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RehabMeasures Instrument

Hand-held Dynamometer / Grip Strength

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Purpose

A quantitative and objective measure of isometric muscular strength of the hand and forearm.

Cost

Not Free

Diagnosis/Conditions

  • Stroke Recovery

Key Descriptions

  • This instrument is scored using force production in kilograms (0-90) or pounds (0-200).
  • Standardized procedure for positioning of instrument when using normative data is the following:
    1) Subject is seated with back, pelvis, and knees as close to 90 degrees as possible.
    2) Shoulder is adducted and neutrally rotated, elbow flexed at 90 degrees, forearm neutral, wrist held between 0-15 degrees of ulnar deviation.
    3) The arm is not supported by examiner or armrest and the dynamometer is presented vertically and in line with the forearm (Horowitz, 1997).
  • Maximum grip is the mean of three trials.

Number of Items

1

Equipment Required

  • Requires purchase of a handheld dynamometer

Time to Administer

5 minutes

5 minutes or less

Required Training

Reading an Article/Manual

Instrument Reviewers

Initially reviewed by Michele Lamb, OTR in 11/2013

ICF Domain

Body Structure
Body Function

Considerations

  • There is a wide range of instruments that test grip strengths, most studies use the Jamar dynamometer 
  • Must follow the standardized testing protocol and testing position for reliability and normative data. Changes in body position from protocol will result in altered grip strengths (Richards et al., 1996)
  • The positioning of the handle will affect result in measurement discrepancies, instrument should be set at the second position on hydraulic instruments (Innes, 1999)
  • Maximal grip is the mean of three trials, studies have shown that the mean of three trials is the most accurate measure of hand strength (Mathiowetz, V., Weber, K. et al., 1984)
  • It is recommended that a 3 second or less grip contraction is sufficient to register maximum reading (Innes, 1999)
  • 60 second rest periods between trials may prevent fatigue although studies have shown measurements taken at shorter durations result in minimal differences (Innes, 1999)
  • Instrument calibration is required annually or more frequently if used on a daily basis (Roberts et al., 2011)
  • Use the same test instrument for pre and post-testing for accurate results
  • Coefficient of variation (CV), a statistical stability of measures, is based on three trials of maximum grip strength at a single setting. Acceptable CV for the Jamar dynamometer are 10% male and 12% female (Innes, 1999)

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Stroke

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Standard Error of Measurement (SEM)

Chronic Stroke:

(Bertrand, et al, 2007; n = 17; mean age 53.7(13.0); paresis of the arm as a result of a unilateral stroke that occurred > one year earlier; three trials with time intervals between two sessions as well as the time of day not fixed; participants were not involved in a rehabilitation program) 

 

Session/Trial

Paretic SEM

Non-paretic SEM

1,1

28.78 (20%)

22.27 (8%)

1,3

26.15 (18%)

17.10 (6%)

2,1

20.35 (14%)

16.07 (6%)

2,3

18.49 (13%)

12.23 (4%)

 

  • SEM = 0.10 (19%) session 1
  • SEM = 0.07 (13%) session 2 

 

(Boissy et al, 1999; n=15; mean age = 47 (14) years; single CVA with upper limb paresis > one year ; three measurement sessions held one week apart at approximately the same time of day; Lafayette modified prehensile dynamometer) 

  • SEM = 33 (non-affected handgrip force)
  • SEM = 25 (affected handgrip force)
  • SEM = 16 (Left handgrip force control)
  • SEM = 66 (Right handgrip force control) 

Reported acceptable SEMs (mean SEM = 14% of mean MVGF)

Minimally Clinically Important Difference (MCID)

Stroke:

(Lang et al, 2008; n = 52; mean age 64 (14); independent prior to hemiparesis, Jamar grip dynamometer, Acute Stroke)

  • 5.0 and 6.2 (kg) for the affected dominant and non-dominant sides

Test/Retest Reliability

Stroke: 

(Bertland et al, 2007, Chronic Stroke) 

  • Excellent test-retest reliability (ICC 0.80 to 0.89)

Interrater/Intrarater Reliability

Stroke: 

(Boissey et al, 1999, Chronic Stroke) 

  • Excellent intrarater reliability (ICC > 0.086-0.95)

