deficits are distinctive, more precise application of rTMS is warranted. Therefore, the objective of this study was to determine the effects of personalized protocols of rTMS therapy based on the functional reserve of each stroke patient in subacute phase.

Methods

This study will recruit 120 patients with stroke in subacute phase suffering from the upper extremity motor impairment, from five different hospitals in Korea. The participants will be allocated into three different study conditions based on the functional reserve of each participant, measured by the results of TMS-induced motor evoked potentials (MEPs), and brain MRI with diffusion tensor imaging (DTI) evaluations. The participants of the intervention-group in the three study conditions will receive different protocols of rTMS intervention, a total of 10 sessions for 2 weeks: high-frequency rTMS on ipsilesional primary motor cortex (M1), high-frequency rTMS on ipsilesional ventral premotor cortex, and high-frequency rTMS on contralesional M1. The participants of the control-group in all three study conditions will receive the same rTMS protocol: low-frequency rTMS on contralesional M1. For outcome measures, the following assessments will be performed at baseline (T0), during-intervention (T1), post-intervention (T2), and follow-up (T3) periods: Fugl-Meyer Assessment (FMA), Box-and-block test, Action Research Arm Test, Jebsen-Taylor hand function test, hand grip strength, Functional Ambulatory Category, fractional anisotropy measured by the DTI, and brain network connectivity obtained from MRI. The primary outcome will be the difference of upper limb function, as measured by FMA from T0 to T2. The secondary outcomes will be the differences of other assessments.

Discussion

This study will determine the effects of applying different protocols of rTMS therapy based on the functional reserve of each patient. In addition, this methodology may prove to be more efficient than conventional rTMS protocols. Therefore, effective personalized application of rTMS to stroke patients can be achieved based on their severity, predicted mechanism of motor recovery, or functional reserves.

Clinical trial registration

https://clinicaltrials.gov/, identifier NCT06270238.

Neighbourhood walkability and greenspace and their associations with health-related fitness in urban dwelling Canadian adults

OBJECTIVE

Muscular strength and body composition are important components of health-related fitness (HRF). Grip strength and body fat percent, in particular, are associated with chronic disease and affected by health behaviours. Evidence suggests relationships between the neighbourhood built environment (BE) and HRF exist, however, few studies have focused on grip strength and body fat percent. Therefore, our study aimed to estimate the sex-specific associations between the neighbourhood BE, grip strength, and body fat percent among urban-dwelling Canadian adults.

METHODS

We analyzed cross-sectional survey and HRF data collected in 2011-2015 from 4052 males and 7841 females (Alberta's Tomorrow Project, Canada). Grip strength and body fat percent were measured via handgrip dynamometry and bioelectrical impedance analysis, respectively. Walkability (Canadian Active Living Index) and greenness (Normalized Difference Vegetation Index) estimates were linked to participant data. Sex-stratified covariate-adjusted linear regression models estimated the associations between the BE and HRF variables.

RESULTS

Walkability was negatively associated with grip strength and body fat percent in males (β -0.21, 95%CI: -0.31 to -0.11 and β -0.08, 95%CI: -0.15 to -0.02, respectively) and females (β -0.06, 95%CI: -0.10 to -0.01 and β -0.08, 95%CI: -0.14 to -0.02, respectively). Greenness was positively associated with grip strength in males (β 6.99, 95%CI: 3.62 to 10.36) and females (β 2.72, 95%CI: 1.22 to 4.22) but not with body fat percent. Controlling for physical activity and sitting did not attenuate these associations.

CONCLUSION

Characteristics of the neighbourhood BE appear to be associated with muscular strength and body composition, independent of physical activity and sedentary behaviour.

Modifiable Physical Factors That Influence Physical Function for People Receiving Peritoneal Dialysis

Introduction

People receiving peritoneal dialysis experience physical function decline, impairing their ability to complete everyday activities, leading to poorer quality of life. Physical factors, including cardiorespiratory fitness, muscle strength, physical activity, and sedentary behavior are associated with physical function. However, little is known about this relationship, or temporal changes of these factors in this cohort. This study aimed to explore modifiable physical factors that are associated with physical function, identify which factor has the strongest influence, and explore temporal changes.

Methods

Adults receiving peritoneal dialysis underwent objective and self-reported physical function, cardiorespiratory fitness, muscle strength, physical activity and sedentary behavior assessments 3 times over a 12-month observation period (at baseline, 6 months, and 12 months).

Results

Eighty-two participants underwent assessments. All modifiable physical factors were predominantly moderate to strongly associated with physical function at baseline. Cardiorespiratory fitness had the strongest and most consistent influence with every meter conferring a 0.08-unit (P < 0.01) and 0.01-unit (P < 0.05) increase in self-report and objective physical function score, respectively. Temporal changes were observed for modifiable physical factors with significant mean changes in cardiorespiratory fitness (-9.8%), quadricep strength (-5%), moderate-to-vigorous (-25.9%) and total (-16.2%) physical activity, and sedentary behavior (+7.1%).

Conclusion

The results of this study indicate that cardiorespiratory fitness could be routinely monitored to detect risk of physical function decline and targeted through intervention to enhance physical function for people receiving peritoneal dialysis. Nevertheless, all factors should be considered when designing interventions to mitigate temporal changes and induce the numerous health benefits offered by being physically active.

Predictors of Hand Grip Strength in Adults Without Sarcopenia: Data From the NHANES, 2013-2014

Background

Grip strength measurement is used to estimate muscle strength and predict health status; yet, an accurate examination of grip strength predictors from body composition variable is lacking.

Objectives

This study aimed to examine the association of grip strength with lumbar bone mineral density (BMD) and total lean mass in adults without sarcopenia.

Methods

Adults without sarcopenia (N = 3100) were included from the NHANES, 2013-2014, in this cross-sectional study. Body mass (kg), body height (cm), body mass index (kg/m2), grip strength (kg), total percent fat (%), lumbar BMD (g/cm2), and total lean mass excluding bone mineral content (BMC, kg) were obtained and tested as predictors of grip strength.

Results

The regression analysis yielded a significant model [F(2,343732) = 71,284.2; R2 = 0.713; P < 0.001], with all predictors explaining ∼71.3% of the variance in grip strength. Age [β: -0.043; 95% confidence interval (CI): -0.040, -0.036], sex (β: -0.296; 95% CI: -6.431, -6.270), total percent fat (β: -0.245; 95% CI: -0.315, -0.308), lumbar BMD (β: 0.037; 95% CI: 2.529, 2.806), and total lean mass (β: 0.482; 95% CI: 0.001, 0.001) were all significant predictors of grip strength.

Conclusions

The predictive value of the BMD and total lean mass can serve as a useful measure in predicting grip strength and overall health status in adults without sarcopenia.

Impact of chronic wrist hypermobility on proprioception, strength, and functional performance in young adults

BACKGROUND

Chronic joint hypermobility has been attributed to repetitive ligamentous microtrauma, benign joint hypermobility syndrome (BJHS), or genetic connective tissue disorders that lead to pain and functional impairment, especially among females. Chronic wrist hypermobility (CWH) prevalence, etiology, and effects on proprioception, strength, and function have yet to be established.

PURPOSE

This pilot study aimed to determine the CWH prevalence among adults; its effects on proprioception, strength, and function; and whether these effects are gender based.

STUDY DESIGN

This was a quasi-experimental cross-sectional study.

METHODS

Ninety wrists (55 participants, mean age 27.46 years) with no wrist range of motion (ROM) restrictions or previous trauma for ≥6 months were screened for CWH based on an exploratory set of diagnostic criteria. Fifty-eight wrists (34 adults) were allocated to a CWH group, and 32 wrists (21 adults) were allocated to a healthy control group. Twenty-five CWH and 25 healthy control matched (gender, age, and handedness) participants were compared. Assessment included the active wrist joint position sense test, hand-held dynamometry for wrist extension and grip strength, and the patient-rated wrist evaluation for function. Testers were blinded to group allocation.

RESULTS

A 64.4% CWH prevalence existed among CWH participants, who were mostly asymptomatic females (74%). Frequent etiologic factors were midcarpal (96.5%) and scapholunate (39%) instabilities and BJHS (37%), which was higher among females (30%) than males (8%). Independent t-tests showed statistically significant (p < 0.05) group differences in wrist proprioception, wrist isometric extension, grip strength, and function with moderate-high (0.41-0.75) effect size. No significant gender differences existed in proprioception and function.

