title: Measurement error in grip and pinch force measurements in patients with hand injuries.
abstract: OBJECTIVE
  There is limited documentation of measurement error of grip and pinch force evaluation methods. The purposes of this study were (1) to determine indexes of measurement error for intraexaminer and interexaminer measurements of grip and pinch force in patients with hand injuries and (2) to investigate whether the measurement error differs between measurements of the injured and noninjured hands and between experienced and inexperienced examiners.
  
  
  METHODS
  The subjects were a consecutive sample of 33 patients with hand injuries who were seen in the Department of Rehabilitation Medicine of Erasmus MC-University Medical Center Rotterdam in the Netherlands.
  
  
  METHODS
  Repeated measurements were taken of grip and pinch force, with a short break of 2 to 3 minutes between sessions. For the grip force in 2 handle positions (distance between handles of 4.6 and 7.2 cm, respectively), tip pinch (with the index finger on top and the thumb below, with the other fingers flexed) and key pinch force (with the thumb on top and the radial side of the index finger below) data were obtained on both hands of the subjects by an experienced examiner and an inexperienced examiner. Intraclass correlation coefficients (ICCs), standard errors of measurement (SEMs), and associated smallest detectable differences (SDDs) were calculated and compared with data from previous studies.
  
  
  RESULTS
  The reliability of the measurements was expressed by ICCs between .82 and .97. For grip force measurements (in the second handle position) by the experienced examiner, an SDD of 61 N was found. For tip pinch and key pinch, these values were 12 N and 11 N, respectively. For measurements by the inexperienced examiner, SDDs of 56 N for grip force and 13 N and 18 N for tip pinch and key pinch were found.
  
  
  CONCLUSIONS
  Based on the SEMs and SDDs, in individual patients only relatively large differences in grip and pinch force measurements can be adequately detected between consecutive measurements. Measurement error did not differ between injured and noninjured hands or between experienced and inexperienced examiners. Criteria for judging whether the measurement error does allow application of the measurements in individual patients are discussed.
authors.affiliation: Department of Rehabilitation Medicine, Hand Therapy Unit, Erasmus MC-University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands. a.schreuders@erasmusmc.nl
authors.forename: Ton A R
authors.initials: TA
authors.lastname: Schreuders
authors.forename: Marij E
authors.initials: ME
authors.lastname: Roebroeck
authors.forename: Janine
authors.initials: J
authors.lastname: Goumans
authors.forename: Johan F
authors.initials: JF
authors.lastname: van Nieuwenhuijzen
authors.forename: Theo H
authors.initials: TH
authors.lastname: Stijnen
authors.forename: Henk J
authors.initials: HJ
authors.lastname: Stam
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D005260:Female; D006230:Hand Injuries / Q000503:physiopathology* / Q000534:rehabilitation*; D018737:Hand Strength; D006801:Humans; D015601:Injury Severity Score; D007537:Isometric Contraction; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000209:etiology / Q000503:physiopathology; D009426:Netherlands; D016059:Range of Motion, Articular; D012016:Reference Values; D015203:Reproducibility of Results