Self-Report Measures of Fatigue for People With Multiple Sclerosis: A Systematic Review.

BACKGROUND AND PURPOSE: The symptom of fatigue impairs function in people with multiple sclerosis (MS). Choosing appropriate measures to assess fatigue is challenging. The purpose of this article is to report the findings of a systematic review of patient-reported fatigue measures for people with MS. METHODS: PubMed, CINAHL, and Embase databases were searched through January 2020 using terms related to fatigue and MS. Studies were included if the sample size was 30 or more or smaller samples if adequately powered, and if information about measurement characteristics (ie, test-retest reliability, content validity, responsiveness, interpretability, or generalizability) of the measure(s) could be extracted. Study quality was appraised with the 2-point COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. Data about measurement characteristics, psychometrics, and clinical utility were extracted and results were synthesized. RESULTS: Twenty-four articles met inclusion criteria with information about 17 patient-reported fatigue measures. No studies had critical methodologic flaws. Measurement characteristic data were not available for all measures. Clinical utility varied in time to complete and fatigue domains assessed. DISCUSSION AND CONCLUSIONS: Five measures had data pertaining to all properties of interest. Of these, only the Modified Fatigue Impact Scale (MFIS) and Fatigue Severity Scale (FSS) had excellent reliability, responsiveness data, no notable ceiling/floor effects, and high clinical utility. We recommend the MFIS for comprehensive measurement and the FSS for screening of subjective fatigue in people with MS.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A443 ).

Collaboration in the midst of chaos: perspectives of inpatient occupational and physical therapists during the COVID-19 pandemic.

The COVID-19 pandemic has affected over 700 million people globally, straining healthcare systems and highlighting the need for interprofessional collaboration. The aim of this study was to describe interprofessional collaborative practice (IPCP) experiences from the perspectives of occupational therapists (OTs) and physical therapists (PTs) who were employed in a medical center both before and during the COVID-19 pandemic. This qualitative study, conducted from July 2020-November 2021, delved into the lived experiences of occupational and physical therapists in an inpatient setting during the pandemic through analysis of semi-structured interviews and journal entries. The pandemic prompted fear, uncertainty, and ethical dilemmas among therapists, affecting patient-centered care. Roles expanded, and teamwork challenges emerged in defining boundaries, while communication dynamics were transformed by virtual technologies. The pandemic affected therapists' values and ethics, and evolving roles brought expanded tasks. The crisis showcased both collaboration potential and the need to address team disparities. This study highlights the significance of values, roles, teams, and communication for occupational and physical therapists during the COVID-19 pandemic providing valuable insights into interprofessional collaboration's effect on healthcare delivery in times of crisis and beyond.

Standardizing Outcome Assessment in Parkinson Disease: A Knowledge Translation Project.

BACKGROUND AND PURPOSE: Rehabilitation therapists do not consistently utilize standardized outcome measures. The purpose of this study was to develop and implement a tailored knowledge translation (KT) intervention to facilitate application of standardized outcome measures used in patients with Parkinson disease (PD) receiving outpatient rehabilitation. METHODS: Four clinics within a hospital-based outpatient system including physical therapists (n = 7) and occupational therapists (n = 2) collaborated with researcher clinicians. A mixed-methods study, using the knowledge to action (KTA) framework, was executed to standardize the assessment battery completed on patients with PD. The project was titled iKNOW-PD (integrating KNOWledge translation for Parkinson Disease). RESULTS: Four measures were selected for iKNOW-PD (9-Hole Peg Test, miniBESTest, 10-m walk test, and 5 times sit-to-stand). A multimodal intervention that overcame specific identified barriers (equipment, time) was implemented to ensure successful uptake. Consistency of utilizing iKNOW-PD measures on initial evaluation and discharge, across therapists and clinics, was evaluated. Therapists significantly increased the use of iKNOW-PD measures from 1.9 to 3.1 on initial evaluation (P < 0.001). The 10-meter walk test demonstrated the greatest uptake (>50%) from pre-iKNOW-PD to post-iKNOW-PD. DISCUSSION AND CONCLUSIONS: Standardizing outcome assessment for persons with PD in an outpatient setting can be successfully implemented. Overcoming identified barriers and capitalizing on facilitators promoted the uptake of standardized outcomes. Following the 6-month intervention period, therapists endorsed an improvement in their application of standardized measures and labeled iKNOW-PD as a positive experience that allowed them to minimize variability in practice.Video Abstract available for more insights from the authors (see the Video, Supplemental Content 1, available at: http://links.lww.com/JNPT/A329).

