Validation of a pictorial rating scale for grip strength evaluation in 3- to 6-year-old children

The present study aimed to validate a pictorial rating scale to evaluate the child's ability to produce grip forces. Thirty-seven children aged 3 to 6 years participated as subjects in this investigation. We used a tailor-made pictorial scale and a hand grip strength meter, as well as a Piaget's clinical interview aimed to gather information on the child's understanding of the rating scale. The sensitivity of the rating scale was measured by testing a 4-intensity-level hand grip effort with 3- to 6-year-old children. In addition, the reproducibility of this pictorial rating scale was investigated by a test and randomised re-test procedure. Statistical analysis revealed that no significant main effect (P > 0.05) for test was observed in any child. In addition, no significant main effect (P > 0.05) for intensity was found in 3-year-old children. However, in the 4-year-old children and over, a significant main effect (P < 0.05) was found for intensity. The results also showed that 5- and 6-year-old children were able to produce four differentiated intensities of grip forces. These findings suggest that the pictorial rating scale for grip strength evaluation showed acceptable reproducibility and was sensitive to the age of the children tested. To conclude, this pictorial rating scale appears to be a valid tool to investigate accurately the child's ability to produce grip forces in young children from 5-year-old and over.