CONCLUSIONS

CWH is very prevalent among functional independent young adults with atraumatic midcarpal and intercarpal ligamentous laxities and BJHS. CWH prevails among women and adversely affects wrist proprioception, strength, and function. The study's specific CWH diagnostic criteria may be useful for clinicians to identify and timely manage impacted individuals by CWH.

Effectiveness of non-invasive therapies on pain, maximum grip strength, disability, and quality of life for lateral elbow tendinopathy: A systematic review and meta-analysis

BACKGROUND

Lateral elbow tendinopathy is a common musculoskeletal disorder. Effectiveness of non-invasive therapies for this health condition are unclear.

OBJECTIVE

To investigate the effectiveness of non-invasive therapies on pain, maximum grip strength, disability, and quality of life for lateral elbow tendinopathy.

METHODS

Searches were conducted on MEDLINE, Embase, CINAHL, AMED, PEDro, Cochrane Library, SPORTDiscus and PsycINFO without language or date restrictions up to May 3rd, 2023. Randomized trials investigating the effectiveness of any non-invasive therapy compared with control or other invasive interventions were included. Two independent reviewers screened eligible trials, extracted data, and assessed the risk of bias of included trials and certainty of the evidence.

RESULTS

Twenty-two different therapies investigated in 47 randomized trials were included in the quantitative analysis. Moderate certainty evidence showed that betamethasone valerate medicated plaster may reduce disability (mean difference -6.7; 95% CI -11.4, -2.0) in the short-term when compared with placebo. Low certainty evidence showed that acupuncture may reduce disability (MD -9.1; 95% CI -11.7, -6.4) in the short-term when compared with sham. Moderate to very low certainty of evidence also showed small to no effect of non-invasive therapies on pain intensity, maximum grip strength, and disability outcomes in the short-term compared to control or invasive interventions. Most therapies had only very low certainty of evidence to support their use.

CONCLUSIONS

Decision-making processes for lateral elbow tendinopathy should be carefully evaluated, taking into consideration that most investigated interventions have very low certainty of evidence. There is an urgent call for larger high-quality trials.

Effectiveness of Community-Based Rehabilitation (CBR) Centers for Improving Physical Fitness for Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis

To synthesise the best available evidence for the effectiveness of interventions delivered in community-based rehabilitation (CBR) centers on physical fitness, for community-dwelling older adults living in Asian countries. This study is a systematic review and meta-analysis. Seven English and two Chinese electronic databases were searched for randomised controlled trials (RCTs) and quasi-experimental studies that were conducted by centers providing CBR. Independent reviewers screened, quality-appraised and extracted data. The primary outcome was physical fitness measured by validated assessment tools, including the Timed Up and Go Test (TUG), gait speed, hand grip strength, Functional Reach Test (FRT), and one-leg standing test. Assessments of activity of daily living and quality of life using tools including the Barthel Index, Short Form (SF)-12, and SF-36 were secondary outcomes. After screening 5,272 studies, 29 studies were included (16 RCTs, 13 quasi-experimental studies) from four countries. Meta-analyses found that CBR programs significantly decreased TUG time (mean difference [MD], -1.89 seconds; 95% confidence interval [95% CI], -2.84 to -0.94; I2=0%; Z=3.90, p<0.0001), improved gait speed (MD, 0.10 m/s; 95% CI, 0.01-0.18; I2=0%; Z=2.26, p=0.02), and increased one-leg standing time (MD, 2.81 seconds; 95% CI, 0.41-5.22; I2=0%; Z=2.29, p=0.02). Handgrip strength and FRT showed no statistically significant improvement in the meta-analyses. CBR may improve aspects of physical fitness for older adults in Asian countries. However, variability in intervention components and measurement tools reduced the ability to pool individual studies. Further trials are required with robust designs including standardised measures of physical fitness.

Improvements in cardiorespiratory fitness, muscle strength and body composition to modest weight loss are similar in those with adult- versus childhood-onset obesity

Adults who have had obesity from childhood are at greater risk of obesity-related comorbidities compared to those who only develop obesity in adulthood. The main way of mitigating these risks in obesity is with weight loss, which has been shown to positively affect the cardiorespiratory fitness (CRF) and body composition of adults. However, it is unclear whether the response of these outcomes to weight loss may be influenced by age of obesity onset. The objective of our study was to investigate how age of obesity onset mitigates the responsiveness of CRF, muscle strength and body composition to modest weight loss. Measurements were conducted at baseline and 12 weeks. In total, 37 participants (childhood-onset = 19, adult-onset = 18) lost 3.7% ± 0.4% through aerobic exercise and diet. The YMCA cycle ergometer test (YMCA) and the 20-m shuttle run test (20MSR) were used to estimate CRF (mL kg-1  min-1 ) and a handgrip dynamometer was used to estimate muscle strength. Total body composition was assessed by dual-energy x-ray absorptiometry (DEXA). Overall, CRF and body composition improved (time effect: p < 0.05) after 12 weeks. There was no group-by-time interaction for YMCA, 20MSR, muscle strength and body composition variables. Therefore, the present study suggests that individuals with childhood-onset obesity and adult-onset obesity can improve their CRF and body composition similarly after mild weight loss.

Multimorbidity-associated emergency hospital admissions: a "screen and link" strategy to improve outcomes for high-risk patients in sub-Saharan Africa: a prospective multicentre cohort study protocol

Background

The prevalence of multimorbidity (the presence of two or more chronic health conditions) is rapidly increasing in sub-Saharan Africa. Hospital care pathways that focus on single presenting complaints do not address this pressing problem. This has the potential to precipitate frequent hospital readmissions, increase health system and out-of-pocket expenses, and may lead to premature disability and death. We aim to present a description of inpatient multimorbidity in a multicentre prospective cohort study in Malawi and Tanzania.

Primary objectives

Clinical: Determine prevalence of multimorbid disease among adult medical admissions and measure patient outcomes. Health Economic: Measure economic costs incurred and changes in health-related quality of life (HRQoL) at 90 days post-admission. Situation analysis: Qualitatively describe pathways of patients with multimorbidity through the health system.

Secondary objectives

Clinical: Determine hospital readmission free survival and markers of disease control 90 days after admission. Health Economic: Present economic costs from patient and health system perspective, sub-analyse costs and HRQoL according to presence of different diseases. Situation analysis: Understand health literacy related to their own diseases and experience of care for patients with multimorbidity and their caregivers.

Methods

This is a prospective longitudinal cohort study of adult (≥18 years) acute medical hospital admissions with nested health economic and situation analysis in four hospitals: 1) Queen Elizabeth Central Hospital, Blantyre, Malawi; 2) Chiradzulu District Hospital, Malawi; 3) Hai District Hospital, Boma Ng'ombe, Tanzania; 4) Muhimbili National Hospital, Dar-es-Salaam, Tanzania. Follow-up duration will be 90 days from hospital admission. We will use consecutive recruitment within 24 hours of emergency presentation and stratified recruitment across four sites. We will use point-of-care tests to refine estimates of disease pathology. We will conduct qualitative interviews with patients, caregivers, healthcare providers and policymakers; focus group discussions with patients and caregivers, and observations of hospital care pathways.

The acceptability, practicality, implementation and efficacy of a physical and social activity intervention 'BreatheHappy' for people with long-term respiratory conditions: A feasibility study

OBJECTIVES

This study aimed to determine the feasibility of a group-based pilot programme of low-to-moderate physical activity training, education and social activities, by investigating acceptability, practicality, implementation and efficacy testing. We offer suggestions on programme adaptions for future study.

METHODS

People with a range of chronic respiratory diseases were invited to participate in a pilot 12 week group activity programme. Activities included outdoor walking, tai-chi, education and a range of social activities. Acceptability was determined by participant experiences determined during interviews. Practicality was determined by programme and outcome measure completion, cost and adverse events. Implementation was determined according to whether the programme ran as planned. Efficacy was determined by statistical analyses of outcomes including hand grip strength, timed up and go test, COPD Helplessness Index, COPD Assessment Test, and measures of physical activity via accelerometry.

