Question

I was interested to read about the new research from the ME Biobank that looked at hand grip strength in people with ME. As this appears to be a good predictor of both loss of muscle strength and disease severity why isn’t it part of the examination protocol when doctors examine people with ME

Answer

Thanks for raising a very valid point. I fully agree that testing hand grip strength (HGS) would be a useful addition to the examination of people with ME/ CFS. So, I will be adding it to the relevant section on clinical assessment in the ME Association ME/CFS/PVFS Clinical & Research Guide (The ‘Purple Book'). I will also raise this when the NICE guideline committee discusses examination findings in ME/CFS.

The HGS test was originally developed to determine capacity after hand trauma/surgery. It is a reliable measurement of localised muscle strength and correlates well with other muscle function tests, such as knee extension strength. Reduced HGS has been associated with reduced muscle strength, falls, impaired health-related quality of life, and loss of functional status. It is therefore a useful but rather neglected predictor of future health status.

In 2018, the ME/CFS Biobank team investigated the potential use of HGS as an objective measure of disease status and severity in ME/CFS and assessed correlations with fatigue/pain severity and physical/ mental functioning. HGS was markedly reduced in people with ME/CFS compared with controls, particularly those who are severely affected, even after controlling for age, sex, and body mass index. HGS also decreased with each successive measurement among people with ME/CFS, which is consistent with early fatigability after physical activity. This effect was not observed in the control groups.

Research: Nacul et al. Hand Grip Strength as a Clinical Biomarker for ME/CFS and Disease Severity. Frontiers in Neurology | November 2018

The causative mechanisms involved in reduced muscle power and fatigability require further exploration. Even so, these results have practical implications for using HGS as a diagnostic tool to help identify people with ME/CFS and to measure disease severity. HGS is easily assessed using what is called a handheld dynamometer. The test is particularly useful for community-based evaluations, especially for people with severe ME/CFS, who are often house-bound.