Research
Validated Effort Test
The validated Eforto test consists of 3 test from Eforto are
1. Muscle strength - maximal grip strength test
Grip strength is recognized as an essential biomarker for assessing overall strength, physical resilience, and vitality. It is indicative of bone mineral density and can signal the risk of fractures, falls, malnutrition, cognitive impairments, depression, sleep disturbances, diabetes, and multimorbidity, thereby affecting overall quality of life. Additionally, it serves as a predictor of all-cause and disease-specific mortality, future functional capacity, bone health, cognitive functions, and mental health. It also provides insights into complications related to hospitalization.
2. Muscle endurance - fatigue resistance test
The fatigue resistance test builds upon the maximal grip strength test by not only requiring participants to squeeze as hard as they can but also as long as they can. The test automatically stops when the squeezed pressure drops below 50% of the maximal grip strength. We then calculate the area under the pressure curve which we define as Grip Work. This test, which measures muscle fatigability or endurance, is more sensitive and responsive to changes or interventions than the maximal grip strength test, thus making it suitable for evaluating the effectiveness of rehabilitation programs, tracking progress, and assessing the impact of specific treatments or interventions.
3. Self perceived fatigue - questionnaire
We evaluate self perceived fatigue based on only 2 short questions.
Combined these test are a biomarker for a person's physical reserves and vitality capacity as defined by the WHO Eforto
Eforto related publications
The Eforto protocol, its methods and unique bulb form factor, is grounded in scientific and clinical evidence, reflecting our deep commitment to research.
De Dobbeleer, L., et al., Martin Vigorimeter assesses muscle fatigability in older adults better than the Jamar Dynamometer. Experimental Gerontology, 2018. 111: p. 65-70.
Sipers, Walther, et al. “The Martin Vigorimeter Represents a Reliable and More Practical Tool Than the Jamar Dynamometer to Assess Handgrip Strength in the Geriatric Patient.” Journal of the American Medical Directors Association, vol. 17, no. 5, Elsevier BV, May 2016, p. 466.e1-466.e7
De Dobbeleer, L., et al., Muscle fatigability measured with Pneumatic and Hydraulic handgrip systems are not interchangeable. Exp Gerontol, 2020. 136: p. 110950.
Desrosiers, Johanne, et al. “Comparison of the Jamar Dynamometer and the Martin Vigorimeter for Grip Strength Measurements in a Healthy Elderly Population.” Journal of Rehabilitation Medicine, vol. 27, no. 3, Foundation for Rehabilitation Information, May 2020, pp. 137–43
Neumann, Sina, et al. “Comparison of the Grip Strength Using the Martin-Vigorimeter and the JAMAR-Dynamometer: Establishment of Normal Values.” In Vivo, vol. 31, no. 5, Stanford University Highwire Press, Sept. 2017
De Dobbeleer L,et al. (2023) Comparison between Two Different Handgrip Systems and Protocols on Force Reduction in Handgrip Assessment. Gerontology 69:1259-1268.
Knoop, V., et al., The interrelationship between grip work, self-perceived fatigue and pre-frailty in community-dwelling octogenarians. Experimental Gerontology, 2021. 152: p. 111440.
De Dobbeleer, L., et al., Martin Vigorimeter assesses muscle fatigability in older adults better than the Jamar Dynamometer. Experimental Gerontology, 2018. 111: p. 65-70.
Avlund, Kirsten. “Fatigue in Older Adults: An Early Indicator of the Aging Process?” Aging Clinical and Experimental Research, vol. 22, no. 2, Springer Science+Business Media, Apr. 2010, pp. 100–15
Eldadah, Basil A. “Fatigue and Fatigability in Older Adults.” Pm&R, vol. 2, no. 5, Elsevier BV, May 2010, pp. 406–13
Simonsick, Eleanor M., et al. “Assessing Fatigability in Mobility‐Intact Older Adults.” Journal of the American Geriatrics Society, vol. 62, no. 2, Wiley-Blackwell, Feb. 2014, pp. 347–51
Mets, T., et al., The influence of celecoxib on muscle fatigue resistance and mobility in elderly patients with inflammation. Am J Geriatr Pharmacother, 2004. 2(4): p. 230-8.
