title: The use of the rapid exchange grip test in detecting sincerity of effort, Part II: validity of the test.
abstract: The rapid exchange grip (REG) test was developed to identify patients exerting insincere effort. The premise of the REG test is that a maximal, sincere effort yields a "negative REG," in which peak static grip (SG) scores are greater than peak REG scores, and that a submaximal, insincere effort yields a "positive REG," in which REG scores are greater than SG scores. There is disagreement in the literature concerning what constitutes a positive REG test, suggesting that the REG may not be a valid measure of sincerity of effort. The purpose of the present study was to investigate the validity of the REG test by examining its premise as well as its sensitivity and specificity values. The 146 uninjured subjects performed a series of randomized grip strength tests, exerting both maximal and submaximal efforts. The tests included the REG at hand switch rates of 45 rpm (REG-45) and 60 rpm (REG-60), the maximal static grip test (MSGT), and the five-rung test (5R). Our findings supported the concept of a "negative REG" for both REG maneuvers and both comparative SG tests. The concept of a "positive REG," however, was supported only when peak REG scores were compared with peak 5R scores. The authors found relatively low sensitivity and specificity values, suggesting that the REG test may not be sensitive or specific enough to effectively detect sincerity of effort. The authors discuss the likelihood that mistakes will be made when the REG test is used to diagnose sincerity of effort and the possible consequences of making such mistakes.
authors.affiliation: Department of Occupational Therapy, College of Health Professions, University of Florida, Gainesville 32610, USA. oshechtm@hp.ufl.edu
authors.forename: O
authors.initials: O
authors.lastname: Shechtman
authors.forename: C
authors.initials: C
authors.lastname: Taylor
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D015982:Bias; D019937:Diagnostic Techniques and Procedures / Q000592:standards*; D005260:Female; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D005082:Physical Exertion; D012680:Sensitivity and Specificity