Co-relation of handgrip strength and upper extremity function in pregnant women aged 20-35 years Introduction

Co-relation of handgrip strength and upper extremity function in pregnant women aged 20-35 years

Introduction:
Pregnancy is typified by a series of physiological, psychological and physical alterations. Particularly, musculoskeletal changes resulting from pregnancy are widely acknowledged, though, its magnitude is scarcely quantified.1 During pregnancy the pregnant women woman during pregnancy undergoes various anatomical and physiological changes in her body. The changes of pregnancy are chiefly the direct result of the interaction of four factors. The hormonally mediated changes in collagen and involuntary muscle.. The increase in body weight and adaptive changes in centre of gravity and posture. These changes also include various musculoskeletal problems, respiratory, cardiovascular, endocrinal changes etc.2 During the 3rd trimester of pregnancy, fluid retention can lead to oedema, which, as well as being visible in the ankles, feet, hands and face of the pregnant women, can lead to reduced joint mobility and a variety of nerve compression syndromes.3 In pregnancy water retention quite frequently cause unusual pressure on nerves, particularly nerves which are passing through canals formed by bone and fibrous tissue with resulting neuropraxia (e.g. CTS).4 Bone turnover is low in the first trimester and increases in the third trimester when foetal calcium needs are increased. The source of the calcium in the third trimester is previously stored skeletal calcium.5

Usually weight gain experienced during pregnancy results in postural changes that produce pain and musculoskeletal complaints in pregnant women. Exaggerated lordosis of the lower back, forward flexion of the neck, and downward movement of the shoulders typically occur to compensate for the enlarged uterus and change in center of gravity. A significant increase in the anterior tilt of the pelvis occurs, with increased use of hip extensor, abductor, and ankle plantar flexor muscles.6 Other musculoskeletal changes seen in pregnancy include: exaggerated lordosis of the lower back, forward flexion of the neck and downward movement of the shoulder joint laxity in the anterior and longitudinal ligaments of the lumbar spine, widening and increased mobility of the sacroiliac joints and pubic symphysis.7

Hand Grip Strength (HGS) is reported as an indicator of the total body strength 8, 9 an objective test for physical capability 10 and a valid predictor of work capacity 11, 12 degree of disease/injury, and rehabilitation outcomes 13, 14. A better performance on the HGS is associated with high functional index of nutritional status 15, 16, reduced risk of a series of ill health outcomes 15-18 and decreased functional limitations19-21 disability22-23 and morbidity and mortality rates especially among older populations24-25. Hand grip strength reflects the maximum strength derived from combined contraction of extrinsic and intrinsic hand muscles which lead to the flexion of hand joints 26. Since muscle function correlates closely with whole body protein 27-28, body cell mass 29 anthropometrically measured arm muscle mass, and even with body mass index (BMI) 30 loss of weight or muscle mass invariably results in decreased muscle strength, i.e. weakness, which is reflected in deteriorating function tests as well as in prominently altered muscle morphology. In healthy people, age and gender are the strongest influencing factors on hand grip strength 31.

Upper limb dysfunction is a common musculoskeletal condition in general population 32. The prevalence of upper limb dysfunction at any given point of time has been estimated as 20% to 53% in the working population of Western industrial countries. The lifetime prevalence of upper limb dysfunction is greater than 70%33-34. Upper limb dysfunction can arise from a spectrum of clinical conditions including neck pain 35-36. This can have a substantial effect on quality of life, work absenteeism, and loss of productive capacity and is therefore a substantial socioeconomic burden for patients and society 37-38.

There are many studies in India regarding the common musculoskeletal dysfunctions experienced by a pregnant woman throughout the trimesters but from them fewer studies are there which correlates the upper extremity function and handgrip strength in pregnant women. This study may highlight the affection of upper limb function and handgrip strength in pregnant women in India.

