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Can early assessment of hand grip strength in older hip fracture patients predict functional outcome?

ABSTRACT: Decreased muscle strength is not only a risk factor for hip fracture in older patients, but plays a role in recovery of physical function. Our aim was to assess the role of grip strength measured early after hip fracture, and classified according to the EWGSOP2 criteria in predicting short- and long-term functional recovery. One hundred ninety-one patients with acute hip fracture consecutively admitted to an orthopaedic hospital have been selected. A multidimensional geriatric assessment evaluating sociodemographic variables, cognitive status, functional status and quality of life prior to fracture, as well as perioperative variables were performed. Follow-ups at 3 and 6 months after surgery were carried out to evaluate functional recovery. Multivariate regression models were used to assess the predictive role of handgrip strength. The mean age of the participants was 80.3 ±6.8 years. Thirty-five percent of our patients with clinically relevant hand grip strength weakness were significantly older, more often female, had a lower BMI, and were of worse physical health. They also had a lower cognitive level, lower Barthel index, and lower EQ5D scores before fracture. Multivariate regression analysis adjusted for age and gender revealed that hand grip weakness was an independent predictor of worse functional outcome at 3 and 6 months after hip fracture for both genders and in all age populations. Our study supports the prognostic role of hand grip strength assessed at hospital admission in patients with hip fracture. Thus, clinicians should be encouraged to include hand grip assessment in their evaluation of hip fracture patients in the acute setting in order to optimize treatment of high-risk individuals.

SUBMITTER: Selakovic I

PROVIDER: S-EPMC6675283 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Can early assessment of hand grip strength in older hip fracture patients predict functional outcome?

Selakovic Ivan I Dubljanin-Raspopovic Emilija E Markovic-Denic Ljiljana L Marusic Vuk V Cirkovic Andja A Kadija Marko M Tomanovic-Vujadinovic Sanja S Tulic Goran G

PloS one 20190801 8

Decreased muscle strength is not only a risk factor for hip fracture in older patients, but plays a role in recovery of physical function. Our aim was to assess the role of grip strength measured early after hip fracture, and classified according to the EWGSOP2 criteria in predicting short- and long-term functional recovery. One hundred ninety-one patients with acute hip fracture consecutively admitted to an orthopaedic hospital have been selected. A multidimensional geriatric assessment evaluat ...[more]

PMID: 31369561

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Project description:In the scientific literature, there is much evidence of a relationship between age and dexterity, where increased age is related to slower, less nimble and less smooth, less coordinated and less controlled performances. While some suggest that the relationship is a direct consequence of reduced muscle strength associated to increased age, there is a lack of research that has systematically investigated the relationships between age, strength and hand dexterity. Therefore, the aim of this study was to examine the associations between age, grip strength and dexterity. 107 adults (range 18-93 years) completed a series of hand dexterity tasks (i.e. steadiness, line tracking, aiming, and tapping) and a test of maximal grip strength. We performed three phases of analyses. Firstly, we evaluated the simple relationships between pairs of variables; replicating the existing literature; and found significant relationships of increased age and reduced strength; increased age and reduced dexterity, and; reduced strength and reduced dexterity. Secondly, we used standard Multiple Regression (MR) models to determine which of the age and strength factors accounted for the greater variance in dexterity. The results showed that both age and strength made significant contributions to the data variance, but that age explained more of the variance in steadiness and line tracking dexterity, whereas strength explained more of the variance in aiming and tapping dexterity. In a third phase of analysis, we used MR analyses to show an interaction between age and strength on steadiness hand dexterity. Simple Slopes post-hoc analyses showed that the interaction was explained by the middle to older aged adults showing a relationship between reduced strength and reduced hand steadiness, whereas younger aged adults showed no relationship between strength and steadiness hand dexterity. The results are discussed in terms of how age and grip strength predict different types of hand dexterity in adults.

Project description:Background:Hand grip strength (HGS) is gaining the attention of researchers and clinicians, including geriatricians as a readily available, inexpensive, and useful measure of muscle strength. Objective:To identify the indicators of abnormal HGS as measured by a Jamar handheld dynamometer in community-dwelling Egyptian senior citizens. Study Design:The study was approved by the relevant ethical committee. This cross-sectional study included 200 randomly selected older adults of both sexes who attended geriatric and internal medicine outpatient clinics. Informed consent was obtained, and comprehensive geriatric assessment was performed, including assessment of the health-related quality of life by the 12-Item Short-Form Health Survey (SF-12). Measurement:HGS was measured, and values of 20 kg or less in females and 30 kg or less in males were considered abnormal. Statistical Methods:IBM SPSS statistics v25.0 was used for data analysis. Data were expressed as the mean ± SD for quantitative parametric measures and as the number and percentage for categorical data. Student's t-test, the chi-squared test, the diagnostic validity test, and multiple logistic regression analysis were performed. The ROC (receiver operating characteristic) curve was constructed, and the AUC (area under the curve) was also calculated. Results:The subjects' ages ranged from 60 to 95 years with a mean age of 69 ± SD 7.1 years. The sample consisted of 117 females (58.5%) and 83 males (41.5%). The chi-squared test showed that abnormal findings for grip strength were significantly more common among females than males (67.7% vs 32.3%). Student's t-test showed that both height and weight were significantly lower among subjects with abnormal than normal HGS, while body mass index (BMI) showed a non-significant difference. Stepwise multiple logistic regression analysis showed that there was no actual relationship between sex and abnormality of HGS. Conclusion:The best indicators of abnormal HGS were found to be a general health score below 25 points on the SF-12 and a height of less than 178 cm. As the values of general health and height decrease below those cut-off points, HGS decreases as well, and vice versa.

