Background: the European Working Group on Sarcopenia in Older People has developed a clinical definition of sarcopenia based on low muscle mass and reduced muscle function (strength or performance). Grip strength is recommended as a good simple measure of muscle strength when ‘measured in standard conditions’. However, standard conditions remain to be defined. Methods: a literature search was conducted to review articles describing the measurement of grip strength listed in Medline, Web of Science and Cochrane Library databases up to 31 December 2009. Results: there is wide variability in the choice of equipment and protocol for measuring grip strength. The Jamar hand dynamometer is the most widely used instrument with established test–retest, inter-rater and intra-rater reliability. However, there is considerable variation in how it is used and studies often provide insufficient information on the protocol followed making comparisons difficult. There is evidence that variation in approach can affect the values recorded. Furthermore, reported summary measures of grip strength vary widely including maximum or mean value, from one, two or three attempts, with either hand or the dominant hand alone. Conclusions: there is considerable variation in current methods of assessing grip strength which makes comparison between studies difficult. A standardised method would enable more consistent measurement of grip strength and better assessment of sarcopenia. Our approach is described.

A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach

https://www.acilci.net/wp-content/uploads/2014/02/Guidelines-for-reporting-reliability-and-agreement-studies-GRRAS-were-proposed.pdf

Guidelines for Reporting Reliability and Agreement Studies (GRRAS) were proposed.

Background: Poor muscular strength has been shown to be associated with increased morbidity and mortality in diverse samples of middle-aged and elderly people. However, the oldest old population (i.e., over 85 years) is underrepresented in such studies. Our objective was to assess the association between muscular strength and mortality in the oldest old population. Methods: We included 555 participants (65% women) from the Leiden 85-plus study, a prospective population-based study of all 85-year-old inhabitants of Leiden, Netherlands. We measured the handgrip strength of participants at baseline and again at age 89 years. We collected baseline data on comorbidities, functional status, levels of physical activity, and adjusted for potential confounders. During the follow-up period, we collected data on mortality. Results: During a follow-up period of 9.5 years (range 8.5-10.5 years), 444 (80%) participants died. Risk for all-cause mortality was elevated among participants in the lowest tertile of handgrip strength at age 85 years (hazard ratio [HR] 1.35, 95% confidence interval [CI] 1.00-1.82, p = 0.047) and the lowest two tertiles of handgrip strength at age 89 years (HR 2.04, CI 1.24-3.35, p = 0.005 and HR 1.73, CI 1.11-2.70, p = 0.016). We also observed significantly increased mortality among participants in the tertile with the highest relative loss of handgrip strength over four years (HR 1.72, CI 1.07-2.77, p = 0.026). Interpretation: Handgrip strength, a surrogate measurement of overall muscular strength, is a predictor of all-cause mortality in the oldest old population and may serve as a convenient tool for prognostication of mortality risk among elderly people.

/pdf/handgrip-strength-and-mortality-in-the-oldest-old-population-17n5jhkzh2.pdf

Handgrip strength and mortality in the oldest old population: the Leiden 85-plus study

Objectives This paper reports on a systematic review of the international qualitative research literature on return to work. This review was undertaken in order to better understand the dimensions, processes, and practices of return to work. Because return to work often includes early return before full recovery while a person is undergoing rehabilitation treatment, physical recovery is embedded in complicated ways with workplace processes and practices and social organization. These process-oriented dimensions of return to work are well described in the qualitative literature. Methods This systematic review of the literature covered peer-reviewed papers that focused on musculoskeletal and pain-related injuries and were published in English or French between 1990 and 2003. Findings from papers meeting relevance and quality criteria were synthesized using the meta-ethnographic approach. Results This review found that return to work extends beyond concerns about managing physical function to the complexities related to beliefs, roles, and perceptions of many players. Good will and trust are overarching conditions that are central to successful return-to-work arrangements. In addition, there are often social and communication barriers to return to work, and intermediary players have the potential to play a key role in facilitating this process. Conclusions This paper identifies key mechanisms of workplace practice, process, and environment that can affect the success of return to work. The findings illustrate the contribution that qualitative literature can make to important aspects of implementation in relation to return to work. Key terms meta-ethnographic approach; occupational health; social relations; synthesis; work organization.

Systematic review of the qualitative literature on return to work after injury

Testing grip strength is a popular assessment used by occupational therapists in a range of clinical settings. It is fast, easy to perform, reliable and produces a result which is simple to record. Results of grip strength testing have been used to determine a baseline measure of performance against which change can be compared, as well as comparison of results to normative data. This article reviews the literature associated with the measurement of grip strength. It addresses the purposes of grip strength measurement; the instruments used and their reliability and accuracy; the testing position and protocol suggested for use and aspects of these which may influence results; the use of normative data and factors which influence grip strength, including age, gender and occupation; and various methods to determine level or sincerity of effort. Recommendations are made regarding these issues to enable clinicians to conduct grip strength assessments and interpret the results with confidence.

