Watson Jeffrey, Ring David
Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA 02114, USA.
J Hand Surg Am. 2008 Dec;33(10):1791-5. doi: 10.1016/j.jhsa.2008.07.006.
Grip strength is widely used to assess upper-extremity function. Although grip strength is a quantitative measure of function, grip strength is a reflection of both physical impairment as well as subjective, psychological factors. We investigated the determinants of grip strength with the hypothesis that psychological factors are associated with diminished grip strength.
One hundred thirty-four patients with an isolated, discrete upper-extremity condition had grip strength measurements, and, as part of one of several prospective clinical studies, during the same visit they completed 2 or more of the following surveys: the Center for Epidemiologic Studies-Depression (CES-D) scale, Pain Anxiety Symptoms Scale, and Pain Catastrophizing Scale. Univariate and multivariable statistical analysis sought determinants of absolute grip strength and grip strength as a percentage of the opposite, uninvolved limb.
Determinants of absolute grip strength included gender and grip strength of the uninvolved limb. The association between CES-D score and absolute grip strength was near significant but very weak. Multivariable regression analysis produced a best-fit model that retained grip strength of the uninvolved limb and CES-D scores. When grip strength of the involved limb was evaluated as a percentage of grip strength of the uninvolved limb, CES-D score was a weak but significant predictor, and patients recovering from a fracture of the distal radius had weaker grip strength than did patients with nontraumatic conditions.
Depression scores were minimally associated with diminished grip strength. Psychological factors appear to affect disability (patient-reported health status) more than they affect performance-based measures of function.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.
握力被广泛用于评估上肢功能。尽管握力是功能的一种定量测量方法，但握力既反映了身体损伤，也反映了主观心理因素。我们研究了握力的决定因素，假设心理因素与握力下降有关。
134例患有孤立性、离散性上肢疾病的患者进行了握力测量，作为几项前瞻性临床研究之一的一部分，在同一次就诊期间，他们完成了以下2项或更多项调查：流行病学研究中心抑郁量表（CES-D）、疼痛焦虑症状量表和疼痛灾难化量表。单变量和多变量统计分析旨在寻找绝对握力以及患侧握力占对侧未受累肢体握力百分比的决定因素。
绝对握力的决定因素包括性别和未受累肢体的握力。CES-D评分与绝对握力之间的关联接近显著，但非常微弱。多变量回归分析得出了一个最佳拟合模型，该模型保留了未受累肢体的握力和CES-D评分。当将患侧握力评估为未受累肢体握力的百分比时，CES-D评分是一个微弱但显著的预测因素，从桡骨远端骨折恢复的患者握力比非创伤性疾病患者弱。
抑郁评分与握力下降的关联极小。心理因素似乎对残疾（患者报告的健康状况）的影响大于对基于表现的功能测量的影响。
研究类型/证据水平：预后性II级。
