When I was working in an outpatient setting, I would rummage through the bottom drawer and pull out our dynamometer whenever I had a patent who had suffered a CVA.
I would document grip strength, check it against normative data, write a goal related to strengthening, and move on.
I had no idea the implications of the data I was collecting.
There is new research out about why occupational therapists working with adults should always keep a dynamometer strapped to their OT utility belt.*
*I don't think "OT utility belts" exist, but they should.
The Prognostic Value of Grip Strength for Stroke and Heart Attack
"Grip strength is a strong predictor of cardiovasuclar death and a moderately strong predictor of cardiovascular incident." This research nugget is part of a study recently published in Lancet: “Prognostic value of Grip strength: findings from the Urban Rural Epidemiology (PURE) study.”
The researchers assessed community based adults, ages 35-75, for grip strength and other health factors then followed up 4 years later. After controlling for other variables, the scientists calculated that each 11-pound decrease in grip strength was associated with a 17 percent increased risk of cardiovascular death, a 7 percent increased risk of heart attack and a 9 percent increased risk of stroke.
Why the Research is Compelling
Previous studies had already documented the prognostic value of grip strength, but only in male, high-income populations.
The PURE study was large and longitudinal. 142,861 participants were enrolled in the study. They were from 17 countries, and came from various income and sociocultural settings.
This study demonstrates that the results are generalizable for people of both sexes of a wide age range and living in countries of all income strata.
Implications for OT Evaluations
Measuring grip strength was already a nice addition to an OT eval, because the test is reliable, valid, and has handy norms for comparison.
But, now this data puts you in a position to start discussions about the prognostic value of these numbers. It gives weight to the importance of treatment for poor grip strength.
When documenting, this study also gives evidence based justification for addressing poor grip strength through resistive exercise. (Note: More research is needed about how precisely to improve outcomes for people with poor hand strength, but at least this is a start!)
What Not to Document
UE weakness may be indicative of an increased fall risk.-- An interesting finding from the study was that no strong association was found between grip strength and the risk of injury from a fall. This is a good reminder that grip strength is not a good predictor of LE strength, that muscle strengthening alone may not improve balance, and that falls are complex.
Poor grip strength may cause...-- Leave the word "cause" out of your vocabulary on this one. This study is only addressing associations.
Need some more reasons to strap the dynamometer to your OT utility belt? You can access these articles on Proquest through MyNBCOT.
- Does admission grip strength predict length of stay in hospitalised older patients?
- Hand-Grip Dynamometry Predicts Future Outcomes in Aging Adults
- Hand-grip strength cut points to screen older persons at risk for mobility limitation
- Hand grip strength: outcome predictor and marker of nutritional status