Reliability and Validity of Patient-Reported, Rater-Based, and Hybrid Physical Activity Assessments in COPD: A Systematic Review.

Selecting valid and reliable PA assessments in chronic obstructive pulmonary disease (COPD) is crucial to ensure that the information obtained is accurate, valuable, and meaningful. The purpose of this systematic review was to compare the validity and reliability among PA assessments in COPD. An electronic database search of PubMed and CINAHL was completed in December 2019 using MeSH terms on physical activity, COPD, validation, and questionnaires. Transparency in reporting was assessed with the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist while methodological quality was assessed with the modified Quality Appraisal tool for Reliability studies (QAREL) for reliability studies and the Quality Appraisal of Validity Studies (QAVALS) for validity studies. The search yielded fifteen different measures. The Stanford 7-day recall (PAR) demonstrated the strongest correlations with SenseWear Armband on energy expenditure (r = 0.83; p < 0.001) and moderate correlations for time spent in activity over 3 METs (r = 0.54, p < 0.001). The Multimedia Activity Recall (MARCA) also demonstrated moderate to good correlations with both SenseWear and Actigraph GT3X + accelerometers (r = 0.66-0.74). Assisted and computerized PRO measures (PAR and MARCA) and hybrid measures (C-PPAC and D-PPAC) demonstrate better psychometric properties as compared to other subjective measures and may be considered for quantification of PA in COPD. However, observations drawn from single validation studies limit strength of recommendations and further research is needed to replicate the findings.

A virtual patient educational activity to improve interprofessional competencies: A randomized trial.

The purpose of the present study was to determine whether an interprofessional virtual patient educational activity improved interprofessional competencies in pharmacy, physician assistant, and physical therapy graduate students. Seventy-two fifth semester pharmacy (n = 33), fourth semester physician assistant (n = 27) and fourth semester physical therapy (n = 12) graduate students participated in the study. Participants were stratified by discipline and randomized into control (n = 38) and experimental groups (n = 34). At baseline and at study completion, all participants completed an original, investigator-developed survey that measured improvement in selected Interprofessional Education Collaborative (IPEC) competencies and the Readiness for Interprofessional Learning Scale (RIPLS). The experimental group had statistically significantly greater odds of improving on a variety of IPEC competencies and RIPLS items. The use of a single, interprofessional educational activity resulted in having a greater awareness of other professions' scopes of practice, what other professions have to offer a given patient and how different professions can collaborate in patient care.

Virtual patient care: an interprofessional education approach for physician assistant, physical therapy and occupational therapy students.

The purpose of this retrospective qualitative case report is to describe how a case-based, virtual patient interprofessional education (IPE) simulation activity was utilized to achieve physician assistant (PA), physical therapy (PT) and occupational therapy (OT) student IPE learning outcomes. Following completion of a virtual patient case, 30 PA, 46 PT and 24 OT students were required to develop a comprehensive, written treatment plan and respond to reflective questions. A qualitative analysis of the submitted written assignment was used to determine whether IPE learning objectives were met. Student responses revealed three themes that supported the learning objectives of the IPE experience: benefits of collaborative care, role clarification and relevance of the IPE experience for future practice. A case-based, IPE simulation activity for physician assistant and rehabilitation students using a computerized virtual patient software program effectively facilitated achievement of the IPE learning objectives, including development of greater student awareness of other professions and ways in which collaborative patient care can be provided.

From the Flight Deck to the Bedside: Core Aviation Concepts Applied to Acute Care Physical Therapist Practice and Education.

The health care industry has sought to reduce errors and patient harm by drawing upon human factors research developed largely in the aviation industry. However, literature that explicitly applies human factors concepts to physical therapist practice is scarce. Therefore, this clinical perspective highlights the key concepts in aviation safety and training that should be considered for application to physical therapist education and practice in the acute care setting, including the law of primacy, pilot in command, crew resource management, situational awareness, the instrument scan, currency versus proficiency, the advanced qualification program, and the use of checklists. The authors identify, discuss, and apply existing parallel concepts in physical therapist literature. The authors then challenge acute care physical therapists, academic faculty, and clinical instructors on ways to integrate these concepts in practice.

Effects of nordic walking exercise on gait, motor/non-motor symptoms, and serum brain-derived neurotrophic factor in individuals with Parkinson's disease.