Beyer, I., et al., Effects on muscle performance of NSAID treatment with piroxicam versus placebo in geriatric patients with acute infection-induced inflammation. A double blind randomized controlled trial. BMC Musculoskelet Disord, 2011. 12: p. 292.
Bautmans, I., et al., Circulating acute phase mediators and skeletal muscle performance in hospitalized geriatric patients. J Gerontol A Biol Sci Med Sci, 2005. 60(3): p. 361-7.
Bautmans I, et al. (2024) The relationship between self-perceived fatigue, muscle endurance, and circulating markers of inflammation in participants of the Copenhagen aging and Midlife Biobank (CAMB). European Review of Aging and Physical Activity
Knoop V et al. (2023) Muscle Endurance and Self-Perceived Fatigue Predict Decline in Gait Speed and Activities of Daily Living After 1-Year Follow-Up: Results From the BUTTERFLY Study. J Gerontol A Biol Sci Med Sci 78:1402-1409.
Knoop V et al. (2021) The interrelationship between grip work, self-perceived fatigue and pre-frailty in community-dwelling octogenarians. Exp Gerontol 152:111440.
Clinical studies
Ongoing studies
Additional clinical relevance is currently evalueted in the following studies
Study objective & design
In this study, 160 community-dwelling older adults (65 years and older) will be provided with an Eforto® system to self-monitor their muscle fatigability and self-perceived fatigue for 2 consecutive days per week during 12 months (if needed with assistance by an informal caregiver). Preferably, the participants will use their own smartphone because mitigating smartphone-use-related issues.
The aims of the study are:
- to evaluate the usability and feasibility of self-monitoring intrinsic capacity by using the eforto® system in the home setting.
- to investigate if changes and variability in intrinsic capacity as measured with eforto® (muscle fatigability and self-perceived fatigue), are related to changes in frailty status, functional independency and quality of life.
- to explore whether intrinsic capacity as measured with eforto® (muscle fatigability and self-perceived fatigue) is related to circulating inflammatory biomarkers.
Sponsors: Vrije Universiteit Brussels, UZ Brussel, (Belgium)
Funding: AAL, VLAIO, Horizon 2020
Study objective
In this study will evaluate the validity of grip work and self-perceived fatigue measured with the Eforto® system for monitoring hip fracture recovery and insight in resilience.
Study design
This study is a prognostic cohort study, during which we will evaluate if daily measurements of grip work and self-perceived fatigue in patients with an acute hip fracture are a reliable method for monitoring and predicting recovery, and getting more insight in how resilient a patient is. For the current study, daily muscle fatigability measurements and two self-perceived wellbeing and fatigue questions will be added, and for baseline measurements The Older Person and Informal Caregiver Survey short-form (TOPICS-SF) and the Multidimensional Fatigue Inventory (MFI-20) questionnaires will be asked. These measurements will be conducted twice daily during admission supervised by a researcher.
Sponsors: Ziekenhuisgroep Twente, (Netherlands)
Fundng: AAL, ZonMW, Horizon 2020
Study objective
This study aims to evaluate the predictive ability of the muscle fatiguability test to predict recovery in older adults admitted to the department of geriatric medicine. Recovery is defined as length of stay, daily functioning after 3 and 6 months and mortality.
Study design
The current study is an extension to the Bedside Resilience Registry, an ongoing study that aims to develop and validate indicators of resilience in
patients admitted to the geriatrics ward. In this ongoing study, questionnaires are completed twice daily on mood, fatigue and mobility. Three
and six months after discharge, patients are asked to complete a brief follow-up questionnaire via telephone. For the current FORTO study, muscle
fatiguability measurements will be added. These measurements will be conducted twice daily during admission supervised by a researcher.
Patients who possess a smartphone and are able to independently (or with support of a spouse or kin) complete the fatiguability test using the FORTO system, will be asked if they are willing to continue the FORTO measurements at home. If willing, the app will be installed on their phone and they will receive a device to continue the measurements twice per week for one month post discharge.
Sponsors: Radboud UMC (Netherlands)
Fundng: AAL, ZonMW, Horizon 2020
Integrated System of Healthy Ageing (ISHA)
Study start date: July 2024, duration: 12 months
Partners: WHO, VUB (BE), UZA (BE), Leiehome (BE),
Fundng: AAL, VLAIO, Horizon 2020