Less-Affected Hand Function Is Associated With Independence in Daily Living: A Longitudinal Study Poststroke

Stroke ◽  
2021 ◽  
Author(s):  
Samar Hmaied Assadi ◽  
Haim Barel ◽  
Israel Dudkiewicz ◽  
Revital Feige Gross-Nevo ◽  
Debbie Rand
Keyword(s):  
Grip Strength ◽  
Daily Living ◽  
Minimal Clinically Important Difference ◽  
Hand Function ◽  
Brain Lesion ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Clinically Important Difference ◽  
Stroke Type ◽  
Block Test

Background and Purpose: The upper extremity (UE) ipsilateral to the brain lesion is mildly affected poststroke. It is unclear whether patients perceive this, and the association between less-affected hand function and independence in activities of daily living (ADL) is unknown. We aimed to (1) assess longitudinal changes in function, dexterity, grip strength, and self-perception of the less-affected UE, (2) compare them to the normative data, and (3) determine the association of both UEs to ADL during the first 6 months poststroke. Methods: Consecutive adults following a first stroke were assessed on rehabilitation admission (T1), 6 weeks (T2), and 6 months (T3) poststroke onset. Box and block test assessed function of both UEs. The functional dexterity test (FDT) and Jamar Dynamometer assessed dexterity and grip strength of the less-affected UE. The functional independence measure assessed ADL, and instrumental ADL was assessed at T3. Spearman correlations and multiple regression models were used. Results: Participants were assessed at T1 (N=87), T2 (N=82), and T3 (N=68). At T1, less-affected UE deficits were apparent (median [interquartile range] box and block test-45 [35–53] blocks, FDT-44.5 [33.3–60.8] seconds, grip-25.5 [16.2–33.9] kilograms), but only 19.5% of the participants self-perceived this. Less-affected hand function significantly improved with 32% and 33% achieving a minimal clinically important difference for box and block test at T2 and T3, respectively. Dexterity improved significantly between T1 and T2 ( P <0.001, no established minimal clinically important difference) and grip strength improved significantly between T2 and T3; 3.4% achieving a minimal clinically important difference ( P <0.01). At T3, most participants did not reach the norms (box and block test-67.4 blocks, FDT-32.2 seconds, grip-40.5 kilograms). Both the less- and more-affected UEs explained a large portion of the variance of ADL at all time-points, after controlling for age, days-since-stroke-onset, stroke type, and cognition. Conclusions: Despite some improvement, the less-affected UE at 6 months poststroke remained below norms, explaining difficulties in ADL and instrumental ADL. Further research is needed.

scholarly journals Reliability of Grip Strength as a Predictor of Hand Limitation Among U.S. Older Adults: How Good is Grip Strength?

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 903-904
Author(s):  
Rachel Logue ◽  
Susan Brown ◽  
Rebecca Hasson ◽  
Matthew Davis
Keyword(s):  
Older Adults ◽  
Grip Strength ◽  
Daily Living ◽  
Area Under Curve ◽  
Hand Function ◽  
Functional Limitations ◽  
Functional Independence ◽  
Health And Nutrition ◽  
Poor Predictor ◽  
Race Ethnicity

Abstract Grip strength is commonly used to assess hand function in older adults and is associated with health outcomes including muscle strength, cognition, and mortality. However, the degree to which grip strength predicts an actual hand limitation is unknown. This study evaluated grip strength as a predictor of hand limitations associated with activities of daily living. Using the 2011-14 National Health and Nutrition Examination Survey (NHANES), we selected five self-reported hand-related functional limitations to classify older adults reporting one or more limitations versus those with no limitations. We identified 2,064 older adults (age≥65), 31% of whom reported a hand-related limitation. Odds ratios were used to assess the association between grip strength quartile and the likelihood of a hand limitation while controlling for sex, race/ethnicity, education level, income, and pain. Receiver operator curves were used to evaluate the degree to which grip strength discriminates between those with limitations versus those without. Older adults with very low grip strength (lowest quartile) were more likely to have at least one limitation (OR:6.1, 95% CI:3.2,11.8) than those with high grip strength (highest quartile). However, receiver operator curves suggested grip strength only modestly discriminated hand limitations (area under curve:0.71). While self-reported hand limitations were associated with lower grip strength, it was a relatively poor predictor of hand impairments among older adults. This study suggests grip strength may not predict hand function as well as previously thought. Better assessments are needed to adequately evaluate upper extremity impairments to help older adults maintain functional independence.