Objective: The primary purpose of this study was to investigate the immediate and long-term effects of Nordic Walking (NW) exercise on walking function, motor/non-motor Parkinson's Disease (PD) symptoms, and serum brain-derived neurotrophic factor (BDNF) in persons with idiopathic PD. Methods: Twelve community-dwelling participants with mild to moderate idiopathic PD and varied degrees of gait dysfunction were recruited for this prospective, repeated measures design that examined clinical measures and BDNF levels at baseline (T0), post-intervention (T1) and 3-month follow-up (T2). Participants engaged in 6 weeks of supervised NW exercise training with individualized instruction, followed by 14 weeks of independent NW exercise with remote coaching. Outcome measurements included daily step counts, 6-Minute Walk Test (6-MinWT), 10-Meter Walk Test (10MWT), spatiotemporalparameters, Timed Up and Go Test (TUG), dual-task TUG, Revised-Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Revised-Freezing of Gait Questionnaire, MDS-Nonmotor Symptom scale (NMS), Parkinson's Fatigue Scale, and serum BDNF levels. The Friedman test with post hoc Wilcoxon sign-ranked pairwise comparisons were used to compare baseline to T1, baseline to T2, and T1 to T2 timepoints with a Benjamini-Hockberg correction applied. Results: Statistically significant improvements found post-training and retained at 3-month follow-up included 6-MinWT, daily step count, 10mWT, MDS-UPDRS, and TUG with effect sizes of 0.57 to 1.03. Serum BDNF at T2 was significantly greater than T0 and T1. Although no statistically significant improvements were observed in the MDS-NMS, 9 of 12 participants had improved non-motor symptoms. There was good adherence, sustained independent exercise engagement, and no adverse events over the 5-month study duration. Conclusions: This study demonstrated that NW exercise was a safe, feasible, and sustainable mode of aerobic exercise for this sample of participants with varied Parkinson's disease duration and severity. Following an individualized and progressive NW training intervention, significant improvements in walking function, daily activity level, and motor function were observed. Following the supervised NW training phase, independent three-month engagement in NW exercise was sustained with long-term retention of these clinical improvements and an increase in serum BDNF levels over this five-month NW exercise trial. Impact: Nordic walking exercise may be a safe, feasible and sustainable mode of independent exercise for improving daily ambulatory activity, gait and motor function, and serum BDNF in individuals with mild to moderate PD with varied gait abilities. Clinical Trials Registry ID: 20-101-H.

Development and validation of a quality appraisal tool for validity studies (QAVALS).

Background: Appraisal of methodological quality of included studies is an important component of conducting systematic reviews. Although several quality appraisal tools are available for intervention studies, fewer tools are available for non-randomized designs, especially for studies of measurement properties.Objectives: The purpose of this study was to develop a quality appraisal tool specific to validity studies (QAVALS) and to examine its reliability and validity.Methods: Following identification of key concepts, an initial list of 34 possible items was developed. Content experts rated each item as either 'essential', 'useful but not essential', and 'not necessary'. The content validity ratio (CVR) and content validity index (CVI) were calculated to establish content validity following two rounds of review. Inter-rater and test-retest reliability were assessed by two external reviewers using weighted kappa coefficients.Results: Items below a CVR of 0.50 were eliminated resulting in the modified version with 27 items. Following the second round, the final tool with 24 items was developed. The content validity index of QAVALS was 0.90. QAVALS demonstrated excellent test-retest reliability (k = 0.80-0.84, 95% CI = 0.76-0.90) and good overall inter-rater reliability (k = 0.70, 95% CI = 0.61-0.79).Limitations: Individual item reliability was low for four items. Further research is warranted to examine reliability using larger number of studies and raters with different experience levels.Conclusion: QAVALS is the first quality appraisal tool specifically designed to address common types of validity. The QAVALS demonstrates strong content validity, good overall inter-rater and excellent test-retest reliability.

Dynamic factor analysis of seasonal variation in daily physical activity in individuals with heart failure and implanted cardiac devices.

BACKGROUND: The purpose of the present study was to determine the presence and magnitude of seasonal variation in daily physical activity (PA) in those with heart failure (HF). METHODS: Retrospective study and dynamic factor analysis (DFA) of Patient Activity data from Medtronic implanted cardioverter defibrillator and cardiac resynchronization devices (ICD/CRTs). RESULTS: In a data set of 435 patients, distinct states/trends were identified by DFA including a classic, sinusoidal pattern of seasonal variation and a pattern of decline over the course of 12 months, which were associated with specific clinical characteristics. Overall, model fitting was good. CONCLUSIONS: Those with low comorbidities, better NYHA Class, higher BMI, no hospitalization, and male sex demonstrated greater seasonal variation of at least 40 min per day between winter (lowest PA) and spring/summer (highest PA). Those with female sex and hospitalization demonstrated overall downward trajectories of approximately 40 and 80 min, respectively, over the course of the year.

