Getting to grips with grip strength: A scoping review of patients mapped against sarcopenia consensus cut points

Purpose

Sarcopenia is a progressive and generalised skeletal muscle disorder that is associated with increased likelihood of adverse outcomes including falls and fractures. In 2019 a new European consensus document was published that allowed effective diagnosis of sarcopenia in a clinical setting (Cruz-Jentoft et al 2019). As sarcopenia is a disorder that can be improved by physical interventions, it is important that physiotherapists working with older adults consider assessment for sarcopenia. However, the numbers of patients who this could affect was unknown. The overarching aim of this project was to identify the number of people with sarcopenia, as a baseline scoping review, who presented to the older peoples physiotherapy services within Fifes Health and Social care partnership (HSCP). The objectives of this project were to:

· Ascertain if people attending physiotherapy for older adults in Fife would be defined as needing further assessment for sarcopenia based on their grip strength

· Ascertain if there was any difference in grip strength for patients in different clinical locations in Fife

This would allow an understanding of the number of people presenting to physiotherapy who would benefit from an intervention to address their sarcopenia and therefore the most effective way to intervene given the numbers identified

Approach

Each HSCP physiotherapy department whose remit was predominantly with the assessment and rehabilitation of older people was included in this project. During September 2019 all patients were assessed for their grip strength during their physiotherapy assessment. Possible sarcopenia was defined using the cut points of 16kg for women and 27kg for men from the European consensus paper. To minimise variability a set protocol was used for all grip strength measurements.

Outcomes

Results: Over three quarters of patients assessed during September 2019 would meet the criteria for further investigation of sarcopenia based on their grip strength. The pattern of meeting the criteria related cut points based on grip strength was as expected; in that day patients, who are capable of travelling to their assessments, were least likely to have a grip strength below the cut point, then people assessed at home and most likely were inpatients.

Conclusion(s): Grip strength is a feasible way of screening to indicate further assessment for sarcopenia, following the protocol published in the consensus paper. If probable sarcopenia is found, then the recommended interventions include exercise and nutritional advice. It is suggested that a Fife wide intervention pathway is developed following best available evidence.

Cost and savings

Cost was minimal - £20 for each hand grip dynamometer

Implications

Grip strength will now be incorporated as a routine measurement during physiotherapy assessment. This will enable the identification of possible sarcopenia and prompt further assessment using the published screening protocol from the European consensus paper. The Fife wide physiotherapy group are planning to develop a pathway for intervention based on the best available evidence for resistance training and nutritional support.

Top three learning points

No further data 

Funding acknowledgements

No funding