Construct Validity

Stroke: 

(Boissy et al, 1999, stroke >1 yr, Chronic Stroke) 

  • Adequate correlation with Fugi-Myer upper limb performance test (r = 0.84) 
  • Adequate correlation with TEMPA upper limb function test 
  • Adequate correlation with Box and Block affected upper limb score 
  • Adequate correlation with finger-to-nose affected limb score

Responsiveness

Stroke:

(Roberts et al, 2011) 

  • Recovery after a stroke estimate the differences in repeat measures of hand grip strength to be between 4.7 kg and 6.2 kg

Older Adults and Geriatric Care

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Normative Data

Community dwelling older adults:

(Desrosiers et al, 1994; n = 360; mean age = 73.9 (8.0) years; community dwelling older adults, Quebec, Canada , comparison Jamar dynamometer (kg) and Martin Vigorimeter (kPa))

 

Mean (Standard Deviation)

 

 

 

 

Women

Jamar

Jamar

Martin

Martin

Age

Right Hand (kg)

Left Hand (kg)

Right Hand (kPa)

Left Hand (kPa)

60-69

25.3 (4.8)

23.6 (4.7)

53.7 (10.2)

52.4 (9.9)

70-79

23.7 (5.1)

22.0 (4.7)

52.3 (12.0)

50.1 (11.2)

80+

20.0 (4.3)

18.5 (4.4)

44.1 (9.4)

42.7 (10.9)

Men

 

 

 

 

60-69

45.6 (8.6)

43.6 (8.7)

89.4 (16.7)

88.1 (17.2)

70-79

42.4 (9.1)

40.5 (8.5)

83.0 (18.2)

79.6 (16.2)

80+

34.5 (7.2)

32.1 (7.0)

64.6 (14.5)

64.3 (14.7)

 

Stegink Jansen et al, 2008; n = 224; mean age = 75.4 (6.8); good health with normal hand functions; Jamar dynamometer)

Men Norm in Pounds

 

 

 

Age

Hand

Mean

SD

65-69

R

91.5

15.5

 

L

88.2

14.4

70-74

R

84.2

17.2

 

L

81.4

18.4

80-84

R

70.6

14.6

 

L

63.1

16.2

85+

R

54.2

14.2

 

L

50.3

13.8

 

Women Norms in Pounds

 

 

 

Age

Hand

Mean

SD

65-69

R

54.9

10.1

 

L

51.5

9.5

70-74

R

52.5

9.5

 

L

48.3

10.5

75-79

R

48.2

10.3

 

L

43.6

10.7

80-84

R

44.5

11.1

 

L

41.0

9.3

85+

R

40.4

11.6

 

L

37.7

8.6

Test/Retest Reliability

Community Dwelling Older Adults: 

(Bohannon et al, 2005; = 21; mean age 75(5.9); 2 trials over a 12-week period; healthy community dwelling) 

  • Excellent test-retest reliability (ICC = 0.954 L, 0.912 R) 

 

(Abizanda, et al., 2012, n=281; mean age = 74.3 (4.9) years, healthy older adults) 

  • Excellent test-retest reliability (ICC = 0.9874)

Non-Specific Patient Population

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Standard Error of Measurement (SEM)

Healthy Adults and Patients with Primary Osteoarthritis of the hand (POAH): 

(Ziv et al, 2008; n = 32 POAH; mean age 70.4 (10), = 25 healthy adults; mean age 74.6 (8.4); measured twice within one week; Jamar dynamometer)

  • SEM = 0.90 (kgf) right grip (healthy adults)
  • SEM = 0.70 (kgf) left grip (healthy adults)
  • SEM = 1.51 (kgf) right grip (POAH)
  • SEM = 1.98 (kgf) left grip (POAH) 

 

Healthy Basketball players:

(Vassilis, G., 2012; n = 90; three groups: prepubertal 9.8(0.7), adolescents 14.4 (0.6), and adults 26.1 (5.6); three maximal isometric contractions on each hand, two occasions, one day apart)