Measurement Properties of the Dizziness Handicap Inventory-Children and Adolescents for Children and Adolescents Postconcussion.

PURPOSE: The purpose of this study was to examine and report the construct validity, internal consistency, and item structure of the Dizziness Handicap Inventory-Children and Adolescents (DHI-CA) in postconcussion children and adolescents. METHODS: A retrospective chart review was conducted for 132 participants. Data were extracted on the DHI-CA, Sports Concussion Assessment Tool-III symptom inventory, and Vestibulo-ocular Motor Screening. The DHI-CA was examined for validity, internal consistency, and factor structure. RESULTS: The DHI-CA had fair convergent validity (rs = 0.30-0.40), but discriminant validity findings were inconclusive. The functional subscale demonstrated least consistent loadings and 4 items had cross-loading. Reliability analysis indicated possible item redundancy given that the overall Cronbach α was higher than the subscales. CONCLUSION: Despite demonstrating convergent validity, structural inconsistencies and possible item redundancy warrant further exploration and restructuring of the DHI-CA. Caution is recommended while making clinical decisions based on the DHI-CA results alone. VIDEO ABSTRACT: For more insights from the authors, see Supplemental Digital Content 1, available at: http://links.lww.com/PPT/A303.

Reference values for the balance error scoring system in adolescents.

OBJECTIVES: Adolescents with mild traumatic brain injury (i.e. concussion) may experience postural stability impairments. The Balance Error Scoring System (BESS) is widely used in assessment of postural stability after concussion. Despite its common use in adolescents, the BESS lacks reference values in adolescents, limiting its clinical utility. The objective of this study is to report the reference values for the BESS in adolescents and to examine the effect of gender on the BESS scores. METHODS: One hundred and ninety-one high school adolescents between the ages of 14-18 (M = 16.1, SD = 1.1) years of age completed the BESS. The effects of gender, age, body mass and height on the performance of BESS were examined. Additionally, the reported reference values for the BESS were stratified by gender. RESULTS: Female participants demonstrated better performance on five of the six BESS conditions as well as the total error score (p < 0.001). No relationships were observed between age and body mass to the BESS scores. CONCLUSIONS: The effects of gender on the BESS performance support the gender-specific reference values reported in this study. These reference values provide benchmarks for clinicians when interpreting the BESS in the absence of individual baseline scores.

Reliability and Construct Validity of Limits of Stability Test in Adolescents Using a Portable Forceplate System.

OBJECTIVE: To examine the reliability, convergent, and discriminant validity of the limits of stability (LOS) test to assess dynamic postural stability in adolescents using a portable forceplate system. DESIGN: Cross-sectional reliability observational study. SETTING: School setting. PARTICIPANTS: Adolescents (N=36) completed all measures during the first session. To examine the reliability of the LOS test, a subset of 15 participants repeated the LOS test after 1 week. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Outcome measurements included the LOS test, Balance Error Scoring System, Instrumented Balance Error Scoring System, and Modified Clinical Test for Sensory Interaction on Balance. RESULTS: A significant relation was observed among LOS composite scores (r=.36-.87, P<.05). However, no relation was observed between LOS and static balance outcome measurements. The reliability of the LOS composite scores ranged from moderate to good (intraclass correlation coefficient model 2,1=.73-.96). CONCLUSIONS: The results suggest that the LOS composite scores provide unique information about dynamic postural stability, and the LOS test completed at 100% of the theoretical limit appeared to be a reliable test of dynamic postural stability in adolescents. Clinicians should use dynamic balance measurement as part of their balance assessment and should not use static balance testing (eg, Balance Error Scoring System) to make inferences about dynamic balance, especially when balance assessment is used to determine rehabilitation outcomes, or when making return to play decisions after injury.

Weathering the Storm: Professional Quality of Life in Acute Care Physical Therapy Before and During the COVID-19 Pandemic.

