Simple Clinical Test Helps Predict Fall Risk

A simple clinical test can effectively predict fall risk in older adults by assessing lower limb strength, according to the results of a recent study.

In the “paper-grip-test” (PGT), participants are asked to grip a paper card with their hallux while it is pulled from underneath their foot.

“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),” the researchers explained.

To assess reliability of the test, two examiners conducted a trial of 20 healthy volunteers using a test/retest set-up. Using a dynamometer, the researchers measured EPGT force, while a pressure mat was used to measure hallux grip force. To test clinical applicability, they conducted the same trial with 10 individuals with diabetes.

Overall, reliability was found to be excellent for the first examiner and good for the second. Using linear regression analysis, the researchers found that hallux grip force was strongly associated with variability in EPGT force. Using Spearman rank order correlation, they found that individuals with diabetes who also had higher differences in the EPGT force between limbs had greater postural sway than those with lower differences.

“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,” the researchers concluded. 

—Michael Potts

Reference:

Chatzistergos PE, Healy A, Balasubramanian G, et al. Reliability and validity of an enhanced paper grip test; a simple clinical test for assessing lower limb strength. Published online July 16, 2020. Gait Posture. Doi:10.1016/j.gaitpost.2020.07.011