Nicola Massy-Westropp

Hand Grip Strength: age and gender stratified normative data in a population-based study

BackgroundThe North West Adelaide Health Study is a representative longitudinal cohort study of people originally aged 18 years and over. The aim of this study was to describe normative data for hand grip strength in a community-based Australian population. Secondary aims were to investigate the relationship between body mass index (BMI) and hand grip strength, and to compare Australian data with international hand grip strength norms.MethodsThe sample was randomly selected and recruited by telephone interview. Overall, 3 206 (81% of those recruited) participants returned to the clinic during the second stage (2004-2006) which specifically focused on the collection of information relating to musculoskeletal conditions.ResultsFollowing the exclusion of 435 participants who had hand pain and/or arthritis, 1366 men and 1312 women participants provided hand grip strength measurement. The study population was relatively young, with 41.5% under 40 years; and their mean BMI was 28.1 kg/m2 (SD 5.5). Higher hand grip strength was weakly related to higher BMI in adults under the age of 30 and over the age of 70, but inversely related to higher BMI between these ages. Australian norms from this sample had amongst the lowest of the hand grip strength of the internationally published norms, except those from underweight populations.ConclusionsThis population demonstrated higher BMI and lower grip strength in younger participants than much of the international published, population data. A complete exploration of the relationship between BMI and hand grip strength was not fully explored as there were very few participants with BMI in the underweight range. The age and gender grip strength values are lower in younger adults than those reported in international literature.

Average grip strength: A meta-analysis of data obtained with a Jamar dynamometer from individuals 75 years or more of age

Background and Purpose: Although strength diminishes with age, average values for grip strength have not been available heretofore for discrete strata after 75 years. The purpose of this meta‐analysis was to provide average values for the left and right hands of men and women 75–79, 80–84, 85–89, and 90–99 years. Methods: Contributing to the analysis were 7 studies and 739 subjects with whom the Jamar dynamometer and standard procedures were employed. Results: Based on the analysis, average values for the left and right hands of men and women in each age stratum were derived. Conclusions: The derived values can serve as a standard of comparison for individual patients. An individual whose grip strength is below the lower limit of the confidence intervals of each stratum can be confidently considered to have less than average grip strength.

Reliability and validity of indices of hand-grip strength and endurance.

BACKGROUND/AIM Grip strength is useful in clinical practice for the assessment of disease and/or rehabilitation progression. Brief maximal gripping is seldom required in everyday occupations, with repeated or sustained gripping at sub-maximal power more commonly involved. It has been proposed that assessment of both maximal hand-grip force and endurance is utilised. While the suitability of maximal contraction measures has been clearly established, the reliability and validity of other hand-grip indices have not been investigated. This study examined the reliability of various hand-grip indices and their validity in relation to distance walked during the six-minute walk test, a standardised exercise capacity test. METHODS Subjects undertook static sub-maximal (50%) and maximal force contraction hand-grip testing from which various indices were derived, and six-minute walk testing from which distance walked was determined. Testing was repeated on three separate occasions for determination of test-retest reliability. RESULTS Pre- and post-fatigue maximal contraction measurements demonstrated excellent test-retest reliability and validity. Conversely, other hand-grip indices were shown to be unreliable and exhibited no relationship with distance walked and hence concurrent validity could not be established. CONCLUSIONS Based on the results of this study, it is recommended that pre- and post-fatigue maximal contraction may be utilised for the assessment of client ability and progression due to their established validity and test-retest reliability. However, previously proposed measures of fatigue such as endurance (duration of sustained contraction), Strength Decrement Index and work performed (function of endurance and force of contraction) are unreliable and invalid and may have limited use in clinical practice.

Therapy gloves for patients with rheumatoid arthritis: a review

Rheumatoid arthritis is a chronic inflammatory disease that causes pain, joint stiffness and swelling leading to impaired hand function and difficulty with daily activities. Wearing therapy gloves has been recommended by occupational therapists as one of the alternative treatment methods for rheumatoid arthritis. This study aims to review the available literature on the effects of wearing therapy gloves on patients’ hand function and symptoms as well as to discuss the attributes of gloves that might influence the glove performance. An electronic databases search of MEDLINE, Physiotherapy Evidence Database, Occupational Therapy Systematic Evaluation of Evidence, Wiley Online Library, ScienceDirect and Cochrane Central Register of Controlled Trial was performed. Eight articles met the inclusion criteria, and covered seven clinical trials and one case study. Seven outcome measures were identified from the included studies and were then classified into two categories: hand function and hand symptoms. The hand symptoms such as pain, stiffness and swelling improve substantially when the therapy gloves are used. However, marginal or no improvement in hand function (with the exception of grip strength) linked to the use of therapy gloves is being reported. Further research is needed to quantify the effectiveness of therapy gloves, especially in improvement of hand function and in patients’ interest in wearing therapy gloves. Furthermore, future studies should include parameters which might influence therapy gloves’ performance, such as duration of trials, interface pressure generated by the gloves on the underlying skin and tissue, glove fit and construction, as well as thermophysiological comfort.

Autologous Blood Injection and Wrist Immobilisation for Chronic Lateral Epicondylitis

Purpose. This study explored the effect of autologous blood injection (with ultrasound guidance) to the elbows of patients who had radiologically assessed degeneration of the origin of extensor carpi radialis brevis and failed cortisone injection/s to the lateral epicondylitis. Methods. This prospective longitudinal series involved preinjection assessment of pain, grip strength, and function, using the patient-rated tennis elbow evaluation. Patients were injected with blood from the contralateral limb and then wore a customised wrist support for five days, after which they commenced a stretching, strengthening, and massage programme with an occupational therapist. These patients were assessed after six months and then finally between 18 months and five years after injection, using the patient-rated tennis elbow evaluation. Results. Thirty-eight of 40 patients completed the study, showing significant improvement in pain; the worst pain decreased by two to five points out of a 10-point visual analogue for pain. Self-perceived function improved by 11–25 points out of 100. Women showed significant increase in grip, but men did not. Conclusions. Autologous blood injection improved pain and function in a workers compensation cohort of patients with chronic lateral epicondylitis, who had not had relief with cortisone injection.