Materials and Methodology:
A cross sectional survey study was conducted during period of August to December 2017. Approval was taken from Institutional Review Board. A sample of 300 pregnant women based on inclusion and exclusion criteria. Inclusion criteria were pregnant women of all 3 trimesters with age between 20-35 years, Multigravida or primigravida and subjects who were willing to participate were selected according to convenience sampling technique from Obstetrics and Gynaecology OPD, General Hospital, Ahmedabad. Subjects with previous history of injury to upper limb (e.g. fractures, burns, dislocation) SOL such as ganglia at wrist , medically unstable subjects and Underlying disease like RA, Gout, hypothyroidism were excluded.
Handheld dynamometer was used to measure handgrip Strength. Subject is seated upright against the back of a chair with flat on the floor. The shoulder adducted and neutrally rotated, the elbow flexed at 90 degree and forearm in neutral and wrist between 0 degree and 30 degree of extension.39 Subjects were asked to squeeze the hand dynamometer with their maximum strength .Therapist was standing in front of subject to read amount of force.1 minute rest was given between each attempt to prevent fatigue. 3 successive trials were recorded for each treatment and maximum of them to be taken.
Mbada et al tested the reliability of one trial versus three HGS trials in pregnant and non-pregnant females and recommended that that taking the mean of three repeated grip trials provides more reliable results than only one trial. 39 However, the American Society of Hand Therapist recommended that the mean of the three successive trials be used as a measure of hand grip strength.40

However, some others advocate for the best of three trials 41, 42 while others investigators prefer a single trial. 43, 44 However, the repeated measure analysis used in the study showed significant difference in the HGS trials for the dominant and non-dominant hand.

The subjects were explained about the study and written consent was taken prior to the study. The questionnaire concerning handgrip strength affection and related to that difficulty in performing upper limb functional activities during pregnancy were administered to the subjects with all three trimesters of pregnancy. Upper extremity function scale was used to measure upper extremity function.

Flow chart of procedure:

Statistical Analysis:
The data was analyzed using SPSS Version 16. Significance level was kept at 5%.

A sample of 300 pregnant women during all three trimesters participated in the study. The handgrip strength and scale related to upper extremity function were administered in subjects with all three trimesters of pregnancy. Upper extremity function scale (UEFS) was used to evaluate upper extremity function.

Table 1 below shows mean, SD and median values of demographic
data and variables.

Table 1: Mean of demographic data and variables
Variable Mean SD Median
Age(years) 24.68 3.67 24
BMI(kg/m2) 21.34 4.27 20.54
Duration of pregnancy (months) 5.05 2.37 5
Rt HGS (kg) 16.67 2.99 18
Lt HGS (kg) 13.29 2.94 14
UEFS 7.18 3.74 5

Handgrip Strength in all 3 trimesters:
Mean handgrip strength in 1st trimester for Right and Left hand is 17.05±3.28 kg and 13.43±3.10 kg, in 2nd trimester for Right and Left hand is 16.32±2.99 kg and 13.24±2.90 kg and in 3rd trimester for Right and Left hand is 16.66±2.66 kg and 13.20±2.84 kg respectively as shown in table 2.

Table 2: Mean value of Handgrip strength in all 3 trimesters
Rt Handgrip Strength
Mean±SD (kg) Lt Handgrip Strength
Mean±SD (kg) Total
Subjects
1st trimester 17.05±3.28 13.43±3.10 100
2nd trimester 16.32±2.99 13.24±2.90 100
3rd trimester 16.66±2.66 13.20±2.84 100

One way Analysis of Variance (One way ANOVA) was used to compare the handgrip strength in the three trimesters. It shows that comparison of handgrip strength of both hands between trimester were statistically not significant (p>0.05) as shown in table 3.

Table 3: Comparison of Right and Left side handgrip strength between trimesters

1st trimester 2nd trimester 3rd trimester F value p value
Right side 17.05±3.28 16.32±2.99 16.66±2.66 1.492 0.227
Left side 13.43±3.10 13.24±2.90 13.20±2.84 0.173 0.841

UEFS Score in all 3 trimesters:
Mean UEFS Score in 1st trimester is 3.37 ± 1.3, in 2nd trimester is 4.95 ± 2.12, in 3rd trimester 10.85 ± 2.41 respectively shown in table 4.
Table 4: Mean value of UEFS in all 3 trimesters
UEFS Mean±SD F value p value
1st trimester 3.37 ± 1.39 378.747