S2628 Implementing Hand Grip Strength Testing for Patients With Liver Cirrhosis in a GI Clinic: A Quality Improvement Project

Introduction: Patients with cirrhosis are at increased risk of sarcopenia, which worsens disability, morbidity and mortality. Hand grip strength (HGS) testing is a reliable, simple and noninvasive screening tool for sarcopenia. The goal of this project was to implement HGS testing in a Gastroenterology clinic at the University of Kansas School of Medicine-Wichita to improve sarcopenia detection, guide management for those displaying muscle weakness, and improve patients’ quality of life. Methods: Starting from January 2025, all patients with a diagnosis code of cirrhosis were offered HGS testing after vital signs were obtained, using a digital dynamometer per the most recent American Society of Hand Therapists (ASHT) protocol with the corresponding age and sex-adjusted HGS cutoff values. Rooming staff provided a standard explanation and demonstration. Rooming times, wait times, and total visit duration with the same provider before and after implementation were compared. The provider discussed HGS results with patients during their visits. After their visit, patients were given a 6-item survey to complete. Results: More than 100 total patients have undergone HGS testing since January 2025. Fifty total patients completed the survey. Ninety-eight percent understood both the HGS protocol and the relevance of HGS testing. Ninety-four percent reported no discomfort while performing the test, and ninety-six percent were willing to repeat testing on subsequent visits. Ninety-two percent expressed increased encouragement to adhere to their provider’s dietary and lifestyle recommendations after undergoing HGS testing. Mean satisfaction (on a scale of 1-5, 5 being the highest satisfaction possible) was 4.78. HGS instructions and measurements took 4 minutes on average, but did not delay provider access. Pre-versus post-implementation wait time was 7 minutes and 3 minutes, respectively. Conclusion: This first phase of HGS implementation into the clinic workflow for cirrhotic patients was feasible, positively received by patients, and did not lengthen total visit times or patient wait times. Next steps include longitudinal tracking of HGS trends along with targeted interventions for low values, and expansion to additional clinics and providers.