1
|
Szulc P, Lewis JR, Chapurlat R. Decline in muscle strength and physical function after fracture in men - the prospective STRAMBO study. J Bone Miner Res 2024; 39:252-259. [PMID: 38477746 DOI: 10.1093/jbmr/zjae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/06/2024] [Accepted: 01/15/2024] [Indexed: 03/14/2024]
Abstract
Studies on muscle strength and physical function after fracture are focused on short follow-ups and adjacent anatomical region. We compared loss of muscle strength and physical function in men after fracture with normal ageing-related decline. In 823 men aged 60-87, measurements of grip strength and clinical tests (chair stands, balance) were performed every 4 years for 12 years. In 155 men with incident fracture, we compared the status after vs. before the fracture. In men without fracture (controls), we compared the status on the first follow-up (4 years) vs. baseline. In men with fracture, grip strength decreased more than in the controls (41%, 0.28SD, P < .01). Men with fracture had higher risk of incident deterioration on the five chair-stand test vs. the controls (OR = 2.45, P < .001). They had higher risk of incident inability to stand for 10s with closed eyes vs. the controls (OR = 4.80, P < .01). They also had higher risk of deterioration on the tandem walk than the controls: forwards (OR = 2.04, P < .01), backwards (OR = 2.25, P < .005). The rapid physical decline was not limited to the region of the fracture site. In men who had incident non-upper limb fractures, grip strength decreased more (32%, P < .05) vs. the controls. In men who had incident non-lower limb fractures, the risk of decline in the tests of the lower limbs was higher vs. controls (chair stands, OR = 2.73, P < .001). The risk of decline was higher in men with clinical fractures which occurred >1 year before the next visit vs. controls (tandem walk forwards, OR = 2.98, P < .005). Overall, in older men, fractures were associated with greater loss of muscle strength and physical function vs. normal ageing. This accelerated decline was also found in the anatomical regions remote from the fracture site. Thus, programs to decrease or reverse the post-fracture decline could have beneficial effects on subsequent fracture risk.
Collapse
Affiliation(s)
- Paweł Szulc
- INSERM UMR 1033, University of Lyon, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437 Lyon, Place d'Arsonval, France
| | - Joshua R Lewis
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth WA 6027, Australia
| | - Roland Chapurlat
- INSERM UMR 1033, University of Lyon, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437 Lyon, Place d'Arsonval, France
| |
Collapse
|
2
|
Soukkio PK, Suikkanen SA, Sintonen H, Kukkonen-Harjula KT, Kautiainen H, Kääriä SM, Hupli MT, Aartolahti EM, Pitkälä KH, Sipilä S. Health-related quality of life after hip fracture: effects of a 12-month home-based exercise intervention-secondary analyses of an RCT. Qual Life Res 2024; 33:541-550. [PMID: 37932555 DOI: 10.1007/s11136-023-03545-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE In this randomized controlled trial, we analyzed the effects of a 12-month home-based exercise intervention on the health-related quality of life (HRQoL) of patients with a hip fracture. METHODS Participants (n = 121) aged ≥ 60 years, with a Mini-Mental State Examination (MMSE) score of ≥ 12 and an operated hip fracture, were placed into Exercise (n = 61) or Usual care (n = 60) groups. Physiotherapist-supervised, home-based training was given twice a week over 12 months. HRQoL was assessed using the 15D instrument at baseline and at 3, 6, and 12 months. The total 15D scores and dimension scores were analyzed and compared to national age- and sex-matched reference data. RESULTS The participants' mean age was 81 years (SD 7), 75% were women, and 61% had a femoral neck fracture. The mean within-group change in total 15D score over 12 months was 0.023 (95% CI: -0.003 to 0.048) in the Usual care group, and 0.028 (CI: 0.003 to 0.054) in the Exercise group (between-group p = 0.76). We found a statistically significant change in total 15D score in the Exercise group, as well as in the dimension scores of mobility and usual activities in both groups. All 15D scores remained below the general population reference level. CONCLUSION Exercise training for 12 months did not enhance the HRQoL of home-dwelling patients with hip fractures any more than usual care. In addition, HRQoL remained below the population level in both groups.
