An exploration of the mechanistic link between the enhanced paper grip test and the risk of falling

Assessment of the enhanced paper grip test for quantifying balance deficits in people with multiple sclerosis: A reliability and applicability study

This study assessed the reliability and applicability of the Enhanced Paper Grip Test (EPGT) for quantifying balance deficits in people with multiple sclerosis (MS). Thirty individuals with MS (mean age: 41.9 ± 9.66 years, mean Expanded Disability Status Scale (EDSS) score: 2.13 ± 0.94; mean disease duration: 8.3 ± 6.0 years) were recruited. The EPGT demonstrated excellent intra-visit reliability, with intraclass correlation coefficients (ICC) of 0.96 (95 % CI: 0.93-0.98) for the weaker side and 0.94 (95 % CI: 0.89-0.97) for the stronger side. Inter-visit reliability, assessed in 15 participants, also showed excellent ICCs (0.97-0.99), with coefficients of variation ranging from 4.23 % to 5.50 %. Additionally, high and statistically significant correlations were observed between EPGT performance and balance, as assessed by the modified Mini-BESTest (r = 0.81-0.87, p < 0.001). Small but statistically significant correlations were found between EPGT results and EDSS scores (r = -0.36 to -0.38, p < 0.05). These findings suggest that the EPGT can reliably assess foot/ankle strength and identify balance deficits in people with MS, with potential clinical application for monitoring disease progression and guiding rehabilitation interventions. The EPGT may provide a simple and effective method for identifying balance impairments in MS, potentially supporting early interventions and fall prevention strategies.

Reliability of enhanced paper grip test for testing foot strength in volleyball and soccer players

OBJECTIVES

To evaluate the reliability of the Enhanced Paper Grip Test (EPGT) for assessing foot strength in volleyball and soccer players.

DESIGN

A cross-sectional observational study with repeated measurements.

SETTING

Field-based study.

PARTICIPANTS

A convenience sample of 28 athletes (13 volleyball players and 15 soccer players) participated in the study.

MAIN OUTCOME MEASURES

The main outcome measures were the intraclass correlation coefficients (ICC) for intra-visit and inter-visit reliability, typical error, and coefficient of variation for the force (N) recorded in EPGT test.

RESULTS

The EPGT demonstrated good to excellent relative reliability (ICC values ranged from 0.93 to 0.97) and acceptable absolute reliability (typical error = 5-8 % of the mean). Significant inter-limb asymmetries were observed in both volleyball (16.0 ± 10.2%) and soccer players (15.3 ± 9.8%).

CONCLUSIONS

The EPGT is a reliable tool for assessing foot strength in volleyball and soccer players. Further research is required to explore the applicability of EPGT in different athletic and clinical contexts, and its potential role in athletic performance and injury prevention.

Effect of Exercises for Strengthening the Intrinsic Muscles of the Foot and Improving Ankle Mobility on Patients of Diabetic Peripheral Neuropathy

Background and objectives The study aimed to compare the efficacy of standard home care versus structured ankle mobility exercises in enhancing ankle and foot joint range of motion (ROM) among individuals with diabetes mellitus (DM). Additionally, it investigated the impact of foot intrinsic muscle strengthening exercises on hallux grip force in those with Diabetic Peripheral Neuropathy (DN). Materials and methods In a study of 200 patients with Diabetic Neuropathy (DN), selected from 345 screened diabetics with stable glucose levels and routine monitoring at a tertiary care facility, the efficacy of structured exercises versus standard care was evaluated. Participants, aged 40-70 years with mild neuropathic symptoms (neuropathy disability score of 3 to 5), were divided into two groups. Group 1 received standard care per International Diabetic Foot guidelines, while Group 2 performed targeted foot intrinsic muscle strengthening and ankle mobility exercises over eight weeks. The range of motion (ROM) for ankle and first metatarsophalangeal (MTP) joints and hallux grip force were measured, showing significant improvements in Group 2. Analysis was done using IBM SPSS. Results The average age of the individuals in group 1 (n=100) was 53.87±5.42 years, whereas the average age of the subjects in group 2 (n=100) was 54.23±4.69 years. The study included a total of 97 male participants, with 48 in group 1 and 49 in group 2. The groups exhibited homogeneity in terms of age, gender, duration of DM, and BMI (p>,0.05). When comparing the ROM for ankle dorsiflexion between the groups, it was shown that subjects in group 2 had a substantially higher ROM following exercise for both the right (27.97°±5.3° Vs 19.24°±2.54°) and left (28.55°±4.61° Vs 18.22°±1.14°) ankles compared to the patients in group 1 (p<,0.01). Nevertheless, there were statistically insignificant differences (p>,0.05) observed within the groups, both before and after the exercises, for all the variables examined except for right and left ankle dorsiflexion, and right ankle plantarflexion in group 2. Group 2 subjects exhibited a considerably greater hallux grip force compared to group 1 subjects. The mean enhanced paper grip strength for the right and left big toe of group 2 was 44±3.58 N and 43.2±2.62 N respectively. The mean enhanced paper grip force for the right and left big toe of group 1 was 38±3.11 N and 37.92±2.13 N respectively. A statistically highly significant difference was observed for hallux grip force between the groups (p<,0.01). Conclusion The findings of this study suggest that performing the foot intrinsic muscle strengthening and ankle mobility exercises on the foot and ankle joints can potentially enhance ROM and hallux grip force in patient groups with DN.

The enhanced paper grip test can substantially improve community screening for the risk of falling

BACKGROUND

Lower-limb strength measures can enhance falls risk assessment but due to the lack of clinically applicable methods, such measures are not included in current screening. The enhanced paper grip test (EPGT) is a simple-to-use and cost-effective test that could fill this gap. However, its outcome measure (EPGT force) has not yet been directly linked to the risk of falling.

RESEARCH QUESTION

Is the EPGT a good candidate for falls risk screening in older people in the community?

METHODS

Seventy-one older people living independently in the community were recruited for this prospective observational study (median age 69 y, range 65y-79y). Lower-limb and whole-body strength were assessed at baseline using the EPGT and a standardised hand-grip method respectively. Incident falls were recorded monthly for a year through follow-up telephone conversations. The capacity of individual strength measures to predict falls and to enhance an established falls risk assessment tool (FRAT) commonly used by UK's national health service (NHS) was assessed using binomial logistic regression. The analysis was repeated for the subset of participants without history of falling at baseline (prediction of first-ever falls).

RESULTS

Increased EPGT force and increased symmetry in strength between limbs were significantly associated with reduced risk of falling. Compared to the NHS-FRAT, the EPGT correctly classified more people (73% vs 69%), it achieved higher sensitivity (56% vs 26%) and higher negative predictive value (76% vs 68%). Complementing the NHS-FRAT with the EPGT produced a more comprehensive model that correctly classified 91% of participants and achieved 98% specificity, 81% sensitivity, 89% negative and 96% positive predictive value. Replacing the EPGT with hand-grip strength consistently undermined prediction accuracy. The EPGT remained highly accurate when focused on the prediction of first-ever falls.

SIGNIFICANCE

The EPGT can substantially enhance falls screening in the community. These results can also inform effective personalised strength exercise interventions.