握力測定の標準化

握力測定の標準化に向けたレビュー論文を紹介します。

Roberts HC, Denison HJ, Martin HJ, Patel HP, Syddall H, Cooper C, Sayer AA. A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach. Age Ageing. 2011 May 30. [Epub ahead of print]

握力はEWGSOPのサルコペニアの診断基準に含まれてたり、栄養指標として使用されることが増えたり、臨床栄養の世界で改めて注目されつつあります。私も診察で握力を評価する機会が増えました。ただし、標準的な測定方法はまだ定義されていません。

握力の測定方法を記載してある論文をレビューした結果、ばらつきが大きいことが明らかになりました。最大値か平均値か、1回か2回か3回か、両側か片側か、測定時のポジションなど、いろんな方法があります。

臨床で使用する分には、最大値、1回、両側で構わないと私は思っています。研究で使用するためには信頼性、妥当性のある評価方法にしなければいけないので、標準化された測定方法の開発が望まれます。

Abstract
BACKGROUND: the European Working Group on Sarcopenia in Older People has developed a clinical definition of sarcopenia based on low muscle mass and reduced muscle function (strength or performance). Grip strength is recommended as a good simple measure of muscle strength when 'measured in standard conditions'. However, standard conditions remain to be defined.

METHODS: a literature search was conducted to review articles describing the measurement of grip strength listed in Medline, Web of Science and Cochrane Library databases up to 31 December 2009.

RESULTS: there is wide variability in the choice of equipment and protocol for measuring grip strength. The Jamar hand dynamometer is the most widely used instrument with established test-retest, inter-rater and intra-rater reliability. However, there is considerable variation in how it is used and studies often provide insufficient information on the protocol followed making comparisons difficult. There is evidence that variation in approach can affect the values recorded. Furthermore, reported summary measures of grip strength vary widely including maximum or mean value, from one, two or three attempts, with either hand or the dominant hand alone.

CONCLUSIONS: there is considerable variation in current methods of assessing grip strength which makes comparison between studies difficult. A standardised method would enable more consistent measurement of grip strength and better assessment of sarcopenia. Our approach is described.