Grip Strength to Assess Functional Strength in Patients Receiving Stem Cell Transplant

Purpose/Aims: 1. Determine feasibility of measuring Hand Grip Strength (HGS) in patients hospitalized in preparation for or for complications of myeloablative hematopoetic stem cell transplant (HSCT). 2. Describe changes in strength as measured by HGS during course of hospitalization. 3. Compare relative timing of detection of change in muscle strength as measured by HGS and subjective assessment by nurses providing care to the patient. Background: Despite aggressive fall prevention programs, rates of falls in hospitals have increased from 2.7 falls per thousand patient days in 2001, to 3-5 falls per thousand patient days in 2014. Patients hospitalized for oncological diagnoses have increased risk of a fall compared with other hospitalized patients on medical surgical units (6.3 vs. 3.1 per thousand patient days) and are more likely to be injured if they do fall. There is further evidence that patients may already have mild weakness on presentation for HSCT, although this may be imperceptible to the patient. Current fall risk screening tools fail to identify up to 17% of patients who subsequently fall. Although weakness is a well-known risk factor for falls, there is currently no objective measure of strength routinely used in hospital settings.  Weak HGS is a well-established physiologic marker for frailty. HGS measurements can be obtained quickly, are non-invasive and the instrumentation (hand held dynamometer) is relatively inexpensive. There is evidence of positive correlations between HGS and mobility tests, such as the two and six minute walk and measures of lower extremity strength. Thus, HGS may represent a non-invasive, inexpensive and objective measure that can serve as proxy for global functional strength. Methods: For this prospective, observational study participants will be 45 consecutive patients admitted in preparation for or for complication of HSCT. HGS will be measured at baseline and daily until day 30 of hospitalization, achievement of absolute neutrophil count of 500 X3 or discharge from hospital, whichever comes first. Mediating variables such as medications (opioid, benzodiazepine), physical therapy and laboratory measures of hemoglobin and hematocrit will be abstracted from the medical record as will nurse assessment of strength. Subjects will rate the difficulty of completing testing on a Likert scale to assess for feasibility and acceptability. Analysis plan: Descriptive statistics will be used to report demographics and results from the Likert scale. Analysis of the HGS data will be performed using a linear regression model to determine relationships between percent change of HGS from baseline (dependent variable) and day of hospitalization (independent variable). Survival analysis will be performed to examine time to change (day of hospitalization) to first measured decline in HGS and time to first nursing assessment documenting need for assistance or supervision for mobility transfer and ambulation or unsteady gait. These analyses are expected to determine whether HGS is a more sensitive measure of weakness as compared to nurse assessment. Implications: Findings may lead to identification of patterns of strength in patients undergoing HSCT, allowing nurses to enhance fall prevention interventions during periods when patients are weakest and most at risk for a fall.