Normative Value of Grip Strength and Pinch Strength of Elderly Population in Dakshina

RESEARCH PROPOSAL

NORMATIVE VALUE OF GRIP STRENGTH AND PINCH STRENGTH OF ELDERLY POPULATION IN DAKSHINA KANNADA DISTRICT

MPT (MUSCULOSKELETAL AND SPORTS PHYSIOTHERAPY)

MS.NEETHU.M. JOSEPH

DEPARTMENT OF PHYSIOTHERAPY

FR. MULLER MEDICAL COLLEGE

MANGALORE-575002

Rajiv Gandhi University of Health Science, Karnataka, Bangalore

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. / NAME OF THE CANDIDATE AND ADDRESS: / NEETHU. M. JOSEPH
DEPT. OF PHYSIOTHERAPY
FATHERMULLERMEDICALCOLLEGE
KANKANADY,
MANGALORE-575002
2. / NAME OF THE INSTITUTION / FATHERMULLERMEDICALCOLLEGE
3. / COURSE OF THE STUDY AND SUBJECT: / MASTER OF PHYSIOTHERAPY
(MUSCULOSKELETAL AND SPORTS PHYSIOTHERAPY)
4. / DATE OF ADMISSION TO COURSE: / 23.07.2012
5. / TITLE OF THE TOPIC:
NORMATIVE VALUE OF GRIP STRENGTH AND PINCH STRENGTH OF ELDERLY POPULATION IN DAKSHIN KANNADA DISTRICT
6 / BRIEF RESUME OF INTENDED WORK
6.1 NEED FOR THE STUDY
Hand grip is an important component of human function. It involves grasping of objects between any two surface of the hand.1And it is a unique feature in human and primates. It enables human to perform activities ranging from fine motor activities to carrying heavy loads and manipulating objects.
Effective function of hand and adequate grip strength is important in accomplishing activities of daily living. Grip strength is important for holding heavy and light objects in hand, pinch strength is important in fine motor activities. And can be used to identify and predict all kinds of morbidities and mortalities of middle age and old age,also helps to predict the general health condition and disability.2,3,4 In rheumatoid arthritis grip strength is a tool used for measuring disability. In older population grip strength is used for evaluation of chances of fall, fracture, bone mineral density and function of skeletal muscle.3, 5, 6, 7
It is a simple measure which is easy to perform and is less time consuming but provides valuable information regarding health and disability in elderly8. Grip and pinch strength test are easy to understand by patients with demonstration. These tests do not cause any harm to the patient and it indicates the functional status and strength of the entire upper limb and also any motor and neurological deficits. As these deficits are common in elderly a measure of hand grip strength will help to evaluate and quantify the gradual progression of neurological and motor conditions.9 In elderly age, sex and body dimensions like height and weight also influence grip strength. Few studies have identified significant positive correlation between hand grip and BMI.10 So the measurements of these parameters are important in measuring grip.
Elderly population of Asia has a high risk of chronic diseases because of the genetic composition and environmental factors. It may contribute to lowering the grip strength and impair the capacity for independent activities of daily living.10 Many population based studies are done on hand grip strength concluded that there are variations in grip strength and pinch strength with variation in geographical location. So the normative values of western population cannot be used in India.11, 12
Normative values are not available for Indian elderly. It is necessary to have a normative value for identifying the impairment in grip strength. Also literature is less in South India regarding grip strength and pinch strength in elderly. So the current study is significant in assessing the grip and pinch strength in elderly.
RESEARCH QUESTION
What is the normative value of grip strength and pinch strength in elderly population of Dakshina Kannada district?
HYPOTHESIS(H1)
To establish a normative value of grip strength of elderly population in Dakshina Kannada district, Karnataka.
To identify the correlation between BMI, age, gender and grip strength in elderly population.
OPERATIONAL DEFINITION
Elderly population: Male and female of age of 60 and above of Dakshina Kannada district of Karnataka in India.
6.2REVIEW OF LITERATURE:
Prehension activities involve holding of objects between any two surfaces of the hand. It is classified into power grip using entire hand and precision handling using fingers and thumb. Power grip is a result of forceful contraction of fingers and precision is the skillful placing of objects between fingers and thumb.1 Power grip can be assessed using hand dynamometer and precision strength can be assessed using pinch gauge. Jamar dynamometer is a reliable and accurate tool for measuring grip strength13
There are several studies done on the grip strength in elderly. Normative values of grip strength in different age groups are done in different population.
Desrosiers et alconducted a study on normative data for grip strengthof Canadian elderly men and women in 1995. Grip strength measure was done in 360 subjects of age 60 and above using Jamar dynamometer and Martin Vigorimeter. The results of the study showed it is important to measure hand circumference, body height, age and gender, when comparing grip strength to that of a population without disability. 9
Bohannon et al conducted a meta-analysis to obtain a average grip strength using data obtained by Jamar dynamometer in individuals of age of 75 years or more. 7 relevant studies done in USA, Australia and Canada were used for the study. The provided a standardized value which can be used for elderly population of similar age group.14
Studies on grip strengths have pointed out the significant correlation of grip strength with age, gender and body dimensions. Grip strength also varies in different geographical locations which can be explained by genetics.15
Shechtman and colleagues included 832 elderly with functional limitations for grip strength measurement using Jamar dynamometer in 2004. They concluded that age is not a contributing factor for reduced grip strength in frail elderly, but the associated motor or cognitive impairment contributes to impairment in grip strength.16
Sasaki et al conducted a study in Japan on middle aged and elderly person about the significance of grip strength in predicting cause specific mortality. 4912 individuals participated in the study. They concluded that grip strength is an accurate predictor of mortality.2
A curvilinear relationship was obtained of grip and pinch strength with age in a study done in Swiss population of age between 18 and 19 years.12
An Indian study done by Prakash and colleagues on the relationship of body dimensions and nutritional status on hand grip strength on elderly concluded that age, gender, body dimensions like height, weight, forearm circumference, skin fold are factors that can influence hand grip strength in elderly.17
Sindhu and colleaguesconducted a study in India on significance of grip strength on geriatric rehabilitation in assessing and predicting physical disability. The participants of the study were of the age 60 years or above. The article mentioned about the need for conducting studies in Indian population to establish population specific normative values. They concluded that grip strength measurement is a simple, less time consuming and safe procedure to assess disability in elderly.8
6.3) OBJECTIVES OF THE STUDY