  • SEM = 2.88% preferred hand (whole group)
  • SEM = 2.41% non-preferred hand (whole group) 
  • SEM = 5.55% preferred hand (prepubertal)
  • SEM = 4.13% non-preferred hand (prepubertal)
  • SEM = 2.83% preferred hand (adolescents)
  • SEM = 2.86% non-preferred hand (adolescents) 
  • SEM = 2.40% preferred hand (adults)
  • SEM = 2.22% non-preferred hand (adults)

Normative Data

Healthy Adults:

(Massy-Westropp et al, 2011; 1366 mean and 1312 women, community based Australian population, healthy adults, Jamar hand dynamometer)

 

Men Hand Grip Strength in kilograms: Mean (SD) 

 

 

Age

Right

Left

20-29

47 (9.5)

45 (8.8)

30-39

47 (9.7)

47 (9.8)

40-49

47 (9.5)

45 (9.3)

50-59

45 (8.4)

43 (8.3)

60-69

40 (8.3)

38 (8.0)

70+

33 (7.8)

32 (7.5)

 

Women Hand Grip Strength in kilograms: Mean (SD)

 

 

Age

Right

Left

20-29

30 (7)

28 (6.1)

30-39

31 (6.4)

29 (6)

40-49

29 (5.7)

28 (5.7)

50-59

28 (6.3)

26 (5.7)

60-69

24 (5.3)

23 (5)

70+

20 (5.8)

19 (5.5)

(Mathiowetz et al, 1985; 628 volunteers between the ages of 20 - 94, free from disease or injury that can affect UE strength; Jamar dynamometer in pounds)

 

Test/Retest Reliability

Healthy Adults: 

(Mathiowetz et al, 1984; n = 27; mean age 25; female OT students; two separate observations) 

  • Excellent test-retest reliability (ICC = 0.822 R, 0.915 L) 

 

(Reddon et al., 1985, n = 12, 6 men (21 to 36 yr.), 6 women (20 to 31 yr.), tested weekly for 10 weeks) 

  • Excellent test-retest reliability (ICC = 0.81-0.99) for preferred and non-preferred hands in men 
  • Excellent test-retest reliability (ICC = 0.83-1.0) for preferred and non-preferred hands in women

Interrater/Intrarater Reliability

Healthy Adults: 

(Lindstrom-Hazel et al., 2009, n = 73 convenience sample, three trials bilaterally, healthy students, facility, and staff members from Midwest University) 

  • Excellent interrater reliability (ICC = 0.996-0.998) 

 

(Mathewetz, V., 2002; n = 60; 30 females 30-49 years old mean 38.4 and 30 males 20-50 mean age 37.8; free from any neuromuscular or orthopedic dysfunction; testing between Jamar and Rolyan dynamometers) 

  • Excellent inter-instrument reliability Male R hand (ICC = 0.97) 
  • Excellent inter-instrument reliability Male L hand (ICC = 0.90) 
  • Excellent inter-instrument reliability Female R hand (ICC = 0.90) 
  • Excellent inter-instrument reliability Female L hand (ICC = 0.93) 

 

(Mathiowetz, et al, 1984,) 

  • Excellent interrater reliability (ICC = 0.996 R, 0.999 L) 

 

(Peolsson, 2001; n = 32; mean age = 29; convenient sample healthy adults; three test leaders) 

  • Excellent intrarater reliability (ICC = 0.94 and 0.98) 
  • Excellent interater reliability (ICC = 0.98 for right and left handgrip strength)

Criterion Validity (Predictive/Concurrent)

Healthy Adults: 

(Bellace et al, 2000; n = 62; ages of 18-50, randomized order of testing between Jamar and Dexter dynamometer; healthy adults) 

  • Excellent concurrent validity between dominant hand (ICC = 0.99) and nondominant hand (ICC = 0.98) 

 

(Mathewetz, V., 2002, healthy adults) 

  • Excellent concurrent validity Rolyan dynamometer with known weights (0.9994 and 0.9997 before and after study) 
  • Excellent concurrent validity Jamar dynamometer with known weights (0.9998 and 0.9998 before and after study)

Responsiveness

Healthy Adults : 

(Nitschke et al, 1999; n = 42; mean age 32.3 (7.3) healthy female subjects & 42.6 (11.8) nonspecific regional pain in upper arm female subjects; Jamar dynamometer) 

  • A change of more than 6 kg (13.2 lb) is necessary to detect a genuine change in grip strength 95% of the time. 