Ultrasound of the Carpal Tunnel and Median Nerve A Reproducibility Study

The authors describe a protocol for measuring the carpal tunnel and median nerve in a reproducible manner using ultrasound, as well as the variability of ultrasound measurements of the median nerve in the carpal tunnel on repeated testing. Measurements of the median nerve in the wrist and carpal tunnel and measurements of the carpal tunnel were taken on 23 wrists using high-resolution ultrasound following a specified protocol. These measurements were repeated a short time later to enable the initial measurements to be tested for reproducibility and stability. The same person obtained all measurements for the purposes of this study; thus, the results represent findings in an intraobserver variability study. Good correlation between the test and retest measurements was demonstrated, withr 2 values between 0.72 and 0.98. Pairedt test demonstrated no significant difference between the test and retest measurements. The study shows that repeated ultrasound measurements of the cross-sectional areas of the carpal tunnel, median nerve at the proximal edge of the carpal tunnel, distal to the carpal tunnel and at the level of the proximal wrist crease can all be satisfactorily reproduced when a strict ultrasound protocol is adhered to.

Reporting of allocation method and statistical analyses that deal with bilaterally affected wrists in clinical trials for carpal tunnel syndrome

ABSTRACTThe authors aimed to describe how often the allocation method and the statistical analyses that deal with bilateral involvement are reported in clinical trials for carpal tunnel syndrome and to determine whether reporting has improved over time. Forty-two trials identified from recently published systematic reviews were assessed. Information about allocation method and statistical analyses was obtained from published reports and trialists. Only 15 trialists (36%) reported the method of random sequence generation used, and 6 trialists (14%) reported the method of allocation concealment used. Of 25 trials including participants with bilateral carpal tunnel syndrome, 17 (68%) reported the method used to allocate the wrists, whereas only 1 (4%) reported using a statistical analysis that appropriately dealt with bilateral involvement. There was no clear trend of improved reporting over time. Interventions are needed to improve reporting quality and statistical analyses of these trials so that these can provide more reliable evidence to inform clinical practice.

Systematic review: hand activity and ultrasound of the median nerve

Background Ultrasound is an established method of viewing the median nerve in the carpal tunnel syndrome (CTS). There is some evidence to suggest that immediate changes may occur in the median nerve before and after hand activity. The evidence for the validity and reliability of ultrasound for testing acute changes in the median nerve has not been systematically reviewed to date. Aims To evaluate the evidence for visible change in ultrasound appearance of the median nerve after hand activity. Methods A literature search was designed, and three reviewers independently selected published research for inclusion. Two reviewers independently appraised papers using the Evidence Based Library and Information Practice (EBLIP) appraisal checklist, while the third reviewer resolved discrepancies between appraisals. Results Ten studies were appraised and the results showed an increase in median nerve cross-sectional area following activity, with a return to normal size within 1 h following activity. Both healthy individuals and those diagnosed with CTS participated, all were small convenience samples. Ultrasonographic measurements of the median nerve were reliable in the four studies reporting this, and the studies demonstrated high quality. Conclusions Good-quality evidence as identified by the EBLIP appraisal checklist suggests that following hand activity, the median nerve changes in size in the carpal tunnel. The results may not be generalizable to all people and activities due to the use of small convenience sampling and narrow range of activities studied, in all of the studies appraised.

The cerebral basal arterial network: morphometry of inflow and outflow components.

The aim of this project was to study how the morphology of the incoming and outgoing arterial components of the cerebral basal arterial network influence the blood flow to the brain. The cerebral basal arterial network consists of the circulus arteriosus cerebri anteriorly and the basilar artery posteriorly. Diameters of inflow vessels (bilateral vertebral and internal carotid arteries), connecting vessels (anterior communicating, basilar and bilateral posterior communicating arteries) and outflow vessels (anterior, middle and posterior cerebral arteries) were measured and cross‐sectional areas calculated in 51 cadaveric brain specimens. The individual and the average cross‐sectional areas of inflow arteries (51.43 mm2) were significantly bigger than the major outflow arteries (37.76 mm2) but smaller than the combined cross‐sectional areas of outflow (37.76 mm2) and connecting (25.33 mm2) arteries. The difference in the size of arterial cross‐sectional area and the presence of the connecting arteries in the cerebral basal arterial network provides a mechanism for lowering peaks in pressure, and demonstrates a function of the cerebral basal arterial network.

Arthritis patients’ experience and perception of therapeutic gloves

ABSTRACT Therapeutic gloves are widely used to manage arthritis patients’ hand symptoms and improve their hand function, but patients’ experience and perception towards the gloves are poorly understood. This research sought to gain insight into patients’ experience of wearing therapeutic gloves, their perceptions of the gloves and their preference in terms of glove design. Thirty arthritis patients who used therapeutic gloves as part of their rehabilitation treatment were surveyed. Adherence in wearing was good with 80% of the participants wore the gloves up to 8 hours a day. Most respondents found therapeutic gloves were soft to the skin and believed that they were effective. Problems identified included gloves leaving marks on the skin and itchy hands after gloves removal. The key characteristics identified by participants on gloves design will facilitate manufacturers and clinicians to improve the existing gloves in order to enhance its functions, comfort and users’ needs.