Measurement of Grip Strength: Validity and
Reliability of the Sphygmomanometer and
Jamar Grip Dynamometer
George F. Hamilton, MS, PT, OCS'
Carolyn McDonald, BS, PT2
Thomas C. Chenier, PhD3
H
and grip strength is a
fundamental proce-
d u r e used by thera-
pists and physicians
t o assess patient sta-
Downloaded from www.jospt.org by 180.190.163.242 on 07/01/19. For personal use only.
tus fbllowing injuries, surgical tech-
niques, and treatment procedures t o
the hand and upper extremity. An
accurate, quantifiable assessment of
hand grip strength helps the clinician
establish realistic treatment goals,
provides treatment outcome data,
and is frequently utilized during de-
termination of hand disability
ratings.
Over the years, several instru-
J Orthop Sports Phys Ther 1992.16:215-219.
ments and methods for measuring
hand grip strength have been devel-
oped. In the 1950s. instruments such
as the Sklar, Narrangansett, Geckler,
and Collins dynamometers were used
but were proven unsatisfactory for
standardized grip strength measure-
ment (5, 1 I).
In 1954, Bechtol introduced the
Jamar dynamometer. It consisted of
a sealed hydraulic system with ad-
justable hand spacings that regis-
tered hand grip force in pounds per
square inch (PSI) (1). It became the
most accepted instrument in Califor-
nia for quantitative measurement of
hand grip (5).
Brewer e t al discussed two meth-
ods for hand grip strength measure-
ments. T h e Lansbury method, used
JOSPT Volume 16 Number 5 November 1992
Quantitative measurement of grip strength is an important variable when plotting the prog-
ress of a hand-injuredpatient. When utilizing traditional commercially available apparatuses, obtain-
ing meaningful grip strength measurement in these subjects is frequently difficult due to severe
deformity, high tissue sensitivity, and low levels of force generated. The purpose of this study was to
measure hand grip strength using two instruments having different physical characteristics and units
of measurement to determine the reliability of repeated measures with each instrument. Addition-
ally, validity of the sphygmomanometer for strength measurement was established through compari-
son with the values obtained from measurements using the research-validatedlamar dynamometer.
Twenty-nine right hand dominant female college-agesubjects volunteered to perform hand grip
strength testing. Measurements were taken with a sphygmomanometer and a lamar dynamometer
while utilizing standardized measurement procedures. A Spearman Rho correlation coefficient test
utilized in measuring within-instrument reliability showed a high correlation for each instrument at
.85 for the sphygmomanometerand .82 for the lamar dynamometer. Construct validity testing
performedto determine validity of the measurements by the sphygmomanometer compared with
the lamar dynamometer produced a .75 correlation. A formula for conversion of the sphygmoma-
nometer scores into lamar units was developed to enhance reporting of sphygmomanometer scores
utilizing the lamar standard. The study showed that the sphygmomanometer and lamar dynamome-
ter exhibit good within-instrument reliability. Validity of the sphygmomanometer as a grip measure-
ment device is acceptable and reportable using the conversion formula developed. Therefore, it can
be utilizedwith confidence as essentially equal to the lamar unit for grip strength measurement.
Key Words: grip strength, hand injury, reliability
Professor, Department of Physical Therapy, School of Allied Health Sciences, East Carolina Uniwrsity, Creen-
ville, NC 27858
Staff physical therapist, Department of Physical Therapy, Nash General Hospital, Rocky Mount, NC
'Assistant professor, Epidemiology and Statistics, School of Allied Health Sciences, East Carolina University,
Creenville. NC
prior t o 1958, consisted of a sphyg- examined grip strength measure-
momanometer cuff folded twice and ment instruments based upon pneu-
inflated t o 20 mmHg. T h e Winthrop matic, spring, and hydraulic systems.
