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Review
. 2020 Oct;86(10):1969-1981.
doi: 10.1111/bcp.14201. Epub 2020 Feb 11.

The development of a test battery to assess the hand-eye functions relevant in predicting easy and accurate tablet subdivision in older people: A pilot study

Diana van Riet-Nales  1 , Linda Donkerbroek  1 , Agnes Nicia  1 , Christien Oussoren  2 , Anthonius de Boer  1   2 , Bart van den Bemt  3   4
Affiliations
Review

The development of a test battery to assess the hand-eye functions relevant in predicting easy and accurate tablet subdivision in older people: A pilot study

Diana van Riet-Nales et al. Br J Clin Pharmacol. 2020 Oct.

Abstract

Aims: Tablets may be subdivided for dose adaptations or to ease swallowing. The handling is common in older patients but can be difficult and inaccurate. Currently, it is not known which hand-eye functions determine the ability of older people to break tablets by hand and to do so with acceptable ease and accuracy. The aim of this study was to develop a test battery to assess the hand-eye functions relevant in predicting easy and accurate tablet subdivision in older people.

Methods: A mixed methods study was conducted including literature reviews and a pilot experiment. The reviews were conducted in Pubmed, Google Scholar, Dutch journals and professional standards. The first review tried to identify the hand-eye functions relevant to tablet subdivision and the second the associated measuring instruments, testing protocols and normative data. A test battery was empanelled. A pilot experiment was conducted in 30 adult volunteers to optimize and evaluate the test battery.

Results: Five domains were considered relevant: hand size, hand strength, flexibility/manual dexterity, vision and coordination. Hand size could best be measured by finger circumference, hand strength by pinch- and grip strength, flexibility by active range of joint motion, manual dexterity (and flexibility, coordination, cognition, vision) by pegboard function, vision by near visual acuity. Older people preferred the use of tablet splitters over hand breaking.

Conclusion: Easy and accurate tablet subdivision is essential to the good use of medicines. We developed a test battery for older people, but probably of value to all age groups.

Keywords: clinical pharmacology; drug information; medication errors; medication safety.

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Conflict of interest statement

There is no conflict to disclose according to BJCP statements. However, for transparency reasons please note the following. Anthonius de Boer, Agnes Nicia and Diana van Riet‐Nales are experts of the European Medicines Agency (EMA). Diana van Riet and Bart van den Bemt are both a member of the MEB's Committee of Clinical Practice. Anthonius de Boer is the chair of the MEB.

Figures

Figure 1
Figure 1
Methods for tablet subdivision: Participant hands, HealthCare Logistics tablet splitter, Pilltool tablet splitter
Figure 2
Figure 2
Order of the tests in the draft (top) and optimized (bottom) battery
Figure 3
Figure 3
Measuring instruments used for the draft and/or optimized test battery. (A) Jamar dynamometer for measuring grip strength; (B) Early Treatment Diabetic Retinopathy Study chart for measuring near‐visual acuity; (C) grooved pegboard test (left) and 9‐hole pegboard test (right) for measuring manual dexterity; (D) B&L Engineering pinch gauge for measuring tip and key pinch; (E) standard ring gauge for measuring finger circumference; (F) finger goniometer for measuring active range of joint motion
Figure 4
Figure 4
A scatterplot indicating the relationships between 1 of the evaluated hand–eye functions (grip strength) and the accuracy and acceptability of tablet subdivision for hand broken tablets (A, B) and those subdivided by the Pilltool (PT; C, D) and HealthCare Logistics tablet splitter (E, F)
See this image and copyright information in PMC

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