Hand grip strength as a clinical biomarker for ME/CFS, 2018, Nacul et al

Suffolkres

Suffolkres

Senior Member (Voting Rights)
Source: Frontiers in Neurology
Preprint
Date: November 5, 2018
URL:
https://www.frontiersin.org/articles/10.3389/fneur.2018.00992/abstract

Hand grip strength as a clinical biomarker for ME/CFS and disease
severity
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Luis C. Nacul(*), Kathleen Mudie, Caroline Kingdon(*), Taane G.
Clark, Eliana M. Lacerda
- London School of Hygiene & Tropical Medicine, United Kingdom
* Correspondence: Dr. Luis C. Nacul <luis.nacul@lshtm.ac.uk>
Mrs. Caroline Kingdon <caroline.kingdon@lshtm.ac.uk>
 
Methods
We compared [hand grip strength] HGS measurements from participants in the UK ME/CFS Biobank, with groups consisting of people with ME/CFS of differing severity (n=272), healthy (n=136), multiple sclerosis (n=76) controls, and others with chronic fatigue not meeting the diagnosis of ME/CFS (n=37). We correlated the maximum and minimum of, and differences between, 3 repeated HGS measurements with parameters of disease severity, including fatigue and pain analog scales, and physical and mental component summaries from the SF-36v2TM questionnaire across recruitment groups.

Results
HGS indicators were associated with having ME/CFS, with magnitudes of association stronger in severely affected than in mild/moderately affected patients. Compared with healthy controls, being severely affected was associated with a reduction in minimum HGS of 15.3kg (95%CI 19.3-11.3; p<0.001), while being mild/moderately affected was associated with a 10.5kg (95%CI 13.2-7.8; p<0.001) reduction. The association persisted after adjusting for age, sex and body mass index. ME/CFS cases also showed lower values of maximum HGS and significant drops in values from the first to second and third trials, compared to other study groups. There were significant correlations between HGS indicators and clinical parameters of disease severity, including fatigue analog scale (Spearman’s Rho= -0.40, p<0.001), pain analog scale (Rho=-0.38, p<0.001), and physical component summary (Rho=0.42, p<0.001).

Discussion
HGS is markedly reduced in ME/CFS, particularly in patients with more severe disease, and may indicate muscle and fatigue related symptoms. HGS is a potential diagnostic tool in ME/CFS, and could also be used to enhance patient phenotyping and as an outcome measure following interventions.
 
Merged thread

Hand grip strength is markedly reduced in ME/CFS, particularly in patients with more severe disease, and may indicate muscle and fatigue related symptoms. Hand grip strengthis a potential diagnostic tool in ME/CFS, and could also be used to enhance patient phenotyping and as an outcome measure following interventions.
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Full article is not yet available.

https://www.frontiersin.org/articles/10.3389/fneur.2018.00992/abstract
 
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If this turns out to be reliable it should be really easy to do and not trigger significant worsening afterwards... I'd be interested to see how grip strength varies over months on different days and whether this can be tied to the muscles themselves or something neurological. We usually only think about how hard repeating aerobic performances is, but anecdotally I do remember that I always had a significant drop-off in repetitions for strength exercises after the first set after the first ~3 years. Seems like a really obvious and good idea to explore this area.

Does anybody know how HGS is in e.g. MS or other diseases with significant neurological fatigue?
 
I wonder how they can show that people exert maximum force on each attempt? In CPET tests, I think they can show maximum effort by means of a ratio of gases exhaled, I think (RER? I can't remember what it stands for - maybe 'respiratory exchange ratio').

Otherwise, I can see this new test being dismissed as reflecting patients' behaviour.

I haven't read the paper, though (since it's not available yet!).
 
For many years what i found was my strength was about the same. Less then a normal person and i could not build muscle but i could function till PEM. Over time how much i could do till i hit PEM became less and less. But as i became mostly homebound my strength started declining rather quickly as well as how much i could do till PEM diminished just as quickly. And simultaneously my cognitive functioning also started dropping rapidly and my non 24 sped up drastically. :(
I am only able to post due to the many supplements i am taking for cognitive function otherwise i'd almost be a vegetable cognitively :dead:
 
The thing I noticed from the start along with my legs losing power quickly (rapid muscle fatiguability) was that I couldn't write as much as I used to be able to do. Being from the generation where writing meant handwriting, not typing, I was accustomed to being able to write long essays, plans, documents etc without any problem.

Once I had ME, things like writing reports had to be done in small doses with rests in between as my handwriting would deteriorate after a couple of pages and my hand would feel week and painful.

Now I can't write more than a couple of sentences before my writing starts falling apart. Thank goodness I can still type. It's a different action that doesn't require grip. Though after a day bumbling around on the forum my arm pain is pretty bad.
 
This looks really interesting and it's helpful to know it's recognised as a measure of severity in MS too, so is seen as a valid measure.

Is there any way this can be misused by the BPS crowd? I'm just imagining them accusing us of not trying hard enough to grip because of some sort of fear avoidance. And adding hand grip strengthening exercises to their GET treatment regimes so they can use it as a marker to prove we've improved. Sorry to sound negative, I just don't trust the BPS lot not to twist this to their advantage.
 
Trish said:
This looks really interesting and it's helpful to know it's recognised as a measure of severity in MS too, so is seen as a valid measure.

Is there any way this can be misused by the BPS crowd? I'm just imagining them accusing us of not trying hard enough to grip because of some sort of fear avoidance. And adding hand grip strengthening exercises to their GET treatment regimes so they can use it as a marker to prove we've improved. Sorry to sound negative, I just don't trust the BPS lot not to twist this to their advantage.
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This is exactly my concern. Just because it's seen as a valid test in 'valid' diseases doesn't mean that it will be seen as valid in ours.
 
Hutan said:
could also be used to enhance patient phenotyping and as an outcome measure following interventions.
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In my eyes, they lost some serious street creds with that line. There are no proven sustained interventions across the ME community.
 
duncan said:
In my eyes, they lost some serious street creds with that line. There are no proven sustained interventions across the ME community.
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I think the point is that one could easily use it as an objective outcome measure and if there is no beneficial change, it will be noticeable. If an intervention does nothing, this test should show it unless it turns out to be unreliable in some way (due to random fluctuations when tested on different days being too huge or sth like that), so expect the BPS crowd to not adopt it.
 
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