Project description:ObjectiveTo assess the association between SARS-CoV-2 infection and decreased hand grip strength (HGS).DesignLongitudinal population-based study.SettingCommunity-dwelling older adults (aged ≥60 years) living in a rural Ecuadorian village struck by the SARS-CoV-2 pandemic.ParticipantsOf 282 enrolled individuals, 254 (90%) finished the study.MeasurementsHGS was measured 3 months before (January 2020) and 9 months after the introduction of the virus into the population (January 2021). SARS-CoV-2 antibody testing was performed in two rounds: in May-June (early) and September-November (late), 2020. An independent association between SARS-CoV-2 infection and HGS decline was assessed by fitting linear mixed models for longitudinal data. Changes in HGS scores in SARS-CoV-2 seropositive subjects, according to the time elapsed since seroconversion, were compared with those who remained seronegative.ResultsOverall, 149 (59%) individuals became seropositive for SARS-CoV-2. The mean HGS (in kg) was 25.3 ± 8.3 at baseline and 23.7 ± 8.1 at follow-up (p = 0.028), with 140 individuals having >5% HGS decline between both measurements. The follow-up HGS measurement decreased by 1.72 kg in seropositive individuals, and by 0.57 kg in their seronegative counterparts (p < 0.001). SARS-CoV-2 seropositive individuals were 2.27 times more likely (95% CI: 1.33-3.87) to have a lower HGS measurement at the time of follow-up than those who remained seronegative. When compared with seronegative subjects, seropositive patients with early seroconversion were 3.41 times (95% CI: 1.73-6.74) more likely to have >5% HGS decline at the time of the follow-up than those with later, i.e., more recent, infections.ConclusionsThis study shows an independent deleterious impact of SARS-CoV-2 on HGS that is more marked among individuals with infections that occurred more than 8 months before follow-up HGS. Results suggest the possibility of chronic damage to skeletal muscles by SARS-CoV-2.

Project description:BackgroundFrailty and low handgrip strength (HGS) are associated with adverse outcomes after hip fracture (HF) surgery. We aimed to compare the predictive role of frailty and HGS for adverse outcome in HF patients.MethodsWe included older patients (age ≥ 65 years) who underwent HF surgery to compare the predictive role of HGS and hip-multidimensional frailty score (Hip-MFS) for postoperative complications and mortality. The Hip-MFS was calculated based on comprehensive geriatric assessment (CGA), and HGS was measured with a hand dynamometer. The primary outcome was a composite of postoperative complications (e.g., pneumonia, urinary tract infection, delirium, acute pulmonary thromboembolism, and unplanned intensive care unit admission). The secondary outcomes were 6-month mortality and mortality at the end of follow-up.ResultsThe median observation time was 620.5 days (interquartile range: 367.0-784.8 days). Among the 242 patients (mean age: 81.5 ± 6.7 years, 73.1% women), 106 (43.8%) experienced postoperative complications. The 6-month mortality and mortality at the end of follow-up were 7.4% (n = 18) and 20.7% (n = 50), respectively. The Hip-MFS (odds ratio [OR], 1.250; 95% confidence interval [CI], 1.092-1.432) and HGS (OR, 1.147; 95% CI, 1.082-1.215) could predict postoperative complications. The Hip-MFS could predict both 6-month mortality (hazard ratio [HR], 1.403; 95% CI, 1.027-1.917) and mortality at the end of follow-up (HR, 1.493; 95% CI, 1.249-1.769) after adjustment, while HGS was only associated with mortality at the end of follow-up (HR, 1.080; 95% CI, 1.024-1.139). For mortality at the end of follow-up, predictive models with the Hip-MFS were superior to those with HGS in the time-dependent receiver-operating curve analysis after adjustment (p = 0.017). Furthermore, the addition of Hip-MFS or HGS to the American Society of Anesthesiologists (ASA) classification improved its prognostic ability.ConclusionsBoth the Hip-MFS and HGS could predict postoperative complications and improve prognostic utility when combined with the ASA classification. The Hip-MFS was a stronger predictor of mortality than HGS after HF surgery. HGS could be a useful pre-screening tool to identify patients at a high risk of postoperative complications and those who may benefit from further CGA.

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Can early assessment of hand grip strength in older hip fracture patients predict functional outcome?

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Can early assessment of hand grip strength in older hip fracture patients predict functional outcome?

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