Evaluation of the hand grip dynamometer as a tool for nutritional assessment.

Abstract

The purpose of this study was to explore utility of handgrip strength measured by the hand-grip dynamometer for assessment of nutritional status in protein-calorie malnutrition. The first study included six subjects (all right-handed), who had grip strength measured daily for five days, then weekly for three weeks. Intra-individual variability was approximately 10%. No learning or training effect was observed. Change in leg position from feet on the floor to elevation of feet made no significant difference in grip-strength measurement. In Phase Two, 43 healthy adult subjects (three left-handed) prior to elective surgery, height was significantly related to handgrip strength (r = 0.82, p < 0.001). Males were stronger than females. After surgery, the non-dominant hand lost significant strength (2.68 kilograms) and recovered more quickly than the dominant hand. Multiple regression analyses provided predictive equations for pre-surgery left hand-grip strength using age, sex, and height (R² = 0.77); from age, sex, hand measured, and grip strength two days after surgery or three days after surgery (R² = 0.89 for each). Ten sequential grip-strength measurements analyzed by repeated measures analysis of variance with orthogonal comparisons showed a difference in measurements between hands as well as before and after surgery. The slope of the measurement line was more linear before and three days after surgery, but more quadratic in shape two days after surgery. The effects seen by type of surgery were inversion of the slope of right hand sequential measurements two days after knee surgery and before-surgery drop and increase from trial five to trial seven in left hand sequential measurements of knee and vaginal hysterectomy subjects. In a six-month-long case study, grip-strength measurements were followed in a seriously-ill 68-year-old patient hospitalized for surgical repair of hiatal hernia and mucous fistula who underwent several periods of nutritional depletion. Grip strength varied throughout the period (although not differently from healthy subjects), but did not directly parallel changes in serum albumin or prealbumin. The conclusion was that hand strength measured by the handgrip dynamometer did not change enough with fasting and surgery from normal day-to-day variability to be useful for nutritional assessment.