Reliability and clinical applicability of lower limp strength using an enhanced paper grip strength


Submitted: 19 September 2023
Accepted: 19 October 2023
Published: 1 December 2023
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The enhanced paper grip test (EGPT) quantitatively assesses lower limb strength. EGPT assesses the hallux grip force by reacting a pulling force derived from a card, being positioned underneath the participant's hallux. This study aimed to investigate the repeatability and clinical applicability of the EPGT for assessing foot muscle strength. EPGT force was measured using a dynamometer. The reliability of the measurement of EPGT force was assessed by having two examiners performing the test on the same group of healthy adults. Clinical applicability was assessed in community-dwelling adults of both genders. EPGT force was recorded for both feet using the same standardised protocol for all participants. Regarding reliability, 20 healthy adults aged 23.04±5.5 years participated in the present study. The EGPT demonstrated good to excellent test-retest (ICC1,2 0.8 to 0.86) and interrater reliability (ICC1,2 0.82 to 0.88). A convenience sample of 15 community-dwelling adults (71.6±7.8 years, 68.5% women) was recruited for clinical applicability testing. All participants performed the test with mean score 15±5.7 N. EPGT is a reliable measurement of the hallux grip force strength and can be used for clinical and research purposes.


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Tsekoura, M., Pantou, M., Fousekis, K., Billis, E., Gliatis, J., & Tsepis, E. (2023). Reliability and clinical applicability of lower limp strength using an enhanced paper grip strength. European Journal of Translational Myology, 33(4). https://doi.org/10.4081/ejtm.2023.11841

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