RESULTS

Thematic analysis indicated that the "BreatheHappy" programme was acceptable. Seven of nine participants completed eight out of 10 sessions and the majority completed all outcome measures. "BreatheHappy" was therefore considered practical. The programme was not implemented as planned, with only 10 sessions running rather than the 12 intended. There was a significant increase in daily step counts (MD: 1284 95% CI: 240-2329 p: 0.024 effect size: 0.988), stepping time (MD: 16 min 95% CI: 5-27 min p: 0.011 effect size: 1.36) and daily minutes completing light physical activity (MD: 23 95% CI: 6-38 p: 0.006 effect size: 1.6). However, time spent sitting for ≥30 min but ≤60 min significantly increased (MD: 26 95% CI: 0.2-52 min p: 0.049 effect size: 0.931), showing signs of efficacy and changing physical activity behaviour patterns.

DISCUSSION

A 10-week programme of low-moderate physical activity training, education and social activities shows signs of feasibility for future research. Suggested adaptions for future study include using physical activity measures such as daily step count or light physical activity for a primary outcome, and mental health and social health related outcome measures relatable to participant's beneficial experiences of the programme. Recruitment in future studies will try and reach both those less socially active and possibly those who have completed pulmonary rehabilitation (PR). Venues should be close to efficient transport links whilst different frequencies and durations of programme delivery should be trialled. Adequate funding should be provided for both staff running the programme and blinded research staff for outcome measurement.

Moderating Effect of Grip Strength in the Association between Diabetes Mellitus and Depressive Symptomatology

Diabetes mellitus and depression rank among the leading causes of disease burden and are present in the top ten causes of disability-adjusted life years worldwide. Numerous studies have shown that both depression and diabetes have a detrimental effect on the quality of life, and when they coexist, the effect is considerably worse. This study aimed to analyse how grip strength moderates the relationship between diabetes and depressive symptoms among middle-aged and older adults. In total, 41,701 participants (18,003 men) in wave 8 of the cross-sectional population-based Survey of Health, Ageing, and Retirement in Europe (2019/2020) data were studied. A dynamometer was used to test grip strength twice on each hand. Depressive symptoms were measured using the 12-item EURO-D scale. The relationship between diabetes and depressive symptoms is negatively moderated by grip strength (male: B = -0.03, 95% CI = -0.04, -0.03; female: B = -0.06, 95% CI = -0.07, -0.06). Furthermore, the significant zone grip strength moderation values for males and females were less than 48.7 kg and 38.9 kg, respectively. Muscular strength was a moderator of depressive symptoms, attenuating its association with diabetes. This supports the premise that physical activity, namely muscle-strengthening exercises, should be included in diabetes treatment programs.

Immediate and localized effect of Kinesio tape on the hand grip strength of sedentary female adults

The current study aimed to assess the immediate and localized effect of Kinesio Taping (KT) on hand grip strength. A cross-sectional study was conducted on 60 sedentary female university students (aged 18-23) divided into two groups of 30 subjects each. The experimental group received KT with 50% tension of the tape on the forearm and 100% tension on the hand, and the control group received a placebo application of KT (KT without tension on the hand and forearm). Hand grip strength was assessed before and immediately after applying KT using a hand-held dynamometer with a one-minute rest between trials. The experimental group detected a significant improvement in hand grip strength during the post-intervention stage compared to the control group (mean difference 9.72 Lbs; 95% CI, -12.90 to -6.54; P<0.05) with a medium effect size. In addition, a significant improvement in handgrip strength was observed between pre-intervention and post-intervention in the experimental group (mean difference 6.5 Lbs.; 95% CI, -7.58 to -5.42; P<0.05) with a high effect size. However, the control group failed to show significant improvement in handgrip strength between pre-and post-intervention (P=0.666). KT application on the hand and forearm immediately augmented the hand grip strength of the dominant hand in sedentary female university students.

Validity and reliability of the Turkish version of the patient-specific functional scale in patients with low back pain

BACKGROUND

The Patient-Specific Functional Scale (PSFS) is among the most used measures to evaluate physical function. The PSFS has not been translated into Turkish for patients with low back pain to date. The purpose of the present study was to translate and cross-culturally adapt the PSFS into Turkish (PSFS-T) and to assess its reliability and validity in patients with low back pain.

METHODS

A total of 105 participants completed the PSFS-T, Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ), and Visual Analogue Scale (VAS) for pain. Sixty-nine participants completed the PSFS-T questionnaire twice in 7 days. The internal consistency of the PSFS-T was assessed using Cronbach's alpha while the Intraclass Correlation Coefficient (ICC) was used to evaluate test-retest reliability. The convergent validity of PSFS-T was determined with ODI, RMDQ, and VAS questionnaires by using Pearson's correlation coefficient analysis.

RESULTS

The PSFS-T demonstrated acceptable internal consistency (Cronbach's α = 0.79) and good test-retest reliability (ICC2,1 = 0.75) with no floor or ceiling issues. The PSFS-T showed a moderate correlation with ODI (Rp =0 .49, p<0.001) and RMDQ (Rp =0 .46, p<0.001). A poor correlation was found between PSFS-T and VAS (Rp = 0.36, p< 0.001). Standard Error of Measurement (SEM) and Minimal Detectable Change (MDC) for the PSFS-T scores were 0.69 and 1.91 respectively.

CONCLUSION

The Turkish version of PSFS is a valid and reliable instrument for the assessment of low back patients. It may be considered a preferable scale for clinical assessment of Turkish-speaking patients with low back pain.

Influence of hand dominance, gender, and body mass index on hand grip strength

Background

Hand grip strength (HGS) measurements serve as an objective measure of upper extremity function. Reliable hand strength evaluation is vital for assessing treatment effectiveness.

Objectives

To determine the influence of hand dominance, gender, and body mass index (BMI) on HGS among university students in Ghana.

Method

In our cross-sectional study of 304 participants, height, weight, and BMI were measured using a stadiometer and weighing scale. Hand grip strength was assessed with a dynamometer. We compared HGS in dominant and non-dominant hands for males and females using a paired t-test and analysed the correlation between grip strength and weight, height, and BMI using Pearson's correlation coefficient.

Results

The mean HGS for right-hand dominant (RHD) male participants was 35.62 kg (± 7.36) for the right hand compared with 32.84 kg (± 7.36) for the left hand. For females RHD the mean HGS in the right hand was 24.60 kg (± 6.42) compared to 22.12 kg (± 5.37) in the left hand. The mean weight, height and BMI of participants were 62.86 kg (± 10.30), 1.67 m (± 0.09) and 22.9 kg/m2 (± 4.9), respectively. A significant relationship existed between HGS and height (r = 0.492; p < 0.01) as well as HGS and BMI (r = 0.290; p < 0.01). However, no notable connection was found between HGS and weight (r = 0.001; p = 0.982).

Conclusion

Hand grip strength was significantly stronger in the dominant hand of both males and females.

Clinical implications

Physiotherapists should test HGS objectively and quantitatively for use in disease evaluation, diagnosis, and therapy.

Piloting an ICU follow-up clinic to improve health-related quality of life in ICU survivors after a prolonged intensive care stay (PINA): feasibility of a pragmatic randomised controlled trial

BACKGROUND

ICU survivors often suffer from prolonged physical and mental impairments resulting in the so called "Post-Intensive Care Syndrome" (PICS). The aftercare of former ICU patients affected by PICS in particular has not been addressed sufficiently in Germany so far. The aim of this study was to evaluate the feasibility of a pragmatic randomised trial (RCT) comparing an intensive care unit (ICU) follow-up clinic intervention to usual care.

METHODS

This pilot study in a German university hospital evaluated the feasibility of a pragmatic RCT. Patients were assigned in a 1:1 ratio to an ICU follow-up clinic intervention or to usual care. The concept of this follow-up clinic was previously developed in a participatory process with patients, next of kin, health care professionals and researchers. We performed a process evaluation and determined acceptability, fidelity, completeness of measurement instruments and practicality as feasibility outcomes. The RCT's primary outcome (health-related quality of life) was assessed six months after ICU discharge by means of the physical component scale of the Short-Form-12 self-report questionnaire.

RESULTS

The pilot study was conducted from June 2020 to May 2021 with 21 and 20 participants in the intervention and control group. Principal findings related to feasibility were 85% consent rate (N = 48), 62% fidelity rate, 34% attrition rate (N = 41) and 77% completeness of outcome measurements. The primary effectiveness outcome (health-related quality of life) could be measured in 93% of participants who completed the study (N = 27). The majority of participants (85%) needed assistance with follow-up questionnaires (practicality). Median length of ICU stay was 13 days and 85% (N = 41) received mechanical ventilation, median Sequential Organ Failure Assessment Score was nine. Six-month follow-up assessment was planned for all study participants and performed for 66% (N = 41) of the participants after 197 days (median).

