September 2020


Illustration of the “enhanced paper grip test” courtesy of Staffordshire University/Josh Thomas.

The “enhanced paper grip test,” validated by researchers from the Centre for Biomechanics and Rehabilitation Technologies (CBRT) at Staffordshire University, England, involves pulling a small card from underneath the participant’s foot while asking them to grip with their big toe (hallux). The proposed test can potentially be used in clinics to monitor muscle weakness for better falls-risk assessment in patients with diabetes. According to the study authors, it is simple, clinically applicable, and is valuable to use in low-resource settings.

“The current paper builds on our previous work and shows its usefulness in assessing strength and balance in this group of vulnerable patients,” said Aoife Healy, PhD, associate professor of Human Movement Biomechanics at CBRT.

The experiment involved assessing 20 healthy volunteers and 10 people with diabetes. Hallux grip force was previously found to be strongly linked to the strength of all muscle groups of the foot and ankle and to the ability to maintain balance. The latest results, published in Gait and Posture, on a modified test shows the reliability and validity of hallux grip force during clinical assessment.

“The original version of the paper grip test was shown to be effective in detecting foot muscle weakening, but its outcome is operator-dependent,” said Panagiotis Chatzistergos, PhD, associate professor in Orthopaedic and Rehabilitation Biomechanics, who led this study. “To overcome this limitation, we have developed this enhanced test that replaces the pass/fail outcome with a continuous measurement of the pulling force that is needed to remove the card.”

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