For evaluating vascular surgery patients, a handheld device available on Amazon for $50 provides a low-cost and simpler alternative to other frailty measures.
Using a grip strength test to evaluate surgical patients for frailty is a high-value assessment, says the leader of a research team that published a study on grip strength testing this month.
"We were looking for something quick, easy, cheap, and reliable, and that is a rare combination in healthcare," says Matthew Corriere, MD, MS, an associate professor at the University of Michigan in Ann Arbor and a vascular surgeon at Michigan Medicine.
In vascular surgery, assessing patients for frailty is a key step, Corriere and his fellow researchers wrote. "Frailty is associated with adverse events, length of stay, and nonhome discharge after vascular surgery."
If a patient is found to be frail, it impacts medical decision-making and creates an opportunity for intervention, the researchers wrote.
"Accurate identification … might inform treatment or patient selection, enabling patients and providers to avoid (or at least to minimize) stressors and related risks. Frailty detection might also provide opportunities for prehabilitation through exercise, nutritional, and behavioral interventions to better prepare patients," according to the research paper.
Related: Frailty Index Helps Cut Readmissions, ICU Stays
Grip strength testing for frailty has multiple benefits, the researchers found. "Grip strength may have utility as a simple and inexpensive risk screening tool that is easily implemented in ambulatory clinics, avoids the need for imaging, and overcomes possible limitations of walking-based measures."
Testing grip strength is likely to be applicable in fields beyond vascular surgery, Corriere says. "Grip strength testing has potential in any field where you are trying to assess whether to provide a treatment, and trying to decide what the chances are of the patient having a normal life with or without that treatment."
He says other fields such as orthopedic surgery, cardiology, and general internal medicine practices—where physicians often face decisions on whether to refer patients for treatment—could benefit from grip strength testing.
'Low risk and low cost'
Grip strength testing has multiple advantages over other frailty tests, Corriere says.
The primary testing method for frailty is a walking speed test; however, many patients have walking impairments including peripheral artery disease and amputation that disqualify a walking test. Grip strength testing is appropriate for all patients as long as they do not have a hand or arm impairment such as arthritis, he says.
Grip strength testing is logistically easier to manage than other assessments for frailty.
"I had 25 patients in my clinic this week, and the longest I was budgeted to spend with any of them was 30 minutes. If I had tried doing different frailty tests on those patients, it would have been time-consuming and require space and equipment," Corriere says.
Hand dynamometers are compact and relatively inexpensive. Corriere bought the device he used in the research on Amazon for $50.
"These hand dynamometers fit in a drawer or sit on a counter. To me, this is an intervention that is low risk and low cost, while providing very useful information. It's a no-brainer, and it sounds a lot like how we define value," he says.
Financially, improving frailty detection with grip strength testing has several impacts, including better risk adjustment and risk prediction, and avoiding costs.
"When you talk about cost, inpatient rehab, nursing home stays, and increased complication rates are all expensive. The grip strength test allows you to be a lot smarter in selecting patients who are candidates for surgical treatments," he says.
Grip strength testing is better than visual assessments of frailty, Corriere says. "When you rule out frailty with grip strength, it gives you reassurance about not denying an elderly patient a procedure because of assumptions that could be incorrect."
There is little science in visual assessments, he says.
"Some 85-year-olds are robust and remarkably healthy, and they get aggravated when we don't listen to their complaints or we deny them a procedure that they need. Grip strength and frailty assessment can lead to opting into a procedure, and make the patient and provider feel more comfortable," he says.
Having a simple scientific test also helps family members understand the concept of frailty, Corriere says.
"Measuring grip strength is a demonstration of frailty to family members who are there watching it happen. It takes a concept that can be sort of abstract and make it evident to everybody in the room," he says.
Grip strength testing is attractive both clinically and practically, he says. "We were looking for something that could be deployed like another vital sign. This takes very little time, and it can be done on many people."
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Christopher Cheney is the CMO editor at HealthLeaders.