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Use of different reference values for handgrip strength in individuals with COPD: analysis of agreement, discriminative capacity, and main clinical implications

Uso de diferentes valores de referência de força de preensão manual em indivíduos com DPOC: análise de concordância, capacidade discriminativa e principais implicações clínicas)

 
METHODS OF THE LITERATURE SEARCH
 
Studies reporting reference values and/or prediction equations for handgrip strength were retrieved by searching the MEDLINE (PubMed) database on September 13, 2021. The search strategy consisted of a combination of the following terms: "reference values"; "reference ranges"; "normative data"; "normative values"; "normal ranges"; "prediction equation"; "reference equation"; "hand strength"; "handgrip strength"; "handgrip force"; "grip"; "grasp" and similar terms. The term "cut-off values" was not included in the search because in general it does not take age into consideration. A manual search of the reference lists of the selected studies was also conducted.
 
The selection process was performed by one reviewer, initially by looking for the terms reference values and prediction equation(s) for handgrip strength in the title, and, subsequently, by checking this information in the abstract of the studies selected by title. After the reading of the full text of the studies selected by title and abstract, they were included if they reported normative data or prediction equations for handgrip strength based on healthy adult men and women.
 
As a final step of the selection process we identified studies to be included in the statistical analysis. Given that the present sample was in the 47- to 89-year age bracket and in order to avoid bias (overestimation or underestimation), we considered for inclusion in the analysis sets of reference values that had the following characteristics: 1) values derived from samples consisting of individuals = 45 years of age or older (70 years of age at least); and 2) values from studies employing methods of assessment of handgrip strength similar to those used in the present study, which were those recommended by the American Society of Hand Therapists(1) and Nyberg et al.(2) (i.e., with the patient in a seated position, with arms along the body, elbows flexed to 90°, and wrists in a neutral position, three trials being performed for each hand). Regarding prediction equations, we included studies presenting equations with easy-to-measure predictive variables (i.e., variables that do not require extensive training and/or complex equipment and are commonly assessed in any setting, such as anthropometric variables).

   
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