Grip strength testing to identify sarcopenia in lower limb amputee outpatients: a quality improvement project.

Introduction: The demand for lower limb amputation is growing due to factors including rising rates of diabetes and vascular disease as well as an ageing population.  Sarcopenia, the loss of muscle mass and strength associated with ageing, can exacerbate the risk of unfavourable health outcomes and mortality.  Consequently, early detection and management of sarcopenia is important in the rehabilitation of older people who have had lower limb amputation.

Clinical practice guidelines recommend using grip strength testing to identify probable sarcopenia in high-risk patients during routine care and offering resistance exercise.

Previously, patients attending the outpatient amputee physiotherapy service were not assessed for sarcopenia.  This quality improvement project seeks to implement best practice, supporting physiotherapy staff to identify sarcopenia, so interventions can be initiated to optimise outcomes and independence.   

Project aim: Is it possible for physiotherapy staff to implement grip strength testing, to identify sarcopenia, as part of the outpatient care of lower limb amputee patients?

Methods: Plan-Do-Study-Act approach with interventions of teaching and assessment proforma re-design to include grip strength testing were employed.

Measures: The number of patients with grip strength measurement recorded was collected between June and September 2025. Staff views regarding acceptability and feasibility were explored using questionnaires. Results and cohort data were described using descriptive statistics.

Results: Grip strength was measured and recorded in 30 patients (mean age 68 years, 80% men): 8/30 (27%) had probable sarcopenia, a further 6/30 (20%) were within 10% of the cut-off values. Staff reported feeling confident and supportive of identifying sarcopenia in routine clinical assessment.

Conclusions: Physiotherapy staff can implement an assessment of sarcopenia as part of the outpatient care of lower limb amputee patients.  Implementation has potential benefits of enhancing therapy plans to address sarcopenia and optimise rehabilitation outcomes, benefiting patients and the healthcare system.