Schreuders Ton A R, Roebroeck Marij E, Goumans Janine, van Nieuwenhuijzen Johan F, Stijnen Theo H, Stam Henk J
Department of Rehabilitation Medicine, Hand Therapy Unit, Erasmus MC-University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
Phys Ther. 2003 Sep;83(9):806-15.
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.
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.
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.
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.
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.
握力和捏力评估方法的测量误差相关文献有限。本研究的目的是：（1）确定手部受伤患者中，检查者自身以及不同检查者测量握力和捏力时的测量误差指标；（2）调查受伤手与未受伤手的测量误差，以及经验丰富与经验不足的检查者之间的测量误差是否存在差异。
受试者为荷兰鹿特丹伊拉斯姆斯大学医学中心康复医学科连续纳入的33例手部受伤患者。
对握力和捏力进行重复测量，每次测量之间有2至3分钟的短暂休息。对于2种手柄位置（手柄间距分别为4.6厘米和7.2厘米）的握力、指尖捏力（食指在上、拇指在下，其他手指弯曲）和钥匙捏力（拇指在上、食指桡侧在下），由一名经验丰富的检查者和一名经验不足的检查者在受试者的两只手上获取数据。计算组内相关系数（ICC）、测量标准误差（SEM）以及相关的最小可检测差异（SDD），并与先前研究的数据进行比较。
测量的可靠性用ICC表示，范围在0.82至0.97之间。对于经验丰富的检查者测量握力（在第二个手柄位置），发现SDD为61牛。对于指尖捏力和钥匙捏力，这些值分别为12牛和11牛。对于经验不足的检查者的测量，握力的SDD为56牛，指尖捏力和钥匙捏力的SDD分别为13牛和18牛。
基于SEM和SDD，在个体患者中，连续测量之间只能充分检测到握力和捏力测量中相对较大的差异。受伤手与未受伤手之间或经验丰富与经验不足的检查者之间的测量误差没有差异。讨论了判断测量误差是否允许在个体患者中应用测量结果的标准。
