This month saw our first “ME Journal Club” with the aim to share interesting studies and stimulate discussion via our Twitter and Facebook pages.
This month the chosen study was "Hand grip strength and fatigability: correlation with clinical parameters and diagnostic suitability in ME/CFS" (Jäkel et al, 2020).
Quick Summary
People with ME have lower maximal and mean hand grip strength
Healthy controls can match their results after 60 mins rest, but people with ME cannot
Critique
A detailed critique of this study has been discussed over on the “Science for ME” forums, which is well worth reading through.
The Canadian diagnostic criteria was used to select ME/CFS participants, which includes post exertional malaise as a symptom, so the sample was a good representation of ME.
Hand grip has been found to be reduced in diabetes, cancer survivors, rheumatoid arthritis, linked to low bone mineral density in women and, for some reason, “high hostile men” (whatever that means!) So the presence of a weaker hand grip alone isn’t enough to define ME.
However the repeated test 60 minutes later was of greater interest. Unfortunately no comparison studies with the repeated test could be found in other conditions, but could be an excellent area to continue to explore.
While many liked the simplicity of the test, there was doubt over its reliability and whether it should replace other more established tests like the two-day cardio-pulmonary exercise test. One person described having a stronger hand grip than the testing health professional and a fear that if this test was used in isolation it could yield results that are not reflective.
We heard from many people who donate to the ME biobank that they use repeat hand grip strength tests there. The pattern of reduced strength with each repetition was common.
Implications for practice
Some physios discussed whether hand grip strength could be used as an objective measure when writing reports for third-party insurers.
We heard of an ME medical clinic in Amsterdam who already use routine hand grip tests in favour of a cardio-pulmonary exercise test because it was usually sufficient and less of a strain on patients.
The pattern of reduced strength on repeat testing, found also in biceps and tibialis, called into question whether traditional strength training was appropriate for people with ME, and really highlighted the difference between ME and a typical “weak” or “deconditioned” muscle, which can be repeatedly trained to great benefit.
The importance of how grip strength is tested was discussed. Grip strength was measured by a neurosurgeon in one example, but it was not repeated and the person noted that it was a meaningless result unless seen in functional activities (eg opening bottles etc). Another example was that grip strength was measured simply by squeezing the assessors hands, which seemed very subjective and was again not repeated.
Lived experience
Reduced hand strength was a common experience for people with ME. For example, some reported being able to lift a kettle in the morning, but found it too difficult as the day went on.
Quality and duration of hand writing was a good indicator of current function for one person.
One person said reduced hand strength was the first symptom of their ME and affected their ability to work. Activities like hanging out the washing would mean other tasks like holding cutlery would become impossible.
Conclusion
Hand grip strength is a quick and easy measurement that physiotherapists should consider when working with people with ME, but to fully determine results they should be repeating the test (for example do it at the start and end of a session) to see whether results can be matched.
Consideration of hand grip strength and its impact on quality of life and function should form part of a management plan. Adjustments to tasks and equipment modifications may provide benefit for people with ME who are struggling with reduced hand grip.
Traditional strength training approaches involving repetitions and short rests may be counter-productive for people with ME.
Keep an eye out at the start of July for our next study to discuss, and if you have full-text copies of anything worth of further discussion then please let us know.