Subjective Daily Physical Activity Measures in Heart Disease: A Systematic Review.

BACKGROUND: The measurement of daily physical activity (DPA) is important for the prognosis and quantifying clinical outcomes in individuals with heart disease. The measurement of DPA is more feasible using subjective measures when compared with objective measures. The purpose of this systematic review of the literature was to identify the subjective measures of DPA that have established reliability and validity in individuals with heart disease to assist clinician and researcher instrument selection. METHODS: A systematic search of PubMed, CINAHL, MEDLINE, and ProQuest databases was performed. Methodological rigor was assessed using 3 different quality appraisal tools. Qualitative synthesis of included studies was performed. RESULTS: Twenty-two unique studies covering 19 subjective DPA measures were ultimately included. Methodological rigor was generally fair, and validity coefficients were moderate at best. CONCLUSIONS: Only 4 subjective measures that have established test-retest reliability and that provide an estimate of energy expenditure, metabolic equivalents, or minutes of DPA were compared against accelerometry or a DPA diary in patients with heart disease: SWISS Physical Activity Questionnaire, Total Activity Measure 1 and 2, and Mobile Physical Activity Logger. Depending on the clinician or researcher needs, instrument selection would depend on the recall period and the DPA construct being measured.

A Knowledge Translation Framework for Optimizing Physical Therapy in Patients With Heart Failure.

The American Physical Therapy Association has supported the development of clinical practice guidelines to promote and support evidence-based practice and reduce unwarranted practice variation. Essential to the success of this effort is the generation of knowledge translation, a concept that emphasizes the translation of global knowledge to an application that can be effectively integrated into clinical practice. The Physical Therapy Clinical Practice Guideline for the Management of Individuals with Heart Failure published in the Physical Therapy Journal in January 2020 provides a broad base of knowledge related to evidence-based treatment interventions for patients with heart failure. However, the application and integration of this knowledge in clinical practice need further elucidation. Therefore, this perspective paper aims to serve as a complementary knowledge translation resource to the recently published practice guideline to maximize the utilization of contemporary evidence in clinical practice. This resource provides the physical therapist with practical guidance in the management of patients with heart failure by placing research findings in the context of other knowledge and practice norms that can be applied at the point of care and across the continuum of care. We propose a novel ABCDE (assessment, behavior modification, cardiorespiratory fitness, dosage, and education) practical framework. This clinical paradigm is grounded in ongoing physical therapist assessment throughout the episode of care, along with behavior modification, assessment of cardiorespiratory fitness, appropriate selection and dosing of interventions, and patient education. Examples highlighting the use of this model in patients with heart failure across the continuum of care are provided for application in clinical care.

Physical Therapist Clinical Practice Guideline for the Management of Individuals With Heart Failure.

The American Physical Therapy Association (APTA), in conjunction with the Cardiovascular and Pulmonary Section of APTA, have commissioned the development of this clinical practice guideline to assist physical therapists in their clinical decision making when managing patients with heart failure. Physical therapists treat patients with varying degrees of impairments and limitations in activity and participation associated with heart failure pathology across the continuum of care. This document will guide physical therapist practice in the examination and treatment of patients with a known diagnosis of heart failure. The development of this clinical practice guideline followed a structured process and resulted in 9 key action statements to guide physical therapist practice. The level and quality of available evidence were graded based on specific criteria to determine the strength of each action statement. Clinical algorithms were developed to guide the physical therapist in appropriate clinical decision making. Physical therapists are encouraged to work collaboratively with other members of the health care team in implementing these action statements to improve the activity, participation, and quality of life in individuals with heart failure and reduce the incidence of heart failure-related re-admissions.

Quantification of Seasonal Variation in Daily Physical Activity in Individuals with Heart Failure and Implantable Cardioverter Defibrillator/Cardiac Resynchronisation Therapy Devices.