CONCLUSION

The participatory developed intervention of an ICU follow-up clinic and the pragmatic pilot RCT both seem to be feasible. We recommend to start a pragmatic RCT on the effectiveness of the ICU follow-up clinic.

TRIAL REGISTRATION

ClinicalTrials.gov US NLM, NCT04186468, Submission: 02/12/2019, Registration: 04/12/2019, https://clinicaltrials.gov/ct2/show/NCT04186468.

The effectiveness of neuromobilization exercises in carpal tunnel syndrome: Systematic review and meta-analysis

PURPOSE

To examine the effectiveness of Neuromobilization Exercises (NE) on pain, grip and pinch strength, two-point discrimination, motor and sensory distal latency, symptom severity, and functional status using the Boston Carpal Tunnel Questionnaire (BCTQ) in Carpal Tunnel Syndrome (CTS).

METHODS

Major electronic databases were searched from inception up to September 2021 for randomized trials comparing the effects of NE with or without other interventions against no treatment, surgery, or other interventions in patients with CTS. Standardized Mean Differences (SMD) and 95% confidence interval (CI) were calculated using a random-effects inverse variance model according to the outcome of interest and comparison group. Methodological quality was assessed with PEDro and quality of evidence with the GRADE approach.

RESULTS

Twenty-five articles were included and sixteen of them demonstrated high methodological quality. NE was superior to no treatment on pain (very low-quality evidence; SMD = -2.36, 95% CI -4.31 to -0.41). NE was superior to no treatment on the functional scale of the BCTQ (low-quality evidence; SMD = -1.27 95% CI -1.60 to -0.94). Most importantly, NE did not demonstrate evidence of clinical effectiveness.

CONCLUSION

Low to very low-quality evidence suggests that there are no clinical benefits of NE in patients with mild to moderate CTS.

Incorporating Exercise Training into Cardio-Oncology Care: Current Evidence and Opportunities: JACC: CardioOncology State-of-the-Art Review

Cancer treatment-induced cardiotoxicities are an ongoing concern throughout the cancer care continuum from treatment initiation to survivorship. Several "standard-of-care" primary, secondary, and tertiary prevention strategies are available to prevent the development or further progression of cancer treatment-induced cardiotoxicities and their risk factors. Despite exercise's established benefits on the cardiovascular system, it has not been widely adopted as a nonpharmacologic cardioprotective strategy within cardio-oncology care. In this state-of-the-art review, the authors discuss cancer treatment-induced cardiotoxicities, review the existing evidence supporting the role of exercise in preventing and managing these sequelae in at-risk and affected individuals living after cancer diagnoses, and propose considerations for implementing exercise-based services in cardio-oncology practice.

A systematic review of the psychometric properties of pressure pain detection threshold in evaluating mechanical pain threshold in people with hand or wrist injuries

PURPOSE

The aim of this study was to conduct a systematic review of the psychometric properties of Pressure Pain Detection Threshold (PPDT) measures in people with hand or wrist injuries.

STUDY DESIGN AND METHODS

MEDLINE, Embase, and CINAHL databases were searched to identify eligible studies evaluating psychometric properties of PPDT in samples composed of at least 50% of people with hand or wrist injury. The Consensus-based Standards for the Measurement of Health Instruments' risk of bias checklist was used to critically appraise the included studies, and qualitative synthesis was performed by pooling the results of all studies that presented the same measurement property using Grading of Recommendations, Assessment, Development, and Evaluation.

RESULTS

From 415 studies, 11 relevant studies were identified. Of the 11 studies, four hand or wrist injuries were represented; carpal tunnel syndrome, distal radius fractures, osteoarthritis, and complex regional pain syndrome. Intra-rater reliability was considered sufficient (intraclass correlation coefficient 0.64-0.94), with small reported standard error of the mean values (5.3-39.2 kPa). Results of validity and responsiveness could not be synthesized due to heterogeneity. Risk of bias for reliability and measurement error was assessed as very good or adequate, whereas validity and responsiveness were doubtful or inadequate. Overall quality of evidence was low or very low for all measurement properties.

CONCLUSIONS

Inconsistent results and low quality evidence provide little confidence in the overall measurement properties of PPDT in a hand or wrist injury population. No criterion standard for pain further highlights complexities around pain measurement such that the results obtained from PPDT measures in clinical practice cannot be compared to a gold standard measure.

START - physical exercise and person-centred cognitive skills training as treatment for adult ADHD: protocol for a randomized controlled trial

BACKGROUND

Core symptoms in attention deficit hyperactivity disorder (ADHD) are inattention, impulsivity and hyperactivity. Many individuals with this disorder also have a sedentary lifestyle, co-morbid mental illness such as depressive and anxiety disorders, and reduced quality of life. People with ADHD often have impaired executive function, which among other things may include difficulty in time management and structuring of everyday life. Pharmacological treatment is often the first-line option, but non-pharmacological treatment is also available and is used in clinical settings. In children and adolescents with ADHD, physical exercise is used as a non-pharmacological treatment. However, the evidence for the effectiveness of exercise in adults is sparse.

OBJECTIVE

To implement the START intervention (START = Stöd i Aktivitet, Rörelse och Träning [Support in activity, movement and exercise]) consisting of a 12-week, structured mixed exercise programme with or without a cognitive intervention, in adults with ADHD, and study whether it has an effect on core symptoms of ADHD as well as physical, cognitive, mental and everyday functioning compared with usual treatment. A secondary aim is to investigate the participants' experiences of the intervention and its possible benefits, and to evaluate the cost-effectiveness of START compared with usual treatment.

METHODS

This is a randomized controlled trial planned to be conducted in 120 adults with ADHD, aged 18-65. The intervention will be given as an add-on to standard care. Participants will be randomized to three groups. Group 1 will be given a physiotherapist-led mixed exercise programme for 12 weeks. Group 2 will receive the same intervention as group 1 with the addition of occupational therapist-led cognitive skills training. Group 3 will be the control group who will receive standard care only. The primary outcome will be reduction of ADHD symptoms measured using the World Health Organization (WHO) Adult ADHD Self-Report Scale (ASRS-v1.1), Clinical Global Impression-Severity scale (CGI-S) and CGI-Improvement scale (CGI-I). The effect will be measured within 1 week after the end of the intervention and 6 and 12 months later.

DISCUSSION

Data collection began in March 2021. The final 12-month follow-up is anticipated to be completed by autumn 2024.

TRIAL REGISTRATION

ClinicalTrials.gov (Identifier: NCT05049239). Registered on 20 September 2021 (last verified: May 2021).

Association between arthritis and hand grip strength indices combined with anthropometry in an older Korean population

BACKGROUND

Hand grip strength (HGS) is related to arthritis and all-cause mortality. Many studies have examined the association between HGS and arthritis, but these studies did not consider relative HGS indices. The objectives of this study were to examine the association between arthritis and HGS indices in an older Korean population and to compare an absolute HGS index and a relative HGS indices.

METHODS

In a large-scale cross-sectional study, a total of 16,860 subjects older than 50 years from the Korea National Health and Nutrition Survey from 2014 to 2019 were included for statistical analysis. A binary logistic regression model was used to examine the association between arthritis and HGS indices in crude and covariate-adjusted models.

RESULTS

In the crude analysis, all anthropometric and HGS indices were associated with arthritis except for weight in men. In adjusted models 1 and 2, among the anthropometric indices, waist circumference (WC) and waist-to-height ratio (WHtR) were associated with arthritis in men but not in women. Absolute HGS and all relative HGS indices showed a negative association with arthritis among both men and women, and the magnitude of the association of arthritis with the absolute HGS index and the relative HGS indices was similar. However, the magnitude of the association between all HGS indices and arthritis was higher for men than for women except in the crude analysis.

DISCUSSION

Absolute and relative HGS indices had negative associations with arthritis, and the magnitude of the association between the absolute HGS index and arthritis and between the relative HGS indices and arthritis was similar in all models. To our knowledge, this is the first report of an association between arthritis and relative HGS indices, which was not observed in previous studies.

Handgrip Strength in Lung Transplant Candidates and Recipients

OBJECTIVES

Handgrip strength is increasingly used to assess muscle strength in various conditions. In this review, we investigated handgrip strength in patients receiving or awaiting lung transplant.

MATERIALS AND METHODS

For this integrative review, we searched 8 databases from inception through February 2023. Two keyword entries, "handgrip strength" and "lung transplantation," were matched using the Boolean operator, AND. No filters were applied for document type, age, sex, publication date, language, and subject.

