Validation Bundle With Grip Strength

Detailed Protocol

• Collect the Energy Score and the measured bundle on the same day whenever possible.
• Grip strength: seated if possible, shoulder neutral, elbow near 90 degrees, forearm neutral, wrist in comfortable neutral position.
• Grip strength: complete three maximal squeezes per hand with 15 to 30 seconds rest between trials.
• Record the best value from each hand and note which hand is dominant.
• 5x sit-to-stand: use a standard-height chair, ask the participant to stand up and sit down five times as quickly and safely as possible, ideally with arms folded if safe.
• Fatigue survey: use the same validated survey at every visit rather than changing instruments between visits.

Time Of Day And Pre-Test Conditions

• Try to measure at the same time of day for each visit, ideally within the same 2-hour window.
• Morning or late morning is usually best because it reduces variability from accumulated daytime exertion.
• Record whether the participant is fasting, post-meal, acutely ill, sleep-deprived, menstruating, or recovering from unusual exertion.
• Record caffeine use, pain flare, recent medication changes, and any assistive-device use that might affect performance.
• If the person has post-exertional worsening, do the fatigue survey before the physical tests.

How To Measure Grip Strength

• Use the same dynamometer model at every visit whenever possible.
• Use the same handle setting at every visit unless hand size makes that impossible.
• Preferred position: seated, feet flat, back supported, shoulder adducted and neutral, elbow at about 90 degrees, forearm neutral.
• Ask for one short submaximal practice squeeze before formal testing if the person is unfamiliar with the device.
• Then perform three maximal efforts per hand, alternating hands if helpful, with 15 to 30 seconds of rest between attempts.
• Record every trial, but use the best value from the strongest hand for the calculator.
• Document dominant hand, hand pain, arthritis, neuropathy, tremor, or recent upper-extremity injury.

Recommended Device

Handeful digital grip strength dynamometer

A practical low-cost option for this protocol is the Handeful Grip Strength Tester. It reads in pounds or kilograms, stores multiple users, and is easy to keep consistent across repeat visits.

• Use the same unit setting each visit, ideally pounds if you are using the current calculator inputs.
• Keep the same handle position for the same participant unless hand size requires a change.
• Record the device model once so follow-up measurements stay standardized.

Exact 5x Sit-to-Stand Setup

• Use a standard, stable chair without wheels.
• Preferred seat height is about 43 to 46 cm, which is roughly 17 to 18 inches.
• Use the same chair for every visit in the same participant whenever possible.
• Place the chair on a non-slip surface with clear space around it.
• Standard instruction: sit with back against the chair, feet flat, stand up fully and sit down fully five times as quickly and safely as possible.
• Preferred method is arms folded across the chest, but if arms are used for safety, record that clearly and keep the method consistent at future visits.
• Start timing on “go” and stop when the participant stands fully at the end of the fifth repetition.
• Record the time in seconds and note any abnormal mechanics, hesitation, balance concern, or need for arm assistance.
• If the participant holds the chair, pushes off repeatedly, or uses steady hand support, record that because the measured-function calculator applies a penalty for assisted completion.

How To Measure Fatigue

• Use one fatigue instrument consistently rather than switching surveys between visits.
• A practical option is the Fatigue Severity Scale if you want something short and familiar.
• Administer the survey before performance testing if exertion could worsen symptoms the same day.
• Ask the participant to answer based on their recent usual state, not just how they feel in the last few minutes.
• Normalize the survey to a 0 to 100 fatigue burden score before comparing it to the measured-function calculator.
• Record whether the fatigue score reflects a typical day, a flare day, or a recovery day after unusual exertion.

Recommended Visit Schedule

How To Reduce Noise

• Use the same dynamometer model each time.
• Measure at similar times of day when possible.
• Note acute illness, recent hard exertion, sleep disruption, or hand pain.
• Keep the chair height and sit-to-stand instructions constant.
• Record fatigue before any strenuous testing if post-exertional worsening is a concern.

What To Record At Every Visit

• Date and exact time of testing.
• Sex, age, and any major clinical change since the last visit.
• Best grip strength by hand and strongest-hand value used for scoring.
• 5x sit-to-stand time and whether arms were used.
• Whether chair support was none, light, or moderate during sit-to-stand.
• Fatigue survey raw score and normalized fatigue burden score.
• Any acute confounders: illness, flare, poor sleep, unusual exercise, pain, injury, or medication change.