To establish normative value of grip strength and pinch strength in elderly..
To identify the correlation between age, gender, BMI and grip strength.

7. / MATERIALS AND METHODS
7.1SOURCE OF DATA
Elderly population of age above 60 years will be recruited from old age homes, hospitals and public places
7.2 METHOD OF COLLECTION OF DATA INCLUDING SAMPLING PROCEDURE
The participants of the study will be recruited according to the inclusion and exclusion criteria. Informed consent will be signed by the participants.
STUDY DESIGN: Cross sectional study
SAMPLING TECHNIQUE: Convenience sampling.
SAMPLE SIZE: 200
INCLUSION CRITERIA

Male and female elderly population of age 60 years or more
Left and right dominant individuals

EXCLUSION CRITERIA

Musculoskeletal pain in upper limb
Neurological disorders that affect upper limb function
ROM deficit in upper extremity
Cervical pain

STATISTICAL ANALYSIS
Collected data will be analyzed using mean and standard deviation with confidence interval and t test. The correlation between age, gender and BMI with grip strength will be obtained by using Karl Pearson correlation coefficient.
TOOL OF THE STUDY

Baseline dynamometer

Weighing scale
Stadiometer
Pinch Gauge

STUDY DURATION- 3months
PROCEDURE:
Procedures will be explained and demonstrated and the following measures will be taken from all the participants.

