Use of different reference values for handgrip strength in individuals with COPD: analysis of agreement, discriminative capacity, and main clinical implications

Fonseca, Jéssica; Machado, Felipe Vilaça Cavallari; Santin, Laís Carolini; Medeiros, Letícia; Andrello, Ana Carolina; Hernandes, Nidia Aparecida; Pitta, Fabio

doi:10.36416/1806-3756/e20210510

Jéssica Fonseca

study conception

statistical analysis

interpretation of results

revised

approved the final version

. Laboratório de Pesquisa em Fisioterapia Pulmonar - LFIP - Hospital Universitário, Universidade Estadual de Londrina, Londrina (PR) Brasil.

https://orcid.org/0000-0002-2173-4906

Felipe Vilaça Cavallari Machado

study conception

statistical analysis

interpretation of results

revised

approved the final version

. Laboratório de Pesquisa em Fisioterapia Pulmonar - LFIP - Hospital Universitário, Universidade Estadual de Londrina, Londrina (PR) Brasil.

. Department of Research and Development, Ciro, Horn, the Netherlands.

. Department of Respiratory Medicine, School of Nutrition and Translational Research in Metabolism-NUTRIM-Maastricht University Medical Center+, Maastricht, the Netherlands.

https://orcid.org/0000-0003-1910-7695

Laís Carolini Santin

drafting

revision

revised

approved the final version

. Laboratório de Pesquisa em Fisioterapia Pulmonar - LFIP - Hospital Universitário, Universidade Estadual de Londrina, Londrina (PR) Brasil.

https://orcid.org/0000-0003-4449-1342

Letícia Medeiros

revised

approved the final version

. Laboratório de Pesquisa em Fisioterapia Pulmonar - LFIP - Hospital Universitário, Universidade Estadual de Londrina, Londrina (PR) Brasil.

https://orcid.org/0000-0001-9029-4142

Ana Carolina Andrello

revised

approved the final version

. Laboratório de Pesquisa em Fisioterapia Pulmonar - LFIP - Hospital Universitário, Universidade Estadual de Londrina, Londrina (PR) Brasil.

https://orcid.org/0000-0002-4959-7827

Nidia Aparecida Hernandes

revised

approved the final version

. Laboratório de Pesquisa em Fisioterapia Pulmonar - LFIP - Hospital Universitário, Universidade Estadual de Londrina, Londrina (PR) Brasil.

https://orcid.org/0000-0002-5219-851X

Fabio Pitta

study conception

statistical analysis

interpretation of results

revised

approved the final version

. Laboratório de Pesquisa em Fisioterapia Pulmonar - LFIP - Hospital Universitário, Universidade Estadual de Londrina, Londrina (PR) Brasil.

https://orcid.org/0000-0002-3369-6660

Correspondence to:
Fabio Pitta. Departamento de Fisioterapia, Centro de Ciências da Saúde, Hospital Universitário, Universidade Estadual de Londrina, Avenida Robert Koch, 60, Vila Operária, CEP 86038-350, Londrina, PR, Brasil. Tel.: 55 43 3371-2477. E-mail: fabiopitta@uel.br

CONFLICTS OF INTEREST

None declared.