torqueometer was a device used t o They concluded that grip is a force
measure hand grip and rotational rather than a pressure and that it
ability (2). should be measured in force units
Kirkpatrick reported the find- such as Ibs o r gms; they recom-
ings of a California Commission that mended use of the Jamar dynamom-
 RESEARCH STUDY
eter (5). Most of the recent studies of
grip strength measurement have re-
ported the Jamar dynamometer t o
be the most reliable and accurate de-
vice for measurement of hand grip
strength (6-9). However, Solgaard e t
al tested three units utilized in grip
strength measurement; two were
steel spring force dynamometers
("Collins" and "My-Gripper") and
one was pneumatic ("Martin Vigori-
meter"). Accuracy of the units was
tested by placing each instrument be-
tween two compressible plates of a
machine that yielded force and de-
flection information. Machine test
results demonstrated near linearity
of all units, with the pneumatic unit
performing the best. T h e instru-
ments were also subjected t o a clini-
cal test of measured grip strength in
100 normal men and women sub-
jects. T h e pneumatic unit demon-
strated the highest precision and was
Downloaded from www.jospt.org by 180.190.163.242 on 07/01/19. For personal use only.
deemed t o be the superior instru-
ment for grip strength measurement
by those investigators (1 2). Due t o
problems of discomfort conformity
and convenience in hand-injured pa-
tients, many clinicians continue to
utilize the soft cuff of the Sphygmo-
manometer t o measure grip strength.
T h e purpose of this study was t o
determine the repeated measures re-
liability of the sphygmomanometer
J Orthop Sports Phys Ther 1992.16:215-219.
under well-controlled test conditions,
t o compare those reliability out-
comes t o values obtained for the re-
search-validated Jamar dynamome-
ter, and t o test for construct validity
of the sphygmomanometer's meas-
urement scale (mmHg) by compari-
son with the Jamar (PSI) unit. If the
sphygmomanometer proved t o be
valid and reliable, then clinicians
might use this instrument with
greater confidence when obtaining
hand grip measurements.
METHODS
Subjects
Twenty-nine normal healthy fe-
male college-age subjects with n o
known history of orthopaedic disor- provided the closest hand grip di-
ders of their dominant hand volun- mension to the rolled up sphygmo-
teered t o participate in this study. manometer cuff.
Descriptive characteristics of the sub- T h e Jamar dynamometer was
jects a r e listed in Table 1. calibrated by suspending a range of
weights, comparable to anticipated
Apparatus study values, from the handle of the
Apparatuses used in this experi-
ment were an Aneroid type adult
sphygmomanometer U.A. Preston,
Inc., 6 0 Page Road, Clifton, New
Jersey, 270 12) (Figure 1). which
measures force in units of mmHg,
and a Jamar dynamometer (Item
3363, G.E. Miller, Inc., 484 Broad-
way, Yonkers, New York, 10705)
(Figure 2). which measures in units
of PSI.
Many dinicians
continue to utilize the FIGURE 1. The sphygmomanometer.
soff cuff of the
sphygmomanometer
to measure grip
strength.
T h e sphygmomanometer cuff
was evenly rolled, forming a circum-
ference of approximately 7 in t o
conform with a normal functional
hand position for grip.A rubber
band was placed around each end of
the cuff t o hold it in position. T h e
cuff was inflated t o 20 mmHg, which
was the starting position for meas-
urement of each subject. T h e Jamar
dynamometer was set a t the third
handle space, which is reported to be
the most commonly used position for
measurement (1). Additionally, it FIGURE 2. The lamar dynamometer.
Factor Units Total Mean SD
Age (yean) 29 23.8 4.9
Height (in) 29 66.1 2.2
Weight (Ibd 29 131.9 26.3
TABLE 1. Subject characteristics.
Volume 16 Number 5 November 1992 JOSPT

fixated instrument. Dial readings ob-
tained were identical t o those of the
suspended weights, thus, confirming
the validity of the Jamar dynamome-
ter with which the sphygmomanome-
ter would be compared.
Design
Under the direction of the same
operator, 29 subjects performed
hand grip strength testing for each
instrument. A mean score was calcu-
lated from three measurements per
instrument, obtained at each of
three independent measurement ses-
sions occurring approximately 1
week apart.
