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What is the Minimum Clinically Important Difference in Grip Strength?

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

A CORR Insights to this article was published on 10 July 2014

Abstract

Background

Grip strength reflects functional status of the upper extremity and has been used in many of the clinical studies regarding upper extremity disease or fracture. However, the smallest difference in grip strength that a patient would notice as an improvement resulting from treatment (defined as the minimum clinically important difference [MCID]), to our knowledge has not been determined.

Questions/purposes

We asked (1) how 1-year postsurgery grip strength compares with preinjury values; (2) if grip strength correlated with patient’s ratings; (3) what the MCID is in the grip strength; and (4) if these values are equivalent to or greater than what can be explained by measurement errors in patients treated for distal radius fracture.

Methods

Fifty patients treated by volar locking plate fixation for a distal radius fracture constituted the study cohort. Grip strengths were measured 1 year after surgery on the injured and uninjured sides using a dynamometer. Grip strengths before injury were estimated using the grip strengths of the uninjured side with consideration of hand dominance. Patients were asked to rate their subjective level of grip strength weakness at 1 year postoperatively. Receiver operator characteristic curve analysis was used to determine MCIDs. Minimal detectable change in grip strength, which is a statistical estimate of the smallest change between two measurement points expected by measurement error or chance alone, also was determined using the formula 1.65 × √2 × standard error of measurement.

Results

One year after surgery, grip strength (23 kg; 95% CI, 20–27) was less compared with calculated preinjury values (28 kg; 95% CI, 25–31; p < 0.001). Patients’ rating of grip strength and measured grip strength changes correlated well (p = 0.56). MCIDs were 6.5 kg for grip strength and 19.5% for percentage grip strength. The MCID was not less than the minimum detectable change for grip strength (also 6.5 kg).

Conclusions

The MCID of the grip strength was a decrease of 6.5 kg (19.5%). We believe the MCID of grip strength is useful for evaluating effectiveness of new treatments and for determining appropriate sample size in clinical trials of distal radius fractures.

Level of Evidence

Level III diagnostic study. See the Instructions for Authors for a complete description of levels of evidence.

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References

  1. Arora R, Lutz M, Deml C, Krappinger D, Haug L, Gabl M. A prospective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients sixty-five years of age and older. J Bone Joint Surg Am. 2011;93:2146–2153.

    PubMed  Google Scholar 

  2. Balogun JA, Akomolafe CT, Amusa LO. Grip strength: effects of testing posture and elbow position. Arch Phys Med Rehabil. 1991;72:280–283.

    CAS  PubMed  Google Scholar 

  3. Bohannon RW, Schaubert KL. Test-retest reliability of grip-strength measures obtained over a 12-week interval from community-dwelling elders. J Hand Ther. 2005;18:426–427.

    Article  PubMed  Google Scholar 

  4. Crosby CA, Wehbe MA, Mawr B. Hand strength: normative values. J Hand Surg Am. 1994;19:665–670.

    Article  CAS  PubMed  Google Scholar 

  5. Dawson J, Doll H, Boller I, Fitzpatrick R, Little C, Rees J, Carr A. Comparative responsiveness and minimal change for the Oxford Elbow Score following surgery. Qual Life Res. 2008;17:1257–1267.

    Article  PubMed  Google Scholar 

  6. Dawson J, Doll H, Coffey J, Jenkinson C. Responsiveness and minimally important change for the Manchester-Oxford foot questionnaire (MOXFQ) compared with AOFAS and SF-36 assessments following surgery for hallux valgus. Osteoarthritis Cartilage. 2007;15:918–931.

    Article  CAS  PubMed  Google Scholar 

  7. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996;29:602–608.

    Article  CAS  PubMed  Google Scholar 

  8. Katz JN, Fossel KK, Simmons BP, Swartz RA, Fossel AH, Koris MJ. Symptoms, functional status, and neuromuscular impairment following carpal tunnel release. J Hand Surg Am. 1995;20:549–555.

    Article  CAS  PubMed  Google Scholar 

  9. Kim JK, Jeon SH. Minimal clinically important differences in the Carpal Tunnel Questionnaire after carpal tunnel release. J Hand Surg Eur Vol. 2013;38:75–79.

    Article  CAS  PubMed  Google Scholar 

  10. Kim JK, Park ES. Comparative responsiveness and minimal clinically important differences for idiopathic ulnar impaction syndrome. Clin Orthop Relat Res. 2013;471:1406–1411.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Klum M, Wolf MB, Hahn P, Leclere FM, Bruckner T, Unglaub F. Normative data on wrist function. J Hand Surg Am. 2012;37:2050–2060.

    Article  PubMed  Google Scholar 

  12. Leopold SS. Editor’s spotlight/take 5: Comparative responsiveness and minimal clinically important differences for idiopathic ulnar impaction syndrome. Clin Orthop Relat Res. 2013;471:1403–1405.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Levine DW, Simmons BP, Koris MJ, Daltroy LH, Hohl GG, Fossel AH, Katz JN. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am. 1993;75:1585–1592.

    CAS  PubMed  Google Scholar 

  14. MacDermid JC. Development of a scale for patient rating of wrist pain and disability. J Hand Ther. 1996;9:178–183.

    Article  CAS  PubMed  Google Scholar 

  15. Petersen P, Petrick M, Connor H, Conklin D. Grip strength and hand dominance: challenging the 10% rule. Am J Occup Ther. 1989;43:444–447.

    Article  CAS  PubMed  Google Scholar 

  16. Scheer JH, Adolfsson LE. Radioulnar laxity and clinical outcome do not correlate after a distal radius fracture. J Hand Surg Eur Vol. 2011;36:503–508.

    Article  CAS  PubMed  Google Scholar 

  17. Stratford PW, Binkley JM, Riddle DL. Health status measures: strategies and analytic methods for assessing change scores. Phys Ther. 1996;76:1109–1123.

    CAS  PubMed  Google Scholar 

  18. Stucki G, Daltroy L, Liang MH, Lipson SJ, Fossel AH, Katz JN. Measurement properties of a self-administered outcome measure in lumbar spinal stenosis. Spine (Phila Pa 1976). 1996;21:796–803.

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Acknowledgments

We thank Kyoung Ae Gong MD, PhD, of the Department of Preventive Medicine for help and advice regarding the statistical analysis and Jung Mee No BD, for performing the physical examinations and collecting the patients’ questionnaires.

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Authors and Affiliations

  1. Department of Orthopedic Surgery School of Medicine, Ewha Womans University, Seoul, Korea

    Jae Kwang Kim MD, PhD

  2. Ewha Womans University Medical Center, 911-1 Mok-6-dong, Yangcheon-gu, Seoul, 158-710, Korea

    Jae Kwang Kim MD, PhD

  3. Department of Orthopedic Surgery, Ewha Womans University Medical Center, Seoul, Korea

    Min Gyue Park MD & Sung Joon Shin MD

Authors
  1. Jae Kwang Kim MD, PhD
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  2. Min Gyue Park MD
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  3. Sung Joon Shin MD
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Corresponding author

Correspondence to Jae Kwang Kim MD, PhD.

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Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Kim, J.K., Park, M.G. & Shin, S.J. What is the Minimum Clinically Important Difference in Grip Strength?. Clin Orthop Relat Res 472, 2536–2541 (2014). https://doi.org/10.1007/s11999-014-3666-y

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  • DOI: https://doi.org/10.1007/s11999-014-3666-y

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