Handgrip Strength: A Comparison of Values Obtained From the NHANES and NIH Toolbox Studies.

IMPORTANCE: Handgrip dynamometry is probably the most commonly used method to characterize overall human muscle strength. OBJECTIVE: To compare and summarize grip strength measurements obtained from two population-based studies. DESIGN: Secondary data analysis. SETTING AND PARTICIPANTS: Data from (1) the 2011-2014 National Health and Nutrition Examination Survey (NHANES) with 13,918 participants and (2) the 2011 normative phase of the National Institutes of Health (NIH) Toolbox project with 3,594 participants. OUTCOMES AND MEASURES: The NHANES values used were the mean and best of three trials; the NIH Toolbox value used was the one maximum trial after a practice trial. RESULTS: General linear model analysis revealed that values obtained from the NIH Toolbox differed from NHANES best values but not from NHANES mean values. The analysis also indicated, regardless of the values used, that grip strength differed significantly between dominant and nondominant sides, males and females, and age groups. We provide updated reference values for handgrip strength. CONCLUSIONS AND RELEVANCE: On the basis of these analyses, we summarize grip strength measures obtained from the NHANES and NIH Toolbox for side, gender, and age group strata. Reference values are essential to assist in the interpretation of testing results and clinical decision making.

Assessing manual dexterity: Comparing the WorkAbility Rate of Manipulation Test with the Minnesota Manual Dexterity Test.

STUDY DESIGN: Cross-sectional study. INTRODUCTION: The WorkAbility Rate of Manipulation Test (WRMT), an adaptation of the Minnesota Manual Dexterity Test (MMDT), contains a revised board and protocols to improve its utility for therapy or fitness assessment. PURPOSE OF THE STUDY: To describe the development and preliminary psychometric properties of WRMT. METHODS: Sixty-six healthy participants completed MMDT and WRMT in a random order followed by a user experience survey. We compared tests using repeated-measures analysis of variance, test-retest reliability, and examined agreement between tests. RESULTS: Despite the similarities of these 2 instruments, the different administration protocols resulted in statistically different score distributions (P < .001). Results supported good test-retest reliability of WRMT (placing test ICC = 0.88-0.90 and turning test ICC = 0.68-0.82). The WRMT correlated moderately with MMDT (r = 0.81 in placing test and r = 0.44-0.57 in turning test). Bland-Altman plot showed that the differences in completion time were 3.8 seconds between placing tests and 19.6 (both hands), 0.3 (right hand), and 3.9 (left hand) seconds between turning tests. Overall, participants felt that the instruction of WRMT was easier to follow (44%) and preferred its setup, color, and depth of the test board (49%). Time required to complete 1 panel of 20 disks correlated highly with the time needed to finish a complete trial of 60 disks in both MMDT (r = 0.91-0.97) and WRMT (r = 0.88-0.95). CONCLUSIONS: Caution is warranted in comparing scores from these 2 test variants. LEVEL OF EVIDENCE: 3b.

Intervention to Improve Medication Management: Qualitative Outcomes From a Phase I Randomized Controlled Trial.

OBJECTIVES: We sought to define an occupational therapy intervention to promote medication management and to evaluate the acceptability and effectiveness of the intervention. METHOD: Nineteen adults with chronic health conditions and poor medication adherence participated in a two-group, blinded, randomized study. They received either an occupational therapy or a standard care intervention. We used a qualitative method to measure participants' changes in medication management through an interview regarding participants' perceptions and behaviors. RESULTS: The occupational therapy intervention group reported greater improvements in medication management and implemented twice as many new adaptive strategies as the standard care group. Participants indicated that interventions related to advocacy, education, assistive technology, environmental modifications, self-monitoring, and good rapport were the active ingredients of the intervention. CONCLUSIONS: Occupational therapy is an acceptable intervention for medication management, and it can lead to self-perceived improvements and the adoption of new medication management behaviors. Further research is warranted.

Nurse-directed care model in a psychiatric hospital: a model for clinical accountability.

PURPOSE: The focus on recovery for persons with severe and persistent mental illness is leading state psychiatric hospitals to transform their method of care delivery. This article describes a quality improvement project involving a hospital's administration and multidisciplinary state-university affiliation that collaborated in the development and implementation of a nursing care delivery model in a state psychiatric hospital. DESCRIPTION OF THE PROJECT: The quality improvement project team instituted a new model to promote the hospital's vision of wellness and recovery through utilization of the therapeutic relationship and greater clinical accountability. Implementation of the model was accomplished in 2 phases: first, the establishment of a structure to lay the groundwork for accountability and, second, the development of a mechanism to provide a clinical supervision process for staff in their work with clients. Effectiveness of the model was assessed by surveys conducted at baseline and after implementation. OUTCOME: Results indicated improvement in clinical practices and client living environment. As a secondary outcome, these improvements appeared to be associated with increased safety on the units evidenced by reduction in incidents of seclusion and restraint. CONCLUSIONS: Restructuring of the service delivery system of care so that clients are the center of clinical focus improves safety and can enhance the staff's attention to work with clients on their recovery. IMPLICATIONS: The role of the advanced practice nurse can influence the recovery of clients in state psychiatric hospitals. Future research should consider the impact on clients and their perceptions of the new service models.