RESULTS AND CONCLUSIONS

The searched databases returned 73 citations. Nine articles considering 487 patients (49% female) were included in the final analysis; 7 studies were observational, and 2 were randomized controlled trials. In 7 of 9 studies, handgrip strength was measured with a hydraulic dynamometer. In candidates for lung transplant, handgrip strength ranged from 27.1 kg (before rehabilitation) to 31.2 kg (after rehabilitation). In lung transplant recipients, handgrip strength ranged from 21.1 kg (before rehabilitation) to 35.7 kg (after rehabilitation). Handgrip strength in lung transplant candidates with chronic obstructive pulmonary disease was higher (89 ± 18% predicted) versus patients with interstitial lung disease (79 ± 18% predicted). Improvements in maximal inspiratory pressure and maximal expiratory pressure were observed in those patients whose handgrip strength improved after rehabilitation. Nonsarcopenic patients walked longer distances for the 6-minute walking test (>450 m) versus sarcopenic patients (<310 m) and had higher handgrip strength (>20 kg) versus sarcopenic patients (<20 kg). Handgrip strength testing should be implemented both in preoperative and postoperative contexts to evaluate physical potential of patients and drive rehabilitative activities toward the most impaired domains.

Is the ECOG-PS similar to the sarcopenia status for predicting mortality in older adults with cancer? A prospective cohort study

PURPOSE

Sarcopenia is a muscle dysfunction that increases negative outcomes in patients with cancer. However, its diagnosis remains uncommon in clinical practice. The Eastern Cooperative Oncology Group Performance Status (ECOG-PS) is a questionnaire to assess the functional status, but it is unknown if is comparable with sarcopenia. We aimed at comparing ECOG-PS with sarcopenia to predict 12-month mortality in patients with cancer.

METHODS

Cohort study including older adult patients with cancer in treatment (any stage of the disease or treatment) at a reference hospital for oncological care. Socio-demographic, clinical, and anthropometric data, muscle mass, and physical function variables (handgrip strength [HGS] and gait speed [GS]) were collected. Skeletal muscle quantity and quality were assessed by computed tomography at the L3. Sarcopenia was diagnosed according to the EWGSP2. ECOG-PS and all-cause mortality were evaluated. The Cox proportional hazards model was calculated.

RESULTS

We evaluated 159 patients (69 years old, 55% males). Low performance (ECOG-PS ≥ 2) was found in 23.3%, 35.8% presented sarcopenia, and 22.0% severe sarcopenia. ECOG-PS ≥ 2 was not an independent predictor of mortality. Sarcopenia, severe sarcopenia, and probable sarcopenia has increased by 3.25 (confidence interval, CI 95% 1.55-6.80), 2.64 (CI 95% 1.23-5.67), and 2.81 (CI 95% 1.30-6.07) times the risk of mortality, respectively.

CONCLUSION

Sarcopenia, but not ECOG-PS, was a predictor of mortality. Therefore, ECOG-PS was not similar to sarcopenia to predict mortality in patients with cancer.

Feasibility and tolerability of moderate intensity regular physical exercise as treatment for core symptoms of attention deficit hyperactivity disorder: a randomized pilot study

Background

Attention deficit hyperactivity disorder (ADHD) is associated with sedentary lifestyle, low quality of life and low physical fitness. Studies in children with ADHD have shown that regular physical exercise can help reduce core ADHD symptoms, but evidence for this is lacking in adults. Although guidelines recommend multi-modal treatment, central stimulants (CS) remain the mainstay of treatment. CS are effective in the short-term, but their long-term efficacy remains to be established. There is thus huge unmet need for developing non-pharmacological treatment options, and for well-designed randomized controlled trials (RCTs).

Objective

The study aimed to test the feasibility and tolerability of structured moderate-intensity 12-week physical exercise program for adults with ADHD, as a prelude to an adequately powered RCT which includes long-term follow-up.

Materials and methods

Fourteen adults with ADHD were recruited, 9 randomized to an intervention group and 5 to a control group. The intervention group received physiotherapist-led 50-minute mixed exercise program, three times a week for 12 weeks, and the control group treatment as usual. Participants were assessed at baseline and after 6 and 12 weeks using clinical and physical evaluations, self-rating questionnaires, and functional magnetic resonance imaging (fMRI) together with paradigms that tested attention, impulsivity and emotion regulation.

Results

Three participants (21%) dropped out shortly after inclusion before receiving any intervention, while roughly 80% completed the intervention according to protocol. One participant from the intervention group participated in less than 60% of treatment sessions, and one who had done baseline fMRI was unwilling to do post-intervention imaging. Four participants in the intervention group (67%) reported increased stress in prioritizing the intervention due to time-management difficulties. Overall, consistent trends were observed that indicated the feasibility and potential benefits of the intervention on core ADHD symptoms, quality of life, body awareness, sleep and cognitive functioning.

Conclusion

Physiotherapist-led twelve-week regular physical exercise is a feasible and potentially beneficial intervention for adults with ADHD. There was a 20% drop-out initially and 67% of those who completed the intervention reported stress with time management difficulties due to participation. A third arm was thus added to the planned RCT where cognitive intervention administered by an occupational therapist will be given together with physical exercise.Clinical Trial Registration: https://clinicaltrials.gov, identifier NCT05049239.

Comparison of two relative motion extension approaches (RME with versus without an additional overnight orthosis) following zones V-VI extensor tendon repairs: A randomized equivalence trial

STUDY DESIGN

Multi--center randomized controlled trial with two intervention parallel groups. An equivalence trial.

INTRODUCTION

Relative motion extension (RME) orthoses are widely used in the postoperative management of finger extensor tendon repairs in zones V-VI. Variability in orthotic additions to the RME only (without a wrist orthosis) approach has not been verified in clinical studies.

PURPOSE OF THE STUDY

To examine if two RME only approaches (with or without an additional overnight wrist-hand-finger orthosis) yields clinically similar outcomes.

METHODS

Thirty-two adult (>18 years) participants (25 males, 7 females) were randomized to one of two intervention groups receiving either 1) a relative motion extension orthosis for day wear and an overnight wrist-hand-finger orthosis ('RME Day' group), or 2) a relative motion extension orthosis to be worn continuously ('RME 24-Hr' group); both groups for a period of four postoperative weeks.

RESULTS

Using a series of linear mixed models we found no differences between the intervention groups for the primary (ROM including TAM, TAM as a percentage of the contralateral side [%TAM], and Millers Criteria) and secondary outcome measures of grip strength, QuickDASH and PRWHE scores. The models did identify several covariates that are correlated with outcome measures. The covariate 'Age' influenced TAM (P = .006) and %TAM (P = .007), with increasing age correlating with less TAM and recovery of TAM compared to the contralateral digit. 'Sex' and 'Contralateral TAM' are also significant covariates for some outcomes.

DISCUSSION

With similar outcomes between both intervention groups, the decision to include an additional night orthosis should be individually tailored for patients rather than protocol-based. As the covariates of 'Age' and 'Sex' influenced outcomes, these should be considered in clinical practice.

CONCLUSIONS

A relative motion extension only approach with or without an additional overnight wrist-hand-finger orthosis yielded clinically similar results whilst allowing early functional hand use, without tendon rupture.

Associations of height, weight, and body mass index with handgrip strength: A Bayesian comparison in older adults

BACKGROUND & AIMS

Handgrip strength is commonly normalized or stratified by body size to define subgroup-specific cut-points and reference limits values. However, it remains unclear which anthropometric variable is most strongly associated with handgrip strength. We aimed to, in older adults with no self-reported mobility limitations, determine whether height, weight, and body mass index (BMI) were meaningfully associated with handgrip strength.

METHODS

This cross-sectional study included community-dwelling ambulant participants, and we identified 775 older adults who reported no difficulty walking 100 m, climbing stairs, and rising from the chair. Handgrip strength was measured with a digital dynamometer. Bayesian linear regression was used to estimate the probabilities that the positive associations of height, weight, and BMI with handgrip strength exceeded 0 kg (the null value) and 2.5 kg (the clinically meaningful threshold value).

