Validity and reliability of handgrip dynamometry in older adults: A comparison of two widely used dynamometers

BackgroundAmong older adults, decreased handgrip strength is associated with greater risk of frailty, and loss of physical function, mobility, lean mass, and overall muscular strength and power. Frailty is also associated with sarcopenia, for which handgrip strength measurement has been recommended for diagnostic purposes. Specific cutoff points for diagnosis have been identified, but use of different devices may affect measurement. Therefore to assess validity and reliability, we compared the two most frequently used devices, the Jamar hydraulic and Smedley spring handgrip dynamometers. MethodsSixty-seven older (76.2 +/- 0.9 years) men (n = 34) and women (n = 33) completed two trials of handgrip strength measurement on sequential days (T1, T2) using both devices in random order. Intraclass correlations were used to assess test-retest reliability, and Bland-Altman analysis was used to assess validity as the level of agreement between devices. ResultsThere were significant (p < 0.001) relationships between devices at T1 (r = 0.94) and T2 (r = 0.94) and strong (p < 0.001) intraclass correlations were observed for both devices (Jamar = 0.98; Smedley = 0.96), indicating excellent reliability. However, there were significant differences between devices. Strength measured with Jamar was greater than Smedley at both T1 (27.4 +/- 1.4 vs. 23.4 +/- 1.1 kg, p < 0.001) and T2 (25.3 +/- 1.4 vs. 21.8 +/- 1.2 kg, p < 0.001). Bland-Altman analysis confirmed these differences. Subgroup analysis to evaluate the effect of gender and age indicated that in women and old-old (>75 years) participants, differences between devices were closer to zero for both measurements compared to men and young-old (65-75 years) participants. ConclusionsOur results demonstrate that despite excellent reliability, there is poor agreement between devices, indicating a lack of validity. For use as a diagnostic tool, standardization and device-specific cutoff points for handgrip dynamometry are needed.