Reliability and validity of an enhanced paper grip test; A simple clinical test for assessing lower limb strength

Panagiotis E. Chatzistergos; Aoife Healy; Gayathri Balasubramanian; Lakshmi Sundar; Ambady Ramachandran; Nachiappan Chockalingam

doi:10.1016/j.gaitpost.2020.07.011

Reliability and validity of an enhanced paper grip test; A simple clinical test for assessing lower limb strength

Panagiotis E. Chatzistergos, Aoife Healy, Gayathri Balasubramanian, Lakshmi Sundar, Ambady Ramachandran, Nachiappan Chockalingam

Research output: Contribution to journal › Article › peer-review

11 Citations (Scopus)

Abstract

Background

The paper-grip-test (PGT) involves pulling a small card from underneath the participant's foot while asking them to grip with their hallux. The PGT is shown to be effective in detecting foot muscle-weakening but its outcome is operator-dependent. To overcome this limitation, an enhanced PGT (EPGT) is proposed that replaces the pass/fail outcome of the PGT with a continuous measurement of the pulling force that is needed to remove the card (EPGT-force).

Research question

Is the EPGT-force an accurate, reliable and clinically applicable measurement of strength?

Methods

Reliability and clinical applicability were examined in two ways. Firstly, two examiners measured EPGT-force for twenty healthy volunteers in a test/retest set-up. EPGT force was measured using a dynamometer, the hallux grip force was measured using a pressure mat. The clinical applicability of the EPGT was tested in ten people with diabetes. Postural sway was also measured.

Results

Interclass correlation coefficients (ICC) revealed excellent inter-rater reliability (ICC > 0.75). Intra-rater reliability was excellent for the first examiner (ICC = 0.795) and good for the second (ICC = 0.703). Linear regression analysis indicated that hallux grip force accounted (on average) for 83 %±4 % of the variability in EPGT force. This strong relationship between EPGT force and hallux grip force remained when the test was performed in a clinical setting with the latter accounting for 88 % in EPGT force variability. Spearman rank order correlation showed that people with diabetes with a higher difference in EPGT force between limbs swayed more. Significance: EPGT force is a reliable and accurate measurement of hallux grip force. Hallux grip force was previously found to be strongly correlated to the strength of all muscle groups of the foot and ankle and to the ability to maintain balance. The proposed EPGT could be used to monitor muscle weakness in clinics for better falls-risk assessment.

Original language	English
Pages (from-to)	120-125
Number of pages	6
Journal	GAIT and POSTURE
Volume	81
Early online date	16 Jul 2020
DOIs	https://doi.org/10.1016/j.gaitpost.2020.07.011
Publication status	Published (in print/issue) - 1 Sept 2020

Bibliographical note

Publisher Copyright:
© 2020 Elsevier B.V.

Keywords

Accidental falls
Ankle
Foot
Muscle strength dynamometer
Postural balance

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.gaitpost.2020.07.011

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title = "Reliability and validity of an enhanced paper grip test; A simple clinical test for assessing lower limb strength",

abstract = "BackgroundThe paper-grip-test (PGT) involves pulling a small card from underneath the participant's foot while asking them to grip with their hallux. The PGT is shown to be effective in detecting foot muscle-weakening but its outcome is operator-dependent. To overcome this limitation, an enhanced PGT (EPGT) is proposed that replaces the pass/fail outcome of the PGT with a continuous measurement of the pulling force that is needed to remove the card (EPGT-force). Research question Is the EPGT-force an accurate, reliable and clinically applicable measurement of strength? MethodsReliability and clinical applicability were examined in two ways. Firstly, two examiners measured EPGT-force for twenty healthy volunteers in a test/retest set-up. EPGT force was measured using a dynamometer, the hallux grip force was measured using a pressure mat. The clinical applicability of the EPGT was tested in ten people with diabetes. Postural sway was also measured. Results Interclass correlation coefficients (ICC) revealed excellent inter-rater reliability (ICC > 0.75). Intra-rater reliability was excellent for the first examiner (ICC = 0.795) and good for the second (ICC = 0.703). Linear regression analysis indicated that hallux grip force accounted (on average) for 83 %±4 % of the variability in EPGT force. This strong relationship between EPGT force and hallux grip force remained when the test was performed in a clinical setting with the latter accounting for 88 % in EPGT force variability. Spearman rank order correlation showed that people with diabetes with a higher difference in EPGT force between limbs swayed more. Significance: EPGT force is a reliable and accurate measurement of hallux grip force. Hallux grip force was previously found to be strongly correlated to the strength of all muscle groups of the foot and ankle and to the ability to maintain balance. The proposed EPGT could be used to monitor muscle weakness in clinics for better falls-risk assessment.",

keywords = "Accidental falls, Ankle, Foot, Muscle strength dynamometer, Postural balance",

author = "Chatzistergos, {Panagiotis E.} and Aoife Healy and Gayathri Balasubramanian and Lakshmi Sundar and Ambady Ramachandran and Nachiappan Chockalingam",

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AU - Chatzistergos, Panagiotis E.

