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.

中文翻译：

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增强的纸张抓握力测试的可靠性和有效性；用于评估下肢力量的简单临床测试。

背景

纸握测试（PGT）涉及从参与者的脚下拉出一张小卡片，同时要求参与者握住拇指。PGT被证明可有效检测足部肌肉的衰弱，但其结果取决于操作者。为克服此限制，提出了一种增强型PGT（EPGT），该功能可以通过连续测量移除卡所需的拉力（EPGT力）来代替PGT的通过/失败结果。

研究问题

EPGT-force是否是一种准确，可靠且可在临床上应用的强度测量方法？

方法

通过两种方式检查了可靠性和临床适用性。首先，两名检查员在测试/重新测试设置中为20名健康志愿者测量了EPGT力。使用测力计测量EPGT力，使用压力垫测量拇指握力。在十名糖尿病患者中测试了EPGT的临床适用性。姿势摇摆也被测量。

结果

类间相关系数（ICC）显示出极好的评估者间可靠性（ICC> 0.75）。评估者内部的可靠性对于第一个检查者而言极佳（ICC = 0.795），对于第二个检查者而言则极好（ICC = 0.703）。线性回归分析表明，拇指抓握力（平均）占EPGT力变异性的83％±4％。当在临床环境中进行测试时，EPGT力和拇指握力之间的这种强关系仍然存在，后者占EPGT力变异性的88％。Spearman等级顺序相关性表明，糖尿病患者四肢间EPGT力差异较大。

意义

EPGT力是对拇指抓握力的可靠且准确的测量。先前发现，Hallux抓握力与脚和脚踝所有肌肉群的力量以及保持平衡的能力密切相关。拟议中的EPGT可用于监测临床中的肌肉无力，以更好地评估跌倒风险。