Spearman Rho correlation coef-
ficient tests were administered to de-
termine relationships within and be-
tween the instruments. Repeated
measures reliability was obtained by
calculating correlation coefficients
Downloaded from www.jospt.org by 180.190.163.242 on 07/01/19. For personal use only.
between sessions 1 and 2, sessions 1
and 3, and sessions 2 and 3 for each
instrument. T h e relationship be-
tween the two instruments was ob-
tained by applying a Spearman Rho
correlation coefficient test utilizing
the mean value of all observations
from each instrument and by plot-
ting a simple linear regression to as-
sess construct validity of the sphyg-
momanometer for measurement of
J Orthop Sports Phys Ther 1992.16:215-219.
hand grip strength.
Procedure
All subjects signed a personal
consent form, after which we re-
corded their ID number, age,
height, and weight. T h e American
Society of Hand Therapists' stand-
ardized arm position for hand
strength testing was utilized (4).
Each subject was positioned in a
straight back chair with both feet flat
on the floor. Arm positioning was
demonstrated by the operator, then
each subject was instructed t o place
her left hand on her right thigh and
assume a position of adducted and
neutrally rotated shoulders. For the
arm t o be tested, the elbow was
JOSPT * Volume 16 * Number 5 * November 1992
flexed t o 90". the forearm and wrist
were in neutral positions, and the
fingers were flexed as needed for a
maximal contraction (Figure 3).
Fach subject was instructed to
breathe in through her nose and
blow out through pursed lips as a
maxinlum grip effort was made. At
this time, a verbal command of
"Squeeze! Harder! Harder! Relax!"
was given by the examiner. Demon-
stration of maximum hand grip per-
formance was given prior t o the first
session, and re-instruction was given
prior t o the other two sessions as
needed. T h e instrument t o be tested
first was assigned by random order
t o each subject. Four minutes o r
Results demonstrated
high within-instrument
repeated measures
reliability and an
acceptable correlation
between
sphygmomanometer
and lamar
dynamometer
measurements.
greater were allowed between each
grip measurement. T h e mean score
among three trials of each instru-
ment was recorded for data calcula-
tions. T h e second and third sessions
for hand grip measurements were
repeated approximately 1 week apart
using each instrument.
Extraneous variables were con-
trolled by using the same room with
an average temperature of 74"F,
subjects of the same gender, right
hand dominance, and approximately
the same age group, and approxi-
mately the same time of day. T h e
RESEARCH S T U D Y
FIGURE 3. Positioning of a subject while performing
hand grip strength measurements using the
sphygmomanometer and the lamar dynamometer.
same instructions were given to each
subject regarding position of the u p
per extremity, hand grip strength
performance, and breathing tech-
nique. Each subject was encouraged
not to d o any strenuous activity with
the dominant upper extremity dur-
ing the study.
RESULTS
Mean and standard deviation
grip strength scores for each instru-
ment a t each of the three sessions
a r e presented in Table 2. Spearman
Rho correlation coefficient test out-
comes for each possible pair of Ja-
mar and sphygmonianometer read-
ings collected over all sessions are
presented in Table 3. T h e average r
value for the three observational pe-
riods was .85 for the sphygmoma-
nometer and .8 1 for the Jamar (Ta-
ble 3A), each with a statistically sig-
nificant relationship (/I < .OO 1) for
scores obtained between the three
test intervals.
Sphygnionianometer vs Jamar
mean scores for all observational pe-
riods produced a correlation coeffi-
cient of .75 (Table 3C).
Using the inverse regression
technique (3). we calculated an in-
 RESEARCH STUDY
Sessions 1 2
Sphygmomanometer (mmHg)
Mean
SD
jamar dynamometer (PSI)
Mean
SD
TABLE 2. Mean and standard deviation for three grip strength sessions using the sphygmomanometer and the
lamar dynamometer, plus the mean and standard deviation values for all grip sessions.
