Download pdf - Welcome to the Grip Strength Toolkit! · 2017. 11. 8. · Grip strength examination is a rewarding skill for an RDN or NDTR. Results contribute tocomplete nutritional assessments

11/8/2017©MySurgeryPlateLLCPermissiongrantedtoreprintformembersofspecificDieteticPracticeGroupsoftheAcademyofNutritionandDietetics,orforthosewhohavepurchasedthetoolkitfromthosegroups,orbyseparatearrangementwithauthor. 1of36

Thistoolkitisamemberbenefittoselectdieteticpracticegroupsandothers.Itisdesignedforself-studyorforcollaborativelearningformodest-sizedpeergroups.Thegripstrengthexamfornutritionassessmentisbestperformedbytheregistereddietitiannutritionist,andiswithinboththeRDNscopeofpracticeandthepartofthenutritioncareprocess.

GripstrengthexaminationisarewardingskillforanRDNorNDTR.Resultscontributetocompletenutritionalassessmentsandreassessments,providesupportiveevidenceforthenutritiondiagnosisofprotein-caloriemalnutritionandgripstrengthrespondstochangesinnutritionalintake.Gripstrengthalsoprovidesmeasurementsthatcontributeinformationtoevaluateage-ordisease-relatedmusclewasting.

Gripstrengthexaminationmayseemoverwhelmingatfirst,howeveritiseasytodo,anditisexcitingtoseegrowthinconfidenceandskillafterlearnersperformasfewasthreepracticeexaminations.Thepreparationandreadingtakeseffort.However,aslearnersproceedthroughandcompletethetrainingprogram,theywillbeabletoperformtheexaminationcorrectlyusingthemethoddescribedinthetoolkit.

Thetoolkitisdesignedforindividualsandsmallgroupsto:• Learntogetherandcrosscheckmethodologywithoneanother.• Performtheexaminationinclinicalpractice,healthfairs,researchprojects,specialtyclinicsandin

othercaresettings.• Accuratelydocumentmethodologyandresults.• Alignmethodologyandreliabilityforallcliniciansinvolvedinthepatient’scare.• Interpretanddocumentfindingsandanalysisinthecontextofacompletenutritionalassessment.• Obtainbaselineandperiodicclinicalinformationtocontributetothenutritiondiagnosisofprotein-

caloriemalnutritionandmonitorpatientprogress.• Assureanddocumentskillsforanemployertoconsiderforstaffcompetencyassessment.

Theprogramisdesignedwithmultiplesections;allsectionsmustbecompletedtolearntheskillsandachievecontinuingprofessionaleducationcredits.Itmaybehelpfultodetermineanon-sitecoordinatororclinicalmanager,tohelporganizeandassureindividualandgroupprogress.Theprogramisorganizedsothatsmallstep-wiselearningcanproceed.

Programcomponentsarecompletedinthisorder:1. Readtherecommendedreadingstoorienttotheindications,use,rationaleandapplicationofgrip

strength.Readingprovidesthefoundationtoapplygripstrengthtoclinicalpractice.2. Watchthesuggestedonlineshortvideostoseepositioningofpatientandexaminer.3. ReadtheDPGnewsletterarticle(alsointhistoolkit),describingthemethodologyoftheAmerican

SocietyofHandTherapists(ASHT).TheASHTmethodisconsideredthe“goldstandard”forhandgripexamination.

4. Viewthepre-recordedwebinarthatispostedtoselectDPGwebsites.5. Practice:theexaminationprocess,recordingtheresults,resultsinterpretationandclinicalanalysis.

Usesimulatedpatientresultsandasimulateddynamometer(patternprovided)ifaJamarPlus®handdynamometerisnotavailable.Thepatterncanbetracedandcut-outfromfoamcoreorcardboard.

6. Practiceandcross-checkoneanotherineachofthreeroles,i.e.,asthe“patient”,the“examiner”anda“spotter”toassureunderstandingandcheck-backoftheprocessandmethod.

WelcometotheGripStrengthToolkit!


7. Practiceastheexaminer,aminimumofthreetimes.Record,interpretanddocumentresults.(Usesimulatedresultsfromthispacketuntilyouhaveadynamometer.)

8. Documentyourowncompletiondatesofeachofthestepscompletedonthe“competencyrecord”formprovidedinthetoolkit.

9. CompleteaquizthatisscoredandmanagedontheDieteticPracticeGroupwebsite.10. Complywithanyorganizationalpoliciesorproceduresthatarerequiredtobedesignatedcompetent

toperformtheexaminationatyourworksite.

