Handgrip Strength Score Research Articles

Associations Between Dietary Patterns and Handgrip Strength: The Korea National Health and Nutrition Examination Survey 2014–2016

Objective: The age-related decline in handgrip strength (HGS) is an important indicator of weakening muscle strength concomitant with aging and sarcopenia. This study was to investigate the association between dietary patterns and HGS.Methods: In this cross-sectional study of 7,624 adults aged 19–64 years who were enrolled in the Korea National Health and Nutrition Examination Survey 2014–2016, we assessed HGS with a digital hand dynamometer while the participants adopted a standing position with their arms lowered. Their diets were examined with a food frequency questionnaire which included 112 food items and were categorized into 26 food groups. To determine the associations between dietary patterns and HGS, we employed a weighted multivariable linear regression model.Results: We identified two dietary patterns: the Prudent and the Western dietary patterns. Individuals in the highest tertile of the Prudent dietary pattern had the highest HGS scores (β = 0.54, p < 0.001). No difference was found among the tertiles of the Western dietary pattern. Sex-specific stratification (2,953 men, 4,671 women) indicated that both sexes showed significant associations with HGS according to the tertiles of their factor loading scores in the Prudent dietary pattern (men, β = 0.49, p = 0.014; women, β = 0.51, p < 0.001).Conclusion: This cross-sectional study of 7,624 adults revealed a significantly positive association between HGS and the Prudent dietary pattern, even after adjusting for potential confounding factors.

Prognostic value of NT-proBNP levels in the acute phase of sepsis on lower long-term physical function and muscle strength in sepsis survivors

BackgroundSepsis survivors often develop chronic critical illness (CCI) and demonstrate the persistent inflammation, immunosuppression, and catabolism syndrome predisposing them to long-term functional limitations and higher mortality. There is a need to identify biomarkers that can predict long-term worsening of physical function to be able to act early and prevent mobility loss. N-terminal pro-brain natriuretic peptide (NT-proBNP) is a well-accepted biomarker of cardiac overload, but it has also been shown to be associated with long-term physical function decline. We explored whether NT-proBNP blood levels in the acute phase of sepsis are associated with physical function and muscle strength impairment at 6 and 12 months after sepsis onset.MethodsThis is a retrospective analysis conducted in 196 sepsis patients (aged 18–86 years old) as part of the University of Florida (UF) Sepsis and Critical Illness Research Center (SCIRC) who consented to participate in the 12-month follow-up study. NT-proBNP was measured at 24 h after sepsis onset. Patients were followed to determine physical function by short physical performance battery (SPPB) test score (scale 0 to12—higher score corresponds with better physical function) and upper limb muscle strength by hand grip strength test (kilograms) at 6 and 12 months. We used a multivariate linear regression model to test an association between NT-proBNP levels, SPPB, and hand grip strength scores. Missing follow-up data or absence due to death was accounted for by using inverse probability weighting based on concurrent health performance status scores. Statistical significance was set at p ≤ 0.05.ResultsAfter adjusting for covariates (age, gender, race, Charlson comorbidity index, APACHE II score, and presence of CCI condition), higher levels of NT-proBNP at 24 h after sepsis onset were associated with lower SPPB scores at 12 months (p < 0.05) and lower hand grip strength at 6-month (p < 0.001) and 12-month follow-up (p < 0.05).ConclusionsNT-proBNP levels during the acute phase of sepsis may be a useful indicator of higher risk of long-term impairments in physical function and muscle strength in sepsis survivors.

PS1502 VALIDATION OF HAND GRIP STRENGTH AS A SCREENING TOOL FOR FRAILTY IN OLDER PATIENTS ON TREATMENT FOR HEMATOLOGIC MALIGNANCIES: THE FRAILTY TASK FORCE STUDY