PURPOSE: Understanding seasonal variation of daily physical activity (PA) in patients with heart failure (HF) has important implications for planning and interpretation of clinical trials, but the presence and magnitude of this seasonal variation in daily PA have yet to be established. The purpose of the present study was to determine the presence and magnitude of seasonal variation in daily PA in community-dwelling individuals with HF using several analytic approaches. METHODS: Retrospective chart review of patients with HF and Medtronic implantable cardioverter defibrillator/cardiac resynchronisation therapy (ICD/CRT) devices. Data included in analyses (autocorrelation, analysis of covariance, one-way analysis of variance) were clinical characteristics, the patient activity measure of daily PA from the ICD/CRT devices, temperature and hours of daylight over the 1-year period of 1 November 2017-31 October 2018. RESULTS: One hundred and sixty-eight patients were included. Visual analysis and autocorrelation demonstrated seasonal variation in daily PA. Daily PA seasonal difference between winter and summer months was 0.4 hours per day/24 minutes per day/2.8 hours per week/14.9%. This seasonal effect on daily PA is significantly greater in those with ≤8 comorbid conditions and an overall activity level of >2.2 hours per day compared to those with multiple comorbidities and low overall activity (0.7 versus 0.1 hours per day, respectively). CONCLUSIONS: The present study affirms the seasonality of daily PA in a cohort of patients with HF and ICD/CRT devices and reveals a disproportionate seasonal effect on those with fewer comorbidities and higher overall activity levels. Seasonal variation should be accounted for when interpreting change in daily PA in clinical practice and when designing and interpreting results of clinical trials investigating interventions to improve daily PA.

Levetiracetam for the treatment of neonatal seizures.

Seizures are a common occurrence in the neonatal intensive care unit, especially among low-birth-weight infants. The efficacy and safety of standard anticonvulsants have not been evaluated extensively in the neonate. In addition, there is concern for the adverse effects of phenobarbital on long-term development. Levetiracetam has been a commonly prescribed oral anticonvulsant for the use of adjunctive therapy for partial seizures in adults with favorable tolerability, and it has been recently approved for children older than age 4 years. There are no published studies regarding the safety and efficacy of this medication in the infant population. This report describes the initiation of levetiracetam in 3 infants, aged 2 days to 3 months, for refractory seizures or intolerance to other anticonvulsants. Each patient was without seizure on levetiracetam monotherapy, and there were no adverse effects.

Early Access to Physical Therapy and Specialty Care Management for American Workers With Musculoskeletal Injuries.

OBJECTIVE: The aim of this study was to investigate the effect of very early access to physical therapy and specialty care management in a workers' compensation population. METHODS: A prospective pilot (n = 75) was conducted from 2012 to 2013 in which injured workers with musculoskeletal complaints received physical therapy and started care management during their initial occupational medicine clinic visit. Two retrospective comparator groups with workers' compensation claims from 2009 and 2012 were included in this study. RESULTS: When comparing 2009 data with the 2012 to 2013 prospective pilot study, statistically significant differences were noted in favor of the prospective pilot for total costs per claim, cost of indemnity, number of therapy visits, and time to access physical therapy. When compared with the 2012 nonpilot cohort, differences were not statistically significant. CONCLUSIONS: Expedited access to physical therapy and care management can reduce duration of care, cost of claims, and therapy visits.

The impact of multimorbidity on grip strength in adults age 50 and older: Data from the health and retirement survey (HRS).

BACKGROUND: Multimorbidity, the presence of two or more chronic diseases, is a public health concern. The measurement of grip strength has been proposed as a measure of overall body strength and is reliable and easy to measure. The purpose of this study was to investigate the relationship between the number of chronic diseases and common co-occurring chronic diseases with grip strength. METHODS: A cross-sectional analysis was conducted of 5877 respondents (2744=male, 3103=female) from the 2008 Health and Retirement Study (HRS) who completed grip strength measurements (kg). RESULTS: As the number of chronic diseases increased, an incremental decrease in grip strength occurred and became more pronounced with ≥3 chronic diseases present (b=3.1, 95% CI=2.3-3.9, p<0.001). No statistically significant relationship was identified between specific chronic diseases (except for stroke) and grip strength. CONCLUSION: Multimorbidity has a statistically significant negative relationship on grip strength. Grip strength should be considered as a physical performance measure to incorporate into the care of patients with multimorbidity.

Predicting response to rehabilitation in elderly patients with stroke using the Orpington Prognostic Scale and selected clinical variables.