Hand gripmeasure will be done using Jamar dynamometer. The participant will be standard position recommended by American Society of Hand Therapist,in sitting position with shoulder in adduction and neutral rotation, elbow in flexion of 90 degrees with wrist and forearm in neutral position.13, 18The participant will be asked to hold the Jamar dynamometer19 and asked to use maximum force of hand squeeze around the dynamometer. Patient will be encouraged to squeeze with more force. The procedure will be demonstrated by the examiner.The hand grip strength will be recorded in kilograms. Test will be done on the dominant limb and then the non dominant limb. Three trials will be performed alternating one hand to the other and 15 seconds rest will be given between each trail. Average of the three trails will be taken.

Body Mass Index: Itwill be calculated using height and body weight using;

BMI = weight (kg)\ Height2(cm2)

Height: Participants will be asked standwithout bending knees, hips, spine and head in neutral position, close to wall barefooted. The stadiometer will be attached vertically to the wall. Height will be measured in centimeters.

Weight: Participant will be made to stand on the weighing machinebarefooted and erect, body weight will be measured in kilograms

Pinch Strength: It will be measured using pinch gauge. Patient will be high sitting.3 pinch strength –key pinch,three fingered pinch and finger tip pinch will be tested with the instrument in a standard position.Testing position will be shoulder adducted and neutral rotation, elbow flexed to 90degrees and forearm in mid prone position and wrist between 0 and 30 degrees of extension and 15 degrees of ulnar deviation. Three trials will be done and average of the three trials will be taken.20, 19

Key pinch: Pinch force between the pad of the thumband the lateral aspect of the index finger will be measured using pinch gauge. The pinch gauge is positioned between the thumb pulp and the lateral aspect of the middle phalanx of the index finger. Maximum force will be used to squeeze the Pinch gauge with upper extremity in the position as mentioned above.
Three fingered pinch:The pinch gauge is positioned between the subject's thumb pulp and the pulps of the index and middle fingers. . Maximum force will be used to squeeze the Pinch gauge with upper extremity in the position as mentioned above
Finger tip pinch: Finger tip pinch, produced by opposing thumb and forefinger pulps. Pinch gauge will be positioned between thump and finger tip. It will be squeezed with maximum force with upper extremities in the position as mentioned as above.
7.3 Does the study require any investigation or intervention to be conducted on patients or animals?
Yes
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
Yes. Copy attached.
8. REFERENCES:

Lavangie PK, Norkin CC Joint structure and function a comprehensive analysis.4, Philadelphia, Jaypee publishers;2006.
Sasaki H, Kasagi F, Yamanda M, Fugita S. Grip strength predicts cause specific mortality in middle aged and elderly persons. The American Journal of Medicine. 2007; 120(4): 337-342.
Angst F, Dreruo S, Werle S, Herren DB, Simmen BR, GoldhahnJ.Prediction of grip and key pinch strength in 978 healthy subjects.BMC Musculoskeletal Disorders, 2010, 11:94.
Shetty CS, Prakandy SG, Nagaraja S. Influence of various anthropometric parameters on handgrip strength and endurance in young males and females. Int J Biol Med Res, 2012; 3(3): 2153- 2157.
Vaz M, Hunsberger S, Diffey B. Prediction equations for handgrip strength in healthy Indian male and female subjects encompassing a wide age range. Ann Hum Biol. 2002;29(2):131-41.
Norman K, Stobacus N, Gonzalez MC, Schulzke JD, Pirlich M. Hand grip strength: Outcome predictor and marker of nutritional status. Clinical Nutrition. 2011, 30: 135-142.
Koley S, Kaur N, Sandhu JS. A Study on Hand Grip Strength in Female Labourers ofJalandhar, Punjab, India. J Life Sci. 2009,1(1): 57-62.
Vijayakumar S, Borah D, Sing U. Significance of grip strength in geriatric rehabilitation, a pilot study. IJPMR 2006, April; 17 (1): 5-7.
Desrosiers J, Bravo G, Hebert R, Dutil E. Normative Data for Grip Strength of Elderly Men and Women .The American Journal of Occupational Therapy. 1995, July; 49(7):637-644.