The COVID-19 pandemic overwhelmed hospital systems. Frontline workers, including physical therapists, experienced multiple challenges impacting job satisfaction. The Professional Quality of Life (ProQOL) measures constructs related to workplace quality of life. Purpose: To describe levels of compassion satisfaction and compassion fatigue (consisting of burnout and secondary trauma) among a similar cohort of acute care physical therapy staff prior to and approximately 1 year into the pandemic. Methods: Cross-sectional online survey methodology using the ProQOL was completed. A convenience sample of acute care physical therapy professionals employed at a large Midwestern academic medical center was surveyed at separate time points in 2018 (prepandemic) and 2021 (pandemic). Results: A total of 54 (2018) and 53 (2021) acute care physical therapy professionals completed the survey. Overall, respondents reported moderate to high levels of compassion satisfaction with low to moderate levels of burnout and secondary trauma at both periods, consistent with other previously reported health care professionals. However, the respondents exhibited a shift toward worsening compassion fatigue, with increasing levels of burnout and secondary traumatic stress, and a decreased level of compassion satisfaction. Conclusions: Describing the professional quality of life in a cohort of acute care physical therapy professionals before and during the pandemic provides a foundation of further understanding burnout and secondary traumatic stress. Future studies could be completed longitudinally to track changes in acute care physical therapy staff and explore effective support strategies.

The Impact of COVID-19 on Interprofessional Collaborative Practice Through the Lens of Acute Care Physical Therapists: A Case Series.

This case report describes interprofessional collaborative practice experiences through the viewpoints of 3 acute care physical therapists who worked with patients with coronavirus disease-2019 (COVID-19) during the early months of the pandemic. Methods: The cases presented in this case report were selected from a larger longitudinal qualitative multiple-case study investigating interprofessional collaborative practice experiences of physical therapists employed in inpatient settings prior to and during the pandemic. The cases provide detailed narrative descriptions of interprofessional collaborative practice before and during the pandemic from the perspective of 3 physical therapists working in acute care environments. Results: The 3 physical therapists reported challenges to and opportunities for interprofessional collaborative practices that align with the 4 interprofessional educational competencies (values/ethics, roles/responsibilities, communication, and teams/teamwork). Conclusions: The ability to provide patient-centered care through interprofessional collaborative practices was impacted by the COVID-19 pandemic. The rich narrative descriptions of our participants' experiences as members of interprofessional teams provide additional insight regarding the effect of the COVID-19 pandemic on interprofessional collaborative practice.

Using Interprofessional Simulation with Telehealth to Enhance Teamwork and Communication in Home Care.

Interpersonal communication and teamwork are critical to patient safety. There is evidence supporting the effectiveness of formalized team training strategies such as simulation-based learning experiences to permit opportunities for deliberate practice and skill acquisition. However, there is a paucity of evidence examining the best method for delivery of simulation-based interprofessional education activities (Sim-IPE). The purpose of this project was to explore the effectiveness of using a Sim-IPE with a home-based patient assessment and intervention for students in undergraduate nursing, nurse practitioner, and physical therapy programs with the goal of enhancing interprofessional team communication and team performance. A mixed-methods, observational research design was used to evaluate teamwork and communication following virtual/web-based deliberate practice and a subsequent face-to-face Sim-IPE with telehealth. There were two distinct stages: (1) provision of interprofessional education elements of teamwork and communication via a virtual web-based platform to interprofessional student teams; (2) participation of all 29 student teams in a Sim-IPE activity using a standardized patient in a simulated home-based setting. Teams scored very high on an interprofessional communication and teamwork scale, and students strongly agreed that the prebriefing, scenario, and debriefing assisted in their learning. Students also valued exposure to telehealth and the ability to work with students from other health professions.

Interprofessional education faculty development survey: Perspectives on IPE and collaborative practice and COVID-19.

The cancellation of in-person classes in March 2020 due to COVID-19 caused a sudden shift in the educational experiences of health profession students enrolled at the University of Michigan (U-M). With the move to remote learning, educators engaging in interprofessional education (IPE) were faced with the challenge of preparing students for interprofessional collaboration from a distance. A survey was designed to investigate the impact of the pandemic on IPE practices and discover educator development needs. Faculty and staff from 10 health sciences schools within the U-M and Michigan Medicine were invited to complete a survey investigating their use of IPE competencies prior to, during, and after the pandemic; their development needs; and their ideas for future implementation of IPE and collaborative practice. Fifty-six percent of respondents reported their ability to teach IPE competencies was impacted by changes related to COVID. There was a significant (p ≤ 0.001) difference between self-report of incorporating IPE competencies prior to and during pandemic and during and into the future across all five competencies. Technology was reported as a challenge when teaching IPE, and a need for future faculty development. Leveraging virtual and case-based learning and increasing collaboration between schools were identified as ideas for future implementation.

Use of a Structured Approach to Develop Best Practices in Interprofessional Education.

BACKGROUND: Providing interprofessional education (IPE) is mandated by accrediting agencies for health professions education; however, pedagogical, logistical, and financial challenges exist in implementing and sustaining high-quality IPE. After executing several IPE activities, an IPE team developed a structured approach for organizing, sustaining, and ensuring high-quality IPE. This article introduces the Design-Implement-Assess-Modify (DIAM) Model. A portfolio spreadsheet was developed and includes components from each of the DIAM phases. METHOD: The team documented characteristics from five IPE activities conducted annually for 5 years and tracked progress. RESULTS: The DIAM approach has allowed the team to develop a detailed and living portfolio to design, implement, assess, and modify several IPE activities across different professions. CONCLUSION: This approach has led to the intentional planning and development of multiple IPE activities that include the integration of standards of best practice and accreditation, while preparing practitioners for collaborative practice. [J Nurs Educ. 2021;60(6):309-316.].

Impact of a Leadership Development Program for Students in a Doctor of Physical Therapy Program.

AIMS: Physical therapists are needed in leadership roles to enhance participation in primary care delivery models. This study's purpose was to investigate the impact of a leadership development course in a Doctor of Physical Therapy (DPT) curriculum on student physical therapist leadership practices. It was anticipated that students who completed a structured leadership development course would have a greater increase of leadership practices as measured by the Leadership Practices Inventory-Self (LPI-Self). LITERATURE REVIEW: Published articles on DPT student leadership offer foundational insight into mechanisms for enhancing leadership development. Little evidence exists in understanding how student physical therapists develop leadership practices. PARTICIPANTS: Ten DPT students participated in an elective leadership development pro¬gram; 22 classmates served as controls. METHODS: This was a pretest/posttest quasi-experimental design. The LPI-Self and a demographic survey were completed prior to and immediately after a leadership development course. RESULTS: A significant increase (p=0.030) was found in total change score of the LPI-Self pre- to post-test in the experimental group compared to the control group. CONCLUSION: DPT students who participated in the leadership development program had significant increase in LPI-Self scores. These findings suggest that intentional leadership development implemented in DPT curriculum can increase leadership practices.

CHARACTERIZATION OF CERVICAL SPINE IMPAIRMENTS IN CHILDREN AND ADOLESCENTS POST-CONCUSSION.

BACKGROUND: Patients with concussion may present with cervical spine impairments, therefore accurate characterization of cervical post-concussion impairments is needed to develop targeted physical therapy interventions. PURPOSE: To characterize the type, frequency and severity of cervical impairments in children and adolescents referred for physical therapy after concussion.Study design: Retrospective, descriptive study. METHODS: A retrospective analysis was conducted for 73 consecutive children and adolescents who received cervical physical therapy following a concussion. Data was classified into six broad categories. The frequency and intensity of cervical impairments within and across the categories was reported. RESULTS: Ninety percent of patients demonstrated impairments in at least three out of five assessment categories whereas 55% demonstrated impairments in at least four out five assessment categories. Of the five assessment categories, posture (99%) and myofascial impairment (98%) demonstrated highest impairment frequency followed by joint mobility (86%) and muscle strength (62%). Cervical joint proprioception was the least commonly evaluated assessment category. CONCLUSION: High prevalence of cervical spine impairments was observed in the subjects included in this study with muscle tension, joint mobility, and muscle strength being most commonly affected. The categories of impairments examined in this cohort were consistent with the recommendations of the most recent clinical practice guidelines for neck pain. This study provides preliminary data to support the framework for a cervical spine evaluation tool in children and adolescents following concussion. LEVEL OF EVIDENCE: Level 4.