PURPOSE: Prediction of outcome and response to rehabilitation in patients with stroke can be difficult, especially in the elderly. The purpose of this study was to determine the ability of the Orpington Prognostic Scale (OPS) to predict outcome and response to subacute rehabilitation in older patients with stroke. METHODS: Twenty-two subjects in the subacute care setting diagnosed with acute stroke were prospectively studied. The OPS was scored within 2 weeks of stroke, and the Functional Independence Measure (FIM) motor subscale was scored at admission and discharge. RESULTS: Strong Spearman correlations with OPS scores were found for improvement in FIM score [rs = -.74, 95% CI: (-.88, -.45), p = .0007] and discharge FIM score [rs = -.81, 95% CI: (-.92, -.58), p = .0002]. CONCLUSIONS: The OPS scores were strong predictors of response to subacute rehabilitation and discharge FIM motor subscale scores. The OPS may warrant a broader application as a prognostic indicator for patients with stroke.

Seasonal variation of daily physical activity in individuals with heart failure.

BACKGROUND: Previous studies indicate that seasonal variation affects daily physical activity (PA), but none have investigated this relationship in individuals with heart failure (HF) who also have implanted cardioverter defibrillators and cardiac resynchronization therapy (ICD/CRT) devices. The purpose of the present study was to determine if seasonal variation in temperature affects daily PA in patients with HF and ICD/CRTs. PATIENTS AND METHODS: Secondary analysis of data from 16 subjects with HF and Medtronic® ICD/CRT devices enrolled in a randomized trial investigating interventions to improve daily PA. Due to the rolling study enrollment, daily PA data for all subjects were not available for the entire time frame and were divided into two groups. Determination of seasonal variation of daily PA was determined using visual analysis of daily PA plotted with average temperature, autocorrelation, visual analysis of seasonal subseries plots and boxplot analysis, as well as Wilcoxon signed-rank tests. RESULTS: Subjects 1-8 demonstrated the greatest differences in daily PA during periods of seasonal transition whereas subjects 9-16 demonstrated the greatest variation in daily PA with greatest seasonal temperature difference. Wilcoxon signed-rank testing of the lowest and highest months for daily PA revealed median differences of 0.30 (p = 0.050) and 0.36 hours (p = 0.036) for subjects 1-8 and 9-16, with effect sizes of 0.69 and 0.74, respectively. CONCLUSIONS: Seasonal variation in mean temperature appears to affect daily PA in individuals with HF and ICD/CRT devices by a magnitude of 0.30-0.36 hours, which may need to be accounted for in future research investigating interventions to improve daily PA.

Replicable Interprofessional Competency Outcomes from High-Volume, Inter-Institutional, Interprofessional Simulation.

There are significant limitations among the few prior studies that have examined the development and implementation of interprofessional education (IPE) experiences to accommodate a high volume of students from several disciplines and from different institutions. The present study addressed these gaps by seeking to determine the extent to which a single, large, inter-institutional, and IPE simulation event improves student perceptions of the importance and relevance of IPE and simulation as a learning modality, whether there is a difference in students' perceptions among disciplines, and whether the results are reproducible. A total of 290 medical, nursing, pharmacy, and physical therapy students participated in one of two large, inter-institutional, IPE simulation events. Measurements included student perceptions about their simulation experience using the Attitude Towards Teamwork in Training Undergoing Designed Educational Simulation (ATTITUDES) Questionnaire and open-ended questions related to teamwork and communication. Results demonstrated a statistically significant improvement across all ATTITUDES subscales, while time management, role confusion, collaboration, and mutual support emerged as significant themes. Results of the present study indicate that a single IPE simulation event can reproducibly result in significant and educationally meaningful improvements in student perceptions towards teamwork, IPE, and simulation as a learning modality.

Genomic organization and promoter analysis of the mouse ADP-ribosylarginine hydrolase gene.