A Sphyg 1 vs Sphyg 2
Sphyg 1 vs Sphyg 3
Sphyg 2 vs Sphyg 3
Jamar 1 vs Jamar 2
Jamar 1 vs Jamar 3
Jamar 2 vs Jamar 3
B Sphyg 1 vs Jamar 1
Sphyg 2 vs Jamar 2
Sphyg 3 vs Jamar 3
C Mean scores of Sphyg vs mean scores of jamar
TABLE 3. Spearman Rho correlation coefficient values showing within (A) and between (6) instrument
rekability in hand grip strength measurement for the sphygmomanometer and the lamar dynamometer.
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J Orthop Sports Phys Ther 1992.16:215-219.
FIGURE 4. Inverse regression prediction line
showmg the relationship between
sphygmomanometer (mmHg) and lamar (PSI)
readings and the formulas for conversion of
sphygmomanometer to lamar scores.
verse regression line showing the re-
lationship between Jamarand
monianometer scores and a formula
t o convert sphygmomanometer
scores t o equivalent Jamar values
(Figure 4). T h e formula is Jamar =
.!j4 s~h~gnlOnlanOmeter - 45.12.
DISCUSSION
Results demonstrated high
within-instrument repeated measures
3 Mean Data obtained from the two in-
struments were used to construct a
205.96 200.17
formula Uamar = .54 x Sphygmo-
199.83 203.12
22.53 21.53 14.85 21.10 manometer - 45.12) by which meas-
urements on the sphygmomanome-
63.09 69.21 66.23 64.83 ter (mmHg) could be converted into
9.43 8.08 10.50 9.07 the corresponding Jamar (PSI) meas-
urements. An inverse regression
technique was used t o make these
conversions (3). For these data, it
would be inappropriate to apply the
Rho = .8426 p < .001 usual regresson analysis. O n e of the
Rho = .8616 p < .001 assumptions of the usual regression
Rho = ,8401 p < .001
analysis is that the predictor variable
Rho = ,8764 p < .001
Rho = .8049 p < .001
is measured without error, o r that
Rho = .7844 p < .001 the error of the predictor varible is
Rho = .6079 p < .001 small relative t o the error of the re-
Rho = .7455 p < .001 sponse variable. When a regression
Rho = .5723 p = .001 line is fit t o data where the predictor
variable is measured with error, the
Rho = .7497 p < .001
- - - - resulting estimate of the slope of the
regression line is biased. In this in-
stance, measurements associated with
the sphygmomanometer that are
subject t o error are being used to
reliability and an acceptable correla- predict the values obtained from the
tion between sphygmomanometer Jamar.
and Jamar dynamometer measure- When measuring grip strength
ments. Although statements a r e in the hand-disabled subject, there
available in the literature expressing are multiple advantages of the
the inadequacy of pressure-related Sphygmomanometer over the Jamar
instrumentation for grip strength unit: I ) ready availability of a sphyg-
measurement (5. 8). test results from momanometer in most clinics, 2) a
Solgaard et al demonstrated that a soft compliant surface that may pro-
pneumatic-based (Martin Vigorime- duce less discomfort to the injured
ter) ball type unit provided highly hand during testing, and 3) a scale
linear and reliable data for grip with smaller increments than the Ja-
strength measurement ( 1 2). Robert- mar and, therefore, greater sensitiv-
son and Deitz have advocated the ity t o small changes in strength.
use of the Martin Vigorimeter for
T h e outcome of this study dem-
measuring grip strength in preschool onstrates the ability of the sphygmo-
children due t o its ability t o accu- manometer to provide acceptable
rately measure spherical grip levels of repeated measures reliabil-
strength, which they indicated was a ity in the normal population. How-
more effective indicator of hand ever, further studies a r e needed
function in the child (.1 0),. within the hand-injured population
O u r scores for s ~ h,v ~ m o m a n o m - to fully validate its application. JOSPT
1 <7
eter and Jamar grip strength testing
were similar, each yielding correla-
tion values of .80 o r greater. These
<I
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Volume 16 Number 5 November 1992 JOSPT

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J Orthop Sports Phys Ther 1992.16:215-219.
JOSPT Volume 16 Number 5 November 1992
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