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Comparison of devices used to measure blood pressure, grip strength and lung function: a randomised cross-over study

journal contribution
posted on 2023-08-14, 08:29 authored by Carli Lessof, Rachel Cooper, Andrew Wong, Rebecca Bendayan, Rishi Caleyachetty, Hayley Cheshire, Theodore Cosco, Ahmed Elhakeem, Anna Hansell, Aradhna Kaushal, Diana Kuh, David Martin, Cosetta Minelli, Stella Muthuri, Maria Popham, Seif Shaheen, Patrick Sturgis, Rebecca HardyRebecca Hardy

Background: Blood pressure, grip strength and lung function are frequently assessed in longitudinal population studies, but the measurement devices used differ between studies and within studies over time. We aimed to compare measurements ascertained from different commonly used devices.

Methods: We used a randomised cross-over study. Participants were 118 men and women aged 45-74 years whose blood pressure, grip strength and lung function were assessed using two sphygmomanometers (Omron 705-CP and Omron HEM-907), four handheld dynamometers (Jamar Hydraulic, Jamar Plus+ Digital, Nottingham Electronic and Smedley) and two spirometers (Micro Medical Plus turbine and ndd Easy on-PC ultrasonic flow-sensor) with multiple measurements taken on each device. Mean differences between pairs of devices were estimated along with limits of agreement from Bland-Altman plots. Sensitivity analyses were carried out using alternative exclusion criteria and summary measures, and using multilevel models to estimate mean differences.

Results: The mean difference between sphygmomanometers was 3.9mmHg for systolic blood pressure (95% Confidence Interval (CI):2.5,5.2) and 1.4mmHg for diastolic blood pressure (95% CI:0.3,2.4), with the Omron HEM-907 measuring higher. For maximum grip strength, the mean difference when either one of the electronic dynamometers was compared with either the hydraulic or spring-gauge device was 4-5kg, with the electronic devices measuring higher. The differences were small when comparing the two electronic devices (difference=0.3kg, 95% CI:-0.9,1.4), and when comparing the hydraulic and spring-gauge devices (difference=0.2kg, 95% CI:-0.8,1.3). In all cases limits of agreement were wide. The mean difference in FEV1 between spirometers was close to zero (95% CI:-0.03,0.03), limits of agreement were reasonably narrow, but a difference of 0.47l was observed for FVC (95% CI:0.53,0.42), with the ndd Easy on-PC measuring higher.

Conclusion: Our study highlights potentially important differences in measurement of key functions when different devices are used. These differences need to be considered when interpreting results from modelling intra-individual changes in function and when carrying out cross-study comparisons, and sensitivity analyses using correction factors may be helpful.



  • Sport, Exercise and Health Sciences

Published in

PLoS One


Public Library of Science (PLoS)


  • AM (Accepted Manuscript)

Publisher statement

This is an Open Access Article. It is published by Public Library of Science (PLoS) under the Creative Commons Attribution 4.0 International Licence (CC BY). Full details of this licence are available at: https://creativecommons.org/licenses/by/4.0/

Acceptance date





  • en


Prof Rebecca Hardy. Deposit date: 11 August 2023

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