AU - Healy, Aoife

AU - Balasubramanian, Gayathri

AU - Sundar, Lakshmi

AU - Ramachandran, Ambady

AU - Chockalingam, Nachiappan

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Y1 - 2020/9/1

N2 - BackgroundThe paper-grip-test (PGT) involves pulling a small card from underneath the participant's foot while asking them to grip with their hallux. The PGT is shown to be effective in detecting foot muscle-weakening but its outcome is operator-dependent. To overcome this limitation, an enhanced PGT (EPGT) is proposed that replaces the pass/fail outcome of the PGT with a continuous measurement of the pulling force that is needed to remove the card (EPGT-force). Research question Is the EPGT-force an accurate, reliable and clinically applicable measurement of strength? MethodsReliability and clinical applicability were examined in two ways. Firstly, two examiners measured EPGT-force for twenty healthy volunteers in a test/retest set-up. EPGT force was measured using a dynamometer, the hallux grip force was measured using a pressure mat. The clinical applicability of the EPGT was tested in ten people with diabetes. Postural sway was also measured. Results Interclass correlation coefficients (ICC) revealed excellent inter-rater reliability (ICC > 0.75). Intra-rater reliability was excellent for the first examiner (ICC = 0.795) and good for the second (ICC = 0.703). Linear regression analysis indicated that hallux grip force accounted (on average) for 83 %±4 % of the variability in EPGT force. This strong relationship between EPGT force and hallux grip force remained when the test was performed in a clinical setting with the latter accounting for 88 % in EPGT force variability. Spearman rank order correlation showed that people with diabetes with a higher difference in EPGT force between limbs swayed more. Significance: EPGT force is a reliable and accurate measurement of hallux grip force. Hallux grip force was previously found to be strongly correlated to the strength of all muscle groups of the foot and ankle and to the ability to maintain balance. The proposed EPGT could be used to monitor muscle weakness in clinics for better falls-risk assessment.

AB - BackgroundThe paper-grip-test (PGT) involves pulling a small card from underneath the participant's foot while asking them to grip with their hallux. The PGT is shown to be effective in detecting foot muscle-weakening but its outcome is operator-dependent. To overcome this limitation, an enhanced PGT (EPGT) is proposed that replaces the pass/fail outcome of the PGT with a continuous measurement of the pulling force that is needed to remove the card (EPGT-force). Research question Is the EPGT-force an accurate, reliable and clinically applicable measurement of strength? MethodsReliability and clinical applicability were examined in two ways. Firstly, two examiners measured EPGT-force for twenty healthy volunteers in a test/retest set-up. EPGT force was measured using a dynamometer, the hallux grip force was measured using a pressure mat. The clinical applicability of the EPGT was tested in ten people with diabetes. Postural sway was also measured. Results Interclass correlation coefficients (ICC) revealed excellent inter-rater reliability (ICC > 0.75). Intra-rater reliability was excellent for the first examiner (ICC = 0.795) and good for the second (ICC = 0.703). Linear regression analysis indicated that hallux grip force accounted (on average) for 83 %±4 % of the variability in EPGT force. This strong relationship between EPGT force and hallux grip force remained when the test was performed in a clinical setting with the latter accounting for 88 % in EPGT force variability. Spearman rank order correlation showed that people with diabetes with a higher difference in EPGT force between limbs swayed more. Significance: EPGT force is a reliable and accurate measurement of hallux grip force. Hallux grip force was previously found to be strongly correlated to the strength of all muscle groups of the foot and ankle and to the ability to maintain balance. The proposed EPGT could be used to monitor muscle weakness in clinics for better falls-risk assessment.

KW - Accidental falls

KW - Ankle

KW - Foot

KW - Muscle strength dynamometer

KW - Postural balance

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ER -

Reliability and validity of an enhanced paper grip test; A simple clinical test for assessing lower limb strength

Abstract

Bibliographical note

Keywords

UN SDGs

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