Mono-ADP-ribosylation is a reversible modification of proteins with NAD:arginine ADP-ribosyltransferases and ADP-ribosylarginine hydrolases (ADPRH) catalyzing the opposing arms of an ADP-ribosylation cycle. The ADPRH cDNA had been cloned from human, rat, and mouse tissues and high levels of mRNA were found in brain, spleen, and testis. To begin to understand the molecular mechanisms that regulate ADPRH gene expression, we cloned the full-length cDNA, determined the genomic structure of mouse ADPRH, and investigated promoter function. Northern analysis using different regions of the ADPRH cDNA as probes identified two mRNAs of 1.7 and 3.0 kb, which resulted from the use of alternative polyadenylation signals, CATAAC and ATTAAA, beginning at positions 1501 and 2885, respectively, of the nucleotide sequence (A of ATG = 1). The ADPRH gene, represented in two overlapping genomic clones, spans approximately 9 kilobases with four exons and three introns. The 5'-flanking region contains the features of a housekeeping gene; it has neither a TATA nor a CAAT box, but is, instead, highly GC-rich with multiple transcription initiation sites. Promoter analysis, assessed using transient transfection of PC12, NB41A3, NIH/3T3, and Hepa 1-6 cells with truncated constructs, revealed potent stimulatory (-119 to -89) and inhibitory (-161 to -119) elements, which were utilized similarly in the different cell lines. Further mutational analysis of the promoter and electrophoretic mobility-shift assays identified a positive GC-box element (-107 to -95); Sp1 and Sp3, which bound to this motif, were also detected by supershift assays. In co-transfection experiments using Drosophila SL2 cells that lack endogenous Sp1, Sp1 trans-activated the ADPRH promoter in a manner dependent on the presence of an Sp1-binding motif. The promoter activity pattern and involvement of Sp transcription factors are consistent with prior observations of widespread hydrolase expression in mammalian tissues.

Comparison of clarithromycin and ciprofloxacin therapy for Bacillus anthracis Sterne infection in mice with or without (60)Co gamma-photon irradiation.

Biological agents and ionizing radiation lead to more severe clinical outcomes than either insult alone. This study investigated the survival of non-irradiated and (60)Co-gamma-irradiated mice given therapy for inhalation anthrax with ciprofloxacin (CIP) or a clinically relevant mixture of clarithromycin (CLR) and its major human microbiologically important metabolite 14-hydroxy clarithromycin (14-OH CLR). All B6D2F1/J 10-week-old female mice were inoculated intratracheally with 3 x 10(8) c.f.u. of Bacillus anthracis Sterne spores 4 days after the non-lethal 7 Gy dose of (60)Co gamma radiation. Twenty-one days of treatment with CLR/14-OH CLR, 150 mg kg(-1) twice daily, or CIP, 16.5 mg kg(-1) twice daily, began 24 h after inoculation. Pharmacokinetics indicate that the area under the curve (AUC) for 14-OH CLR on the concentration-versus-time graph was slightly higher in gamma-irradiated than non-irradiated animals. Neither drug was able to increase survival in gamma-irradiated animals. CIP and CLR/14-OH CLR therapies in non-irradiated animals increased survival from 49 % (17/35 mice) in buffer-treated animals to 94 % (33/35) and 100 %, respectively (P < 0.001). B. anthracis Sterne only was isolated from 25-50 % of treated mice with or without irradiation. Mixed infections with B. anthracis Sterne were present in 50-71 % of gamma-irradiated mice but only in 5-10 % of mice without irradiation.

Grip strength values stratified by age, gender, and chronic disease status in adults aged 50 years and older.

BACKGROUND AND PURPOSE: Grip strength is a measure of overall muscle strength and has been found to be a predictor of disability and mortality. Almost 3 in 4 adults aged 65 years and older have multiple chronic conditions, known as multimorbidity. Normative data for grip strength have commonly been reported on healthy convenience samples that may not accurately represent the population of interest. Grip strength values of US adults, utilizing a nationally representative data set based on the number of chronic diseases, would be beneficial to health care providers who serve adults with multimorbidity. The purpose of this study was to describe grip strength values of adults in the United States, based on gender, age, and the number of chronic diseases. METHODS: A cross-sectional analysis was conducted using data collected from adults aged 50 years or older (n = 5877) from the Health and Retirement Study survey administered in 2008. Grip strength values (in kilograms) were determined and stratified on the basis of the number of self-reported chronic diseases (0, 1, 2, ≥3) and stratified by age (decades) and gender. RESULTS: Consistent with previously published values, males demonstrated higher mean hand grip strength than females and grip strength values decreased with age. Adults with multimorbidity demonstrated decreased grip strength as compared with those without chronic conditions (males/females with 0 chronic diseases right grip strength (Equation is included in full-text article.)= 44.2/26.8 kg as compared with males/females with 3 or more chronic disease right grip strength (Equation is included in full-text article.)= 36.1/21.7 kg). CONCLUSIONS: The grip strength values presented can serve as a standard of comparison for the large proportion of adults who have multimorbidity. Clinicians should consider grip strength as a component of a comprehensive physical assessment to identify decreased grip strength and recommend increased physical activity as an appropriate intervention.