Study	Sample Age range, years	Country	Reference values	Method of handgrip strength evaluation	Criteria used in order to identify reduced handgrip strength
Amaral et al.¹¹11 Amaral CA, Amaral TLM, Monteiro GTR, Vasconcellos MTL, Portela MC. Hand grip strength: Reference values for adults and elderly people of Rio Branco, Acre, Brazil. PLoS One. 2019;14(1):e0211452. https://doi.org/10.1371/journal.pone.0211452 https://doi.org/10.1371/journal.pone.021...	n = 1,462 18-102	Brazil	Stratified by sex and age (10-year age groups)	Position in accordance with the ASHT recommendations; measurements were performed with the patient in a seated position, with the elbow at 90° and the handle adjusted to the second position; a familiarization with the instrument was allowed; the procedure was performed three times for each hand alternately, with an interval of 1-min between measurements; a hydraulic hand dynamometer (SH50011; Saehan Corporation, Changwon, South Korea) was used; values were expressed in kg; the highest handgrip strength value for each hand was used.	2 SDs below the mean and group-specific (by sex and age)
Bohannon et al.²⁵25 Bohannon RW, Peolsson A, Massy-Westropp N, Desrosiers J, Bear-Lehman J. Reference values for adult grip strength measured with a Jamar dynamometer: a descriptive meta-analysis. Physiotherapy. 2006;92(1):11-15. https://doi.org/10.1016/j.physio.2005.05.003 https://doi.org/10.1016/j.physio.2005.05...	n = 3,317 20-75^a	USA, Australia, Canada, UK, and Sweden	Stratified by sex and age (5-year age groups)	Position in accordance with the ASHT recommendations; a Jamar dynamometer (Patterson Medical/Sammons Preston, Bolingbrook, IL, USA) was used. Most of the studies included in the meta-analysis used the mean of three trials and assessed both hands.	Values below the 5th percentile and group-specific (by sex and age)
Frederiksen et al.²⁶26 Frederiksen H, Hjelmborg J, Mortensen J, McGue M, Vaupel JW, Christensen K. Age trajectories of grip strength: cross-sectional and longitudinal data among 8,342 Danes aged 46 to 102. Ann Epidemiol. 2006;16(7):554-562. https://doi.org/10.1016/j.annepidem.2005.10.006 https://doi.org/10.1016/j.annepidem.2005...	n = 8,342 45-102	Denmark	Stratified by sex, height (5-cm height groups), and age (5-year age groups)	Measurements were performed in a series of three measurements with the elbow at 90° and the upper arm tight against the trunk; a Smedley dynamometer (TTM, Tokyo, Japan) was used; the width of the handle was adjusted to fit the hand size; the second phalanx should rest against the inner stirrup; three trials were performed for each hand, with each hand in two cohorts of the study and three trials for the preferred hand in the other study cohort; values were expressed in kg.	2 SDs below the mean and group-specific (by sex, height, and age)
Massy-Westropp et al.²⁷27 Massy-Westropp NM, Gill TK, Taylor AW, Bohannon RW, Hill CL. Hand Grip Strength: age and gender stratified normative data in a population-based study. BMC Res Notes. 2011;4:127. https://doi.org/10.1186/1756-0500-4-127 https://doi.org/10.1186/1756-0500-4-127...	n = 2,629 20-70	Australia	Stratified by sex and age (10-year age groups)	Measurements were performed with the patient in a seated position, with the elbow by the side and flexed to right angles, as well as with a neutral wrist position; the dynamometer handle was on position II, and there was provision of support underneath the dynamometer; a Jamar dynamometer (Patterson Medical/Sammons Preston) was used; three trials were performed for each hand; the mean value for each hand was used.	2 SDs below the mean and group-specific (by sex and age)
Mathiowetz et al.⁶6 Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M, Rogers S. Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil. 1985;66(2):69-74.	n = 628 20-94	USA	Stratified by sex and age (5-year age groups, the eldest individuals being > 75 years of age)	Measurements were performed with the patient in a seated position, with shoulders adducted and neutrally rotated, elbows flexed at 90°, forearms in a neutral position, and wrists between 0° and 30° of dorsiflexion and between 0° and 15° of ulnar deviation; a Jamar dynamometer (Patterson Medical/Sammons Preston) was used, being set at the second handle position for all individuals; three successive trials were performed for each hand; values were expressed in pounds; the mean of three trials was used.	2 SDs below the mean and group-specific (by sex and age)
Peters et al.²⁸28 Peters M, van Nes S, Vanhoutte EK, Bakkers M, van Doorn PA, Merkies IS, et al. Revised normative values for grip strength with the Jamar dynamometer. J Peripher Nerv Syst. 2011;16(1):47-50. https://doi.org/10.1111/j.1529-8027.2011.00318.x https://doi.org/10.1111/j.1529-8027.2011...	n = 720 20-96	The Netherlands	Stratified by sex and age (10-year age groups)	Position in accordance with the ASHT recommendations; a Jamar dynamometer (Patterson Medical/Sammons Preston) was used; three trials were performed for each hand; the mean value for each hand was used.	Values below the 5th percentile and group-specific (by age and sex)
Shim et al.²⁹29 Shim JH, Roh SY, Kim JS, Lee DC, Ki SH, Yang JW, et al. Normative measurements of grip and pinch strengths of 21st century korean population. Arch Plast Surg. 2013;40(1):52-56. https://doi.org/10.5999/aps.2013.40.1.52 https://doi.org/10.5999/aps.2013.40.1.52...	n = 366 13-77	Korea	Stratified by sex and age (10-year age groups)	Measurements were performed with the patient in a seated position, with the shoulders adducted and neutrally rotated, the elbows flexed at 90°, the forearms in a neutral position, and the wrists between 0° and 30° of flexion and between 0° and 15° of ulnar deviation; a Jamar hand dynamometer (Patterson Medical/Sammons Preston) was used; three consecutive trials were performed for each hand, 1 min apart; values were expressed in kg.	2 SDs below the mean and group-specific (by sex and age)
Spruit et al.³⁰30 Spruit M, Sillen M, Groenen M, Wouters E, Franssen F. Spruit MA, Sillen MJ, Groenen MT, Wouters EF, Franssen FM. New normative values for handgrip strength: results from the UK Biobank. J Am Med Dir Assoc. 2013;14(10):775.e5-.e11. https://doi.org/10.1016/j.jamda.2013.06.013 https://doi.org/10.1016/j.jamda.2013.06....	n = 224,852 39-73	UK	Stratified by sex, height (5-cm height groups), and age (5-year age groups)	Measurements were performed with the patient in a seated position, with the elbow of the arm holding the dynamometer against the side of the patient and bent to a 90° angle, the forearm pointing forward, and the thumb in the uppermost position; the wrist was straight so that the hand was either pointing forward or bent slightly outward; a Jamar hydraulic hand dynamometer (Patterson Medical/Sammons Preston) was used; three trials were performed for each hand; values were expressed in kg.	Values below the 5th percentile and group-specific (by sex, height, and age)
Werle et al.³¹31 Werle S, Goldhahn J, Drerup S, Simmen BR, Sprott H, Herren DB. Age- and gender-specific normative data of grip and pinch strength in a healthy adult Swiss population. J Hand Surg Eur Vol. 2009;34(1):76-84. https://doi.org/10.1177/1753193408096763 https://doi.org/10.1177/1753193408096763...	n = 1,023 18-96	Switzerland	Stratified by sex and age (5-year age groups, the eldest individuals being > 85 years of age)	Position in accordance with the ASHT recommendations; a Jamar dynamometer (Patterson Medical/Sammons Preston) was used and set at the second handle position; both hands were assessed; the mean of three trials was used; values were expressed in kg.	2 SDs below the mean and group-specific (by sex and age)