 

(Reddon et al., 1985) 

  • Small change: effect size 0.01 for men’s non-preferred and women’s preferred hand and 0.13 for men’s preferred and 0.14 for women’s non-preferred hands over 10 week trial

Bibliography

Abizanda, P., Navarro, J. L., et al. (2012). "Validity and usefulness of hand-held dynamometry for measuring muscle strength in community-dwelling older persons." Arch Gerontol Geriatr 54(1): 21-27. Find it on PubMed  

Bellace, J. V., Healy, D., et al. (2000). "Validity of the Dexter Evaluation System's Jamar dynamometer attachment for assessment of hand grip strength in a normal population." J Hand Ther 13(1): 46-51. Find it on PubMed

Bertrand, A. M., Mercier, C., et al. (2007). "Reliability of maximal static strength measurements of the arms in subjects with hemiparesis." Clin Rehabil 21(3): 248-257. Find it on PubMed

Bohannon, R. W. and Schaubert, K. L. (2005). "Test–retest reliability of grip-strength measures obtained over a 12-week interval from community-dwelling elders." Journal of hand therapy 18(4): 426-428. 

Boissy, P., Bourbonnais, D., et al. (1999). "Maximal grip force in chronic stroke subjects and its relationship to global upper extremity function." Clin Rehabil 13(4): 354-362. Find it on PubMed

Desrosiers, J., Bravo, G., et al. (1995). "Normative data for grip strength of elderly men and women." Am J Occup Ther 49(7): 637-644. Find it on PubMed

Gerodimos, V. (2012). "Reliability of handgrip strength test in basketball players." J Hum Kinet 31(1): 25-36. Find it on PubMed

Innes, E. (1999). "Handgrip strength testing: a review of the literature." Australian Occupational Therapy Journal 46(3): 120-140. 

Jansen, C., Niebuhr, B. R., et al. (2008). "Hand force of men and women over 65 years of age as measured by maximum pinch and grip force." Journal of aging and physical activity 16(1): 24. 

Lang, C. E., Edwards, D. F., et al. (2008). "Estimating minimal clinically important differences of upper-extremity measures early after stroke." Arch Phys Med Rehabil 89(9): 1693-1700. Find it on PubMed

Lindstrom-Hazel, D., Kratt, A., et al. (2009). "Interrater reliability of students using hand and pinch dynamometers." The American Journal of Occupational Therapy 63(2): 193-197. 

Mathiowetz, V. (2002). "Comparison of Rolyan and Jamar dynamometers for measuring grip strength." Occup Ther Int 9(3): 201-209. Find it on PubMed

Mathiowetz, V., Kashman, N., et al. (1985). "Grip and pinch strength: normative data for adults." Arch Phys Med Rehabil 66(2): 69-74. Find it on PubMed

Mathiowetz, V., Weber, K., et al. (1984). "Reliability and validity of grip and pinch strength evaluations." J Hand Surg Am 9(2): 222-226. Find it on PubMed

Nitschke, J. E., McMeeken, J. M., et al. (1999). "When is a change a genuine change?: A clinically meaningful interpretation of grip strength measurements in healthy and disabled women." Journal of Hand Therapy 12(1): 25-30. 

Peolsson, A., Hedlund, R., et al. (2001). "Intra- and inter-tester reliability and reference values for hand strength." J Rehabil Med 33(1): 36-41. Find it on PubMed

Reddon, J. R., Stefanyk, W. O., et al. (1985). "Hand dynamometer: effects of trials and sessions." Percept Mot Skills 61(3 Pt 2): 1195-1198. Find it on PubMed

Richards, L. G., Olson, B., et al. (1996). "How forearm position affects grip strength." The American Journal of Occupational Therapy 50(2): 133-138.

Roberts, H. C., Denison, H. J., et al. (2011). "A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach." Age Ageing 40(4): 423-429. Find it on PubMed

Ziv, E., Patish, H., et al. (2008). "Grip and pinch strength in healthy subjects and patients with primary osteoarthritis of the hand: a reproducibility study." Open Orthop J 2: 86-90. Find it on PubMed

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