Detecting change in community participation with the Enfranchisement scale of the community participation indicators

2021 ◽  
pp. 026921552110521
Author(s):  
Jessica Kersey ◽  
Lauren Terhorst ◽  
Joy Hammel ◽  
Carolyn Baum ◽  
Joan Toglia ◽  
...  
Keyword(s):  
Community Participation ◽  
Functional Independence Measure ◽  
Minimum Clinically Important Difference ◽  
Functional Independence ◽  
Baseline Score ◽  
Sensitivity To Change ◽  
Detectable Change ◽  
Change Scores ◽  
Minimum Detectable Change ◽  
Clinically Important Difference

Objective This study determined the sensitivity to change of the Enfranchisement scale of the Community Participation Indicators in people with stroke. Data sources We analyzed data from two studies of participants with stroke: an intervention study and an observational study. Main measures The Enfranchisement Scale contains two subscales: the Importance subscale (feeling valued by and contributing to the community; range: 14–70) and the Control subscale (choice and control: range: 13–64). Data analysis Assessments were administered 6 months apart. We calculated minimum detectable change and minimal clinically important difference. Results The Control subscale analysis included 121 participants with a mean age of 61.2 and mild-moderate disability (Functional Independence Measure, mean = 97.9, SD = 24.7). On the Control subscale, participants had a mean baseline score of 51.4 (SD = 10.4), and little mean change (1.3) but with large variation in change scores (SD = 11.5). We found a minimum detectable change of 9 and a minimum clinically important difference of 6. The Importance subscale analysis included 116 participants with a mean age of 60.7 and mild-moderate disability (Functional Independence Measure, mean = 98.9, SD = 24.5). On the Importance subscale, participants had a mean baseline score of 44.1 (SD = 12.7), and again demonstrated little mean change (1.08) but with large variation in change scores (SD = 12.6). We found a minimum detectable change of 11 and a minimum clinically important difference 7. Conclusions The Control subscale required 9 points of change, and the Importance subscale required 11 points of change, to achieve statistically and clinically meaningful changes, suggesting adequate sensitivity to change.

scholarly journals Rheumatoid arthritis: hand function, activities of daily living, grip strength and essential assistive devices.

Curationis ◽  
2003 ◽  
Vol 26 (3) ◽  
Author(s):  
I Shipham
Keyword(s):  
Rheumatoid Arthritis ◽  
Activities Of Daily Living ◽  
Grip Strength ◽  
Daily Living ◽  
Hand Function ◽  
Assistive Devices ◽  
Hand Dexterity

Persons with rheumatoid arthritis use assistive devices to enable them, in spite of impaired hand dexterity and grip strength, to manage Activities of Daily Living (ADL).

The Relationship between Knee Extension Strength and Activities of Daily Living in Patients with Dementia

2011 ◽  
pp. 244-256
Author(s):  
Makoto Suzuki ◽  
Hikari Kirimoto ◽  
Atsushi Inamura ◽  
Yoshitsugu Omori ◽  
Sumio Yamada
Keyword(s):  
Lower Extremity ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Functional Independence Measure ◽  
Knee Extensor ◽  
Functional Independence ◽  
Knee Extension ◽  
Daily Activities ◽  
Lower Body ◽  
Knee Extensor Strength

The purpose of this study was to examine the test-retest reliability of hand-held dynamometer measurements in patients with dementia and determine if predictions about a patient’s ability to perform daily activities can be made from knee extension strength measurements. This study was composed of two rounds of data collection. Sixty patients with dementia were enrolled in the first round to assess the reliability of hand-held dynamometer measurements, and 54 patients with dementia were enrolled in the second round for predicting their ability to perform daily activities. Knee extensor strength was measured twice, separated by a three minute interval, with hand-held dynamometer. The authors also assessed daily activities related to the patient’s lower extremities, including dressing the lower body, using the toile, transferring to the bed/toilet/shower, and walking. Lower extremity activities of the Functional Independence Measure were assessed by the nursing home caregiver that had the most regular contact with each subject. When the Functional Independence Measure score of each lower extremity function was =6 points, the subject was considered to be independent. The intraclass correlation coefficient was 0.97. Bland-Altman plots showed the 95% difference value to be within 2 SDs of the mean. The curves of negative and positive predictive values revealed the following threshold levels: 0.8 Nm/kg was the best predictor for dressing the lower body and using the toilet; 1.2 Nm/kg was the best predictor for transferring to the bed/toilet/shower; and 0.6 Nm/kg was the best predictor for gait performance. Strength measurements taken with a hand-held dynamometer were reliable in patients with dementia, and normalized knee extensor strength was found to be a predictor of the ability to perform activities of daily living.

scholarly journals Relationship between upper limb motor function and activities of daily living after removing the influence of lower limb motor function in subacute patients with stroke: A cross-sectional study

2020 ◽  
pp. 156918612092660
Author(s):  
Haruka Yamamoto ◽  
Kazuya Takeda ◽  
Soichiro Koyama ◽  
Keisuke Morishima ◽  
Yuichi Hirakawa ◽  
...  
Keyword(s):  
Activities Of Daily Living ◽  
Motor Function ◽  
Upper Limb ◽  
Lower Limb ◽  
Daily Living ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Motor Score ◽  
Cross Sectional ◽  
The Relationship

Background Previous studies have reported a relationship between upper limb motor function and activities of daily living. However, their relationship after removing the influence of lower limb motor function has not been clarified. Objective This study aimed to investigate the relationship between Fugl-Meyer assessment upper limb and total Functional Independence Measure motor score and between Fugl-Meyer assessment upper limb and each item contained in Functional Independence Measure motor score after eliminating the influence of the motor function of the affected lower limb. Methods This retrospective cross-sectional study included 58 subacute stroke patients. To investigate the relationship between the Fugl-Meyer assessment upper limb and total Functional Independence Measure motor score before and after removing the influence of Fugl-Meyer assessment lower limb, Spearman’s rank correlation coefficient and partial correlation analysis were used. Additionally, the relationship between Fugl-Meyer assessment upper limb and each item of Functional Independence Measure motor score after removing the influence was assessed. Results Before removing the influence of Fugl-Meyer assessment lower limb, Fugl-Meyer assessment upper limb was strongly correlated with total Functional Independence Measure motor score (r = 0.74, p < 0.001). However, it became weak after removing the influence (r = 0.27, p = 0.04). Regarding each item of Functional Independence Measure motor score, Fugl-Meyer assessment upper limb was correlated with grooming (r = 0.27, p = 0.04), bathing (r = 0.28, p = 0.03), dressing upper body (r = 0.33, p = 0.01), dressing lower body (r = 0.31, p = 0.02), and stair-climbing (r = 0.31, p = 0.02) after removing the influence. Conclusion These findings suggest that the relationship between the upper limb motor function and activities of daily living is strongly influenced by lower limb motor function.

scholarly journals Determining the minimal clinically important difference of the hand function sort questionnaire in vocational rehabilitation

2019 ◽  
Vol 62 (3) ◽  
pp. 155-160 ◽  
Author(s):  
Zineb Benhissen ◽  
Michel Konzelmann ◽  
Philippe Vuistiner ◽  
Bertrand Léger ◽  
François Luthi ◽  
...  
Keyword(s):  
Vocational Rehabilitation ◽  
Minimal Clinically Important Difference ◽  
Hand Function ◽  
Clinically Important Difference
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