RESULTS

Mean handgrip strength was 22.1 kg (SD, 4) for women and 32.9 kg (SD, 6) for men. Body height, weight, and BMI had >99.9% probabilities of a positive association with handgrip strength; however, the associations of per interquartile increase in body weight and BMI with handgrip strength had low probabilities (<5%) of exceeding the clinically meaningful threshold of 2.5 kg. In contrast, body height had the highest probability (99.6%) of a clinically meaningful association with handgrip strength: adjusting for age and gender, handgrip strength was 3.2 kg (95% CrI, 2.7 to 3.8) greater in older adults 1.61 m tall than in older adults 1.51 m tall.

CONCLUSIONS

In a large sample of mobile-intact older adults, handgrip strength differed meaningfully by body height. Although requiring validation, our findings suggest that future efforts should be directed at normalizing handgrip strength by body height to better define subgroup-specific handgrip weakness. A web-based application (https://sghpt.shinyapps.io/ippts/) was created to allow interactive exploration of predicted values and reference limits of age-, gender-, and height-subgroups.

Using minimal clinically important differences to measure long-term transitions of osteosarcopenia: The New Mexico Aging Process Study

BACKGROUND/OBJECTIVE

By having a better understanding of transitions in osteosarcopenia, interventions to reduce morbidity and mortality can be better targeted. The aim of this study was to show the rationale and method of using minimal clinically important differences (MCID's) to classify transitions, and the effects of demographic variables on transitions in a 9-year follow-up data from the New Mexico Aging Process Study (NMAPS).

METHODS

Transitions were identified in four aspects of osteosarcopenia: bone mineral density (BMD), appendicular skeletal muscle mass/body mass index ratio (ASM/BMI), grip strength and gait speed. Transitions were identified using a MCID score. As there is currently no available MCID for BMD and ASM/BMI, those were determined using a distribution-based and an anchor-based method. Total transitions were calculated for all four measures of osteosarcopenia in all transition categories (maintaining a health status, beneficial transition, harmful transitions). Poisson regression was used to test for effects of demographic variables, including age, sex, physical activity, medication, and health status, on transitions.

RESULTS

Over the 9-year follow-up, a total of 2163 MCID-derived BMD transitions were reported, 1689 ASM/BMI transitions, 2339 grip strength transitions, and 2151 gait speed transitions. Additionally, some MCID-derived transition categories were associated with sex, age, and health status.

CONCLUSION

Use of MCID-derived transitions reflected the fluctuation and the dynamic nature of health in older adults. Future research should focus on transitions of modifiable markers in osteosarcopenia to design intervention trials.

Body composition and physical fitness in adults born small for gestational age at term: a prospective cohort study

There is lack of research on body composition and physical fitness in individuals born small for gestational age (SGA) at term entering mid-adulthood. We aimed to investigate these outcomes in adults born SGA at term. This population-based cohort study included 46 adults born SGA with birth weight < 10th percentile at term (gestational age ≥ 37 weeks) (22 women, 24 men) and 61 adults born at term with birth weight ≥ 10th percentile (35 women, 26 men) at 32 years. Body composition was examined anthropometrically and by 8-polar bioelectrical impedance analysis (Seca® mBCA 515). Fitness was measured by maximal isometric grip strength by a Jamar hand dynamometer, 40-s modified push-up test and 4-min submaximal step test. Participants born SGA were shorter than controls, but other anthropometric measures did not differ between the groups. Men born SGA had 4.8 kg lower grip strength in both dominant (95% CI 0.6 to 9.0) and non-dominant (95% CI 0.4 to 9.2) hand compared with controls. Grip strength differences were partly mediated by height. In conclusion, body composition and physical fitness were similar in adults born SGA and non-SGA at term. Our finding of reduced grip strength in men born SGA may warrant further investigation.

Distance-based delivery of exercise for people treated for breast, prostate or colorectal cancer: a study protocol for a randomised controlled trial of EX-MED Cancer Sweden

BACKGROUND

Regular exercise has been shown to have beneficial health effects in cancer survivors, including improving quality of life and other important health outcomes. However, providing people with cancer with easily accessible, high-quality exercise support and programs is a challenge. Therefore, there is a need to develop easily accessible exercise programs that draw upon the current evidence. Supervised, distance-based exercise programs have the benefit of reaching out to many people whilst providing the support of an exercise professional. The aim of the EX-MED Cancer Sweden trial is to examine the effectiveness of a supervised, distance-based exercise program, in people previously treated for breast, prostate, or colorectal cancer, on health-related quality of life (HRQoL), as well as other physiological and patient-reported health outcomes.

METHODS

The EX-MED Cancer Sweden trial is a prospective randomised controlled trial including 200 people that have completed curative treatment for breast, prostate, or colorectal cancer. Participants are randomly allocated to an exercise group or a routine care control group. The exercise group will participate in a supervised, distanced-based exercise program delivered by a personal trainer who has undertaken specialised exercise oncology education modules. The intervention consists of a combination of resistance and aerobic exercises with participants completing two 60-min sessions per week for 12 weeks. The primary outcome is HRQoL (EORTC QLQ-C30) assessed at baseline, 3- (end of intervention and primary endpoint) and 6-months post-baseline. Secondary outcomes are physiological (cardiorespiratory fitness, muscle strength, physical function, body composition) and patient-reported outcomes (cancer-related symptoms, fatigue, self-reported physical activity), and self-efficacy of exercise. Furthermore, the trial will explore and describe the experiences of participation in the exercise intervention.

DISCUSSION

The EX-MED Cancer Sweden trial will provide evidence regarding the effectiveness of a supervised, distance-based exercise program for survivors of breast, prostate, and colorectal cancer. If successful, it will contribute to the implementation of flexible and effective exercise programs as part of the standard of care for people following cancer treatment, which is likely to contribute to a reduction in the burden of cancer on the individual, health care system and society.

TRIAL REGISTRATION

www.

CLINICALTRIALS

gov NCT05064670. Registered on October 1, 2021.

Convergent Validity between Electromyographic Muscle Activity, Ultrasound Muscle Thickness and Dynamometric Force Measurement for Assessing Muscle

Muscle fatigue is defined as a reversible decline in performance after intensive use, which largely recovers after a resting period. Surface electromyography (EMG), ultrasound imaging (US) and dynamometry are used to assess muscle activity, muscle morphology and isometric force capacity. This study aimed to assess the convergent validity between these three methods for assessing muscle fatigue during a manual prehension maximal voluntary isometric contraction (MVIC). A diagnostic accuracy study was conducted, enrolling 50 healthy participants for the measurement of simultaneous changes in muscle thickness, muscle activity and isometric force using EMG, US and a hand dynamometer, respectively, during a 15 s MVIC. An adjustment line and its variance (R²) were calculated. Muscle activity and thickness were comparable between genders (p > 0.05). However, men exhibited lower force holding capacity (p < 0.05). No side-to-side or dominance differences were found for any variable. Significant correlations were found for the EMG slope with US (r = 0.359; p < 0.01) and dynamometry (r = 0.305; p < 0.01) slopes and between dynamometry and US slopes (r = 0.227; p < 0.05). The sample of this study was characterized by comparable muscle activity and muscle thickness change between genders. In addition, fatigue slopes were not associated with demography or anthropometry. Our findings showed fair convergent associations between these methods, providing synergistic muscle fatigue information.

Assessment of short- and long-term functionality and quality of life in patients with post-acute COVID-19 syndrome

BACKGROUND

Although the number of new cases of coronavirus 2019 (COVID-19) has been drastically reduced worldwide, patients who demonstrate long-term symptoms need more attention from health systems, as these symptoms can negatively affect functionality and quality of life.

OBJECTIVE

To evaluate muscle function and quality of life at 3, 6, 9 and 12 months in patients with post-acute COVID-19 syndrome and to assess their associations with general fatigue and lung function.

METHODS

This observational and longitudinal study evaluated patients with post-acute COVID-19 syndrome. Participants were subjected to the following evaluations: Short Form-36; handgrip strength; Functional Assessment of Chronic Illness Therapy-Fatigue scale; and spirometry.

RESULTS

Among the 350 participants who were evaluated in the third month, 74.6%, 61.4% and 45.4% reported general fatigue, dyspnoea and cough, respectively. In the comparisons between the third month and the sixth month, there were significant increases in Functional Assessment of Chronic Illness Therapy-Fatigue scale, pulmonary function and several Short Form-36 domains. In the comparisons between the sixth month and the ninth month, there was a significant increase only in the social functioning domain of the Short Form-36. In the comparisons between the ninth month and the twelfth month, there was an increase only in some Short Form-36 domains. Significant correlations were observed between the Short Form-36 domains with Functional Assessment of Chronic Illness Therapy-Fatigue scale, handgrip strength and pulmonary function.

