Fit for Duty: Lessons Learned from Outpatient and Homebound Hematopoietic Cell Transplantation to Prepare Family Caregivers for Home-Based Care.

In the past decade, the demand for home-based care has been amplified by the Coronavirus disease 2019 pandemic. Home-based care has significant benefits for patients, their families, and healthcare systems, but it relies on the often-invisible workforce of family and friend caregivers who shoulder essential health care responsibilities, frequently with inadequate training and support. Hematopoietic cell transplantation (HCT), a potentially curative but intensive treatment for many patients with blood disorders, is being increasingly offered in home-based care settings and necessitates the involvement of family caregivers for significant patient care responsibilities. However, guidelines for supporting and preparing HCT caregivers to effectively care for their loved ones at home have not yet been established. Here, informed by the literature and our collective experience as clinicians and researchers who care for diverse patients with hematologic malignancies undergoing HCT, we provide considerations and recommendations to better support and prepare family caregivers in home-based HCT and, by extension, family caregivers supporting patients with other serious illnesses at home. We suggest tangible ways to screen family caregivers for distress and care delivery challenges, educate and train them to prepare for their caregiving role, and create an infrastructure of support for family caregivers within this emerging care delivery model.

Interrater reliability of hand-held dynamometry: effects of rater gender, body weight, and grip strength.

Clinicians and authors of previous publications have not reached agreement on the interrater reliability of dynametric strength testing. This study investigates the effects of gender, body weight, and grip strength on the reliability of hand-held dynametric strength measurements. Ten male and 10 female raters tested five muscle groups on the same two subjects (one male and one female) with a Chatillon Series D hand-held, spring-scale dynamometer. Both the raters and the test subjects were blinded to the dynametric output readings throughout the testing. Interrater reliability was good for all tests except for female raters when testing the male subjects' stronger muscle groups. Standard deviations were 61% and 50% greater for female vs. male raters for elbow flexors and knee extensors, respectively. Female raters' body weight had a significant correlation with torque when testing male subjects' wrist extensors, ankle dorsiflexors, and knee extensors (r > 0.64). Likewise, female raters' grip strength significantly correlated with torque when testing males' wrist extensors and elbow flexors (r >/= 0.71). The results indicate that gender, body weight, and grip strength affect a rater's ability to stabilize a hand-held dynamometer and could influence reliability when testing stronger muscle groups. J Orthop Sports Phys Ther 1992;16(2):74-81.