Variable	Result
Age, years (min-max)	65 ± 8 (47-89)
Height, m	1.58 [1.52-1.67]
Weight, kg	70 ± 17
BMI, kg/m²	27 ± 6
GOLD stage II/III/IV COPD, n (%)	39/45/15 (39/46/15)
FEV₁, L	1.19 [0.81-1.53]
FEV₁, % predicted	46 ± 15
FVC, L	2.33 [1.91-2.99]
FVC, % predicted	74 ± 20
FEV₁/FVC	51 ± 13
Handgrip strength, kg	26 ± 10
Quadriceps muscle strength, kg	17 [9-23]
Biceps muscle strength, kg	12 [10-15]
Triceps muscle strength, kg	14 [11-17]
Six-minute walk distance, m	453 [388-500]
Six-minute walk distance, % predicted	85 [72-95]
MIP, cmH₂O^a	74 ± 25
MIP, % predicted^a	81 ± 26
MEP, cmH₂O^a	101 ± 32
MEP, % predicted^b	111 ± 36
Fat-free mass, kg^c	46 ± 10
Fat-free mass, % of body weight^c	66 [60-72]
Fat-free mass index, kg/m^c	18 ± 3
Fat mass, kg^c	23 ± 10
Fat mass, % of body weight^c	34 [27-39]
MRC scale score	3 [2-4]
LCADL scale - total^b	23 [18-30]
LCADL - self-care	6 [5-8]
LCADL - domestic	9 [5-13]
LCADL - physical	4 [3-5]
LCADL - leisure	4 [3-6]
BODE index	3 [2-5]
ADO index	4 [4-6]