CONCLUSION

In patients with post-acute COVID-19 syndrome, there was a progressive improvement in quality of life, general fatigue and pulmonary function during the 12 months of follow-up, with this improvement being more pronounced in the first 6 months. There was a relationship between functionality and quality of life in these patients.

Hand function is already reduced before RA development and reflects subclinical tenosynovitis

BACKGROUND

Clinically suspect arthralgia (CSA) is characterised by arthralgia of small joints and considered a risk stage for development of rheumatoid arthritis (RA). However, it remains unknown if the function of the hands is already affected and what mechanisms underlie impaired hand-function in CSA.

METHODS

We studied various measures of hand function in two CSA populations. CSA patients in the TREAT EARLIER-trial (n=236) were evaluated at baseline for: grip strength on a dynamometer (GS), patient-reported difficulties in the grip domain of the Health Assessment Questionnaire (HAQ) questionnaire and incomplete fist closure at physical examination. Findings were validated in an independent CSA cohort (n=600) where hand function was measured as: GS evaluated by squeezing the examiner's fingers, grip domain of the HAQ questionnaire and fist closure. Contrast-enhanced MRI of the hands measured synovitis, tenosynovitis and bone marrow oedema (summed as subclinical inflammation) in both cohorts.

RESULTS

GS (on a dynamometer) was reduced in 75% compared with reference values in healthy controls, 60% reported grip difficulties and 13% had incomplete fist closure. Reduced GS was associated with subclinical inflammation (-0.38 kg/point inflammation, 95% CI -0.68 to -0.08). Studying separate MRI features, GS reduction was independently associated with tenosynovitis, decreasing with -2.63 kg (95% CI -2.26 to -0.33)/point tenosynovitis (range observed tenosynovitis scores: 0-20). Similar relations with tenosynovitis were seen for patient-reported grip difficulties (OR 1.12/point, 95% CI 1.07 to 1.42) and incomplete fist closure (OR 1.36/point, 95% CI 1.03 to 1.79). In the validation cohort, 36% had decreased examiner-assessed GS, 51% reported grip difficulties and 14% incomplete fist closure: all were associated with tenosynovitis. Decreased dynamometer-measured GS was most sensitive for detecting tenosynovitis (75%), while incomplete fist closure was most specific (88%-90%).

CONCLUSION

Hand function is already often affected before RA development. These limitations are related to subclinical inflammation and tenosynovitis in particular.

Gender-Specific Association of Handgrip Strength with Type 2 Diabetes Mellitus in Chinese Han Older Adults

PURPOSE

We aimed to analyze the relationship between handgrip strength/relative handgrip strength among older Han adults with type 2 diabetes mellitus (T2DM) by gender to determine the optimal cut-off value of grip strength for older adults.

METHODS

A multi-stage sampling method was used to conduct a questionnaire survey and physical examination of 6128 older adults in Anhui Province. Chi-squares tests, t-tests, analysis of variance, and logistic regression analysis were used to analyze the association between handgrip strength/relative handgrip strength and T2DM between the sexes. The decision tree model (CRT) was used to explore the predictive value of handgrip strength /relative handgrip strength on T2DM.

RESULTS

There was an association between handgrip strength and T2DM (P = 0.006, OR = 0.985, 95% CI = 0.975, 0.996), which was found in females (P = 0.013, OR = 0.978, 95% CI = 0.961, 0.995) but not in males (P = 0.125, OR = 0.989, 95% CI = 0.976, 1.003). Relative handgrip strength was also correlated with T2DM (P = 0.014, OR = 0.730, 95% CI = 0.568, 0.939), which was found in females (P = 0.003, OR = 0.534, 95% CI = 0.352, 0.809) but not in males (P = 0.432, OR = 0.879, 95% CI = 0.638, 1.212). The incidence of T2DM in elderly females with hypertension who were uneducated and with a handgrip strength of <17.350 kg was 24.3% (115 cases), whereas that in elderly females with hypertension and a relative handgrip strength of <0.240 was 29.0% (127 cases).

CONCLUSION

According to our results, handgrip strength and relative handgrip strength were associated with T2DM. People with hypertension had a higher risk of T2DM in women with a handgrip strength of ≤ 17.350kg and a relative grip strength of ≤ 0.240. Further research is needed to validate the effectiveness of this cut-off for implementing interventions and avoiding risks.

Using exergame-based exercise to prevent and postpone the loss of muscle mass, muscle strength, cognition, and functional performance among elders in rural long-term care facilities: A protocol for a randomized controlled trial

Objective

Elderly individuals in long-term care facilities (LTCFs) have a higher prevalence of sarcopenia than those in the community. Exercise is the gold standard for preventing and treating sarcopenia. Regarding exercise, multicomponent exercises, including progressive resistance training (PRT), are beneficial. However, developing routine, structured exercise programs for the elderly in LTCFs is difficult because of a shortage of healthcare providers, particularly in rural regions. Exergame-based exercises can increase a player's motivation and reduce staff time for an intervention. Nintendo Switch RingFit Adventure (RFA) is a novel exergame that combines resistance, aerobic, and balance exercises. In this study, we aim to investigate the clinical effectiveness of RFA on muscle and functional performance parameters among the elderly in LTCFs.

Methods

The EXPPLORE (using EXergame to Prevent and Postpone the LOss of muscle mass, muscle strength, and functional performance in Rural Elders) trial is a single-center randomized controlled trial involving elderly individuals (≥60 years) living in LTCFs in rural southern Taiwan. The participants will be equally randomized to the intervention group (exergame-based exercise plus standard care) or the control group (standard care alone). Both groups will receive standard care except that the intervention group will receive exergame-based exercises at the time previously scheduled for sedentary activities in the LTCFs. The exergame-based exercise will be performed using RFA in the sitting position with a specialized design, including arm fit skills and knee assist mode. Each session of the exercise lasts 30 mins and will be performed two times per week for 12 weeks. The primary outcomes will be the osteoporotic fracture index, appendicular skeletal muscle mass index, dominant handgrip strength, and gait speed. Meanwhile, the secondary outcomes will be the dexterity and agility, muscle strength and thickness, range of motion of the joints of the dominant upper extremity, Kihon checklist, Medical Outcomes Study 36-Item Short-Form Health Survey, and Brain Health Test.

Discussion

This trial will provide valuable knowledge on whether exergames using RFA can counteract physical decline and improve quality of life and cognition among the elderly in LTCFs.

Clinical trial registration

[www.ClinicalTrials.gov], identifier [NCT05360667].

Muscle Strength Reference Values and Correlation with Appendicular Muscle Mass in Mexican Children and Adolescents

Strength and muscle mass are important determinants of health status, and reference values for pediatric populations from every country or geographic region are needed. The aim of this study was to develop age- and sex-specific reference values of muscle strength and evaluate the correlation between muscle strength and appendicular lean mass in Mexican children and adolescents. A cross-sectional study was conducted in 1111 healthy subjects ages 5 to 19 years of age participating in the "Body Composition Reference Values in Mexican Children and Adolescents" study. Smoothed reference values for the 1, 3, 5, 15, 25, 50, 75, 85, 95, 97, and 99 percentiles of muscle strength for upper and lower limbs were developed based on age and sex using Jamar® and Microfet2® dynamometers. Mean values were derived using the Generalized Additive Models for Location, Scale and Shape (GAMLSS), and lean mass was determined using dual-energy X-ray absorptiometry. Highly positive correlations of muscle strength with lean mass in upper limbs were found r-values 0.87-0.92 for boys and r = 0.80-0.86 for girls. High and moderate positive correlations for lower limbs were also noted for upper limbs: r = 0.74-0.86 for boys and r = 0.67-0.82 for girls. The reference values for appendicular muscle strength established in this study demonstrated a high and positive correlation between appendicular mass and muscle strength. These data will be useful when evaluating conditions and diseases affecting muscle or sports.

