Gutierrez Zeida, Shechtman Orit
Mercy Hospital, Miami, Florida, USA.
Am J Phys Med Rehabil. 2003 Nov;82(11):847-55. doi: 10.1097/01.PHM.0000083667.25092.4E.
The five-handle position (five-rung) test is used to determine sincerity of effort of grip strength. However, there is a controversy in the literature concerning its validity and effectiveness. The purpose of the study was to investigate whether test results are affected by the amount of strength exerted by the gripping hand and to determine the test's effectiveness.
A total of 30 hand therapy patients performed the five-rung grip test both maximally and submaximally with both the injured and uninjured hands. The standard deviation across the five strength trials was used to measure the shape of the curve. Sensitivity and specificity values were calculated for each sex.
The repeated measures analyses of variance revealed that average strength and the standard deviation were greater for men than for women, for maximal effort than for submaximal effort, and for the injured hand in comparison with the healthy hand. The most optimal standard deviation cutoff value was 8.5 (sensitivity, 0.70; specificity, 0.83), and the proportional area under the receiver operator characteristic curve was greater for the men (89%) than for women (80%).
The shape of the curve generated by the five-rung test was strength dependent; thus, the test may yield biased results when assessing sincerity of effort in people with weakened hands. The five-rung test was less effective for women than for men. Thus, we recommend that the five-rung test not be used to detect sincerity of effort.
五手柄位置（五档）测试用于确定握力的用力程度是否真实。然而，文献中对于其有效性存在争议。本研究的目的是调查测试结果是否受握力手施加的力量大小影响，并确定该测试的有效性。
30名手部治疗患者分别用受伤手和未受伤手进行了最大用力和次最大用力的五档握力测试。五次力量测试的标准差用于测量曲线形状。计算了每种性别的敏感度和特异度值。
重复测量方差分析显示，男性的平均力量和标准差大于女性，最大用力时大于次最大用力时，受伤手大于健康手。最理想的标准差临界值为8.5（敏感度为0.70；特异度为0.83），男性的受试者工作特征曲线下的比例面积（89%）大于女性（80%）。
五档测试产生的曲线形状取决于力量大小；因此，在评估手部力量减弱者的用力程度时，该测试可能会产生有偏差的结果。五档测试对女性的效果不如男性。因此，我们建议不要使用五档测试来检测用力程度是否真实。