Collapse
Affiliation(s)
- Paula K Soukkio
- Rehabilitation, South Karelia Social and Health Care District (Eksote), Valto Käkelän Katu 14D, 53130, Lappeenranta, Finland.
- Development Services, Wellbeing Services County of South Karelia, Valto Käkelän Katu 14D, 53130, Lappeenranta, Finland.
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Rautpohjankatu 8, 40700, Jyväskylä, Finland.
| | - Sara A Suikkanen
- Rehabilitation, South Karelia Social and Health Care District (Eksote), Valto Käkelän Katu 14D, 53130, Lappeenranta, Finland
- Faculty of Health Care and Social Services, LAB University of Applied Sciences, Yliopistonkatu 36, 53850, Lappeenranta, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, PO Box 20, 00014, Helsinki, Finland
| | - Katriina T Kukkonen-Harjula
- Rehabilitation, South Karelia Social and Health Care District (Eksote), Valto Käkelän Katu 14D, 53130, Lappeenranta, Finland
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, PO BOX 100, 70029 KYS, Kuopio, Finland
- Folkhälsan Research Center, Haartmaninkatu 8, 00290, Helsinki, Finland
| | - Sanna M Kääriä
- Raatimiehet Oy, Raatimiehenkatu 18, 53100, Lappeenranta, Finland
| | - Markku T Hupli
- Rehabilitation, South Karelia Social and Health Care District (Eksote), Valto Käkelän Katu 14D, 53130, Lappeenranta, Finland
| | - Eeva M Aartolahti
- Institute of Rehabilitation, JAMK University of Applied Sciences, Piippukatu 2, 40100, Jyväskylä, Finland
| | - Kaisu H Pitkälä
- Department of General Practice, University of Helsinki, Tukholmankatu 8 B, 00290, Helsinki, Finland
- Unit of Primary Health Care, Helsinki University Hospital, Tukholmankatu 8 B, 00290, Helsinki, Finland
| | - Sarianna Sipilä
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Rautpohjankatu 8, 40700, Jyväskylä, Finland
| |
Collapse
|
3
|
Pan RJ, Gui SJ, Wang T, Nian F, Wang AY, Liu CJ, Li ZL, Peng D, Zeng GQ. Comparative effectiveness of different exercise interventions for elderly patients with hip fracture: A systematic review and Bayesian network meta-analysis protocol of randomized controlled trials. PLoS One 2023; 18:e0288473. [PMID: 37676894 PMCID: PMC10484429 DOI: 10.1371/journal.pone.0288473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 06/28/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Exercise intervention (EI) is a promising and economical way for elderly patients with hip fracture, but the evidence regarding effective EIs remains fragmented and controversial, and it is unclear which type of exercise is optimal. The purpose of this Bayesian network meta-analysis (NMA) is to compare and rank the efficacy of various EIs in elderly patients with hip fracture. MATERIALS AND METHODS A comprehensive literature search was performed using a systematic approach across various databases including Medline (via PubMed), CINAHL, CNKI, Web of Science, Wan Fang, Embase, VIP, Cochrane Central Register of Controlled Trials and CBM databases. The search encompasses all available records from the inception of each database until December 2022. The Inclusion literature comprises randomized controlled trials that incorporate at least one EI for elderly patients with hip fracture. We will assess the risk of bias of the studies in accordance with the Cochrane Handbook for Systematic Reviews of Interventions, and assess each evidence of outcome quality in accordance with the Grading of Recommendations Assessment, Development and Evaluation framework. The NMA will be performed by STATA 15.0 software and OpenBUGS version 3.2.3. The identification of publication bias will be accomplished through the utilization of a funnel plot. We will rank the EIs effects according to the cumulative ranking probability curve (surface under the cumulative ranking area, SUCRA). The primary outcomes will be hip function in elderly patients, and the secondary outcomes will be activities of daily living, walking capacity and balance ability of elderly patients. TRIAL REGISTRATION PROSPERO registration number: CRD4202022340737.
Collapse
Affiliation(s)
- Rong-jia Pan
- School of Nursing, Hengyang Medical School, University of South China, Hengyang, Hunan Province, China
| | - Si-Jie Gui
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ting Wang
- School of Nursing, Hengyang Medical School, University of South China, Hengyang, Hunan Province, China
| | - Fang Nian
- School of Nursing, Hengyang Medical School, University of South China, Hengyang, Hunan Province, China
| | - Ao-yi Wang
- School of Nursing, Hengyang Medical School, University of South China, Hengyang, Hunan Province, China
| | - Cai-juan Liu
- School of Nursing, Hengyang Medical School, University of South China, Hengyang, Hunan Province, China
| | - Zhuo-lan Li
- School of Nursing, Hengyang Medical School, University of South China, Hengyang, Hunan Province, China
| | - Dan Peng
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Gu-qing Zeng
- School of Nursing, Hengyang Medical School, University of South China, Hengyang, Hunan Province, China
| |
Collapse
|
4
|
Pan RJ, Gui SJ, He YL, Nian F, Ni XY, Zhou YH, Wang MY, Wu JJ, Zeng GQ, Liang JH, Peng D. The effectiveness of optimal exercise-based strategy for patients with hip fracture: a systematic review and Bayesian network meta-analysis. Sci Rep 2023; 13:10521. [PMID: 37386114 PMCID: PMC10310779 DOI: 10.1038/s41598-023-37509-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 06/22/2023] [Indexed: 07/01/2023] Open
Abstract
The implementation of exercise intervention (EI) presents a promising and economical way for patients with hip fracture. However, the optimal type of EI remains unclear. The objective of this study is to evaluate the efficacy of various EI approaches and identify the optimal intervention for improving the prognosis of patients with hip fracture. A comprehensive search of Medline (via PubMed), Web of Science, Embase, Cochrane Central Register of Controlled Trials, CINAHL, CNKI, Wan Fang, VIP, and CBM was conducted from their earliest records to June 2022. The included randomized controlled trials (RCTs) included at least one type of exercise for patients with hip fracture. The methodological quality of these trials was assessed using the Cochrane Collaboration Risk of Bias Tool. All direct and indirect comparisons were analyzed by Stata 14.0 and OpenBUGS 3.2.3 software. The primary outcome was hip function, and the secondary outcomes were activity of daily living (ADL), walking capacity and balance ability of patients. Based on the ranking probabilities, resistance exercise (RE) was ranked as the most effective among all exercise interventions (surface under cumulative ranking curve values [SUCRA]: 94.8%, [MD]: - 11.07, [Crl]: - 15.07 to - 7.08) in improving the efficacy of patients' hip function, followed by balance exercise (BE) ([SUCRA]:81.1%, [MD]: - 8.79, [Crl]: - 13.41 to - 4.18) and muscle strength exercise ([SUCRA]:57.6%, [MD]: - 5.35, [Crl]: - 9.70 to - 0.95). For the improvement of ADL for patients with hip fracture, BE ([SUCRA]:98.4%, [MD]: - 17.38, [Crl]: - 23.77 to - 11.04) may be the best EI. The findings of this study indicate that RE and BE might be the best approach to improve prognosis for patients with hip fracture. However, further rigorous and meticulously planned RCTs are required to substantiate the conclusions drawn from this study.
Collapse
Affiliation(s)
- Rong-Jia Pan
- School of Nursing, Hengyang Medical School, University of South China, 28 West Changsheng Road, Hengyang, 421001, Hunan, People's Republic of China
| | - Si-Jie Gui
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - Yu-Lian He
- Department of Orthopedics and Trauma, the First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, People's Republic of China
| | - Fang Nian
- School of Nursing, Hengyang Medical School, University of South China, 28 West Changsheng Road, Hengyang, 421001, Hunan, People's Republic of China
| | - Xiao-Yan Ni
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - Yan-Hui Zhou
- Department of Orthopedics and Trauma, the First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, People's Republic of China
| | - Man-Yi Wang
- School of Nursing, Hengyang Medical School, University of South China, 28 West Changsheng Road, Hengyang, 421001, Hunan, People's Republic of China
| | - Jing-Jing Wu
- School of Nursing, Hengyang Medical School, University of South China, 28 West Changsheng Road, Hengyang, 421001, Hunan, People's Republic of China
| | - Gu-Qing Zeng
- School of Nursing, Hengyang Medical School, University of South China, 28 West Changsheng Road, Hengyang, 421001, Hunan, People's Republic of China.