Quantification of the forearm muscles mechanical properties using Myotonometer: Intra- and Inter-Examiner reliability and its relation with hand grip strength

The primary objective of this study was to investigate the reliability of the myotonometer in the mechanical properties of the forearm muscles [m. extensor carpi radialis brevis (ECRB), and m. flexor carpi ulnaris (FCU)] in healthy individuals. The secondary objective was to investigate the relationship between the handgrip strength and mechanical properties of these forearm muscles. The mechanical properties (muscle tone, stiffness, and elasticity) of the ECRB and FCU were measured using the MyotonPRO device. Examiner 1 performed two sets of measurements with a time interval of 30 min to determine intra-examiner reliability. Examiner 2 performed measurements during the interval between the two sets of examiner 1. The intra- and inter-examiner reliabilities were excellent (ICC˃0.82) for muscle tone, stiffness, and elasticity of the FCU. Both intra- and inter-examiner reliability in the evaluation of ECRB muscle tone, elasticity, and stiffness was moderate to excellent (ICCs = 0.56-0.98). The muscle tone and stiffness properties of the FCU were positively correlated with the handgrip strength (p <.05). The study findings indicate that the MyotonPRO device is a reliable tool to quantify ECRB, and FCU muscles mechanical properties in healthy individuals.

Effect of Acupuncture on Functional Capacity and Health-Related Quality of Life of Hemodialysis Patients: Study Protocol for a Randomized Controlled Trial

The proposed randomized controlled trial protocol will evaluate the effect of acupuncture treatment on the functional capacity (FC) and health-related quality of life (HRQOL) in chronic kidney disease (CKD) with glomerular filtration rate (GFR) category 5 (CKG G5) patients receiving maintenance dialysis. Patients undergoing hemodialysis (HD) from a dialysis center will be randomly assigned to experimental, placebo and control groups. In order to determine the difference between the same number of treatments performed three times or one treatment a week, experimental (verum acupuncture) and placebo (sham acupuncture) groups will receive a total of nine acupuncture treatments; however, both groups will be divided into subgroups A and B. The same selection of acupuncture points will be applied to both experimental subgroups and the placebo subgroups will receive acupuncture on non-acupuncture points. The results will be assessed by the 6-min Walk Test, Handgrip Test, 30-sec Sit-to-Stand and Kidney Disease Quality of Life-Short Form and will be held at baseline, after treatment and 12 weeks post-treatment follow up. This paper describes the rationale and design for a randomized, patient-assessor blinded controlled trial, which may provide evidence for the clinical application of acupuncture in CKG G5 patients undergoing HD.

Effect of Acupuncture on Functional Capacity in Patients Undergoing Hemodialysis: A Patient-Assessor Blinded Randomized Controlled Trial

Decreased functional capacity (FC) in patients undergoing hemodialysis (HD) is associated with adverse health events and poor survival. Acupuncture is recognized as a safe and effective integrative treatment. The aim of this study is to evaluate the effect of acupuncture treatment on the FC in chronic kidney disease with GFR category 5 (CKG G5) patients undergoing HD. In this patient-assessor blinded randomized controlled trial, seventy-two KF patients were randomly assigned to experimental (n = 24), placebo (n = 24) and control groups (n = 24). The primary outcome was the improvement in FC assessed by the 6-Minute Walk Test (6-MWT). Secondary outcomes included assessment of peripheral muscle strength by the Handgrip Strength Test (HGS) and the 30-Second Sit-to-Stand Test (STS-30) at baseline, after treatment and at 12-week follow up. A mixed ANOVA with interaction time*group was used. The experimental group increased walk distance (p < 0.001), lower limbs strength (p < 0.001) and handgrip strength (p = 0.012) after nine acupuncture sessions and stabilized in the follow-up (p > 0.05). In the placebo and control groups the 6-MWT and 30STS results decreased (p < 0.001) and the HGS scores did not change through time (p > 0.05). Acupuncture treatment improved FC and muscle strength in patients undergoing HD.

Measurement of hand grip strength: A cross-sectional study of two dynamometry devices

Background

Grip strength has been identified as an important indicator of health status and predictor of clinical outcomes. The gold standard for measuring grip strength is the JAMAR® Hydraulic Hand Dynamometer. Less expensive dynamometers are available but have not been validated within a hospital setting.

Objectives

To validate the Camry Digital Handgrip Dynamometer (Model EH101) against the validated JAMAR® Dynamometer (Model J00105) in a hospital population.

Methods

A cross-sectional observational study with a randomised single-blind cross-over component was conducted on consenting adult patients admitted to general hospital wards. The best of three measurements taken using the dominant hand was used for analysis.

Results

Fifty-one participants (median [interquartile range] age 42 [30–58] years; n = 27 [52.9%] female) were included. The mean difference between the Jamar® and Camry measurements was 1.9 kg ± 3.6 kg (t-value 0.9; p = 0.4). There was a strong positive correlation between the Jamar® and the Camry devices (R = 0.94; r² = 0.88; p < 0.0001). Excellent agreement was found between Jamar® and Camry measurements (interclass correlational coefficient 0.97, 95% CI 0.94–0.99, p < 0.0001). Hand dominance significantly affected the agreement between devices (p = 0.002).

Conclusions

The Camry Digital Handgrip Dynamometer is a valid tool for assessing grip strength in hospitalised adult patients.

Clinical implications

The Camry Digital Handgrip Dynamometer could be used as an inexpensive tool to measure grip strength.

Measurement properties for muscle strength tests following anterior cruciate ligament and/or meniscus injury: What tests to use and where do we need to go? A systematic review with meta-analyses for the OPTIKNEE consensus

Objectives

Critically appraise and summarise the measurement properties of knee muscle strength tests after anterior cruciate ligament (ACL) and/or meniscus injury using the COnsensus-based Standards for the selection of health Measurement INstruments Risk of Bias checklist.

Design

Systematic review with meta-analyses. The modified Grading of Recommendations Assessment, Development and Evaluation-guided assessment of evidence quality.

Data sources

Medline, Embase, CINAHL and SPORTSDiscus searched from inception to 5 May 2022.

Eligibility criteria for selecting studies

Studies evaluating knee extensor or flexor strength test reliability, measurement error, validity, responsiveness or interpretability in individuals with ACL and/or meniscus injuries with a mean injury age of ≤30 years.

Results

Thirty-six studies were included involving 31 different muscle strength tests (mode and equipment) in individuals following an ACL injury and/or an isolated meniscus injury. Strength tests were assessed for reliability (n=8), measurement error (n=7), construct validity (n=27) and criterion validity (n=7). Isokinetic concentric extensor and flexor strength tests were the best rated with sufficient intrarater reliability (very low evidence quality) and construct validity (moderate evidence quality). Isotonic extensor and flexor strength tests showed sufficient criterion validity, while isometric extensor strength tests had insufficient construct and criterion validity (high evidence quality).

Conclusion

Knee extensor and flexor strength tests of individuals with ACL and/or meniscus injury lack evidence supporting their measurement properties. There is an urgent need for high-quality studies on these measurement properties. Until then, isokinetic concentric strength tests are most recommended, with isotonic strength tests a good alternative.

Psychometric properties of performance-based measures of physical function administered via telehealth among people with chronic conditions: A systematic review

Background

Telehealth could enhance rehabilitation for people with chronic health conditions. This review examined the psychometric properties of performance-based measures of physical function administered via telehealth among people with chronic health conditions using the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) approach.

Methods

This systematic review was registered with Prospero (Registration number: CRD42021262547). Four electronic databases were searched up to June 2022. Study quality was evaluated by two independent reviewers using the COSMIN risk of bias checklist. Measurement properties were rated by two independent reviewers in accordance with COSMIN guidance. Results were summarised according to the COSMIN approach and the modified GRADE approach was used to grade quality of the summarised evidence.

Results

Five articles met the eligibility criteria. These included patients with Parkinson’s Disease (n = 2), stroke (n = 1), cystic fibrosis (n = 1) and chronic heart failure (n = 1). Fifteen performance-based measures of physical function administered via videoconferencing were investigated, spanning measures of functional balance (n = 7), other measures of general functional capacity (n = 4), exercise capacity (n = 2), and functional strength (n = 2). Studies were conducted in Australia (n = 4) and the United States (n = 1). Reliability was reported for twelve measures, with all twelve demonstrating sufficient inter-rater and intra-rater reliability. Criterion validity for all fifteen measures was reported, with eight demonstrating sufficient validity and the remaining seven demonstrating indeterminate validity. No studies reported data on measurement error or responsiveness.

Conclusions

Several performance-based measures of physical function across the domains of exercise capacity, strength, balance and general functional capacity may have sufficient reliability and criterion validity when administered via telehealth. However, the evidence is of low-very low quality, reflecting the small number of studies conducted and the small sample sizes included in the studies. Future research is needed to explore the measurement error, responsiveness, interpretability and feasibility of these measures administered via telehealth.