Handgrip strength testing: A review of the literature

Insufficient evidence of the validity of work-related assessments is frequently reported as a major concern in occupational rehabilitation. Despite this concern, and the continuing development of new and old assessments, no comprehensive evaluation of the evidence has been conducted. OBJECTIVES: The purpose of this study was to first determine the extent and quality of available evidence for the validity of work-related assessments, and then where sufficient evidence was available, determine the level of validity. STUDY DESIGN: This study examined available literature and sources in order to review the extent to which validity has been established for 28 work-related assessments. RESULTS: The levels of evidence and validity are presented for each assessment. Most work-related assessments have limited evidence of validity. Of those that had adequate evidence, validity ranged from poor to good. There was no instrument that demonstrated moderate to good validity in all areas. Very few work-related assessments were able to demonstrate adequate validity in more than one area, or with more than one study, even when contributory evidence was included. CONCLUSION: With this study clinicians will be able to examine their options with regard to the validity of the assessments they choose to use.

Validity of work-related assessments.

Insufficient evidence of the reliability of work-related assessments is a major concern in this area of practice. Despite this concern there has been ongoing development of new assessments, while existing assessments have been revised, modified and updated and others are no longer used or available. OBJECTIVES: The purpose of this study was to determine the extent and quality of evidence for the reliability of work-related assessments. STUDY DESIGN: This study examined available literature and sources in order to review the extent which reliability has been established for 28 work-related assessments. RESULTS: The levels of evidence and reliability are presented for each assessment. This indicates that a number of commercially available work-related assessments have insufficient evidence of reliability. For the limited number of work-related assessments with an adequate level of evidence on which to judge their reliability, most demonstrate a moderate to good level. Few assessments, however, have demonstrated levels of reliability sufficient for clinical (and legal) purposes. CONCLUSION: With this study clinicians will be able to examine their options with regard to the reliability of the assessments they choose to use. Interpretation of changes in test results can be considered in the light of the evidence for the reliability of the instrument used.

Reliability of work-related assessments.

UNLABELLED The literature has focused predominantly on functional capacity evaluations and related clinic-based assessments, however, there is little that examines workplace-based assessment approaches. In Australia, rehabilitation of injured workers occurs in the workplace wherever possible, and it is expected that workplace-based services will increase elsewhere in the future. There is a lack of knowledge, however, of therapists' current practices regarding workplace- and clinic-based work-related assessments. OBJECTIVES The purpose of this study was to understand the current practice of therapists in Australia who are directly involved in conducting work-related assessments. STUDY DESIGN A naturalistic inquiry approach was utilised for this study. In-depth semi-structured interviews were conducted with 26 occupational therapists and physiotherapists representing a spread of geographical locations, organisations, and experience. FINDINGS Participants described three major types of work-related assessments - workplace assessments, functional capacity evaluations (job) and functional capacity evaluations (no job). The types, purposes, and characteristics of work-related assessments were described and influences and constraints identified. Participants described using processes, data sources, methods of data collection and analysis consistent with qualitative methods, although some quantitative methods were also employed. CONCLUSION The findings suggest that the further a work-related assessment moves away from the actual work environment and requirements of a specific job, the greater its level of standardisation and generalisability. Conversely, when work-related assessments occur in the actual work environment, qualitative processes are used, and results are specific and non-generalisable.

Workplace assessments and functional capacity evaluations: current practices of therapists in Australia.

The establishment of a health and safety committee in the workplace and/or the appointment of an elected health and safety representative is believed to foster employee participation and consultation in the workplace. Despite an emphasis within the Australian occupational health and safety legislation towards employee participation in relation to health and safety issues, there is little known about the effectiveness of the strategies used to involve workers in health and safety matters in the workplace. There is anecdotal evidence published in relation to the implementation of health and safety committees and their effectiveness in the Australian workplace. Few opinions however are substantiated by empirical evidence. Significantly more research has been conducted on the role of health and safety representatives in Australia. This paper presents the findings of a review of the literature and identifies the factors that are considered to impact on the effectiveness of workplace health and safety committees and representatives. Several factors are described as being fundamental to the effective performance of committees and representatives. These factors include management commitment, communication, training and information, union involvement, the infrastructure of an organisation, committee processes and the involvement of professional experts. It is concluded that the effectiveness of health and safety committees in Australia is unexplored and it is unknown if these committees achieve the purpose for which they were established. Recommendations are made for future research to be conducted to test the current anecdotal evidence and assumptions associated with the operation and effectiveness of health and safety committees.

Ev Innes

Papers

Handgrip strength testing: A review of the literature

Validity of work-related assessments.

Reliability of work-related assessments.

Workplace assessments and functional capacity evaluations: current practices of therapists in Australia.

Examining the effectiveness of health and safety committees and representatives: A review