Simulated Interprofessional Education Discharge Planning Meeting to Improve Skills Necessary for Effective Interprofessional Practice.

PURPOSE OF STUDY: The purpose of this study was to evaluate the use of a simulation-enhanced interprofessional education (Sim-IPE) discharge planning learning experience using simulated patients (SPs), to explore the ability for students to communicate with each other and to a patient/caregiver, and to use clinical thinking to make a safe and appropriate interprofessional discharge recommendation. PRIMARY PRACTICE SETTING(S): Educational institution; university simulation center. METHODOLOGY AND SAMPLE: A Sim-IPE was performed with students from physical therapy (N = 46), nursing (N = 25), and social work (N = 11). Students were placed into interprofessional teams. Presimulation, each student was expected to complete a survey and review several items including the patient case, a communication strategy, and community resources. The team then interacted with SPs portraying the patient and the family member. Postsimulation, facilitators led a debriefing session and students completed a post-IPE survey. The Interprofessional Collaborative Competency Attainment Survey (ICCAS) was completed pre- and postexperience. RESULTS: Most students reported that they strongly or somewhat agreed that the experience improved their clinical thinking skills (67%; n = 55), improved awareness of the patient voice in shared decision-making (72.8%; n = 59), improved ability to prioritize patient's list of impairments (75.3%; n = 61), and improved confidence with discharge planning (69.1%; n = 56). IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Discharge planning is inherently an interprofessional process. Utilizing a simulation as a method to practice discharge planning may have a positive impact on future clinical practice. Completing the ICCAS may not be the appropriate assessment when evaluating change before and after an IPE experience based on the high scores noted preexperience. The use of a simulated discharge planning meeting may improve skills necessary for effective interprofessional practice.

Doctor of physical therapy students' attitudes towards people with disabilities: a descriptive study.

Purpose To describe attitudes of doctoral physical therapy (DPT) students towards people with disability and examine predictive ability of demographic variables on those attitudes. Methods Two established surveys, Attitudes Towards Disabled Persons-Form O (ATDP-O) and Disability Attitudes in Health Care (DAHC) were completed by first (Y1) and third year (Y3) students in a DPT programme. Demographics and information about students' contact experience with people with disabilities were collected through a brief questionnaire. Multiple linear regression models were constructed from predictor variables. Results Scores on the ATDP-O and the DAHC were not significantly different between the Y1 and Y3 DPT students. There was a modest correlation (r = 0.342, p < 0.001) between the ATDP-O and the DAHC. Being female and having work contact with people with disabilities both explained about 9% of the variance in the DAHC; while having a close family member explains about 4% of the variance in the ATDP-O. Conclusion Attitudes of DPT students over the course of their education did not change. The DAHC is a more recently developed tool and should continue to be investigated for its usefulness in healthcare professional students. Faculty should consider measuring attitudes and developing specific educational strategies to improve attitudes with the goal to improve patient care. Implications for Rehabilitation Attitudes towards people with disability can impact their health care. Physical therapy students, in general, express positive attitudes towards people with disabilities and no differences in attitudes were determined in a group of Year 1 and Year 3 doctoral physical therapy students. Opportunities exist to intentionally thread educational strategies throughout a professional curriculum to facilitate further development of positive attitudes in doctoral physical therapy students.

Validity and Reliability of the Vestibular/Ocular Motor Screening and Associations With Common Concussion Screening Tools.

