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Miura S1, Seko T2, Matsuda R3, Kumamoto T2
1Hokusei Hospital, Rehabilitation, Chitose, Japan, 2Hokkaido Chitose College of Rehabilitation, Chitose, Japan, 3Sinsapporo Neurosurgical Hospital, Sapporo, Japan
Background: The population aging rate in Japan is 27.7%, which is the highest in the world, and falls in the older people is predicted to increase. Toe muscle strength is important for the balancing ability and involves two strength with different kinetic characteristics, i.e., toe pressure strength (TPS ; strength of pressing the ground) and toe grip strength (TGS ; strength of gripping the ground). Methods of measuring TGS and its relationship with the balancing ability have been reported previously; however, no studies on TPS have been reported, particularly in older people populations.
Purpose: This study aims to validate the usefulness of the method that we have developed to measure TPS using a hand-held dynamometer (HHD) through investigating its reliability and relationships with TGS and balancing ability in older people.
Methods: Seventy-seven community-dwelling older people (73.5 ± 7.3 years) were included in this study. TPS and TGS were measured in an upright sitting position with the knee joint in 90° flexion position and the ankle joint in 0° plantar flexion position. TPS was measured with HHD (mobie MT100, SAKAI Medical Co., Ltd., Tokyo, Japan) while participants placed the foot sole distal to the head of metatarsal bone on a HHD and proximal part on a footrest at the same height as the HHD. In addition, the tester fixed the participant's lower leg manually. Then participants pressed HHD by a maximum isometric contraction of the toe.
TGS was measured using a measuring instrument composed of a toe grip bar attached to the grip of a hand grip dynamometer while the participant´s toe gripping the bar, as described in our previous report. The body weight ratio was calculated from each measured value (kgf/kg). The maximum 2-step test (m/ height) was used to assess the balancing ability as it has been reported to correlate closely with falling.
The reliability of TPS and TGS was examined with ICC (1, 1) and Bland-Altman analysis. Relationships between TPS and TGS and between respective toe muscle strength and 2-step test results were analyzed with Spearman´s rank correlation coefficients.
Results: ICC (1, 1) was 0.92 for TPS and 0.93 for TGS. Results of Bland-Altman analysis showed a large fixed error for the second measurement of TPS and a limit of agreement of -3.21 - 1.95 (kgf/kg). No proportional errors were observed for any measured value of toe muscle strength. The correlation coefficient between measured TPS and TGS was rs = 0.46 (P .05). The correlation coefficients of 2-step test results with TPS and TGS were rs = 0. 31 (P .01) and rs = 0.15 (P = .18), respectively.
Conclusion(s): In TPS measurement using HHD, the maximum muscle strength can be more easily obtained by measuring twice.
TPS moderately correlated with TGS, while TPS may contribute more to the dynamic balancing ability than TGS.
Implications: TPS measurement using HHD in the older people is a useful index for evaluation of balancing ability.
Keywords: Hand-held Dynamometer, toe strength, older people
Funding acknowledgements: None.
Purpose: This study aims to validate the usefulness of the method that we have developed to measure TPS using a hand-held dynamometer (HHD) through investigating its reliability and relationships with TGS and balancing ability in older people.
Methods: Seventy-seven community-dwelling older people (73.5 ± 7.3 years) were included in this study. TPS and TGS were measured in an upright sitting position with the knee joint in 90° flexion position and the ankle joint in 0° plantar flexion position. TPS was measured with HHD (mobie MT100, SAKAI Medical Co., Ltd., Tokyo, Japan) while participants placed the foot sole distal to the head of metatarsal bone on a HHD and proximal part on a footrest at the same height as the HHD. In addition, the tester fixed the participant's lower leg manually. Then participants pressed HHD by a maximum isometric contraction of the toe.
TGS was measured using a measuring instrument composed of a toe grip bar attached to the grip of a hand grip dynamometer while the participant´s toe gripping the bar, as described in our previous report. The body weight ratio was calculated from each measured value (kgf/kg). The maximum 2-step test (m/ height) was used to assess the balancing ability as it has been reported to correlate closely with falling.
The reliability of TPS and TGS was examined with ICC (1, 1) and Bland-Altman analysis. Relationships between TPS and TGS and between respective toe muscle strength and 2-step test results were analyzed with Spearman´s rank correlation coefficients.
Results: ICC (1, 1) was 0.92 for TPS and 0.93 for TGS. Results of Bland-Altman analysis showed a large fixed error for the second measurement of TPS and a limit of agreement of -3.21 - 1.95 (kgf/kg). No proportional errors were observed for any measured value of toe muscle strength. The correlation coefficient between measured TPS and TGS was rs = 0.46 (P .05). The correlation coefficients of 2-step test results with TPS and TGS were rs = 0. 31 (P .01) and rs = 0.15 (P = .18), respectively.
Conclusion(s): In TPS measurement using HHD, the maximum muscle strength can be more easily obtained by measuring twice.
TPS moderately correlated with TGS, while TPS may contribute more to the dynamic balancing ability than TGS.
Implications: TPS measurement using HHD in the older people is a useful index for evaluation of balancing ability.
Keywords: Hand-held Dynamometer, toe strength, older people
Funding acknowledgements: None.
Topic: Outcome measurement; Older people
Ethics approval required: Yes
Institution: Hokusei Hospital
Ethics committee: Hokusei Hospital
Ethics number: 44
All authors, affiliations and abstracts have been published as submitted.