Background:Frailty is a common and important geriatric syndrome characterized by age‐associated declines in physiologic reserve and function across multiorgan systems, leading to increased vulnerability for adverse health outcomes. Two major definitions of frailty have emerged over the past years: 1) the frailty phenotype (FP) defined by at least three or five items between weakness, slowness, low physical activity, low energy and weight loss 2) frailty index (FI) based on a comprehensive geriatric assessment (CGA) that evaluates functional status, polypharmacy, comorbidity, emotional and cognitive mental health status, fatigue, socio‐economic condition, nutrition and quality of life. In patients with cancer, the identification of frailty might be relevant to choose the most appropriate therapy for each patient. In hematology the CGA is not routinely performed because it is complex and time‐consuming. Hand Grip strength (HGS) is a general indicator of muscle strength and low HGS has been linked with premature mortality.Aims:The aim of this study was to test HGS as screening tool for frailty in older patients with hematologic malignancies.Methods:Patients ≥ 70 years on treatment for Acute Myeloid Leukemia (AML), Myelodysplastic Syndrome (MDS), Multiple Myeloma (MM), Chronic Linfocytic Leukemia (CLL) and Non Hodgkin Lymphoma (NHL) who were referred to the hematology department of two centers were included in the study. HGS was evaluated with a Jamar dynamometer and CGA was performed with a set of four questionnaires: Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), G8 screening questionnaire, Cumulative Illness Rating Scale (CIRS). Frailty was defined according to the following cut‐off: ADL (&gt;4 ≤4), IADL (&gt;5 ≤5),G8 (&gt;14 ≤14), CIRS ≥1 score 3–4 or &gt; 8 score 2. Spearman's Rank coefficient was used to evaluate the correlation between HGS and questionnaires score. Age and sex‐adjusted logistic regression model was used to evaluate the association between HGS and frailty. The performance of the HGS screening tool was evaluated using Receiver Operating Curve (ROC) analysis and the area under the ROC curve (AUC). Sensitivity and specificity with 95% confidence interval were calculated. Analysis were performed using the software R version 3.5.0.Results:One hundred and eleven patients were included in the study (12 AML 10.8%, 6 MDS 5,4%, 39 MM 35.1%, 11 CLL 9.9% and 43 NHL 38.7%). Median age was 78 ± 4.7 with 42 patients ≥ 80 years (37.8%). The male/female ratio was 66 (59.5%)/45 (40.5%).Overall, HGS significantly correlated with ADL score (r = 0.45 p &lt; 0.001 for men and r = 0.49 p &lt; 0.001 for women), IADL score (r = 0.5 p &lt; 0.001 for men and r = 0.4 p &lt; 0.001 for women), G8 score (r = 0.57 p &lt; 0.05 for men and r = 0.051 p &lt; 0.001 for women) but not with CIRS score.Age and sex‐adjusted logistic regression analysis demonstrated an association between low HGS and frailty in patients with 2 additive scores in ADL, IADL or G8 but not CIRS (OR = 0.021, p = 0.003). In these patients ROC curves of HGS as screening tool for frailty evidenced AUC 87.4% (95%CI: 77.4%&gt;97.4%) in women and 84% (95%CI 72.2%&gt;96.1%) in men. Moreover, the ROC curves revealed an HGS score ≤14 Kg in women (82.1% sensitivity and 70.6% specificity) and ≤25 Kg in men (91.8% sensitivity and 70.6% specificity) as the optimal cut‐off point according to the best Youden index.Summary/Conclusion:HGS is a valid, reliable, rapid and sensible clinical measure of frailty.

Relationships between hand-grip strength, socioeconomic status, and depressive symptoms in community-dwelling older adults

BackgroundDepressive symptoms have been found to be associated with decreased hand-grip strength (HGS) and low socioeconomic status (SES) in older adults. We aimed to investigate the potential moderating effect of SES on the association between HGS and depressive symptoms and the potential mediating effect of HGS on the association between SES and depressive symptoms using a nationally representative sample of older adults. MethodData from 3169 community-dwelling adults aged 60 years or older were acquired from the Korea National Health and Nutrition Examination Survey conducted in 2014 and 2016. HGS was measured using a digital hand-grip dynamometer. Depressive symptoms were evaluated using the 9-item version of the Patient Health Questionnaire-9 (PHQ-9). SES was assessed using equivalent monthly household income and education level. ResultsOlder adults in the lowest tertile of HGS measures were more likely to have experienced depressive symptoms compared to those in the highest tertile (odds ratio = 1.95, 95% confidence interval = 1.25–2.74). A significant moderating effect of household income level was observed on the association between HGS and PHQ-9 score (P = 0.014). Older adults with a low income had a stronger inverse correlation between HGS and PHQ-9 score compared to those with a high income (low income: beta = −0.162, P < 0.001; high income: beta = −0.119, P = 0.036). HGS partially mediated the association between low income and depressive symptoms. ConclusionOur findings indicate that there may be a stronger relationship between low HGS and depressive symptoms in socioeconomically deprived older people. Further research on muscle strength and income level in older adults is required regarding depression risk assessment.