Ebrahim S, Patel N, Coats M, Greig C, Gilley J, Bangham C, Stacey S. Prevalance and severity of morbidity among Gujarati Asian elders: a controlled comparison.

FamPract. 1991;8(1):57-62.

T Kamarul, TS Ahmad. Hand grip strength in the adult Malaysian population. Journal of Orthopaedic Surgery, 2006; 24(2): 172-7.
Werle S, Drerup S, Goldhahn J, Simmen BR, Sprott H, Herren DB. Age and Gender Specific Normative Data of Grip and Pinch Strength in a Healthy Adult Swiss Population. J Hand SurgEur. 2009; 34 (1):76-84.
Hanten WP. Maximum grip strength in normal subjects from 20 to 64 years of age. 1999, July, 12: 193-200.
Bohannon RW, Lehman JB, Desrosier J, Westropp NM, Mathiowetz V. Average grip strength: a meta-analysis of dataobtained with a jamar dynamometer from individuals of 75 years or more of age.Journal of Geriatric Physical Therapy. 2007; 30:28-30.
Koley S, Melton S. Age-related changes in handgrip strength among healthy Indian males and females aged 6-25 years. J Life Sci, 2010, 2(2): 73-80.
Shechtman O, Mann WC, Justiss MD, Tomita M. Grip strength in the frail elderly.Am J Phys Med Rehabil. 2004; 83(11):819-26.
Dhara PC, Sengupta P, SujayaD.Hand grip strength of older persons in relation to bodydimensions and nutritional status. Journal of The Indian Academy of Geriatrics, 2011; 7(4): 143-149.
Kuzala EA, Vargo MC. The relationship elbow position and grip strength. The American Journal of Occupation therapy, 1992; 46(6): 509-512.
Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M, Rogers S. Grip and pinch strength: Normative data. Arch Phys Med Rehabil, 1985;66: 69-74.
Ziv E, Patish H, Dvir Z. Grip and pinch strength in healthy subjects and patients with primary osteoarthritis of the hand: a reproducibility study.The Open Orthopaedics Journal, 2008, 2: 86-90.

9. / SIGNATURE OF CANDIDATE
10. / REMARK OF THE GUIDE
11. / NAME AND DESIGNATION OF
11.1 GUIDE / MRS. KAVITHA VISHAL
ASSISTANTPROFESSOR
DEPT OF PHYSIOTHERAPY
11.2SIGNATURE
11.3CO-GUIDE
11.4SIGNATURE
11.5 NAME OF THE HEAD OF THE DEPARTMENT / MR. NARASIMMAN S.
PROFESSOR
11.6 SIGNATURE
12. / 12.1 REMARKS OF THE CHAIRMAN & PRINCIPAL
12.2SIGNATURE

APPENDIX- I

PROFORMA

Name: Age: Gender :

Hand dominance:

Date of birth Date of evaluation:

Body height (CM): Body weight (KG):

BMI:

RIGHT HAND / LEFT HAND
Grip strength / Trial 1 / Trail 2 / Trail 3 / Trail 1 / Trail 2 / Trail 3
Average
Pinch Strength / Trail 1 / Trial 2 / Trial 3 / Trial 1 / Trial 2 / Trial 3
1. Finger tip pinch
2. Key pinch
3. Three fingered pinch
Average

APPENDIX II

CONSENT FORM

I______hereby agree to provide my fullest consent and cooperation a subject for the dissertation work of Ms. Neethu. M. Joseph titled “Normative value of grip strength and pinch strength of elderly population in Dakshina Kannada District, Karnataka, India as a part of her post graduation in physiotherapy. The question and queries I have posed have been answered to my satisfaction and I am aware that my identity will be kept confidential. I am also aware that I can discontinue the study at any time I wish to do.

Date:

Place: Signature: