QL17
A Five-Year Study Evaluating Hand Grip Strength As an Assessment Tool for Multiple Sclerosis Disease Progression
Assessment tools such as the Expanded Disability Status Scale (EDSS) focus mainly on gait and ambulation but little attention has been placed on the importance of hand function. As hand function is strongly correlated with quality of life measures in individuals with multiple sclerosis, objective monitoring of grip strength could be a valuable indicator of disease status in people with MS.
Objectives:
To quantify changes in grip strength in people with MS and correlate changes in grip strength with other measures of disease status including the timed 25-foot walk and EDSS score.
Methods:
We conducted a longitudinal study of hand grip strength in 61 MS patients (37 relapsing-remitting, 24 secondary progressive) with EDSS ranging from 0 to 8.5 and who were followed for an average of 5-years. Annual hand-grip strength was quantitatively measured bilaterally using dynamometry. Symptom duration, traditional measures of disease status including, EDSS and timed 25-foot walk, were also collected. Initial analyses correlated grip strength with traditional measures of disease status. We also calculated the rate of change in grip strength using mixed effects linear regression models with patient-specific intercepts.
Results:
Both weaker and dominant hand grip strength correlated significantly with slower timed 25-foot walk time (for weaker hand: r=0.39; P<0.0001; for dominant hand: r=0.29; P<0.0001). Following adjustment for age, disease subtype, symptom duration and sex, we observed a marginally statistically significant annual decline of -0.68 pounds (95% CI: -1.41 to 0.05; P=0.07) in weaker-hand grip function and of -0.78 pounds (95% CI: -1.56 to 0.13; P=0.09) in dominant hand function. We observed a marginally significantly stronger rate of decline in dominant hand function in progressive patients (P=0.05).
Conclusions:
Hand strength is frequently impaired in individuals with MS, and assessing hand strength with a dynamometer is a quantitative way to sensitively monitor changes in disease status over time. Further studies in MS patients are warranted to establish monitoring grip strength as a clinical outcome measure as well as establish a minimal clinically imporant change in grip strength.