The relationship between CrossFit performance and grip strength

There is a growing interest in maximizing CrossFit (CF) performance as the sport becomes more economically viable at elite levels. The ability to delineate the physiological demands of the sport of CF allows coaches and athletes to develop more efficacious exercise programming in order to maximize the athlete’s potential for success at the most elite and lucrative levels of competition. There is also a growing interest in increasing health and fitness in the general population as obesity and chronic disease rates continue to rise. Hand grip strength (HGS) is an indicator of total body strength, mortality, morbidity and independence among aging adults. Given that CF is the “Sport of Fitness”, it would be of interest to determine the relationship between HGS and CF performance. The current study examined the relationship between CF performance and hand grip strength (HGS). It was hypothesized that CF performance would have a meaningful significant relationship with HGS. Fifteen (n=15) female CF participants (age 30.9±7.1 years, height 160.3±4.8 cm, body mass 64.5±9.6 kg) of varying experience levels (51.9±30.6 months) were assessed for HGS and CF performance measures. The CF performance measures were assessed via a Workout of the Day (WOD) comprised of 3 rounds of 30 seconds at each of the following stations: fan bike (FB) for maximum calories, air squats (AS) for maximum repetitions, sit-ups (SU) for maximum repetitions, and burpees (BP) for maximum repetitions. Each 30 second work interval was followed by 2 minutes and 30 seconds of rest to ensure full recovery of the phosphagen energy system. Scores were reported as the mean number of repetitions completed across the 3 attempts at each movement station. Individual movements as well as total repetitions were then compared to HGS with Pearson correlation coefficients (r). Sit-up performance demonstrated a positive moderately (r=0.44) significant relationship with mean HGS (p&amp;lt;0.05). Neither total WOD performance nor any other individual movement had a significant relationship with HGS (p&amp;gt;0.05). Within the parameters of this study, CF participants exhibited a moderate relationship between HGS and sit-up scores.

Longitudinal Changes of Handgrip, Knee Extensor Muscle Strength, and the Disability of the Arm, Shoulder and Hand Score in Cardiac Patients During Phase II Cardiac Rehabilitation.

Handgrip strength (HS) and knee extensor muscle strength (KEMS) showed a negative correlation with the Disabilities of the Arm, Shoulder, and Hand (DASH) score at one month following cardiac surgery. We performed a longitudinal study to examine changes in HS/KEMS and DASH score during phase II cardiac rehabilitation (CR) in patients after cardiac surgery. We measured and assessed HS, KEMS, and DASH score in 41 consecutive patients at one and three months following cardiac surgery and examined the relation between these factors at three months following cardiac surgery. Wilcoxon signed-rank test and Spearman correlation coefficients were used to analyze the results. Finally, 26 patients (63.2 years, 73.1% male) were analyzed. There were significant differences from one month to three months following cardiac surgery in HS (26.78 ± 8.26 to 31.35 ± 9.41 kgf, p < 0.001), KEMS (1.53 ± 0.42 to 1.72 ± 0.46 Nm/kg, p = 0.001), and DASH score (14.76 ± 12.58 to 7.62 ± 9.29, p < 0.001). DASH score correlated negatively with HS (r = −0.41, p = 0.01) but not with KEMS (r = −0.32, p = 0.09) after three months of phase II CR. Although HS, KEMS, and DASH scores changed significantly from one to three months following cardiac surgery during phase II CR, only HS correlated negatively with DASH score at three months following cardiac surgery.

Nutritional status of older patients on hemodialysis: Which nutritional markers can best predict clinical outcomes?

The aim of this study was to investigate nutritional status in older patients undergoing maintenance hemodialysis (MHD) to determine the prevalence of nutritional markers indicating protein-energy wasting (PEW) as assessed by subjective global assessment (SGA) and other methods, and to explore which nutritional markers can best predict clinical outcomes. The study included 173 patients (median age 69 y; 65% men; 38% diabetes) undergoing MHD for >3 mo. Nutritional markers included SGA, malnutrition-inflammation score (MIS), geriatric nutritional risk index (GNRI), handgrip strength (HGS), midarm muscle circumference (MAMC), triceps skinfold thickness (SKF), calf circumference, and albumin. Associations between PEW (diagnosed by different measures and thresholds) and risk for hospitalization (by Poisson regression) and all-cause mortality (by Cox proportional hazards model) were analyzed. Depending on methods and thresholds used, the prevalence of nutritional markers indicatingPEW varied from 6.9% to 59.5%. In the Poisson models adjusted for age, sex, dialysis length, and diabetes, low SGA, HGS, albumin, and high MIS score were associated with high hospitalization events, whereas in the bivariate Cox regression models adjusted for the same variables, low SGA, GNRI, BMI, calf circumference, and high MIS score were associated with high hazard ratio (HR) for mortality. In addition, in the multivariate models, SGA showed the strongest association with mortality (HR, 2.32; 95% confidence interval [CI], 1.27-4.24) and together with MIS (HR, 2.09; 95% CI, 1.20-3.64), the highest values of C-statistics. Among older MHD patients, the prevalence of nutritional markers indicating PEW varies substantially depending on methods applied. SGA, MIS, BMI, GNRI, calf circumference, and HGS predicted worse outcomes. SGA and MIS showed the strongest association with hospitalization and mortality risk in the adjusted models.

The added value of an assessment of the patient's hand grip strength to the comprehensive geriatric assessment in G8-abnormal older patients with cancer in routine practice.

A comprehensive geriatric assessment (CGA) is the key treatment approach to guide decisions in older patients with cancer. In this paper, the added value of an assessment of the patient's hand grip strength to predict survival in patients with an abnormal G8-questionnaire (G8) score is investigated. Patients were screened by the G8, followed by a CGA in case of an abnormal screening (≤14.0). Hand grip strength was assessed by use of the JAMAR® hydraulic hand dynamometer. Cut-offs were applied according to the Fried frailty criteria. The survival rate was calculated twelve months after the CGA date. We retrospectively reviewed data of 2071 patients who were treated at the Kortrijk Geriatric Oncology Clinic (General Hospital Groeninge, Belgium) between November 2012 and December 2016. Of those, 944 patients with a mean age of 79.6 years were included in the analyses. 64.2% of patients presented an abnormal hand grip strength score. A log rank test revealed a statistical significant result between patients when accounting for the hand grip strength score (p < .01). When added to a Cox regression model, a significant result was found (p < .01). However, this added only 0.4% to the explained variance of the model. While a statistically significant result was detected, when adding the hand grip strength score to a regression model for survival, our data indicate that such assessment may clinically be less relevant when included in an already extensive test battery and may therefore provide only limited information in terms of patient survival.

Usefulness of Upper and Lower Limb Muscles Strength in the Evaluation of Clinical Severity of Heart Failure in Elderly Patients

Aim: Assess upper and lower limb functions in elderly with heart failure (HF) and evaluate its relation to HF severity. Methods: Handgrip strength (HGS) in kilograms (kgs.) of both hands using handle mechanical dynamometer and counting the repetitions (rep.) of stand and sit on a chair during 30 seconds [the 30 seconds chair-stand test (CST)] were used in 71 elderly (≥65 years old) patients with clinically stable HF and other matched 32 healthy elderly as a control. HF was diagnosed clinically, by plasma B-Type natriuretic peptide (BNP) and by echocardiography. The New York Heart Association (NYHA) functional classification of HF was used to obtain two groups: NYHA class I-II (33 patients), and NYHA class III (38 patients). Results: Showed significant decrease in both HGS and CST score in all HF patients (9.7 ± 4.4 kgs., 8.8 ± 3.1 rep., respectively) compared to controls (77.8 ± 11 kgs., 13.5 ± 1.1 rep., respectively, p Conclusion: Upper and lower limb muscles strength, assessed by two easy andinexpensive tests (HGS and CST), may reflect clinical severity of HF in elderly patients who cannot usually perform exercise tests. Its prognostic value requires further follow-up studies to verify.

Association between Physical Condition and Body Composition, Nutrient Intake, Sociodemographic Characteristics, and Lifestyle Habits in Older Spanish Adults.

In this study, we assessed physical condition and its association with body composition, nutrient intake, sociodemographic characteristics, and lifestyle habits in older Spanish adults. In this cross-sectional study, we investigated 380 individuals (54% women; men aged 55–80 years and women aged 60–80 years) with no previously documented cardiovascular disease. A general questionnaire was used, and body weight, height, fat, appendicular skeletal muscle mass, and waist circumference were assessed. Physical condition measurements included handgrip strength (HGS) and agility/dynamic balance by eight-foot time up-and-go (8-f TUG) test. The lowest maximum HGS score (kg) was found in older participants, inactive men, and men with abdominal obesity. The highest maximum 8-f TUG score (s) was found in older and inactive, low education, low income, and abdominal obesity and overfat participants; 24.5% of participants had low maximum HGS and 36.8% had a high 8-f TUG score. Sex- and/or age-adjusted odds ratio (OR) for low maximum HGS in women, older participants, overweight and overfat participants were 4.6, 2.9, 0.6 and 0.6 respectively. Sex and/or age adjusted OR for high maximum 8-f TUG in women, overweight, overfat, and abdominally obese participants were 2.4, 1.6, 1.7, and 3.4, respectively; in participants with higher education, those who earned €900 or more per month, and slightly active and active participants had OR values of 0.4, 0.4, and 0.3, respectively. Sarcopenia incidence was 0.3%; however, 4.5% of men and 19.1% of women registered low physical condition (high and low scores in 8-f TUG and HGS tests, respectively). Overall, 36.8%, 24.5%, and 0.3% of participants had high maximum 8-f TUG score, low maximum HGS, and sarcopenia, respectively. Prevalence of these low values varies according to sociodemographic and body composition variables.

Handgrip Strength, but Not 5-Meter Walk, Adds Value to a Clinical Nutrition Assessment.

Decreased physical functioning is associated with malnutrition and common in acute care patients; determining loss of function is often considered part of a comprehensive nutrition assessment. Handgrip strength (HGS) and 5-meter timed walk (5m) are functional measures used in a variety of settings. This analysis sought to determine which functional measure could be added to a hospital nutrition assessment, based on its feasibility and capacity to discriminate patient subgroups. Eligible medical patients (no delirium/dementia, admitted from community; n = 1250), recruited from 5 hospitals that participated in a previous multisite action research study, provided data on demographics, HGS, 5m, nutrition status, perceived disability, and other characteristics. Significantly more patients (z = 17.39, P < .00001) were able to complete HGS than 5m (92% versus 43%, respectively). Median HGS was 28.0 kg for men and 14.7 kg for women. Of patients who completed the 5m, mean completion time was 8.98 seconds (median, 6.79 seconds, SD = 6.59). 5m and HGS scores were significantly worse with patient-perceived disability (z = -9.56, t = 10.69, respectively; P < .0001; 95% confidence interval [CI], [7.33, 10.63]; [1.76, 3.18]). HGS was associated with nutrition status (t = 4.13, P < .001; 95% CI [2.02, 5.67]), although it showed poor validity as a single nutrition indicator. These data indicate that HGS is a more useful functional measure than 5m when added to a hospital nutrition assessment. Determination of HGS cutpoints to identify low strength in acute care patients will promote its use.

Short-term efficacy of paraffin therapy and home-based exercise programs in the treatment of symptomatic hand osteoarthritis.

This study aims to investigate the effects of a home-based exercise program in combination with paraffin therapy on pain, functional status, grip strength, and quality of life (QoL) and to compare the outcomes of these two treatment modalities. This prospective, single-blind, randomized-controlled study included a total of 61 patients (8 males, 53 females, mean age 59.22 years; range, 35 to 78 years) who were diagnosed with hand osteoarthritis (HOA) according to the American College of Rheumatology criteria between November 2016 and February 2017. The first group (group 1) (n=31) received paraffin therapy + home-based exercise program and the second group (group 2) (n=30) received home-based exercise program alone. All patients were assessed using the Visual Analog Scale (VAS), Australian/Canadian (AUSCAN) Osteoarthritis Hand Index, Health Assessment Questionnaire (HAQ), Hand Grip Strength (HGS), and Finger Pinch Strength (FPS) at baseline and at two and six weeks after the intervention. In group 1, there were statistically significant improvements in all parameters at two and six weeks (p<0.05). Statistically significant differences were observed in the HGS and AUSCAN Osteoarthritis Hand Index scores in group 2 at two and six weeks (p<0.05). Inter-group analysis showed statistically significant differences in favor of group 1 in the VAS, HAQ, AUSCAN Osteoarthritis Hand Index, HGS, and FPS scores at two and six weeks compared to baseline scores (p<0.05). Paraffin therapy combined with home-based exercise program in patients with symptomatic HOA provides effective pain control and is effective in improving functional status, HGS, FPS, and QoL in short term.

Relationship of Handgrip Strength and Body Mass Index With Cognitive Function in Patients With Schizophrenia

Background: The relationship between muscle strength and cognition in schizophrenia has not been well studied. We investigated the potential relationship of handgrip strength (HGS) score and body mass index (BMI) with cognitive function in patients with schizophrenia.Methods: Participants included 153 patients with schizophrenia (age: 36.9 ± 9.4 years; 82 males) and 328 healthy controls (age: 36.4 ± 10.7 years; 150 males), matched for age, sex, and ethnicity (Japanese). HGS was measured using a digital handgrip dynamometer. Cognitive function was evaluated using the Brief Assessment of Cognition in Schizophrenia (BACS) test. A two-way multivariate analysis of covariance was used to compare HGS scores between the patient and control groups. Multiple regression analyses of BACS scores were performed in the patient and control groups using HGS and BMI scores as independent variables.Results: In the intergroup comparison, significantly lower HGS scores were observed in patients with schizophrenia than in healthy controls (p < 0.05, corrected). In the patient group, there was a significantly positive correlation between HGS scores and BACS composite score (male, p = 0.0014; female, p = 0.0051). However, BMI scores were significantly negatively correlated with the BACS composite score (male, p = 0.0022; female, p = 0.018). Furthermore, the ratio of HGS/BMI was significantly positively correlated with the BACS composite score in the patient group (p = 0.00000018).Conclusions: Cognitive function in patients with schizophrenia is correlated positively with HGS and negatively with BMI. HGS/BMI may thus be a good index for cognitive performance in schizophrenia.

Comparison Level of Handgrip Strength for the Three Categories among Male Athlete’s Artificial Wall Climbing and Factors WILL Affect

The aim of this study is to compare the level of handgrip strength (HGS) in male’s athletes between three different categories of climbing (boulder, lead, and speed) during competition. Grip strength refers to the ability of the fingers and hand to generate muscle power and force. In sport climbing, performance on climbing athletes are not only depending on handgrip strength but also other factors that should be consider such as anthropometry, finger strength, arm span, experiences in climbing and percentages of body fat. The research design is ex-post facto. The participants were 123 male athletes as subjects (boulders; 41, lead; 41, speed; 41) whose average age is 22.46±4 years. All of them are students of a university in Malaysia. The handgrip strength was measured statically using a hand dynamometer (handgrip). Descriptive statistics were used to explore the differences of handgrip strength in three categories. Descriptive data for boulder (M=102.646; SD=14.71), lead (M=92.42; SD=15.88), and speed (M=88.13; SD=16.43) were determined. The findings showed significant differences handgrip strength score in three categories of climbing [F (2,120) =9.26, p=0.000)]. Data analysis by using post hoc turkey test showed significance difference between boulder and lead (p=0.011), and boulder and speed (p=0.000). Significant difference showed in covariance variable of experience [F (1,115) = 21.41; P = 0.00, eta squared = 0.16], BMI [F (1,115) = 10.50; P = 0.002, eta squared = 0.084], finger strength power [F (1,115) = 60.39; P = 0.00, eta squared = 0.34], and percentage of body fat [F (1,115) = 5.73; P = 0.018, eta squared = 0.047]. Conclusion from this study indicate the level of handgrip strength. Based on the research, boulder climbing found to be stronger compare to lead climbers in handgrip strength. In sport climbing, another factors that should be focus on effected to handgrip strength also on climbing performance.

The efficacy of peloid therapy in management of hand osteoarthritis: a pilot study.

Hand osteoarthritis (OA) is associated with pain, reduced grip strength, loss of range of motion (ROM), and joint stiffness, leading to impaired hand function and difficulty in performance of daily living activities. Mud bath therapy has been reported to play a primary role in the prevention and management of OA. Thus, we planned to conduct a study aimed at investigating the effects of peloid therapy on pain, functional state, grip strength, and the quality of life and performing a comparative analysis of the outcomes of peloid therapy. In this randomized, controlled, single-blind, pilot study, patients (n=33) underwent peloid therapy over 2weeks, 5 sessions a week, for a total of 10 sessions and home exercise program in group 1. Patients in group 2 (control, n=30) received only the same home exercise program as in group 1. Patients were evaluated just before, and 2 and 6weeks after the start of the study with Visual Analogue Scale (VAS), Australian/Canadian Hand Osteoarthritis Index (AUSCAN), Health Assessment Questionnaire (HAQ), hand grip strength (HGS), and pinch strength (PS). Statistically significant improvements were observed in all parameters assessed at week 2 and week 6 in the group 1 (p<0.05). Statistically significant differences were observed in HGS scores in the group 2 at week 2 and in AUSCAN scores at week 6 (p<0.05). Intergroup comparisons of the scores revealed significant differences between the peloid therapy group and control group in VAS, HAQ, AUSCAN, HGS, and PS scores at week 2 and week 6 (p<0.05). This study demonstrates that peloid therapy might be an effective and confident treatment modality in the management of symptomatic osteoarthritis of the hand and may provide effective pain control and improvements in the hand functions, quality of life, and grip strength.

Review on the Eyedrop Self-Instillation Techniques and Factors Affecting These Techniques in Glaucoma Patients.

Objective. This study aims to evaluate eyedrop self-installation techniques and factors affecting these techniques in glaucoma patients. Methods. Researchers directly observed eyedrop instillation procedures of 66 glaucoma patients. Contact with periocular tissues and instillation onto ocular surface or conjunctival fornices were considered. Correlations of instillation patterns with patient characteristics including age, gender, intraocular pressure, cup-to-disc ratio, visual field loss, and total intake of glaucoma medication and handgrip strength score were searched. Results. The average handgrip strength in the instillation without periocular contact group was 66.4 ± 19.7 kg, while the average handgrip strength score was 55.9 ± 20.9 kg in the instillation with contact group. The difference between the two groups was statistically significant (p = 0.039). No statistically significant correlation was found between handgrip strength and the mean number of glaucoma medications, c/d, intraocular pressure (p > 0.05). Also there was no significant relation between mean handgrip strength score and the severity of the visual field defect (p = 0.191). Conclusion. Patients especially with severe glaucomatous damage should be adequately instructed about the proper techniques for self-instillation of eyedrops and motivated to use a proper technique. Also, it is possible to suggest that patients with a higher handgrip strength, indicating the well-being of general health, may be doing better in properly instilling glaucoma eyedrops.

Handgrip dynamometry: a surrogate marker of malnutrition to predict the prognosis in alcoholic liver disease

BackgroundThe aim of the study was to determine the utility of handgrip dynamometry (HGD) in predicting short term mortality and complications in alcoholic liver disease.MethodsPatients with alcoholic liver disease were included and nutritional assessment was done using the Subjective Global Assessment (SGA), HGD and other conventional parameters. Mortality rates and complications were compared to nutritional status.Results80 patients were included in the study. Mean age of patients was 43.06±10.03 years. 69 patients survived and 11 patients died within the 3 month study duration. Handgrip strength (HGS) was higher in SGA A (28.76±5.48 kg) than SGA B (22.43±4.95 kg) and SGA C (16.78±3.83 kg) (P=<0.001). Number of complications including spontaneous bacterial Peritonitis, gastrointestinal bleeding and encephalopathy in SGA C group were 66.66%, in SGA B 20.75% and SGA A 10%. Mean HGS was significantly higher in the survivors (24.23±5.86) compared to non-survivors (18.04±4.82) (P=0.0011). There was a strong negative correlation between the HGS and Child-Pugh score (P=<0.0012). Multivariate logistic regression analysis to assess the risk factors for death showed handgrip to be in the suggestive significance range (P=0.072). The sensitivity of HGS was 88.41% in predicting short term mortality.ConclusionsHGS correlates with Child-Pugh score in predicting short term mortality. HGD is a simple, inexpensive and sensitive tool for assessing the nutritional status in alcoholic liver disease and can reliably predict its complications and survival.

The evaluation in terms of sarcopenia of patients with fibromyalgia syndrome.

Fibromyalgia syndrome (FMS) is an extra-articular rheumatic illness, characterized by widespread body pain and decreased muscle function. Generalized loss of muscle mass and strength is named as sarcopenia. The objective of this study was to evaluate patients with FMS regarding sarcopenia. This was a cross sectional, case-controlled, single-blinded, and single-centered study. The FMS patients were assessed by Fibromyalgia Impact Questionnaire (FIQ), visual analog scale (VAS), Beck Depression Index (BDI), and Pittsburg Sleep Quality Scale (PSQI). All the participants were evaluated for sarcopenia by bioimpedance analysis (BIA), anthropometric measurements, handgrip strength, and the parameters of walking speed. In this study, 82 patients with FMS and 38 healthy control female subjects were included. VAS, BDI, and PSQI scores were statistically higher in the FMS group than the control group (p < 0.001). Handgrip strength (HS) and walking speed (WS) scores in the group with FMS were statistically lower than the control group (p = 0.023, p < 0.001 respectively). VAS score of FMS patients was significantly correlated with BIA, body mass index, waist circumference, HS, and WS scores (r = 0.284, p = 0.012; r = 0.228, p = 0.045; r = 0.249, p = 0.028; r = - 0.361, p = 0.001; and r = - 0.230, p = 0.043 respectively). Also FIQ in patients was significantly correlated with BIA, waist circumference, HS, WS, and body mass index (r = 0.267, p = 0.018; r = 0.291, p = 0.010; r = - 0.319, p = 0.004; r = - 0.360, p = 0.001; and r = 0.304, p = 0.007 respectively). Evaluation of female patients with primary FMS by the sarcopenia parameters could contribute a more objective evaluation during the patients' follow-up.

Developing pathways for cancer rehabilitation in tertiary oncology centers: Initial observations at the McGill University Health Centre.

17 Background: No definitive rehabilitation pathways exist for cancer patients. To address this gap, the Cancer Rehabilitation interdisciplinary team at the McGill University Health Centre has developed three program paths (e.g., Restorative, Supportive, and Cachexia) to meet the various specialized and personalized needs of cancer patients. Methods: A consecutive cohort of patients referred to the Cancer Rehabilitation Clinic between January 1st and June 30th, 2014 was considered. We examined the following baseline characteristics: handgrip strength (HGS), the abridged Patient Generated-Subjective Global Assessment (aPG-SGA) and Edmonton Symptom Assessment System (ESAS) self-reported questionnaires. Results: Of the 54 patients evaluated (57.4% male), 20 (mean age: 47.4 yrs), 8 (59.9 yrs) and 26 (64.6 yrs) were assigned to the restorative, supportive and cachexia streams, respectively. The most common cancer diagnoses were gastrointestinal (15%), gynecological (13%), breast (12%) and lung (12%). Table 1 contains baseline aPG-SGA, ESAS and HGS scores. Conclusions: Our preliminary data confirm clinically significant differences in muscle strength across the 3 streams for both males and females, as well as significant differences in nutritional, appetite and well-being scores between the patients in the restorative and cachexia pathways. Our data confirm the need of personalized and targeted interventions to achieve or maintain optimal performance and quality of life in cancer survivors with different disease and treatment characteristics. [Table: see text]

Effects of oral nutritional supplementation in the management of malnutrition in hospital and post-hospital discharged patients in India: a randomised, open-label, controlled trial.

Hospital malnutrition is a significant problem that still remains under-recognised and under-treated in India. The present study assessed the effects of oral nutritional supplementation (ONS) in conjunction with dietary counselling versus dietary counselling (control) alone in malnourished patients when given in hospital and post-hospital discharge. The present study was conducted in nine private and four public hospitals. Patients from various medical wards were screened for malnutrition using modified Subjective Global Assessment (mSGA) and randomised to control (n = 106) or ONS (n = 106) for 12 weeks. Two servings (460 mL) of ONS were prescribed daily, providing 432 kcal, 16 g of protein and 28 micronutrients. The primary outcome was weight gain over 12 weeks. Other outcomes included change in body mass index (BMI), serum pre-albumin, albumin and C-reactive protein levels, energy and nutrient intakes, and handgrip strength at weeks 4, 8 and 12, as well as mSGA score at week 12. The mean age of patients was 39 years. Fifty-five percent were males and 90.3% were moderately malnourished (mSGA score B) at baseline. At week 12, ONS significantly improved certain parameters compared to control: weight (2.0 versus 0.9 kg; P < 0.001), BMI (0.76 versus 0.37 kg m(-2) ; P < 0.001) and energy intake per day (560 versus 230 kcal; P < 0.05). There were no differences in biochemical parameters and mSGA score between groups. Additionally, patients on ONS who were more functionally impaired at baseline had significantly greater weight gain and improved handgrip strength scores than controls. ONS use throughout hospital stay and post-hospital discharge significantly improved energy intake and weight in malnourished Indian patients. Those patients with poorer functional status at baseline demonstrated the most benefit.