| | - Jing-Hong Liang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-Sen University, No.74 Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China.
| | - Dan Peng
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, People's Republic of China.
| |
Collapse
|
5
|
Douzi W, Bon D, Suikkanen S, Soukkio P, Boildieu N, Nenonen A, Hupli M, Kukkonen-Harjula K, Dugué B. 1H NMR Urinary Metabolomic Analysis in Older Adults after Hip Fracture Surgery May Provide Valuable Information for Patient Profiling-A Preliminary Investigation. Metabolites 2022; 12:metabo12080744. [PMID: 36005617 PMCID: PMC9415398 DOI: 10.3390/metabo12080744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/30/2022] [Accepted: 08/02/2022] [Indexed: 11/16/2022] Open
Abstract
In these times of precision and personalized medicine, profiling patients to identify their needs is crucial to providing the best and most cost-effective treatment. In this study, we used urine metabolomics to explore the characterization of older adults with hip fractures and to explore the forecasting of patient outcomes. Overnight urine specimens were collected from 33 patients (mean age 80 ± 8 years) after hip fracture surgery during their stay at a rehabilitation hospital. The specimens were analyzed with 1H NMR spectroscopy. We performed a metabolomics study regarding assessments of frailty status, Functional Independence Measure (FIM), and Short Physical Performance Battery (SPPB). The main metabolic variations concerned 10 identified metabolites: paracetamol derivatives (4 peaks: 2.15 ppm; 2.16 ppm; 7.13 ppm and 7.15 ppm); hippuric acid; acetate; acetone; dimethylamine; glycine; alanine; lactate; valine; TMAO. At baseline, the urinary levels of these metabolites were significantly higher (i) in frail compared with non-frail patients, (ii) in persons with poorer FIM scores, and (iii) in persons with poorer compared SPPB scores. Our findings suggested that patients with increased levels of urine metabolites associated with metabolic, inflammatory, and renal disorders presented clear signs of frailty, impaired functional independence, and poor physical performance. Metabolomics could be a valuable tool to further characterize older adults, especially after major medical events.
Collapse
Affiliation(s)
- Wafa Douzi
- Laboratoire «Mobilité, Vieillissement, Exercice (MOVE)—UR 20296», Faculté des Sciences du Sport, Université de Poitiers, 8 Allée Jean Monnet, 86000 Poitiers, France
| | - Delphine Bon
- INSERM U1313, (IRMETIST), Poitiers, France and Faculty of Medicine and Pharmacy, University of Poitiers, 86000 Poitiers, France
| | - Sara Suikkanen
- Faculty of Sport and Health Sciences, University of Jyväskylä, 40014 Jyväskylä, Finland
- Faculty of Social Services and Health Care, LAB University of Applied Sciences, 53130 Lappeenranta, Finland
| | - Paula Soukkio
- Rehabilitation and Laboratory Center, South Karelia Social and Health Care District (Eksote), Valto Käkelän katu 3, 53130 Lappeenranta, Finland
| | - Nadège Boildieu
- INSERM U1313, (IRMETIST), Poitiers, France and Faculty of Medicine and Pharmacy, University of Poitiers, 86000 Poitiers, France
| | - Arja Nenonen
- Rehabilitation and Laboratory Center, South Karelia Social and Health Care District (Eksote), Valto Käkelän katu 3, 53130 Lappeenranta, Finland
| | - Markku Hupli
- Rehabilitation and Laboratory Center, South Karelia Social and Health Care District (Eksote), Valto Käkelän katu 3, 53130 Lappeenranta, Finland
| | - Katriina Kukkonen-Harjula
- Rehabilitation and Laboratory Center, South Karelia Social and Health Care District (Eksote), Valto Käkelän katu 3, 53130 Lappeenranta, Finland
| | - Benoit Dugué
- Laboratoire «Mobilité, Vieillissement, Exercice (MOVE)—UR 20296», Faculté des Sciences du Sport, Université de Poitiers, 8 Allée Jean Monnet, 86000 Poitiers, France
- Correspondence: ; Tel.: +33-549-454-040; Fax: +33-549-453-396
| |
Collapse
|