AB0348 Grip power and independent daily living in the patients with rheumatoid arthritis
Authors: H. Ishikawa, A. Abe, T. Kojima, M. Kojima, N. Ishiguro, S. Ito, A. Murasawa
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Grip power is known to be a simple and useful objective index that can be used in the self-assessment of disease activity in patients with rheumatoid arthritis (RA)<sup>1)</sup>. However, the clinical significance of this physical function is unknown. <h3>Objectives</h3> The objective of this study was to clarify the relationship between the grip power and the level of activities of daily living (ADL). <h3>Methods</h3> The grip power was measured in 221 inpatients of our hospital with RA using a mercury dynamometer. The independence level (0: impossible, 1: incomplete and not practical, 2: practical but the means thereof are unusual, 3: normal) for 44 ADL items, including most daily activities was investigated. For each item, the site with the problem (shoulder, elbow, forearm, wrist, thumb, fingers, lower extremity and trunk) and cause of disability (pain, loss of power, decreased range of motion, abnormal prehensile pattern and fatigue) were investigated by interviewing the patient. There were 33 male and 188 female patients. The average age of the patients was 64.6 years, and the average duration of the disease was 13.3 years. Biological therapy had been given to 23% of the patients. The average grip power of the right and left hands was used. <h3>Results</h3> There were 14 items requiring others' assistance (level 0 or 1) in more than 10% of patients. For these 14 items of ADL, the grip power increased with the increase in the independence level (p&lt;0.001)<sup>2</sup>. The site with a problem was, in order of frequency, the fingers (26.1%), wrist (14.8%) and lower extremity (14.0%). The cause of disability was, in order of frequency, pain (38.8%), loss of power (32.8%) and a decreased range of motion. Based on the results of a stepwise regression analysis, the first factor, consisting mainly of "reaching function", including "hair dressing", "washing one's body", "taking on and off one's shoes", "clipping nails", "buttoning", etc., was most strongly related to a loss of grip power and problems at the elbow, the shoulder and the wrist. The second factor, consisting mainly of the "prehensile function", including "opening a plastic bottle", "opening lids", "squeezing towels", etc., was most strongly related to a loss of grip power and problems at the wrist and the thumb. The third factor, consisting mainly of "activities involving changing body position and transfer", including "getting in and out of the bathtub", "standing and sitting", etc., was most strongly related to ageing and problems with the lower extremities and at the elbow and the wrist. In the receiver operating characteristic (ROC) curve, the grip power with the maximum Youden index was 136.5 mmHg (11.8 kg) in females and 152.5 mmHg (13.5 kg) in males. Most activities were performed independently with the grip power more than 136.5 mmHg in females (figure 1). The explanatory variables for the grip power in the female patients were ageing; a long disease duration; a high disease activity score (DAS) 28; problems at the fingers, the thumb and the elbow; decreased flexion at the shoulder and a decreased range of forearm rotation. <h3>Conclusions</h3> The grip power was a determinant of independent daily living in patients with RA in our study. <h3>References</h3> [1] Espinoza F, et al. Rheumatology (Oxford)2016;55:897–901. [2] Thyberg I, et al. Arthritis Rheum2005;53:886–96. <h3>Disclosure of Interest</h3> None declared