BACKGROUND: Sustaining a concussion commonly results in vestibular impairments that may be associated with balance deficits. To screen for vestibular impairments after a concussion, the Vestibular/Ocular Motor Screening (VOMS) tool was developed. The relationship between the VOMS and other concussion screening tools, such as the Balance Error Scoring System (BESS) and King-Devick (K-D), have not been explored. HYPOTHESES: (1) VOMS would provide reliable results and not provoke symptoms in healthy adolescents and (2) VOMS test items would measure related aspects of vestibular function that are not measured through the BESS or K-D. STUDY DESIGN: Cross-sectional, descriptive. LEVEL OF EVIDENCE: Level 4. METHODS: A total of 105 healthy adolescents (53 male, 52 female; mean age, 15.4 years) completed the VOMS, BESS, and K-D tests. A subsample of 21 adolescents (16 male, 5 female; mean age, 15.5 years) completed the VOMS twice. RESULTS: The median total symptom score for all 7 VOMS items was 0 (0-5). The majority of the individual VOMS test items total symptom scores demonstrated a significant correlation with each other ( rs = 0.25-0.66, P < 0.02). The individual VOMS items did not demonstrate a significant relationship to the BESS or K-D. VOMS items demonstrated high agreement in total symptom scores between testing trials, with near point convergence (NPC) distance demonstrating an intraclass correlation coefficient (ICC) of 0.95 (95% CI, 0.89-0.98; P < 0.001). The MDC95 (minimal detectable change with 95 confidence) for NPC distance was 4 cm. CONCLUSION: The VOMS did not provoke vestibular symptoms in healthy adolescents. The VOMS items measured unique aspects of vestibular function other than those measured by the BESS or K-D with good reliability. CLINICAL RELEVANCE: Clinicians should consider implementing the VOMS as part of a comprehensive concussion assessment if vestibular impairment is suspected. If NPC distance is measured twice, a difference of >4 cm would be considered real change outside of measurement error.

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.

Development of a Rat Clinical Frailty Index.

Rats are a commonly used model for aging studies, and a frailty assessment tool for rats would be of considerable value. There has been a recent focus on the development of preclinical models of frailty in mice. A mouse clinical frailty index (FI) was developed based on clinical frailty assessment tools. This FI measures the accumulation of clinically evident health-related deficits in mice. This paper aimed to develop a rat clinical FI. Male Fischer 344 rats were aged from 6 to 9 months (n = 12), and from 13 to 21 months (n = 41). A FI comprised of 27 health-related deficits was developed from a review of the literature and consultation with a veterinarian. Deficits were scored 0 if absent, 0.5 if mild, or 1 if severe. A FI score was determined for each rat every 3-4 months, and for the older group mortality was assessed up to 21 months. Mean FI scores significantly increased at each time point for the older rats. A high FI score measured at both 17 months of age and terminally was also associated with decreased probability of survival as assessed with Kaplan-Meier curves. The rat clinical FI has significant value for use in aging and interventional studies.

Concussion Attitudes and Beliefs, Knowledge, and Clinical Practice: Survey of Physical Therapists.

BACKGROUND: A concussion is considered a mild traumatic brain injury that may cause physical, cognitive, affective, and sleep dysfunction. Physical therapists have been identified as health care providers involved in the multidisciplinary care of a patient with concussion. OBJECTIVE: The purpose of this study was to describe the current attitudes and beliefs, knowledge, and practice of physical therapists in the treatment of patients with concussion. METHODS: A 55-question electronic survey divided into 6 sections-(1) demographics, (2) current practice in concussion, (3) youth concussion legislation, (4) attitudes and beliefs toward concussion management, (5) concussion knowledge, and (6) clinical decision making-was developed and distributed online through selected American Physical Therapy Association sections. RESULTS: A total of 1,272 physical therapists completed the survey. Seventy percent of the respondents (n=894) reported having concussion training. Although supportive of the role of the physical therapist in the treatment of a person with concussion, the respondents demonstrated less confidence when making return-to-play decisions. Respondents correctly answered, on average, 13 (out of 15) concussion knowledge questions, with gaps exhibited in understanding the clinical utilization of concussion severity scales, the conservative treatment of youth who sustain a concussion, and anticipated normal computed tomography and magnetic resonance imaging after a concussion. When provided with clinical scenarios, respondents were able to recognize when a referral to a physician was indicated; however, they demonstrated variability in identifying a need for vestibular or manual physical therapy. LIMITATIONS: Convenience sampling was utilized, limiting generalizability of the results of the study to the physical therapy profession as a whole. CONCLUSION: Physical therapists demonstrated a solid foundation of concussion knowledge, but gaps still existed. Future professional development opportunities should be developed to target identified gaps in knowledge and current practice patterns.

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.