Amaral et al.¹¹11 Amaral CA, Amaral TLM, Monteiro GTR, Vasconcellos MTL, Portela MC. Hand grip strength: Reference values for adults and elderly people of Rio Branco, Acre, Brazil. PLoS One. 2019;14(1):e0211452. https://doi.org/10.1371/journal.pone.0211452 https://doi.org/10.1371/journal.pone.021... vs.	Kappa statistic
Bohannon et al.²⁵25 Bohannon RW, Peolsson A, Massy-Westropp N, Desrosiers J, Bear-Lehman J. Reference values for adult grip strength measured with a Jamar dynamometer: a descriptive meta-analysis. Physiotherapy. 2006;92(1):11-15. https://doi.org/10.1016/j.physio.2005.05.003 https://doi.org/10.1016/j.physio.2005.05...	0.1481
Frederiksen et al.²⁶26 Frederiksen H, Hjelmborg J, Mortensen J, McGue M, Vaupel JW, Christensen K. Age trajectories of grip strength: cross-sectional and longitudinal data among 8,342 Danes aged 46 to 102. Ann Epidemiol. 2006;16(7):554-562. https://doi.org/10.1016/j.annepidem.2005.10.006 https://doi.org/10.1016/j.annepidem.2005...	0.4913
Massy-Westropp et al.²⁷27 Massy-Westropp NM, Gill TK, Taylor AW, Bohannon RW, Hill CL. Hand Grip Strength: age and gender stratified normative data in a population-based study. BMC Res Notes. 2011;4:127. https://doi.org/10.1186/1756-0500-4-127 https://doi.org/10.1186/1756-0500-4-127...	0.7778
Mathiowetz et al.⁶6 Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M, Rogers S. Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil. 1985;66(2):69-74.	0.6944
Peters et al.²⁸28 Peters M, van Nes S, Vanhoutte EK, Bakkers M, van Doorn PA, Merkies IS, et al. Revised normative values for grip strength with the Jamar dynamometer. J Peripher Nerv Syst. 2011;16(1):47-50. https://doi.org/10.1111/j.1529-8027.2011.00318.x https://doi.org/10.1111/j.1529-8027.2011...	0.3463
Shim et al.²⁹29 Shim JH, Roh SY, Kim JS, Lee DC, Ki SH, Yang JW, et al. Normative measurements of grip and pinch strengths of 21st century korean population. Arch Plast Surg. 2013;40(1):52-56. https://doi.org/10.5999/aps.2013.40.1.52 https://doi.org/10.5999/aps.2013.40.1.52...	0.7963
Spruit et al.³⁰30 Spruit M, Sillen M, Groenen M, Wouters E, Franssen F. Spruit MA, Sillen MJ, Groenen MT, Wouters EF, Franssen FM. New normative values for handgrip strength: results from the UK Biobank. J Am Med Dir Assoc. 2013;14(10):775.e5-.e11. https://doi.org/10.1016/j.jamda.2013.06.013 https://doi.org/10.1016/j.jamda.2013.06....	0.7090
Werle et al.³¹31 Werle S, Goldhahn J, Drerup S, Simmen BR, Sprott H, Herren DB. Age- and gender-specific normative data of grip and pinch strength in a healthy adult Swiss population. J Hand Surg Eur Vol. 2009;34(1):76-84. https://doi.org/10.1177/1753193408096763 https://doi.org/10.1177/1753193408096763...	0.2979

Variable	Amaral et al.¹¹11 Amaral CA, Amaral TLM, Monteiro GTR, Vasconcellos MTL, Portela MC. Hand grip strength: Reference values for adults and elderly people of Rio Branco, Acre, Brazil. PLoS One. 2019;14(1):e0211452. https://doi.org/10.1371/journal.pone.0211452 https://doi.org/10.1371/journal.pone.021...		Bohannon et al.²⁵25 Bohannon RW, Peolsson A, Massy-Westropp N, Desrosiers J, Bear-Lehman J. Reference values for adult grip strength measured with a Jamar dynamometer: a descriptive meta-analysis. Physiotherapy. 2006;92(1):11-15. https://doi.org/10.1016/j.physio.2005.05.003 https://doi.org/10.1016/j.physio.2005.05...		Fredericksen et al.²⁶26 Frederiksen H, Hjelmborg J, Mortensen J, McGue M, Vaupel JW, Christensen K. Age trajectories of grip strength: cross-sectional and longitudinal data among 8,342 Danes aged 46 to 102. Ann Epidemiol. 2006;16(7):554-562. https://doi.org/10.1016/j.annepidem.2005.10.006 https://doi.org/10.1016/j.annepidem.2005... ^),b
	Normal handgrip strength (n = 90)	Low handgrip strength (n = 9)	Normal handgrip strength (n = 44)	Low handgrip strength (n = 55)	Normal handgrip strength (n = 66)	Low handgrip strength (n = 16)
Quadriceps muscle strength, kg	17 [10-24]	9 [3.25-11.75]*	20 [16-29]	12 [7-18]*	18 [11.35-24]	8 [5-17.75]*
Biceps muscle strength, kg	15.5 [10-15]	2.5 [1.75-7.75]*	12.5 [10-18]	12 [10-14]*	12.5 [10-15]	11.5 [3.1-13.9]
Triceps muscle strength, kg	13.5 [11.87-17.75]	5.5 [1.75-10]*	15 [12-20]	12 [10-15]*	13.5 [12-17]	11 [6.515.87]*
Handgrip strength, kg	26 [20.75-34]	10 [4-14.5]*	29 [24-42]	20 [16-28]*	26 [21-36]	24.5 [10-29.5]*
FEV₁, % predicted	46 [35-57]	42 [35-46]	49 [41-63]	43 [31-54]*	47 [35-62]	41 [30-53]
MIP, % predicted	80 [66-98]	66 [57-97]	90 [74-106]	72 [58-92]*	80 [65-99]	66 [57-77]*
MEP, % predicted	107 [89-134]	82 [62-119]	107 [89-133]	108 [83-134]	108 [90-134]	97 [65-124]
6MWD, m	458 [399-506]	345 [237-456]*	465 [404-500]	437 [351-510]	459 [401-506]	415 [258-470]*
6MWD, % predicted	86 [75-96]	60 [43-82]*	87 [79-97]	80 [64-93]*	86 [77-97]	68 [46-84]*
FFMI, kg/m²	18.09 [16.22-20.82]	16.03 [14.07-17.01]*	19.23 [17.35-21.24]	16.48 [15.38-19.77]*	17.80 [16.06-20.91]	16.26 [15.80-19.78]
FMI, kg/m²	9.78 [7.12-12.01]	8.35 [5.34-8.02]*	10.23 [7.39-11.82]	8.76 [6.06-11.19]	9.52 [7.00-12.00]	7.45 [4.06-9.87]
MRC scale score	3 [2-4]	4 [3.5-5]*	3 [2-4]	3 [2-4]	3 [2-4]	4 [2.25-4.75]
LCADL scale, total	22 [17-28]	31 [26-42]*	21 [16-28]	23 [20-31]	22 [17-28.75]	23 [18-28.5]
Self-care	5 [5-7]	9 [6.5-10.5]*	5 [5-7]	6 [5-9]	5 [5-7]	6.5 [5-8.75]
Domestic	9 [5-12]	15 [8.5-23.5]*	7 [4-12]	9 [6-15]	8.5 [4.25-13]	7 [4-11.25]
Physical activity	4 [3-5]	5 [4-5]*	4 [3-5]	4 [3-5]	4 [3-5]	4 [3-5]
Leisure	4 [3-6]	6 [4-6.5]	4 [3-5]	5 [4-6]*	4 [3-5]	5 [4-6]
BODE index	3 [2-5]	6 [3-7]*	3 [1-3]	4 [2-6]*	3 [2-4]	4 [3-7]*
ADO index	4 [3-5]	6 [4-7]*	4 [3-5]	5 [4-6]	4 [4-5]	4 [3-7]
	Massy-Westropp et al.²⁷27 Massy-Westropp NM, Gill TK, Taylor AW, Bohannon RW, Hill CL. Hand Grip Strength: age and gender stratified normative data in a population-based study. BMC Res Notes. 2011;4:127. https://doi.org/10.1186/1756-0500-4-127 https://doi.org/10.1186/1756-0500-4-127...		Mathiowetz et al.⁶6 Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M, Rogers S. Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil. 1985;66(2):69-74.		Peters et al.²⁸28 Peters M, van Nes S, Vanhoutte EK, Bakkers M, van Doorn PA, Merkies IS, et al. Revised normative values for grip strength with the Jamar dynamometer. J Peripher Nerv Syst. 2011;16(1):47-50. https://doi.org/10.1111/j.1529-8027.2011.00318.x https://doi.org/10.1111/j.1529-8027.2011...
	Normal handgrip strength (n = 88)	Low handgrip strength (n = 11)	Normal handgrip strength (n = 86)	Low handgrip strength (n = 13)	Normal handgrip strength (n = 67)	Low handgrip strength (n = 32)
Quadriceps muscle strength, kg	17 [10.6-24]	8 [2-11]*	17.5 [11.37-24]	8 [3.5-10.5]*	18 [11-24]	11 [8-17]*
Biceps muscle strength, kg	12.5 [10-15]	3.5 [2-12]*	12.5 [10-15.2]	10 [2-12]*	12 [10-16]	10 [5-12]*
Triceps muscle strength, kg	13.5 [12-18.25]	8 [5-12]*	13.75 [12-18.5]	10 [5.25-12]*	14 [12-19]	11 [7-15]*
Handgrip strength, kg	20 [20.25-34]	11 [4-20]*	26 [21-34]	15 [6.5-19]*	28 [24-36]	18 [14-23]*
FEV₁, % predicted	46 [35-58]	40 [33-46]	47 [36-58]	38 [28-45]*	50 [38-62]	40 [31-46]*
MIP, % predicted	80 [66-99]	73 [53-93]	80 [66-98]	73 [49-97]	88 [67-100]	70 [57-91]*
MEP, % predicted	109 [91-135]	82 [64-101]*	109 [91-135]	82 [66-113]*	114 [95-142]	92 [74-118]*
6MWD, m	457 [398-504]	388 [220-472]	458 [396-506]	428 [244-468]	465 [403-510]	424 [283-465]*
6MWD, % predicted	86 [74-97]	74 [42-82]*	86 [74-97]	76 [43-84]*	88 [77-97]	76 [83-85]*
FFMI, kg/m²	18.21 [16.30-20.86]	16.03 [14.15-16.70]*	18.48 [16.39-20.96]	16.01 [14.20-16.48]*	18.61 [17.02-21.24]	16.26 [14.42-19.76]*
FMI, kg/m²	9.78 [7.15-11.99]	6.13 [4.96-8.96]*	9.88 [7.17-12.01]	6.13 [5.22-8.86]*	10.23 [7.20-12.17]	8.49 [5.72-9.88]*
MRC scale score	3 [2-4]	4 [3-4]	3 [2-4]	4 [2.5-4.5]	3 [2-4]	4 [2.5-4]*
LCADL scale, total	22 [17-28.5]	29 [20-42]	22 [17-28]	29 [20.5-42]	21.5 [17-26.7]	28 [20.2-36]*
Self-care	5 [5-7.5]	8 [5-10]	5 [5-7]	8 [5-10.5]	5 [5-7]	6.5 [5-9]
Domestic	9 [5-13]	10 [7-20]	8 [5-13]	10 [8-19]	7 [5-11]	9.5 [6.25-18]*
Physical activity	4 [3-5]	5 [3-5]	4 [3-5]	5 [3-5]	4 [3-5]	4 [3-5]
Leisure	4 [3-6]	5 [4-6]	4 [3-6]	5 [4-6.5]	4 [3-5]	5 [4-6]
BODE index	3 [2-4]	5 [3-7]*	3 [2-4]	5 [3-7]*	3 [1-4]	4 [3-6]*
ADO index	4 [3-5]	5 [4-6]	4 [3-5]	5 [4-6]	4 [3-5]	5 [4-7]
	Shim et al.²⁹29 Shim JH, Roh SY, Kim JS, Lee DC, Ki SH, Yang JW, et al. Normative measurements of grip and pinch strengths of 21st century korean population. Arch Plast Surg. 2013;40(1):52-56. https://doi.org/10.5999/aps.2013.40.1.52 https://doi.org/10.5999/aps.2013.40.1.52...		Spruit et al.³⁰30 Spruit M, Sillen M, Groenen M, Wouters E, Franssen F. Spruit MA, Sillen MJ, Groenen MT, Wouters EF, Franssen FM. New normative values for handgrip strength: results from the UK Biobank. J Am Med Dir Assoc. 2013;14(10):775.e5-.e11. https://doi.org/10.1016/j.jamda.2013.06.013 https://doi.org/10.1016/j.jamda.2013.06....		Werle et al.³¹31 Werle S, Goldhahn J, Drerup S, Simmen BR, Sprott H, Herren DB. Age- and gender-specific normative data of grip and pinch strength in a healthy adult Swiss population. J Hand Surg Eur Vol. 2009;34(1):76-84. https://doi.org/10.1177/1753193408096763 https://doi.org/10.1177/1753193408096763...
	Normal handgrip strength (n = 86)	Low handgrip strength (n = 13)	Normal handgrip strength (n = 90)	Low handgrip strength (n = 9)	Normal handgrip strength (n = 63)	Low handgrip strength (n = 33)
Quadriceps muscle strength, kg	17 [10.37-24]	9 [3.5-12.75]*	17 [10-24]	9.50 [4.12-15.75]*	19.5 [14-25.5]	10.75 [6.25-17]*
Biceps muscle strength, kg	12.5 [10-15.25]	3.5 [2-12]*	12.50 [10-15]	3.25 [1.87-13.5]*	12.5 [10-16]	11 [7.37-13.37]*
Triceps muscle strength, kg	13.5 [12-18.5]	8 [3.75-12]*	13.5 [11.75-17]	7 [2.15-17]*	14 [12.5-18.5]	11.5 [8.62-14.75]*
Handgrip strength, kg	26 [21.75-34]	11 [6.5-20]*	26 [20-34]	10 [4-21]*	28 [24-36]	20 [16-27.5]*
FEV₁, % predicted	47 [35-58]	40 [34-46]*	46 [34-57]	43 [37-47]	47 [37-62]	43 [30-54]
MIP, % predicted	80 [66-98]	66 [49-97]	84 [66-99]	57 [68-40]*	86 [68-100]	70 [57-91]*
MEP, % predicted	107 [90-134]	85 [66-119]	107 [87-135]	111 [72-129]	107 [91-135]	108 [83-130]
6MWD, m	459 [401-510]	370 [237-453]*	458 [394-507]	412 [265-467]	461 [400-505]	439 [316-490]*
6MWD, % predicted	86 [75-97]	74 [43-81]*	85.87 [73.94-95.5]	75.32 [49.31-83.01]*	86 [76-97]	79 [58-89]*
FFMI, kg/m²	18.09 [16.22-20.96]	16.26 [14.62-18.57]*	17.92 [16.15-20.82]	16.26 [14.07-19.69]	18.52 [16.53-21.10]	16.48 [15.66-19.78]*
FMI, kg/m²	9.67 [7.12-11.85]	8.49 [5.66-9.86]	9.67 [7.03-13.01]	8.49 [5.93-9.33]	9.80 [7.15-12.06]	8.90 [5.92-10.64]
MRC scale score	3 [2-4]	4 [3-4.5]	3 [2-4]	4 [2-4.25]	3 [2-4]	3.5 [2-4]
LCADL scale, total	22 [17-28]	30 [19.5-41]	22 [18-29.25]	26 [16.75-40.5]	22 [17-28]	24 [18-32.5]
Self-care	5 [5-7]	8 [5.5-9.5]	6 [5-8]	6.5 [5-9.5]	5 [5-7.75]	6 [5-9]
Domestic	9 [5-12]	12 [6.5-21.5]	9 [5-13]	9.5 [3.75-20.75]	9 [5-12.75]	9 [5.25-16.5]
Physical activity	4 [3-5]	4 [2-5]	4 [3-5]	4 [3-5]	4 [3-5]	4 [3-5]
Leisure	4 [3-6]	5 [3.5-6]	4 [3-6]	5 [3-6]	4 [3-5]	5 [3.25-6]
BODE index	3 [2-4]	5 [3-7]*	3 [2-5]	4 [2-6]	3 [1-4]	4 [2-6]
ADO index	4 [3-5]	5 [4-6]	4 [4-5]	5 [4-7]	4 [4-5]	4 [3-6]

[1] Correspondence to:
Fabio Pitta. Departamento de Fisioterapia, Centro de Ciências da Saúde, Hospital Universitário, Universidade Estadual de Londrina, Avenida Robert Koch, 60, Vila Operária, CEP 86038-350, Londrina, PR, Brasil. Tel.: 55 43 3371-2477. E-mail: fabiopitta@uel.br

Brasil

Brasil

Use of different reference values for handgrip strength in individuals with COPD: analysis of agreement, discriminative capacity, and main clinical implications

ABSTRACT

Objective:

Methods:

Results:

Conclusions: