Richard W. Bohannon

Reference values for extremity muscle strength obtained by hand-held dynamometry from adults aged 20 to 79 years

OBJECTIVE AND DESIGN Only a few studies have provided reference values for muscle strength obtained by hand-held dynamometry. Such values are essential for establishing the degree to which an individuals strength is impaired. This descriptive study was conducted to provide reference values for the strength of 10 extremity muscle actions. SUBJECTS AND INSTRUMENTATION: A convenience sample of 106 men and 125 women volunteers was tested twice with an Ametek digital hand-held dynamometer. RESULTS The measurements were found to be reliable. Predictive equations are provided for the measurements. Reference values generated are expressed in Newtons and as a percentage of body weight and are organized by gender, decade of age, and side. CONCLUSIONS The values can be employed in a clinical setting to document whether an individual is impaired relative to healthy subjects of the same gender and age.

Reference values for the timed up and go test: a descriptive meta-analysis.

Background and Purpose: The Timed Up and Go (TUG) test is widely employed in the examination of elders, but definitive normative reference values are lacking. This meta‐analysis provided such values by consolidating data from multiple studies. Methods: Studies reporting TUG times for apparently healthy elders were identified through the on‐line search of bibliographic databases. Study specifics and data were consolidated and examined for homogeneity. Results: Twenty‐one studies were included in the meta‐analysis. The mean (95% confidence interval) TUG time for individuals at least 60 years of age was 9.4 (8.9–9.9) seconds. Although the data contributing to this mean were homogeneous, data for individuals who could be categorized by age were more homogeneous. The mean (95% confidence intervals) for 3 age groups were: 8.1 (7.1–9.0) seconds for 60 to 69 year olds, 9.2 (8.2–10.2) seconds for 70 to 79 years, and 11.3 (10.0–12.7) seconds for 80 to 99 years. Conclusions: The reference values presented, though obtained from studies with clear differences, provide a standard to which patient performance can be compared. Patients whose performance exceeds the upper limit of reported confidence intervals can be considered to have worse than average performance.

Hand-grip dynamometry predicts future outcomes in aging adults.

Background and Purpose: One use of clinical measures is the prediction of future outcomes. The purpose of this systematic review was to summarize the literature addressing the value of grip strength as a predictor of important outcomes. Methods: Relevant literature was located using 4 bibliographic databases, searching article reference lists, and perusing personal files. Results: Forty‐five relevant research articles were found. The research involved both healthy subjects and patients; it tended to focus on middle‐aged and older adults. The primary outcome addressed was mortality/survival (24 articles), but disability (9 articles), complications and/or increased length of stay (12 articles), and other outcomes were also examined. Low grip strength was shown consistently to be associated with a greater likelihood of premature mortality, the development of disability, and an increased risk of complications or prolonged length of stay after hospitalization or surgery. Conclusions: Given its predictive validity and simplicity, dynamometrically measured grip strength should be considered as a vital sign useful for screening middle‐aged and older adults.

Treatment Interventions for the Paretic Upper Limb of Stroke Survivors: A Critical Review

Despite a threefold increase in treatment interventions studies during the past 10 years, “best practice” for the rehabilitation of the paretic upper limb is still unclear. This review aims to lessen uncertainty in the management of the poststroke upper limb. Two separate searches of the scientific literature from 1966-2001 yielded 333 articles. Three referees, using strict inclusion and exclusion criteria, selected 68 relevant references. Cohort studies, randomized control trials, and systematic reviews were critically appraised. Mean randomized control trial quality (n = 33) was 17.1/27 (SD = 5.2, 95% CI = 15.2–19.0, range = 6–26). Mean quality of cohort studies (n = 29) was 11.8/27 (SD = 3.8, 95% CI = 10.4–13.2, range = 4–19). Quantitative syntheses were done using theZ-statistic. This systematic review indicated that sensorimotor training; motor learning training that includes the use of imagery, electrical stimulation alone, or combined with biofeedback; and engaging the client in repetitive, novel tasks can be effective in reducing motor impairment after stroke. Furthermore, careful handling, electrical stimulation, movement with elevation, strapping, and the avoidance of overhead pulleys could effectively reduce or prevent pain in the paretic upper limb. Rehabilitation specialists can use this research synthesis to guide their selection of effective treatment techniques for persons with impairments after stroke.

Sit-to-stand test for measuring performance of lower extremity muscles.

When the intent is to quantify performance of lower extremity muscles, the sit-to-stand test is a practical alternative to manual muscle testing and various instrumented options. Several procedures for performing the test are presented in this review as is information relevant to test interpretation. Performance variables known to be associated with sit-to-stand performance are noted.

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.

MUSCLE STRENGTH AND MUSCLE TRAINING AFTER STROKE

For many individuals who have experienced a stroke, muscle weakness is the most prominent impairment. Both the theoretical and statistical relationships between muscle weakness and performance at functional activities suggest that weakness may be an appropriate target for therapeutic interventions. Researchers investigating the outcomes of strengthening regimens after stroke have routinely shown that resistance exercise leads to increased muscle strength, but that strength is typically measured using the same maneuvers that were used in training. Evidence supporting the use of strengthening regimens to reduce limitations in functional activity is equivocal.

Reference Values for the Five-Repetition Sit-to-Stand Test: A Descriptive Meta-Analysis of Data from Elders

This meta-analysis was conducted to generate normative values for the 5-repetition sit-to-stand (STS) test suitable for application to individuals at least 60 years of age. A thorough review of the literature yielded 13 papers (14 studies) relevant to this purpose. After the exclusion of potentially unrepresentative data, meta-analysis of these 13 papers indicated that judgments about normal performance should be based on age. Analysis demonstrated that individuals with times for 5 repetitions of this test exceeding the following can be considered to have worse than average performance: 11.4 sec (60 to 69 years), 12.6 sec. (70 to 79 years), and 14.8 sec. (80 to 89 years).

Reliability and validity of three strength measures obtained from community-dwelling elderly persons.

The purpose of this study was to describe the reliability and validity of 3 strength measures obtained from community-dwelling elderly individuals. The strength of 10 elders was tested initially and 6 and 12 weeks later using the MicroFET 2 hand-held dynamometer (knee extension strength), the Jamar dynamometer (grip strength), and the sit-to-stand (STS) test. Mobility was tested using the timed up-and-go (TUG) test and a timed walk test. Intraclass correlation coefficients, which were used to characterize the reliability of the strength tests, ranged from 0.807 to 0.981. Pearson correlations between the lower extremity strength measures and the TUG and gait speed ranged from 0.635 to 20.943. Our examination of the 3 measures for 12 weeks extends previous evidence of the stability of these strength measures and justifies the use of hand-held dynamometry and the STS test when investigating limitations in mobility.

Standing balance and function over the course of acute rehabilitation

The purpose of this study of 52 acute rehabilitation patients was to describe the reliability and responsiveness of measurements of standing balance and function and to establish the relationships between the measurements over the course of rehabilitation. Standing balance was measured with a seven-level (0 through 6) ordinal scale. Three functional activities (chair to mat transfer, locomotion, and stair climbing) were measured using Functional Independence Measure (FIM) scores. Balance and FIM scores were found to be reliable (weighted kappa > .85). Balance and FIM scores increased significantly (p < .000) between initial and final assessments (mean interval = 17.5 days). All FIM scores were correlated significantly, both cross-sectionally (rs = .444 to .774) and longitudinally (rs = .279 to .616), with balance. Moreover, changes in FIM scores were correlated significantly with changes in balance (rs = .413 to .595). The results of this study support the use of the ordinal balance scale described herein in an acute rehabilitation setting.