Reliability and validity of a novel instrument for the quantification of hand forces during a jar opening task.

STUDY DESIGN

Clinical Measurement INTRODUCTION: Jar opening is a task that relies heavily on the ability to generate adequate hand forces and is often reported in the literature as being difficult for women with hand arthritis. Many have studied relationships between diminished grip/pinch strength and occupational performance but few have investigated how much hand force is necessary to successfully engage in manual tasks. Those who studied this have relied on approaches and tools which lack ecology. Additionally, few have instrumented daily objects to understand if joint protection techniques do, in fact, reduce the hand force generation when performing manual tasks.

PURPOSE OF THE STUDY

The objectives of this study were to one) determine the within session repeatability of a device used to quantify these forces and two) probe into the ecological validity of a novel device to be used in the future study of women with hand osteoarthritis to measure hand force requirements and study the impact of joint protection interventions on hand force profiles.

METHODS

A plastic jar was instrumented with a torque limiter, 6-axis load cell, and six force sensing resistors so as to capture the grip and compressive hand forces which act on a jar lid when opening a sealed jar. To assess intra-rater reliability of the tool and its testing procedures, 31 adult women with hand osteoarthritis were asked untwist the jar's lid so as to break its seal with each hand twice while stabilizing the base with the opposing hand. The agreement between trials of peak forces and torques from each hand was assessed through statistical approaches including Intraclass Correlation Coefficient, Standard Error of the Measurement, and Minimal Detectable Change. The jar's ecological validity was then assessed via survey.

RESULTS

This instrument and methods yielded good to excellent repeatability across all force outputs. The majority of our subjects (87%) reported the jar to be similar to those used at home, 87% reported to use a similar jar 2-3 times/month or greater, and rated the importance of opening such a jar as being, on average, 8.7/10.

DISCUSSION

The jar instrument appears to have high reliability and ecologic validity. It has the potential to reveal hand force requirements for a population known to have difficulties opening jars and understanding these force thresholds could help to inform therapy goal-setting. Beyond this, it has the potential to support the study of the hand forces used across various joint protection approaches so as to inform best "jar-opening" practices.

CONCLUSIONS

This tool was designed to represent the qualities of a standard, large sealed jar while still housing sophisticated kinetic measurement capacities. Our findings support that we have presented a tool which can be used in future study within this population to better understand the hand kinetics associated with the highly problematic task of jar-opening and joint protection strategies intended to reduce hand loads.