Evaluation of hand function in patients undergoing long term haemodialysis

Objective-Haemodialysis is associated with the deposition of Pt microglobulin in musculoskeletal structures, leading to the syndrome of dialysis related amyloidosis and impairment of hand function. This study aimed at assessing hand function using the Sollerman test in a cross section of patients undergoing haemodialysis. Methods-Recipients of haemodialysis underwent the Sollerman test of hand grip function, which assesses 20 activities of daily living using eight grip types, and the JAMAR grip strength test, visual analogue scales (VAS) for pain (VAS-P) and function (VAS-F), and Health Assessment Questionnaire (HAQ) were determined. Results-Thirty five subjects (26 male), with mean age 53.2 years, participated. The average duration of haemodialysis was 6.2 years (range one month to 25 years). The median Sollerman score was 77, with 19/35 (54%) patients receiving haemodialysis having a score below the lower normal value of 78-80. The log Sollerman score correlated poorly with age (r(s)=0.16, p=0.35), and significantly with the HAQ score (r(s)=-0.66, p<0.00005), duration of haemodialysis (r(s)=-0.39, p<0.05), VAS-F (r(s)=-0.41, p<0.05), VAS-P (r(s)=-0.34, p<0.05), and JAMAR score (r(s)=0.57, p<0.05). Sollerman scores were highly correlated between dominant and non-dominant hands (r(s)=0.69, p<000005). Conclusions-Hand dysfunction is a common finding among patients undergoing long term haemodialysis. The Sollerman test accurately reflects patient function as measured by HAQ, VAS-F, and grip strength, but less so pain. Its use for the early detection of dialysis related amyloidosis and in the serial monitoring of the effects of hand treatment programmes is encouraged.