Disclaimers:Completionofthisprogramdoesnotdenotecompetency.Competencyisdeterminedbydepartmentalandorganizationalpolicyandrequirements.Learnersareencouragedtocollaboratewiththeircolleagues,perhapsformstudygroupsorscheduleregularmeetingstocompletetheprogram.Organizationsmaywanttoupdatepoliciesandprocedurestoincludegripstrengthexaminationintheirexistingnutritionalassessmentandmalnutritionrelatedpoliciesandprocedures.Gripstrengthexaminationandresultsdonotindependentlydetermineifapatientismalnourished.Theresultsandanalysismustbeinterpretedbyanexperiencedandcompetentclinician,theexamperformedwithcorrectmethodologyandanalyzedinconjunctionwithallotherclinicalandnon-clinicalinformationavailableatthetimeofthepatientexamination.TheDTRisabletoperformtheexaminationandrecordresults.TheDTRwillcommunicatewiththeRDNwhowillinterpretanddocumenttheclinicalanalysis.Itiscriticalthatallpersonsperformingthegripexaminationstrictlyadheretothecorrectmethodologyinordertoachievemeaningfulclinicalresults.ThemethodologytaughtinthistoolkitisthatoftheAmericanSocietyofHandTherapists(ASHT),whichisconsideredthe“goldstandard.”(www.asht.org).ThemethodologyrequirestheJamarPlus®digitalordialhanddynamometerbyPattersonMedical(www.pattersonmedical.comorwww.performancehealth.com).ThemethodologypublishedintheDPGnewslettersisusedwithpermissionfromtheASHT.Atthetimeofthispublication,thereisnobusinessrelationshiporremunerationbytheauthorwithPattersonMedical,PerformanceHealth,theAmericanSocietyofHandTherapistsortheAmericanSocietyorSurgeryoftheHand.TheauthorhasdonatedthetoolkittoselectDieteticPracticeGroupsoftheAcademyofNutritionandDieteticsasamemberbenefit,toencouragelearning,identification,documentationandtreatmentofprotein-caloriemalnutrition.Atthetimeofthispublication,theAmericanSocietyforEnteralandParenteralNutritionandtheAcademyofNutritionandDieteticshavenotdescribedapreferredmethodologyorequipmentforhandgripexaminationforthepurposeofnutritionormedicaldiagnosesofprotein-caloriemalnutritioninadults.Shouldtheseprofessionalgroupsmakefuturerecommendations,learnersareencouragedtoupdatetheirskillstomeetthoserecommendations.Thistoolkitissolelyforeducationalpurposesandisnotintendedtodiagnoseortreatdiseaseorreplaceassessmentortreatmentbyqualifiedhealthprofessionals.


LearningObjectives:1. Enableskillstoidentifyandreportpatientfunctionalstatususinghandgripstrength,asoneofthe

clinicalcharacteristicsofprotein-caloriemalnutritionasdescribedintheConsensus.2. Assurecorrectmethodologyanddocumentationofhandgripstrengthtestresults.3. Adheretodepartmentpolicyinconductingtheexamination,interpretationandreportingof

examinationresults.4. Verifycompetenceincorrectinterpretationoftheexaminationresults.5. Assurepatientsafetyinconductingthegripstrengthexamination.6. Enablestafftoarticulateandreporttoothersthepurposeandimpactofthetestaspartofanutritional

focusedphysicalassessmentaspartofacompletenutritionalassessmentandreassessment.Presenter:TereseScollard,MBARDN,LDFANDFacilitator:SponsoringDieteticPracticeGroupsParticipants:Accountableforcompetencyverificationbyfacilityandemployerpolicy.ReadingandVideoMaterials:ProvidedandrequiredSuggestedLearningCodes:3030;3010;5285;3000FunctionalEssentialPracticeCompetencies:Sphere10:ClinicalCare10.1,10.2,10.3,10.5.1Registration:DPGmembersregisteroraccesstheprogramandmaterialsaccordingtoinstructionsprovidedbytherespectivedieteticpracticegroups.EstimatesofTimeTime* Topic100minutes Prereadingassigneddocuments(notincludedinCPEhours)10minutes Orientationtoviewwebinarandsetuppracticeequipmentandsupplies75minutes ReviewofkeypointsandreadingsusingHGSPowerpoint“HandgripAssessmentfor

ApplicationinMalnourishedPopulations”;Questions/answers/discussion30minutes Teacherdemonstrationoftechnique,worksheet,practiceonpaper,

Questions/answers/discussion45minutes Structuredpracticeusingdynamometerinsmallgroups20minutesperstudent

Demonstrationtodesignatedtrainerofmethodology(onereturnpracticedemoand2testeddemoswithworksheetscoringanddocumentation)

20minutesTestingperstudent

Score95%ormore.Testisprovidedinonlinetrainingprogram.Sponsorsareaskedtocontrolaccesstothetestquestionsandanswers.

200minutes=3hours

Approximatetotaltime

AppreciationandThankYouforhelpalongtheway!

• AmyRinder,OTR/L,CHT• TheAmericanSocietyofHandTherapists• 2016-2017DPGChairsandofficersofDNS,CNM,ON,MN,HA• Clinicalnutritionstaffpresentandpast,ofProvidenceHealthandServices,Portland,Oregon• JenniferCohen,Layout• JulieMcGuireMSRDNLD• Dietitians:AmyLeininger,NancyFrazeur,ArielaNielson,ChristinaHeiberg,LeslieWeidner]


