Reliability and validity of an enhanced paper grip test; A simple clinical test for assessing lower limb strength

Abstract

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.

Implementing a contextually appropriate foot-ankle exercise programme in primary care for the prevention of modifiable risk factors for ulcers in people with diabetes: protocol for a hybrid type 2 study

“…In the implementation phase (phase 3), to assess the effectiveness of the intervention, two primary outcomes will be analysed: DPN symptoms, measured using the Michigan Neuropathy Screening Instrument, 31 and ankle and first metatarsal phalangeal joint ROM using manual goniometers. 32 Secondary outcomes of the intervention will include the following: (1) DPN severity, measured by the Decision Support System for DPN Classification (Fuzzy software), 33 which is available free of charge at http://www.usp.br/labimph/fuzzy/ ; (2) time up and go test, 34 as a measure of functionality; (3) strength of the flexor muscles of the hallux measured by the enhanced paper grip test; 35 (4) quality of life will be assessed using the EUROQOL (EQ-5D) instrument, which generates an index representing the value of an individual’s health status; 36 and (6) the presence of ulcers or preulcerative lesions monitored by the outcome evaluator via photos sent by the physiotherapists responsible for the IG without identifying the participant.…”

Development and Earliest Validation of a Portable Device for Quantification of Hallux Extension Strength (QuHalEx)

“…Far less has been published about hallux dorsiflexion (extension) strength than plantarflexion (flexion), perhaps because there are fewer available options for quantifying extension strength [ 9 ]. Researchers have quantified flexion strength as the hallux or lesser toes push downward onto a force plate, sensor-impregnated platform, or while resisted by a plantar strap under tension [ 2 , 7 , 10 , 11 , 12 , 13 ]. Alternatively, flexion strength has been quantified as the hallux pulls back toward the heel while curled over a loop or bar [ 13 , 14 , 15 , 16 ].…”

“…Sensors 2023, 23, x FOR PEER REVIEW 2 of 17 by a plantar strap under tension [2,7,[10][11][12][13]. Alternatively, flexion strength has been quantified as the hallux pulls back toward the heel while curled over a loop or bar [13][14][15][16].…”

Intra- and inter-examiner reliability and minimal detectable change for different methods of measuring toe grip strength in healthy adults

“…According to previous studies, several methods exist for evaluating toe grip strength, including the paper grip test 10 ) , a pressure platform 5 ) , a modified grip strength meter 11 ) and a toe grip strength meter 12 ) . The toe grip strength meter is easy to measure and is used for clinical practice at our hospital.…”