Ihopeyoufindthistoolkithelpfultoimplementgripstrengthexaminationtoidentifyanddocumentundernourishedpatients.Increaseduseofgripstrengthwillprovideclinicalinformationanddatathatwillinfluenceandultimatelyhelptheoverallgoaltoreducetheincidenceofprotein-caloriemalnutritioninoursocietyandhealthcaresystems.TereseScollardMBARDNLDFANDMySurgeryPlateLLCOctober2017MoreDisclaimers:2017Thispublicationissolelyforeducationalpurposes.ThispublicationmaybereproducedbycurrentmembersofselectdieteticpracticegroupsoftheAcademyofNutritionandDieteticsorbythosepurchasingacopyofthepublicationfromtheDPG.Theviewsexpressedinthispublicationarethoseoftheauthoranddonotnecessarilyreflectpoliciesand/orofficialpositionsoftheAcademyofNutritionandDietetics,theAmericanSocietyofParenteralandEnteralNutrition,theAmericanSocietyofHandTherapists,theAmericanSocietyforSurgeryoftheHand,PattersonMedical,PerformanceHealth,orthemanufacturersoftheJamar®HandDynamometers.MentionofproductnamesinthispublicationdoesnotconstituteendorsementbytheauthorortheAcademyofNutritionandDieteticsortheAmericanSocietyofParenteralandEnteralNutritiontheAmericanSocietyofHandTherapistsortheAmericanSocietyforSurgeryoftheHand,PattersonMedical,orPerformanceHealthorthemanufacturersoftheJamarHandDynamometers.Theinformationinthispublicationisforeducationalandreferenceuseonlyanddoesnotconstitutetherenderingoflegal,financialorotherprofessionaladvicebytheauthorortheAcademyofNutritionandDietetics,theAmericanSocietyofParenteralandEnteralNutrition,theAmericanSocietyofHandTherapists,theAmericanSocietyforSurgeryoftheHand,PattersonMedical,PerformanceHealth,orthemanufacturersoftheJamarHandDynamometers.Theauthor,theAcademyofNutritionandDietetics,theAmericanSocietyofParenteralandEnteralNutrition,theAmericanSocietyofHandTherapists,theAmericanSocietyforSurgeryoftheHand,PattersonMedical,PerformanceHealth,andthemanufacturersoftheJamarHandDynamometersdisclaimsresponsibilityfortheapplicationoftheinformationcontainedherein.


QuickStartGuideTherecommendedsequenceoflearningisdescribedbelow:Iflearningwithagroup,reviewthematerialsandorganizethegroup;setdeadlinesandstructurethatishelpfulandachievableforthegroup.Rightaway,startworktoobtainingaJamarPlus®handdynamometer.Ittakessometimetolocateyourvendorrepresentativeandtoprocessthepurchase.Ifunabletoobtainahanddynamometer,asame-sizepatternisincludedthatcanbeusedtocutoutamodelonfoamcoreorcardboard.Thissimulationmodelwillassistwithcorrectpositioningoftheexaminerandpatientwhenpracticing.Usethesimulateddynamometerinthemeantimeuntilyoucanobtainone.Simulatedmeasurementresultsareincludedinthistoolkit.Step1

• Reado Readthetoolkitintroduction,theDPGnewsletterarticle(theASHTmethodology),thebackground

readingsandwatchthevideos.o Someofthereadingsareopen-source,somemaybeobtainedfrommedicallibrariesand

universities.Readallarticlesyoucanobtainforthefullestunderstanding.o Readingbeforeviewingthevideoiscriticaltounderstandthepurpose,strengths,weaknessesand

applicationsofthegripstrengthexamination.Readinghelpslearnerscorrectlyapplyandinterpretresultsforthepurposeofconnectinggripstrengthtoprotein-caloriemalnutrition.

o Readasmanyarticlesaspossiblebeforeviewingthewebinar.o Ifyoursituationissuchthatinthefutureyouintendtostudyaspecificpopulationforresearchor

otherpurposes,athoroughreviewofgripexaminationliteratureforthatspecificpopulationisrecommended.

Step2

• ObtainaJamarPlus®(digitalpreferred)handdynamometer,oraJamar®dialhanddynamometer.Alldynamometersarenotthesame.o Rehabilitationoroccupationaltherapydepartmentsoftencontractforrehabilitationequipment,

andthushavebetterpricesthanbuyingdirectfromonlinewebsites.o Onceyouhavethehanddynamometer,makesureitisapprovedforusebyyourfacility

biomedicalengineeringdepartment.o Readtheinstructionbookthatcomesalongwiththedynamometer.o Ifyoudonothaveadynamometer,youcanstillcompletethetrainingusingthesimulatedmodel

andsimulatedresultsprovided.Step3

• Printthetoolkitformsandmaterialsanddistributetoeachmemberofyourstudygroup.Step4

• WatchthewebinaronyourDPGwebsiteasoftenasyoulike.o Feelfreetostopandstartthewebinarasneeded.o Reviewtheworksheet,formsandsupplieswhenwatchingthewebinartobecomefamiliarwith

theiruse.o Notehowtheworksheetispartiallypre-filledoutbeforeperformingtheexamonthepatient.


Step5• Practiceperformingtheexaminationasa“patient”,“examiner”and“spotter”

o Record“patient”resultsontheworksheetforthe“patient”age,sexandhand.Completethecalculations,resultsreporting,andanalysisusingtheformsandsamplesforreference.

o Ifyouaresimulatingthedynamometerandtheresults,fillouttheworksheetusingthesimulatedpatientresultsdocumentfoundinthetoolkit.

Step6

• Recordallthestepstakenonyourcompetencyrecordform,includingthedateseachstepwascompleted.

• OnceSteps1-5arecomplete,takeandpasstheonlinequizthroughyourDPGwebsitetoobtainCPE.RetaintheCPErecord.

Step7

• Presentmaterials(competencyform,CPEcertificate,worksheetresults,documentationresultsandanyorganizationalrequirements)toyoursupervisor.Retaincopiesofyourrecordsintheeventyourcompetencyisquestioned.

• Performthegripstrengthexaminationonyourpatientsaspartofacompletenutritionalassessment.• Continuetoperformhandgripexamperiodicallytoretaincompetencyandskills.Retainrecordsof

examperformanceasdeterminedbyyoursupervisortorecognizeongoingcompetency.Formsandsupplies: GripStrengthWorksheet

GripStrengthNormativechartswith“AlertLevel”ofminus2StandardDeviationsfromthemean.(SamplescreatedbyauthorfromtheJamarPlus®normativetables)

Jamar®HandDynamometerorsimulateddynamometercutoutfromfoamcoreorcardboard

Seatingarrangements–chairs/landingarea

Seat“patient”witharmsnotrestingonchairarms,soarmsarefree,sittingstraightupSeatsuchthatexaminercanbeseateddirectlyopposite“patient”Allowspacefor“spotter”toobserve“patient”andexaminertoassurepositioningandcorrectmethodologyisperformedSpotterChecklistdocumenttoremindofcorrectpositioningandprocess

Tableorlandingspacetoplaceworksheettorecordresultsduringexam(itisalsookayforanotherpersontorecordresultswithexaminerreportingeachtestresultverbally)

Writinginstrument

Calculatortoaveragethe3measuredreadingsfromeachhand

Sign-insheetforgroupsessions

Competencysheetforeachlearnertorecordtheirowncompletedsteps

Simulatedresultsdatasheetifusingsimulateddynamometer

Sampleelectronichealthrecordoptimizationrequesttoincorporategripstrengthresults.

End,QuickStartGuide


TableofContents

Introduction 1Disclaimers 2Appreciationandthankyou! 3QuickStartInformationStep1through7,forms,suppliesReadingandvideolist

Step2ObtainEquipmentStep3PrintformsandchartsStep4WatchthewebinarStep5PracticeStep6TaketheQuizStep7Recordyourstepsandpresentyourevidenceoflearning

5

FormsandSuppliesListReadingandVideoList

68

SampleNormalizationChartsandAlertLevels(males,females,inpoundsandkilograms)

18

WorksheetSamplefilledoutworksheet

2324

PracticeresultsandchartnoteformPracticeresultsandchartnoteformsamplefilled-outSamplecomputersmartphrase

252627

Spotter,Examiner,PatientChecklist 28SimulationDynamometerPatternFaceofDynamometerpracticebuttonsSimulationresults

293031

Sampleelectronichealthrecordoptimizationrequest 32Competencydateform 34GroupSign-inSheet 35

AbouttheAuthor:TereseScollardMBARDNLDFANDisregionalclinicalnutritionmanagerwithProvidenceHealthandServicesinPortland,Oregon,andownerofMySurgeryPlateLLC.Teresehasworkedatmultiplehospitalsinbothclinicalandmanagementroles,withbothin-andoutpatientresponsibilities,asaconsultant,inprivatepracticeandlongtermcare.Shehasservedover29yearsasRegionalClinicalNutritionManagerwithProvidenceHealthandServicesinOregon.Since1990,Tereseandhercolleagueshavesupportedactiontorecognize,prevent,intervene,document,integratecareandaddresscompliancefordisease-relatedmalnutrition.Shehascompletedover50presentationsrelatedtomalnutrition,includingthefirstnationalwebinarbytheAcademyofNutritionandDieteticsoncodingandmalnutrition,in2009.TereseservedontheAcademyofNutritionandDieteticsMalnutritionWorkGroupthatcreatedthe2012ConsensusCharacteristicsofAdultMalnutrition,andthedocument,PhysicalExam:ParametersUsefulintheAssessmentofNutritionalStatus.ShewasamemberofthefirstAcademyNutritionInformaticstaskforce.TereseisasitereviewerwiththeAccreditationCouncilforEducationinNutritionandDietetics.ShewasawardedtheOutstandingDietitianoftheYearbytheOregonAcademyofNutritionandDieteticsin2011,andin2014wasaninauguralrecipientoftheAcademyFoundationAbbottNutritionAllianceAwardthatrecognizedworkonmalnutrition.ShehasbeenawardedProvidencegrantstoaddressmalnutritioninambulatorysettingsandtofundpatient-targetedmalnutritioneducationalmaterialstosupportcommunityoutreach.TeresemanagesclinicalnutritionpracticeandpolicyaffectingtheProvidencefacilitiesinOregon,andispartofamulti-stateProvidenceclinicalnutritioncouncilthatadvisesandsupportsorganizationalbest-practicenutritionpolicy.Sheis2017-2018Chair-electoftheClinicalNutritionManagementDieteticPracticeGroupoftheAcademyofNutritionandDietetics.


HandGripAssessmentforApplicationinMalnourishedPopulationsDietitiansinNutritionSupportDPG

OncologyNutritionDPGClinicalNutritionManagementDPGMedicalNutritionTherapyDPG

HealthyAgingDPG

Somepublicationsmayofferopenaccesswhereasothersmayrequirepurchase.Refertoyourspecificinstitutionlibraryororganizationalmembership(ASPEN,theAcademy,etc)foronlinefulltextavailability.Pre-PresentationReadingandVideo:Itisrecommendedtoreadandviewbeforetheprogrampresentation.

1. ConsensusStatementoftheAcademyofNutritionandDietetics/AmericanSocietyforParenteralandEnteralNutrition:CharacteristicsRecommendedfortheIdentificationandDocumentationofAdultMalnutrition(Undernutrition);JournaloftheAcademyofNutrition.NoteErratuminJAcadNutrDiet.2012Nov;112(11):1899.http://www.sciencedirect.com/science/article/pii/S2212267212003280orhttps://www.clinicalkey.com/#!/content/journal/1-s2.0-S2212267212003280

2. Russell,MaryK,FunctionalAssessmentofNutritionStatus.NutritioninClinicalPractice2015http://ncp.sagepub.com/content/30/2/211.full.pdf+html

3.NormanK,StobausN,GonzalezMC,SchulzkeJ-D,PirlichM.Handgripstrength:Outcomepredictorandmarkerofnutritionalstatus.ClinNutr.2011;30(2):135-142.https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S0261561410001834orhttp://www.sciencedirect.com/science/article/pii/S0261561410001834

4. ClinicalAssessmentRecommendations3rdEdition,AmericanSocietyofHandTherapists.SuggestcontactingOccupationalTherapyfortheHGSsectionin2ndedition.(pages1-8)https://www.asht.org/practice/clinical-assessment-recommendations

5. TheJamarPlus®Digitaldynamometer(selectURLbelow)willbeusedfortrainingduringthisprogram.Ifyouhaveaccesstodifferentequipment,youmaybringit.Notethatstandardsandcutpointsmaychangewithdifferentmanufacturers.Usersshouldutilizethematerialsthatarerecommendedfortheirparticulardynamometer.Physicaltherapyandoccupationaltherapyprogramshaveaccesstoequipmentcatalogsandvendorsatcontractpricing.Hydraulicdynamometersaretypicallyrecommendedoverspringdynamometers.www.pattersonmedical.com(Maychangetowww.performancehealth.com)

6. WindsorJA,HillGL.Gripstrength:Ameasureoftheproportionofproteinlossinsurgical

patients.BrJSurg.1988;75(9):880-882.http://onlinelibrary.wiley.com/doi/10.1002/bjs.1800750917/abstract


7. NIHToolbox:Motor:GripStrengthTestLocateGripStrengthsectionofonlinelearning,under“MotorTests”#52http://www.nihtoolbox.org/WhatAndWhy/Assessments/E-learning%20files/player.htmlVideoDemonstration,showingpositioning,lettingclientholdthedynamometertounderstandandbecomefamiliarinordertohelpcomforttogetaccurateresults.Canletclientsqueezeverygently,only,tolearnhowitfeels.VideodoesnotdemonstraterapidexchangeasrecommendedbyASHT.ExaminerandpatientpositioningisalignedwiththeAHST.AccessedAugust26,2016.

8. GripStrengthMeasurementoftheHand.Notepositioning,andRapidExchangetechniquewhichisalignedwiththeASHT.However,theexaminerdoesnotwritedownresults,whichyouwillneedtodo;andthispatientisinjured,sowewouldnotperformonrecentlyinjuredhand.https://www.youtube.com/watch?v=frcNPiLnWRoErasmusUniversity,TheNetherlands.AccessedAugust26,2016.

9. Sarcopenia:Europeanconsensusondefinitionanddiagnosis.ReportoftheEuropeanWorkingGrouponSarcopeniainOlderPeople.Age and Ageing 2010; 39: 412–423 http://ageing.oxfordjournals.org/content/39/4/412.full.pdf+html or https://www.ncbi.nlm.nih.gov/pubmed/20392703

10. EpidemiologyofSarcopenia:DeterminantsthroughouttheLifecourse2016InternationalConferenceonFrailtyandSarcopeniaResearch,2016.Educationalvideo.AccessedDecember8,2016.:https://www.youtube.com/watch?v=eqRfG-9z3Z4

11. ScollardTM.Handgripstrengthassessment:askilltoenhancediagnosisofdisease-relatedmalnutrition.SupportLine.2017;39(2):7-13.

NOTE:NormalizationtablesusedwiththeJamar®dynamometer:

• Mathiowetz,V.etal,(1985)GripandPinchStrength:NormativeDataforAdults.ArchivesofPhysicalMedicineandRehabilitation,66(2)69-74.

• Mathiowetz,V.etal,(1986)GripandPinchStrength:Normsfor6-19-YearOlds.AmericanJournalofOccupationalTherapy.40(10)705-711.

• GripStrength:ResultsofMeta-AnalysisofGSdata,JournalofGeriatricPhysicalTherapy.Vol.30;1:07,p.28-30.

OptionalReadingandViewing:

1. MatosLC,TavaresMM,AmaralTF.Handgripstrengthasahospitaladmissionnutritionalriskscreeningmethod.EuropeanJClinNutr.2007;61(9):1128-1135.http://www.nature.com/ejcn/journal/v68/n12/full/ejcn2014226a.html

2. SchlusselMM,dosAnjosLA,deVasconcellosMTL,KacG.Referencevaluesofhandgripdynamometryofhealthyadults:Apopulation-basedstudies.ClinicalNutrition.2008;27(4):601-607.http://www.sciencedirect.com/science/article/pii/S0261561408000721orhttps://www.clinicalkey.com/#!/content/journal/1-s2.0-S0261561408000721

3. MathiowetzV,KashmanN,VollandG,WeberK,DoweM,RogersS:Gripandpinchstrength:normativedata.ArchPhysMedRehabil66:69-72,1985.http://www.archives-pmr.org/article/S0003-9993(15)00291-9/abstract


4. JakobsenLH,IngeborgRK,KondrupJ.Validationofhandgripstrengthandenduranceasameasureofphysicalfunctionandqualityoflifeinhealthysubjectsandpatients.Nutrition2010;26:542-550.http://www.sciencedirect.com/science/article/pii/S0899900709002846orhttps://www.clinicalkey.com/#!/content/journal/1-s2.0-S0899900709002846

5. SkeletalMuscleProteolysis,BasicScienceReviewforSurgeons,Saunders,Philadelphia,1992.pg

316-325Readpg321.(Ahealthlibrarycanobtainthisreference).

6. Bohannon,RW.ReferenceValuesforadultgripstrengthmeasuredwithJamardynamometer:adescriptivemeta-analysis.Physiotherapy92(2006)11-15;Approachmorelikelyinresearchsetting.http://www.sciencedirect.com/science/article/pii/S0031940605000878

7. https://www.youtube.com/watch?v=y9r6jqy6tdEMathesonSystem.Isometricgripfora

functionalcapacityassessment.ThisvideoshowssimilartoASHT,however,thetesterchangesthesettingofthegripbecauseofIsometrictesting.Donotdothis.Startandstayatthesamesetting(Typicallypositionnumber2).AccessedAugust26,2016.

8. MeasuringGripStrength;https://www.youtube.com/watch?v=phAC-VIWr5Q.Schrpp,Heineck,demonstratethetestingofgripstrengthwiththeJamardynamometer.Showshowthestaticneedleversionworks.Thisdemoonlyusesonehand.TheASHTrecommendsusingbothhands,alternatingbetweenhands(rapidexchange).Discussesmalingering,whichismorelikelyinPTandOTsettings.AccessedAugust26,2016.

9. Silva,C.,Amaral,TF,HandgripStrengthandNutritionStatusinHospitalizedPediatricPatients,NutritioninClinicalPracticeVolume29,No.3,June2014,380-385.

10. FrailtySarcopeniahttps://youtu.be/_fBYAAiKCZsAccessedDecember9,2016.

11. Sarcopeniahttps://www.youtube.com/watch?v=4LhH3scPGaoAccessedDecember9,2016.

12. HandgripStrengthandAssociatedFactorsinHospitalized

PatientsRitaS.Guerra;IsabelFonseca,MSc;FernandoPichel,BScHons;MariaT.Restivo,PhD;andTeresaF.Amaral,PhDJPENJParenterEnteralNutr.2015;39:322-330)

13. HandgripStrengthatAdmissionandTimetoDischargeinMedicalandSurgicalInpatientsJoanaMendes,MSc;AnaAzevedo,MD,PhD;andTeresaF.Amaral,PhDVolume38Number4May2014481–488

14. ComparisonBetweenHandgripDynamometryandManualMuscleTestingPerformedby

RegisteredDietitiansinMeasuringMuscleStrengthandFunctionofHospitalizedPatientsLindsayDowhan,MS,RD,CSO,LD,CNSC;RobertDeChicco,MS,RD,LD,CNSC;etal.CNSCJournalofParenteralandEnteralNutritionVolume40Number7September2016951–958

15. Handgripstrengthtesting:Areviewoftheliterature.InnesE.;AustralianOccupationalTherapyJournal(1999)46,120-140.













FEMALE75YearsPLUSGripStrength:resultsofMeta-AnalysisofGSdataJournalGeriatricPhysicalTherapyVol.30;1:07p28-30

"Alert"levelinferredfromdata

FEMALEPOUNDSAgeGroup Side Mean(95%CI) RangeNormal "Alert"Level

75-79 Right 47.6 40.9-54.2 40.8 Left 42.5 35.5-49.4 35.4

80-84 Right 38.2 32.6-43.8 32.5 Left 37.6 31.9-43.3 31.8

85-89 Right 37.7 28.3-47.1 28.2 Left 34.6 26.9-42.3 26.8

90-99 Right 33.6 25.3-42.0 25.2 Left 32.6 24.6-40.5 24.5

FEMALE75YearsPLUSGripStrength:resultsofMetaAnalysisofGSdataJournalGeriatricPhysicalTherapyVol.30;1:07p28-30


FEMALEKILOGRAMSAgeGroup Side Mean(95%CI) RangeNormal "Alert"Level

75-79 Right 21.6 18.6-24.6 18.5 Left 19.3 16.1-22.4 16

80-84 Right 17.3 14.8-19.9 14.7 Left 17.1 14.5-19.6 14.4

85-89 Right 17.1 12.8-21.4 12.7 Left 15.7 12.2-19.2 12.1

90-99 Right 15.2 11.5-19.1 11.4 Left 14.8 11.2-18.4 11.1

MALE75YearsPLUSGripStrength:resultsofMetaAnalysisofGSdataJournalGeriatricPhysicalTherapyVol.30;1:07p28-30


MALEPOUNDSAgeGroup Side Mean(95%CI) RangeNormal "Alert"Level

75-79 Right 72.7 59.7-85.7 59.6 Left 68.5 56.4-80.6 56.3

80-84 Right 66.4 53.6-79.1 53.5 Left 59.6 49.0-70.2 48.9

85-89 Right 56.9 50.3-63.5 50.2 Left 55.3 45.1-65.5 45.0

90-99 Right 41.5 31.1-51.9 31.0 Left 41.6 38.3-44.8 38.2

MALE75YearsPLUSGripStrength:resultsofMetaAnalysisofGSdataJournalGeriatricPhysicalTherapyVol.30;1:07p28-30


MALEKILOGRAMSAgeGroup Side Mean(95%CI) RangeNormal "Alert"Level

75-79 Right 33 27.1-38.9 27.0 Left 31.1 25.6-36.6 25.5

80-84 Right 30.1 24.3-35.9 24.2 Left 27 22.2-31.8 22.1

85-89 Right 25.8 22.8-28.8 22.7 Left 25.1 20.5-29.7 20.4

90-99 Right 18.8 14.1-23.5 14.0 Left 18.9 17.4-20.3 17.3



HandGripStrengthWorksheetSamplefilledout TestDate:____4/7/2017___________PatientName:______GregoryGripstrength____DOB:_________4/11/1941______RoomNumber:___221B______Dynamometersetto:PoundsorKilogramsPatientAge:76 Actual:RightHand Actual:LeftHand NormalMeanforthis

patientAlertLevelforThisPatient

Gender:M Measurement1 29.2 26.3 Measurement2 26.5 25.4 Measurement3 22.2 24.7 RighthandMean 25.9 65.7 23.7LefthandMean 25.5 55.0 21.0PatientwithinNorm? YesNo PatientbelowAlertLevel? YesNo

Instructions:1. Beforeexam:locatetheformusingthesex-appropriatechartforpatientage,dynamometermeasurementpreferenceof

lbs.orkg,thenormalmeansandalertlevelsforrightandlefthandsforyourpatient.2. Pre-fill-intheinformationinthespecifiedspace.3. Conducttheexamalternatelyoneachhand,recordingthehighestscorereadfromdynamometeroneachtestforeach

hand.Youwillhave3scoresforeachhand.Averageandrecordtheaveragescore(Mean)foreachhand.4. Comparethepatient’saveragescoreforeachhandtothereferencenormalandtheAlertLevel.Circle“Yes”or“No”

dependingonifpatientiswithinnormorbelowalertlevel.5. Documentthemeasurementresults;Documentyouranalysisaspartofoverallnutritionalassessment.




Sample dot phrases created for electronic health record for outpatient documentation of results (Delete incorrect phrases and edit as needed)

.td Hand Grip Strength Examination - American Society of Hand Therapists 2016 Equipment: Jamar Plus Digital Hand Dynamometer

Test Hand Readings in pounds force

Mean for age and sex

Normal mean for age and sex

Alert level (minus 2 SD for age and sex)

Right Hand ***; ***; ***; *** *** pounds Left Hand ***; ***; ***; *** *** pounds

*Right and left hand mean is more than minus 2 Standard Deviations beyond the mean and measurably reduced. *Right and left hand mean is within 2 Standard Deviations from the mean and is within normal range. *Right hand mean is more than minus 2 Standard Deviations from the mean and measurably reduced. *Left hand mean is within than 2 Standard Deviations from the mean and within normal range. Patient Position: Seated straight up in chair with arms bent at 90 degrees. Patient agreed to exam. Patient tolerated exam. Also present for exam ***

Optionsforresultsreporting:

Right and left hand mean is within 2 Standard Deviations from the mean and is within normal range. Right hand mean is within 2 Standard Deviations from the mean and within normal range. Left hand mean is within 2 Standard Deviations from the mean and within normal range. Right and left hand mean is beyond minus 2 Standard Deviations beyond the mean and measurably reduced. Right hand mean is beyond minus 2 Standard Deviations from the mean and measurably reduced. Left hand mean is beyond minus 2 Standard Deviations from the mean and measurably reduced. Right and left hand mean are within normal range for age and sex, but trending towards minus 2 standard deviations beyond the mean. Right hand mean is within normal range for age and sex, but trending towards minus 2 standard deviations beyond the mean. Left hand mean is within normal range for age and sex, but trending towards minus 2 standard deviations beyond the mean.


HandGripStrengthCompetency:“Spotter”checklistDate:

“Spotter”monitors“Patient”and“Examiner”toassurestrictmethodologyandpatientsafety.

Roleschangeduringtraining;completeminimumof3roleseachtogetcomfortable.

“Patient”____________________________

“Examiner”______________________________

“Spotter”______________________________

Patientposition(seatedinchair): Patientissafeinselectedposition(chair,sideofbed,inbed). Torsoat90degreestolegs(ifinbed,getascloseto90degreesasreasonablewithlegsoutfront). Armbent90degreesatelbowwithupperarmparalleltotorso(notpushingforwardorelbow

stickingout). Shouldersinrelaxedposition,notscruncheduptoneck;donotthrowshoulderforwardtosqueeze. Feetstraightforwardandonfloorifpossible;considerfootstoolorotherchairiffeetnotonfloor. Patientsittingupstraight,notslouching. Elbowsnotrestingonchairarms. Dynamometerincorrectposition,soreadoutisfacingexaminer,notpatient.

Examiner: Positiondirectlyfacingpatient,nottoside,preferablyatsameeyeleveltoassurepatientisinright

positionandnottoweroverpatient. Oncedynamometerisgiventopatient,gentlyputhandunderneath(soitdoesnotdroponpatient)

untilassuredofcorrectpositionandsafeholdofthedynamometerandpatient.(Usestraponpatientwristifunsure).

Holddynamometerattopandbottomtogivetopatientincorrectposition,verifysettings. Writingutensil,formandaplacetowriteisreachablebyexaminerifexaminerisrecorderofresults. Pre-populateworksheetdatawithpatientdataandnormalandalertlevelsforrightandlefthand.

Spotter: Monitorandcheckexaminertoassurepatientinstructedperthemethodology,including

introductions,sanitizingandorientatingpatienttotheexamination. Watchcloselyifpatientmovesfromcorrectpositionwhenbeingtested,forexamplescrunchingup

shoulders,movingelbowfromparalleltotorsoormidline,pushinghandandarmoutduringthesqueezeandthrowingshoulderforwardduringthesqueeze.Makesureexaminercorrectspatient.

Checkexaminerforposition. Checkpatientforposition. Observeandcompletethischecklist. Givefeedbacktoexaminerafterwards. Didexaminerinstructpatientpermethodology? Didexaminerassurepatientsafetyinnotdroppingthedynamometerorslippingoffsideofbed. Didexaminerfilloutworkformcorrectlyandinterpretcorrectly?


Calculationswillbedoneafterleavingpatient,butrecommendthatthecalculationsarecross-checkedandcorrectontheformandinthesamplechartnotecreated.


PracticeDynamometerButtonsRefertoequipmentinstructions


Pra


Sample:RequestforElectronicHealthcareRecordOptimizationtoincludeGripStrengthinflowsheet:

ProblemStatement(Note:notwhatyouwantbuiltinEHR,butwhatclinical/operational/financialproblemareyoutryingtosolve):Gripstrengthforthepurposeofnutritionalassessmentisoneoftheclinicalcharacteristicsofadultmalnutrition.TheOccupationalTherapistshaveanoutpatientfieldcalled“OPHAND.”Theinpatientandoutpatientdietitiansrequesttheseflowsheetfieldsinordertoconsistentlydocumenttheresultstheyfindonpatientsthatarebeingassessedforproteincaloriemalnutrition. Currently,handgripdynamometryperformedforthepurposeofnutritionalassessmentbythedietitianscanonlybefree-textintoNotes.Thereisconsiderablevaluetoseepatternsofgripstrengthinaflowsheetformatforthepurposeofassistinginthenutritionalassessmentforthepurposeofdocumentingpatientstatusandpotentialmalnutritionandformonitoringpatientprogressovertime.ProposedSolution(Ifyouhavearecommendationonhowtoaddresstheproblem):Pleaseallow“OPHAND”orrenamedversionof“OPHAND”(OP-HAND-NUTRITION”?tobeabletobewrenchedintotheDietitiansNutritionalAssessmenttorecordmeasureddatainbothinpatientdietitiansandoutpatientdietitianEHRaccess.Thisdataisthenincorporatedintoacompletenutritionalassessmentandreassessments,andfollowedovertimeintheflowsheetformat.Resultsarepartofthedatathatsupportsnutritiondxofmalnutritionandpotentialpatientrecovery.Requester’sClinicalTitle/Role(AffectedEndUser):XXXXXRDNNeedAssessment(LOW-HIGH):PatientSafety:LowQuality:HighCommunityImpact:ModerateUsability&Adoption:High/MediumCompliance(Pleasecitetheregulationifrankedhighimportance):Low.noregulation:butisbestpracticeandsupportssystem-wideinitiativestoidentifyanddocumentproteincaloriemalnutritionforthepurposeofpatientcare,transitioncareandpotentialinpatientandambulatoryreimbursementfrompayerswhopayintheDRGMSsystem.Ifanauditshouldoccur,thedatabetter-supportsevidenceofcompliancewithregulatoryandnationalstandardsforadequateevidenceofsevere,moderateormildprotein-caloriemalnutrition.Revenue:Nonedirect,howeverindirectlycaninfluencethediagnosisofsevereproteincaloriemalnutritionwhichisanMCCandcontributestoreimbursementandseverityofillnessscores,whenpartofacompletenutritionalassessmentbyaregistereddietitian.NeedsAssessment(LowtoHighDescription)ScollardTM.Handgripstrengthassessment:askilltoenhancediagnosisofdisease-relatedmalnutrition.SupportLine.2017;39(2):7-13WhiteJV,GuenterP,JensenG,etal.Consensusstatement:AcademyofNutritionandDieteticsandAmericanSocietyforParenteralandEnteralNutrition:characteristicsrecommendedfortheidentificationanddocumentationofadultmalnutrition(undernutrition).JPENJParenterEnterNutr.2012;36(3):275-283.http://www.ncbi.nlm.nih.gov/pubmed/22535923.Referencesavailableuponrequest.


(Continued:scoringforoptimizationrequest)Definitions:Safety Low:reduceslikelihoodofpotentialadverseevents

Med:responsetoaspecificdocumentednear-missHigh:responsetoaspecificdocumentedadverseevent

Quality Low:NicetohaveMed:Decreasepracticevariation,promoteevidence-basedpractices,improvescommunication,improvescarecoordination,promotesappropriateutilizationofresources

CommunityImpact Low:Singlefacility,communityorregionMed:MultiplecommunitiesorregionsHigh:healthsystemwide

UsabilityandAdoption

Low:reducesnumberofsteps,timerequired,ortrainingnecessaryorimprovestheuserexperienceMed:Automatesamanualprocessorimprovesinter-connectednessHigh:mitigatessignificantadoption/retentionrisk

Compliance Low:improvescompliancewithsystem-approvedinterpretationofstandards,policiesandregulationsMed:responsetoaspecificupcomingsitevisitoraudit(<3months)

Revenue Low:minimalimpacttorevenueorexpenseMed:Favorablyimpactsrevenueorexpenses(>100K)High:Substantiallyimpactsrevenueorexpenses



Sign-InSheetSignyourname,HomeworksiteandCDRnumberplease

Name)Print CDRnumber Signature Home

Facility

GripStrengthEducationSign-inDate:Location:


Notes: