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Ergen HI, Kudin R, McGee CW. Interrater Reliability and Precision of a Novel Hand Strength Assessment and Treatment Device: The GripAble. Am J Occup Ther 2024; 78:7805205140. [PMID: 39074241 DOI: 10.5014/ajot.2024.050689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024] Open
Abstract
IMPORTANCE Occupational therapy practitioners need modern tools for the assessment of maximal grip strength in clinical and remote settings. OBJECTIVE To establish the (1) interrater reliability and (2) precision of the GripAble among three raters with different expertise in occupational therapy when testing healthy participants, and to (3) evaluate the relative reliabilities of different approaches to estimating grip strength (i.e., one trial, mean of two trials, and the mean of three trials). DESIGN Measurement study. SETTING Minnesota Translational Musculoskeletal and Occupational Performance Research Lab, University of Minnesota, Minneapolis. PARTICIPANTS Thirty volunteers, age ≥18 yr, without any hand problems. OUTCOMES AND MEASURES Using GripAble, three occupational therapy raters with varied experience measured the maximal grip strength of the dominant and nondominant hands of all participants. Using the mean of three trials when testing grip strength with GripAble adds precision. RESULTS GripAble has excellent interrater reliability (i.e., intraclass correlation coefficient > .75) and acceptable precision (minimal detectable change < 15%) among healthy adults. CONCLUSIONS AND RELEVANCE GripAble allows occupational therapy practitioners with different experiences to assess grip strength in healthy hands quickly, precisely, and with excellent reliability. Additional research is needed on its psychometrics in clinical populations and capacities in remote monitoring and exergaming. Plain-Language Summary: The results of this study show that grip strength, an important biomarker and commonly assessed construct in occupational therapy, can be evaluated reliably, precisely, and rapidly with GripAble. The use of GripAble by occupational therapy practitioners in clinical settings may help to build an infrastructure for remote measurements and exergaming interventions in the future.
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Affiliation(s)
- Halil Ibrahim Ergen
- Halil Ibrahim Ergen, PhD, MS, PT, is Assistant Professor, Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Gaziantep University, Gaziantep, Turkey, and Postdoctoral Research Scholar, Occupational Therapy Department, College of Pharmacy, University of Minnesota, Minneapolis;
| | - Roman Kudin
- Roman Kudin, OTD, OTR/L, is Staff Occupational Therapist, Albemarle Health and Rehabilitation Center, Charlottesville, VA
| | - Corey W McGee
- Corey W. McGee, PhD, OTR/L, CHT, is Associate Professor, Occupational Therapy Department, College of Pharmacy, and Associate Department Head of Research, Program in Rehabilitation Science, Medical School, University of Minnesota, Minneapolis
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Jurado-Priego LN, Cueto-Ureña C, Ramírez-Expósito MJ, Martínez-Martos JM. Fibromyalgia: A Review of the Pathophysiological Mechanisms and Multidisciplinary Treatment Strategies. Biomedicines 2024; 12:1543. [PMID: 39062116 PMCID: PMC11275111 DOI: 10.3390/biomedicines12071543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 07/05/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Fibromyalgia is a syndrome characterized by chronic widespread musculoskeletal pain, which may or may not be associated with muscle or joint stiffness, accompanied by other symptoms such as fatigue, sleep disturbances, anxiety, and depression. It is a highly prevalent condition globally, being considered the third most common musculoskeletal disorder, following lower back pain and osteoarthritis. It is more prevalent in women than in men, and although it can occur at any age, it is more common between the ages of thirty and thirty-five. Although the pathophysiology and etiopathogenesis remain largely unknown, three underlying processes in fibromyalgia have been investigated. These include central sensitization, associated with an increase in the release of both excitatory and inhibitory neurotransmitters; peripheral sensitization, involving alterations in peripheral nociceptor signaling; and inflammatory and immune mechanisms that develop concurrently with the aforementioned processes. Furthermore, it has been determined that genetic, endocrine, psychological, and sleep disorders may influence the development of this pathology. The accurate diagnosis of fibromyalgia remains challenging as it lacks specific diagnostic biomarkers, which are still under investigation. Nonetheless, diagnostic approaches to the condition have evolved based on the use of scales and questionnaires for pain identification. The complexity associated with this pathology makes it difficult to establish a single effective treatment. Therefore, treatment is multidisciplinary, involving both pharmacological and non-pharmacological interventions aimed at alleviating symptoms. The non-pharmacological treatments outlined in this review are primarily related to physiotherapy interventions. The effectiveness of physical exercise, both on land and in water, as well as the application of electrotherapy combined with transcranial therapy and manual therapy has been highlighted. All of these interventions aim to improve the quality of life of patients highly affected by fibromyalgia.
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Affiliation(s)
| | | | | | - José Manuel Martínez-Martos
- Experimental and Clinical Physiopathology Research Group CTS-1039, Department of Health Sciences, School of Experimental and Health Sciences, University of Jaén, E-23071 Jaén, Spain (C.C.-U.); (M.J.R.-E.)
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Rikos N, Linardakis M, Smpokos E, Spiridaki E, Symvoulakis EK, Tsiligianni I, Philalithis A. Assessment of Cognitive Function in European Adults Aged 50+in Relation to Their Handgrip Strength and Physical Inactivity: The SHARE Study During 2019-2020. J Res Health Sci 2024; 24:e00611. [PMID: 39072547 PMCID: PMC11264452 DOI: 10.34172/jrhs.2024.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 08/27/2023] [Accepted: 04/23/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Cognitive function is crucial during aging. This study assessed the cognitive function of European adults aged 50 and over in relation to handgrip strength and physical inactivity. Study Design: This was a cross-sectional survey. METHODS Data were collected from 41,395 adults from 27 European countries participating in the Survey of Health, Ageing, and Retirement in Europe (SHARE) during 2019-2020. Cognitive function was assessed based on five tests, and cognitive impairment was defined using 3+tests. Handgrip strength and physical inactivity were also correlated through the analysis of covariance using a complex study design. RESULTS The majority of participants were female (56.6%), with a mean age of 70.9 years, and 22.6% presented multimorbidity. Furthermore, 51.1% had a normal cognitive function, while 13.3% had cognitive impairment (The estimated population was 21,944,722). Moreover, cognitive impairment was more prevalent in females than in males (14.4% vs. 12.0%, P<0.001) in patients with no years of education (P<0.001) and origin from southern European countries (P<0.001). Additionally, participants with cognitive impairment had lower mean handgrip strength compared to those with cognitive impairment in 1-2 criteria or with normal cognitive function (29.3 vs. 33.4 and 35.1 kg, respectively, P<0.001). Physically inactive participants had higher odds ratio (OR) of cognitive impairment than those engaging in moderate/vigorous physical activity, both in 1-2 tests (OR:1.73, 95% confidence interval (CI): 1.32-2.26) and in 3+tests (OR: 3.36, 95% CI: 2.57-4.40). CONCLUSION Cognitive impairment presented low prevalence and was associated with low levels of handgrip strength and physical inactivity. These specific factors may play a special role in early detection, diagnosis, and treatment or may slow down the progression of cognitive impairment.
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Affiliation(s)
- Nikos Rikos
- Department of Nursing, School of Health Sciences, Hellenic Mediterranean University, Heraklion, Greece
| | - Manolis Linardakis
- Department of Social Medicine, Faculty of Medicine, University of Crete, Greece
| | - Emmanouil Smpokos
- Department of Social Medicine, Faculty of Medicine, University of Crete, Greece
| | - Eleni Spiridaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Greece
| | | | - Ioanna Tsiligianni
- Department of Social Medicine, Faculty of Medicine, University of Crete, Greece
| | - Anastas Philalithis
- Department of Social Medicine, Faculty of Medicine, University of Crete, Greece
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Belfield AE, Wilkinson TJ, Henson J, Sargeant JA, Breen L, Hall AP, Davies MJ, Yates T. Sarcopenia prevalence using handgrip strength or chair stand performance in adults living with type 2 diabetes mellitus. Age Ageing 2024; 53:afae090. [PMID: 38706394 PMCID: PMC11070724 DOI: 10.1093/ageing/afae090] [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: 12/19/2023] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND The updated European Working Group on Sarcopenia in Older People (EWGSOP2) recommends handgrip strength (HGS) and the chair stand test (CST) to assess muscle strength, with the CST being a convenient proxy for lower limb strength. However, adiposity may differentially influence these strength criteria and produce discrepant sarcopenia prevalence. OBJECTIVE To determine the prevalence of sarcopenia using HGS or the CST, and to investigate the associations between these strength criteria and adiposity in adults with type 2 diabetes mellitus. METHODS The EWGSOP2 definition was used to assess the prevalence of probable (low muscle strength), confirmed (plus low muscle mass) and severe (plus poor physical performance) sarcopenia. Linear regression models were used to study the association between different measures of muscle strength and adiposity. RESULTS We used data from 732 adults with type 2 diabetes mellitus (35.7% female, aged 64 ± 8 years, body mass index 30.7 ± 5.0 kg/m2). Using the CST compared with HGS produced a higher prevalence of probable (31.7% vs. 7.1%), confirmed (5.6% vs. 1.6%) and severe (1.0% vs. 0.3%) sarcopenia, with poor agreement between strength criteria to identify probable sarcopenia. CST performance, but not HGS, was significantly associated with all measures of adiposity in unadjusted and adjusted models. CONCLUSIONS Higher levels of adiposity may impact CST performance, but not HGS, resulting in a higher prevalence of sarcopenia in adults with type 2 diabetes mellitus. Consideration should be paid to the most appropriate measure of muscle function in this population.
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Affiliation(s)
- Archie E Belfield
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Thomas J Wilkinson
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Joseph Henson
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Jack A Sargeant
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
| | - Leigh Breen
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- NIHR Biomedical Research Centre, Birmingham, UK
| | - Andrew P Hall
- The Hanning Sleep Laboratory, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Melanie J Davies
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Thomas Yates
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
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Dittmer K, Beckmann M, Pfaff H, Karbach U. Contextual factors and mechanisms in the implementation of Value Stream Mapping in breast cancer centres - A multiple case study. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2024; 186:52-61. [PMID: 38644150 DOI: 10.1016/j.zefq.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/26/2024] [Accepted: 03/21/2024] [Indexed: 04/23/2024]
Abstract
INTRODUCTION Lean, especially Value Stream Mapping is increasingly used in hospitals to optimize processes. This method, which originated in the automotive industry, enables all staff involved in the process to make it more customer-friendly. Despite the widely reported success of Lean projects, they have failed in some cases. This study investigated the contextual factors and mechanisms that contribute to a successful implementation of Value Stream Mapping. METHODS Value Stream Mapping was applied to the discharge process in four breast cancer centers. A mixed-method approach was used in two steps. First, to verify the successful implementation, defined as time optimization, time measurement was conducted at three points in time and analyzed using an ANOVA. Second, an analysis of contextual factors was combined with a qualitative content analysis of mechanisms based on normalization process theory, using routine data, meeting protocols, field notes, and interview transcripts as data source. RESULTS At one of the four breast cancer centers, lead- and waiting time were significantly reduced; at the others, these reductions did not occur. Failure/success cannot be explained by the size of the hospital, the number of cases or staffing levels. The variable project team composition is evident, especially leadership involvement. DISCUSSION A comparative analysis was conducted to identify the factors that led to success. These factors were: participation of all leaders relevant to the process, in the case of the discharge process including medical and nursing leaders; dissemination of the changes from the project team to colleagues including its sense and possibility to discuss it; joint reflection of the implementation process in regular work team meetings. CONCLUSIONS These results confirm the important role of leadership in implementation projects. Leadership support enabled the mechanisms found. The used combination of theoretical approaches from management research and implementation science determined the interpretation and should be applied more often in implementation science.
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Affiliation(s)
- Kerstin Dittmer
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Marina Beckmann
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ute Karbach
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Attaway AH, Lopez R, Welch N, Bellar A, Hatipoğlu U, Zein J, Engelen MP, Dasarathy S. Muscle loss phenotype in COPD is associated with adverse outcomes in the UK Biobank. BMC Pulm Med 2024; 24:186. [PMID: 38632546 PMCID: PMC11025247 DOI: 10.1186/s12890-024-02999-7] [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: 12/06/2023] [Accepted: 04/08/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disorder with systemic consequences that can cause a muscle loss phenotype (MLP), which is characterized by the loss of muscle mass, muscle strength, or loss of both muscle and fat mass. There are limited data comparing the individual traits of MLP with clinical outcomes in a large unbiased cohort of COPD patients. Our aim was to determine the proportion of patients who met criteria for MLP in an unbiased sample of COPD patients at the population-level. We also determined if specific MLP features were associated with all-cause and COPD-related mortality. METHODS A retrospective population-based cohort analysis of the UK Biobank was performed. COPD was defined by a FEV1/FVC ratio < 0.7, physician established diagnosis of COPD, or those with a COPD-related hospitalization before baseline assessment. MLP included one or more of the following: 1) Low fat-free mass index (FFMI) on bioelectric impedance analysis (BIA) or 2) Appendicular skeletal muscle index (ASMI) on BIA, 3) Low muscle strength defined by handgrip strength (HGS), or 4) Low muscle and fat mass based on body mass index (BMI). Cox regression was used to determine the association between MLP and all-cause or COPD-related mortality. All models were adjusted for sex, age at assessment, ethnicity, BMI, alcohol use, smoking status, prior cancer diagnosis and FEV1/FVC ratio. RESULTS There were 55,782 subjects (56% male) with COPD followed for a median of 70.1 months with a mean(± SD) age at assessment of 59 ± 7.5 years, and FEV1% of 79.2 ± 18.5. Most subjects had mild (50.4%) or moderate (42.8%) COPD. Many patients had evidence of a MLP, which was present in 53.4% of COPD patients (34% by ASMI, 26% by HGS). Of the 5,608 deaths in patients diagnosed with COPD, 907 were COPD-related. After multivariate adjustment, COPD subjects with MLP had a 30% higher hazard-ratio for all-cause death and 70% higher hazard-ratio for COPD-related death. CONCLUSIONS Evidence of MLP is common in a large population-based cohort of COPD and is associated with higher risk for all-cause and COPD-related mortality.
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Affiliation(s)
- Amy H Attaway
- Departments of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Rocio Lopez
- Center for Populations Health Research, Cleveland Clinic, Cleveland, OH, USA
| | - Nicole Welch
- Inflammation and Immunity, Cleveland Clinic, Cleveland, OH, USA
- Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
| | - Annette Bellar
- Inflammation and Immunity, Cleveland Clinic, Cleveland, OH, USA
| | - Umur Hatipoğlu
- Departments of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Joe Zein
- Department of Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Srinivasan Dasarathy
- Inflammation and Immunity, Cleveland Clinic, Cleveland, OH, USA.
- Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA.
- Department of Inflammation and Immunity, Lerner Research Institute, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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Mojas E, Santisteban A, Muñoz-Pérez I, Larrinaga-Undabarrena A, Arietaleanizbeaskoa MS, Mendizabal-Gallastegui N, Grandes G, Cacicedo J, Río X. Differences in Functional Capacity between Oncologic and Non-Oncologic Populations: Reference Values. Healthcare (Basel) 2024; 12:318. [PMID: 38338203 PMCID: PMC10855221 DOI: 10.3390/healthcare12030318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/12/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
This study is focused on the fact that in the context of increasing global aging and cancer diagnoses, additional challenges arise in clinical care. Adequate functionality and body composition are key to coping with antineoplastic treatment, which can lead to better treatment tolerance, survival, and quality of life. This is a cross-sectional comparative study focused on the assessment and comparison of body composition and functionality between cancer patients and a reference population, with the aim of establishing meaningful baseline values. Techniques such as manual dynamometry, the Five-Times Sit-to-Stand test, and bioimpedance were used to collect data from 374 oncologic patients and 1244 reference individuals. The results reveal significant disparities in functionality and body composition among participants, and provide age group-specific adjusted baseline values for those diagnosed with cancer. These findings may have crucial clinical implications for applying particular cut-off points designed for this population group, which makes the assessment process faster and more accurate, enhances the capacity of medical personnel to act quickly, and improves the management of frailty in cancer patients.
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Affiliation(s)
- Egoitz Mojas
- Department of Physical Activity and Sport Science, Faculty of Education and Sport, University of Deusto, 48007 Bilbao, Spain; (A.S.); (I.M.-P.); (A.L.-U.); (X.R.)
| | - Aitor Santisteban
- Department of Physical Activity and Sport Science, Faculty of Education and Sport, University of Deusto, 48007 Bilbao, Spain; (A.S.); (I.M.-P.); (A.L.-U.); (X.R.)
| | - Iker Muñoz-Pérez
- Department of Physical Activity and Sport Science, Faculty of Education and Sport, University of Deusto, 48007 Bilbao, Spain; (A.S.); (I.M.-P.); (A.L.-U.); (X.R.)
| | - Arkaitz Larrinaga-Undabarrena
- Department of Physical Activity and Sport Science, Faculty of Education and Sport, University of Deusto, 48007 Bilbao, Spain; (A.S.); (I.M.-P.); (A.L.-U.); (X.R.)
| | - Maria Soledad Arietaleanizbeaskoa
- Comprehensive Care Group for Patients with Chronic Diseases, Biocruces Bizkaia Health Research Institute, Plaza de Cruces 12, 48903 Barakaldo, Spain; (M.S.A.); (N.M.-G.); (G.G.)
| | - Nere Mendizabal-Gallastegui
- Comprehensive Care Group for Patients with Chronic Diseases, Biocruces Bizkaia Health Research Institute, Plaza de Cruces 12, 48903 Barakaldo, Spain; (M.S.A.); (N.M.-G.); (G.G.)
| | - Gonzalo Grandes
- Comprehensive Care Group for Patients with Chronic Diseases, Biocruces Bizkaia Health Research Institute, Plaza de Cruces 12, 48903 Barakaldo, Spain; (M.S.A.); (N.M.-G.); (G.G.)
| | - Jon Cacicedo
- Radiation Oncology Department, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Osakidetza, 48903 Barakaldo, Spain;
- Department of Surgery, Radiology and Physical Medicine, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain
| | - Xabier Río
- Department of Physical Activity and Sport Science, Faculty of Education and Sport, University of Deusto, 48007 Bilbao, Spain; (A.S.); (I.M.-P.); (A.L.-U.); (X.R.)
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Johansson J, Grimsgaard S, Strand BH, Sayer AA, Cooper R. Comparing associations of handgrip strength and chair stand performance with all-cause mortality-implications for defining probable sarcopenia: the Tromsø Study 2015-2020. BMC Med 2023; 21:451. [PMID: 37981689 PMCID: PMC10659040 DOI: 10.1186/s12916-023-03172-3] [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: 06/13/2023] [Accepted: 11/13/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND Widely adopted criteria suggest using either low handgrip strength or poor chair stand performance to identify probable sarcopenia. However, there are limited direct comparisons of these measures in relation to important clinical endpoints. We aimed to compare associations between these two measures of probable sarcopenia and all-cause mortality. METHODS Analyses included 7838 community-dwelling participants (55% women) aged 40-84 years from the seventh survey of the Tromsø Study (2015-2016), with handgrip strength assessed using a Jamar + Digital Dynamometer and a five-repetition chair stand test (5-CST) also undertaken. We generated sex-specific T-scores and categorised these as "not low", "low", and "very low" handgrip strength or 5-CST performance. Cox Proportional Hazard regression models were used to investigate associations between these two categorised performance scores and time to death (up to November 2020 ascertained from the Norwegian Cause of Death registry), adjusted for potential confounders including lifestyle factors and specific diseases. RESULTS A total of 233 deaths occurred (median follow-up 4.7 years) with 1- and 5-year mortality rates at 3.1 (95% confidence interval [CI] 2.1, 4.6) and 6.3 (95% CI 5.5, 7.2) per 1000 person-years, respectively. There was poor agreement between the handgrip strength and 5-CST categories for men (Cohen's kappa [κ] = 0.19) or women (κ = 0.20). Fully adjusted models including handgrip strength and 5-CST performance mutually adjusted for each other, showed higher mortality rates among participants with low (hazard ratio [HR] 1.22, 95% CI 0.87, 1.71) and very low (HR 1.68, 95% CI 1.02, 2.75) handgrip strength compared with the not low category. Similar associations, although stronger, were seen for low (HR 1.88, 95% CI 1.38, 2.56) and very low (HR 2.64, 95% CI 1.73, 4.03) 5-CST performance compared with the not low category. CONCLUSIONS We found poor agreement between T-score categories for handgrip strength and 5-CST performance and independent associations with mortality. Our findings suggest that these tests identify different people at risk when case-finding probable sarcopenia. As discussions on an international consensus for sarcopenia definitions proceed, testing both handgrip strength and chair stand performance should be recommended rather than viewing these as interchangeable assessments.
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Affiliation(s)
- Jonas Johansson
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
| | - Sameline Grimsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Bjørn Heine Strand
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Department for Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Avan A Sayer
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle Upon Tyne NHS Foundation Trust and Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Rachel Cooper
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle Upon Tyne NHS Foundation Trust and Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle Upon Tyne, UK
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Spees LP, Young LA, Rees J, Mottus K, Leeman J, Boynton MH, Richman E, Vu MB, Donahue KE. A Cost Analysis of Rethink the Strip: De-implementing a Low-value Practice in Primary Care. Med Care 2023; 61:708-714. [PMID: 37943526 PMCID: PMC10478673 DOI: 10.1097/mlr.0000000000001899] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
BACKGROUND Routine self-monitoring of blood glucose is a low-value practice that provides limited benefit for patients with non-insulin-treated type 2 diabetes mellitus. OBJECTIVES We estimated the costs of Rethink the Strip (RTS), a multistrategy approach to the de-implementation of self-monitoring of blood glucose in primary care. RESEARCH DESIGN RTS was conducted among 20 primary care clinics in North Carolina. We estimated the non-site-based and site-based costs of the 5 RTS strategies (practice facilitation, audit and feedback, provider champions, educational meetings, and educational materials) from the analytic perspective of an integrated health care system for 12 and 27-month time horizons. Material costs were tracked through project records, and personnel costs were assessed using activity-based costing. We used nationally based wage estimates. RESULTS Total RTS costs equaled $68,941 for 12 months. Specifically, non-site-based costs comprised $16,560. Most non-site-based costs ($11,822) were from the foundational programming and coding updates to the electronic health record data to develop the audit and feedback reports. The non-site-based costs of educational meetings, practice facilitation, and educational materials were substantially lower, ranging between ~$400 and $1000. Total 12-month site-based costs equaled $2569 for a single clinic (or $52,381 for 20 clinics). Educational meetings were the most expensive strategy, averaging $1401 per clinic. The site-based costs for the 4 other implementation strategies were markedly lower, ranging between $51 for educational materials and $555 for practice facilitation per clinic. CONCLUSIONS This study provides detailed cost information for implementation strategies used to support evidence-based programs in primary care clinics.
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Affiliation(s)
- Lisa P. Spees
- Department of Health Policy and Management, Gillings School of Global Public Health
- Lineberger Comprehensive Cancer Center
| | - Laura A. Young
- Department of Medicine, Division of Endocrinology and Metabolism
| | - Jennifer Rees
- North Carolina Translational and Clinical Sciences Institute
| | | | - Jennifer Leeman
- Lineberger Comprehensive Cancer Center
- North Carolina Translational and Clinical Sciences Institute
- School of Nursing
| | - Marcella H. Boynton
- North Carolina Translational and Clinical Sciences Institute
- Department of Medicine, Division of Endocrinology and Metabolism
| | | | - Maihan B. Vu
- Department of Health Behavior, Gillings School of Global Public Health
- Department of Family Medicine
| | - Katrina E. Donahue
- Cecil G. Sheps Center for Health Services Research
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Jang JY, Kim D, Kim ND. Pathogenesis, Intervention, and Current Status of Drug Development for Sarcopenia: A Review. Biomedicines 2023; 11:1635. [PMID: 37371730 DOI: 10.3390/biomedicines11061635] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
Sarcopenia refers to the loss of muscle strength and mass in older individuals and is a major determinant of fall risk and impaired ability to perform activities of daily living, often leading to disability, loss of independence, and death. Owing to its impact on morbidity, mortality, and healthcare expenditure, sarcopenia in the elderly has become a major focus of research and public policy debates worldwide. Despite its clinical importance, sarcopenia remains under-recognized and poorly managed in routine clinical practice, partly owing to the lack of available diagnostic testing and uniform diagnostic criteria. Since the World Health Organization and the United States assigned a disease code for sarcopenia in 2016, countries worldwide have assigned their own disease codes for sarcopenia. However, there are currently no approved pharmacological agents for the treatment of sarcopenia; therefore, interventions for sarcopenia primarily focus on physical therapy for muscle strengthening and gait training as well as adequate protein intake. In this review, we aimed to examine the latest information on the epidemiology, molecular mechanisms, interventions, and possible treatments with new drugs for sarcopenia.
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Affiliation(s)
- Jung Yoon Jang
- Department of Pharmacy, College of Pharmacy, Research Institute for Drug Development, Pusan National University, Busan 46241, Republic of Korea
| | - Donghwan Kim
- Functional Food Materials Research Group, Korea Food Research Institute, Wanju-gun 55365, Jeollabuk-do, Republic of Korea
| | - Nam Deuk Kim
- Department of Pharmacy, College of Pharmacy, Research Institute for Drug Development, Pusan National University, Busan 46241, Republic of Korea
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11
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Epidemiological, mechanistic, and practical bases for assessment of cardiorespiratory fitness and muscle status in adults in healthcare settings. Eur J Appl Physiol 2023; 123:945-964. [PMID: 36683091 PMCID: PMC10119074 DOI: 10.1007/s00421-022-05114-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/08/2022] [Indexed: 01/24/2023]
Abstract
Given their importance in predicting clinical outcomes, cardiorespiratory fitness (CRF) and muscle status can be considered new vital signs. However, they are not routinely evaluated in healthcare settings. Here, we present a comprehensive review of the epidemiological, mechanistic, and practical bases of the evaluation of CRF and muscle status in adults in primary healthcare settings. We highlight the importance of CRF and muscle status as predictors of morbidity and mortality, focusing on their association with cardiovascular and metabolic outcomes. Notably, adults in the best quartile of CRF and muscle status have as low as one-fourth the risk of developing some of the most common chronic metabolic and cardiovascular diseases than those in the poorest quartile. The physiological mechanisms that underlie these epidemiological associations are addressed. These mechanisms include the fact that both CRF and muscle status reflect an integrative response to the body function. Indeed, muscle plays an active role in the development of many diseases by regulating the body's metabolic rate and releasing myokines, which modulate metabolic and cardiovascular functions. We also go over the most relevant techniques for assessing peak oxygen uptake as a surrogate of CRF and muscle strength, mass, and quality as surrogates of muscle status in adults. Finally, a clinical case of a middle-aged adult is discussed to integrate and summarize the practical aspects of the information presented throughout. Their clinical importance, the ease with which we can assess CRF and muscle status using affordable techniques, and the availability of reference values, justify their routine evaluation in adults across primary healthcare settings.
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12
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McGrath R, Tomkinson GR, Kieser J, Kisner K, Hackney KJ. Letter to the Editor: Subjective Hand Squeeze: A Practical Solution to Assessing Handgrip Strength Without Equipment? J Frailty Aging 2023; 12:109-110. [PMID: 36946706 PMCID: PMC10502929 DOI: 10.14283/jfa.2023.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- R McGrath
- Ryan McGrath, Healthy Aging North Dakota (HAND), North Dakota State University, Research 2 Building, 1805 NDSU Research Park Dr. N., Fargo, ND 58102, USA,
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13
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A Prospective Evaluation of Grip Strength Comparing a Low-Tech Method to Dynanometry in Preoperative Surgical Patients and Weak Intensive Care Patients. Crit Care Res Pract 2022; 2022:3428851. [PMCID: PMC9605854 DOI: 10.1155/2022/3428851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 09/27/2022] [Indexed: 11/18/2022] Open
Abstract
Objective. Grip strength testing offers a mechanism to identify patients in whom frailty might be present, discriminate between robust elderly and vulnerable younger patients, and can be used as a tool to track changes in muscle bulk over the course of an inpatient stay. We compared gold-standard quantitative grip strength measurement to a low-tech alternative, a manual bedside sphygmomanometer. Design. Under supervision, subjects performed hand-grip strength testing with each instrument. A mean score is calculated from three measurements on the dominant and nondominant hand. Setting. Testing was performed in a tertiary centre in Perth, Western Australia, in both outpatient clinics and intensive care units. Participants. 51 adult pre-operative surgical outpatients were assessed, alongside 20 intensive care inpatients identified as being weak. Main outcome measures. A statistical correlation between the two measures was evaluated. Feasibility, safety, and convenience were also assessed in outpatient and bedside settings. Results. Highly correlated results in both tertiary surgical outpatients (rs = 0.895,
, N = 102; r (100) = 0.899,
) and weak intensive care patients (rs = 0.933,
, N = 39 r (37) = 0.935,
) Conclusions. Modifying a manual bedside sphygmomanometer to measure grip strength is feasible and correlates well with a formal dynamometer in preadmission surgical patients and weak patients in the intensive care unit. The use of an existing, safe, and available device removes barriers to the measurement of weakness in patients and may encourage uptake of objective measurement in multiple settings.
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14
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Michaud TL, Pereira E, Porter G, Golden C, Hill J, Kim J, Wang H, Schmidt C, Estabrooks PA. Scoping review of costs of implementation strategies in community, public health and healthcare settings. BMJ Open 2022; 12:e060785. [PMID: 35768106 PMCID: PMC9240875 DOI: 10.1136/bmjopen-2022-060785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To identify existing evidence concerning the cost of dissemination and implementation (D&I) strategies in community, public health and health service research, mapped with the 'Expert Recommendations for Implementing Change' (ERIC) taxonomy. DESIGN Scoping review. DATA SOURCES MEDLINE, EMBASE, CINAHL, PsycINFO, Scopus and the Cochrane Library were searched to identify any English language reports that had been published between January 2008 and December 2019 concerning the cost of D&I strategies. DATA EXTRACTION We matched the strategies identified in each article using ERIC taxonomies; further classified them into five areas (eg, dissemination, implementation, integration, capacity building and scale-up); and extracted the corresponding costs (total costs and cots per action target and per evidence-based programme (EBP) participant). We also recorded the reported level of costing methodology used for cost assessment of D&I strategies. RESULTS Of the 6445 articles identified, 52 studies were eligible for data extraction. Lack of D&I strategy cost data was the predominant reason (55% of the excluded studies) for study exclusion. Predominant topic, setting, country and research design in the included studies were mental health (19%), primary care settings (44%), the US (35%) and observational (42%). Thirty-five (67%) studies used multicomponent D&I strategies (ranging from two to five discrete strategies). The most frequently applied strategies were Conduct ongoing training (50%) and Conduct educational meetings (23%). Adoption (42%) and reach (27%) were the two most frequently assessed outcomes. The overall costs of Conduct ongoing training ranged from $199 to $105 772 ($1-$13 973 per action target and $0.02-$412 per EBP participant); whereas the cost of Conduct educational meetings ranged from $987 to $1.1-$2.9 million/year ($33-$54 869 per action target and $0.2-$146 per EBP participant). The wide range of costs was due to the varying scales of the studies, intended audiences/diseases and the complexities of the strategy components. Most studies presented limited information on costing methodology, making interpretation difficult. CONCLUSIONS The quantity of published D&I strategy cost analyses is increasing, yet guidance on conducting and reporting of D&I strategy cost analysis is necessary to facilitate and promote the application of comparative economic evaluation in the field of D&I research.
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Affiliation(s)
- Tzeyu L Michaud
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Center for Reducing Health Disparities, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Emiliane Pereira
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Gwenndolyn Porter
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Caitlin Golden
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jennie Hill
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Jungyoon Kim
- Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Hongmei Wang
- Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Cindy Schmidt
- McGoogan Health Sciences Library, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Paul A Estabrooks
- Department of Health and Kinesiology, University of Utah, Salt Lake City, Utah, USA
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15
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Li C, Li Y, Wang N, Ge Z, Shi Z, Wang J, Ding B, Bi Y, Wang Y, Hong Z. Intestinal Permeability Associated with the Loss of Skeletal Muscle Strength in Middle-Aged and Older Adults in Rural Area of Beijing, China. Healthcare (Basel) 2022; 10:healthcare10061100. [PMID: 35742149 PMCID: PMC9223217 DOI: 10.3390/healthcare10061100] [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: 04/25/2022] [Revised: 06/08/2022] [Accepted: 06/11/2022] [Indexed: 11/26/2022] Open
Abstract
The association between intestinal permeability and sarcopenia remains unclear, and few studies have mentioned the relationship between intestinal permeability and skeletal muscle strength. The present cross-sectional community study was conducted in a rural area of Beijing to explore the association between intestinal permeability and handgrip strength (HGS) in middle-aged and older adults. Serum lipopolysaccharide (LPS), diamine oxidase (DAO) and D-lactate were detected to evaluate intestinal permeability. Gut microbiota (GM) and its potential interaction were also analyzed in the decision tree model. HGS was negatively correlated with DAO (r = −0.396, p < 0.01) in males. The negative association between HGS and DAO remained significant with the adjustment of covariates (β = −1.401, p < 0.05). Serum DAO and LPS were both negatively associated with HGS in middle-aged and older males, with the significant interactions of GM in the decision tree model, and D-lactate showed a negative association with HGS in females. Therefore, intestinal permeability was associated with the loss of skeletal muscle strength in middle-aged and older adults, and serum DAO may be a novel predictor for the loss of skeletal muscle strength in middle-aged and older males.
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16
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Villamizar-Pita PC, Angarita-Fonseca A, de Souza HCD, Martínez-Rueda R, Villamizar García MC, Sánchez-Delgado JC. Handgrip strength is associated with risk of falls in physically active older women. Health Care Women Int 2022; 43:1301-1314. [DOI: 10.1080/07399332.2022.2055759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Adriana Angarita-Fonseca
- Université du Québec en Abitibi-Témiscamingue, Rouyn Noranda, Quebec, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montréal, Quebec, Canada
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Bucaramanga, Colombia
| | - Hugo Celso Dutra de Souza
- Laboratory of Physiology and Cardiovascular Physiotherapy, Ribeirão Preto Medical School, University of São Paulo-Brazil, São Paulo, Brazil
| | - Rosmary Martínez-Rueda
- Faculty of Physical Culture, Sports and Recreation, University Santo Tomás, Bucaramanga, Colombia
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Juan Carlos Sánchez-Delgado
- Faculty of Physical Culture, Sports and Recreation, University Santo Tomás, Bucaramanga, Colombia
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Bucaramanga, Colombia
- Laboratory of Cardiology Physiology and Physiotherapy, Ribeirão Preto Medical School, University of São Paulo-Brazil, São Paulo, Brazil
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17
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Dodds RM, Heslop P, Jaffar J, Davies K, Noble JM, Shaw FE, Witham MD, Sayer AA. The assessment of sarcopenia and the frailty phenotype in the outpatient care of older people: implementation and typical values obtained from the Newcastle SarcScreen project. Eur Geriatr Med 2022; 13:763-769. [PMID: 35404041 PMCID: PMC8995690 DOI: 10.1007/s41999-022-00641-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/23/2022] [Indexed: 12/17/2022]
Abstract
Aim Is it possible to implement the Newcastle SarcScreen, an assessment of sarcopenia and physical frailty, as part of the outpatient care of older people? Findings Grip strength measurement was possible in 98.2% and gait speed in 82.1%, with the latter typically not measured due to mobility impairment. We found a high prevalence of probable sarcopenia and the frailty phenotype across all age groups studied. Message We successfully implemented the Newcastle SarcScreen. The proforma is available to download as part of this article. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-022-00641-5. Purpose Sarcopenia and the frailty phenotype both indicate older adults at risk of adverse health outcomes and yet are not widely assessed in practice. We developed the Newcastle SarcScreen to enable assessment of these two ageing syndromes during clinical care. In the setting of our Older People’s Medicine Day Unit, our aims were to describe the implementation of the SarcScreen and to examine the typical values obtained. Methods The SarcScreen comprised height, weight, questions (three on the Fried frailty phenotype and five on the SARC-F questionnaire), grip strength and gait speed. We analysed data from 552 patients completing the SarcScreen. We expressed grip strength as Z-scores (number of standard deviations above the mean expected for a patient’s age and sex). Results It was possible to implement the SarcScreen. In 552 patients (65.9% females) with mean age 80.1 (7.7) years, grip strength was feasible in 98.2% and gait speed in 82.1%. Gait speed was typically not assessed due to mobility impairment. Most patients had weak grip strength (present in 83.8%), slow gait speed (88.8%) and the frailty phenotype (66.2%). We found a high prevalence of probable sarcopenia and the frailty phenotype across all age groups studied. This was reflected by low grip strength Z-scores, especially at younger ages: those aged 60–69 had grip strength 2.7 standard deviations (95% CI 2.5–2.9) below that expected. Conclusion It is possible to implement an assessment of sarcopenia and the frailty phenotype as part of the routine outpatient care of older people. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-022-00641-5.
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Affiliation(s)
- R M Dodds
- AGE Research Group, Newcastle University Institute for Translational and Clinical Research, Newcastle, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle Upon Tyne NHS Foundation Trust, 3rd Floor Biomedical Research Building, Campus for Ageing and Vitality, Newcastle, NE4 5PL, UK
- Department of Older People's Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - P Heslop
- School of Design, Northumbria University, Newcastle, UK
| | - J Jaffar
- AGE Research Group, Newcastle University Institute for Translational and Clinical Research, Newcastle, UK
| | - K Davies
- AGE Research Group, Newcastle University Institute for Translational and Clinical Research, Newcastle, UK
| | - J M Noble
- Department of Older People's Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - F E Shaw
- Department of Older People's Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - M D Witham
- AGE Research Group, Newcastle University Institute for Translational and Clinical Research, Newcastle, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle Upon Tyne NHS Foundation Trust, 3rd Floor Biomedical Research Building, Campus for Ageing and Vitality, Newcastle, NE4 5PL, UK
- Department of Older People's Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - A A Sayer
- AGE Research Group, Newcastle University Institute for Translational and Clinical Research, Newcastle, UK.
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle Upon Tyne NHS Foundation Trust, 3rd Floor Biomedical Research Building, Campus for Ageing and Vitality, Newcastle, NE4 5PL, UK.
- Department of Older People's Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK.
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18
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Sim M, Dalla Via J, Scott D, Lim WH, Hodgson JM, Zhu K, Daly RM, Duque G, Prince RL, Lewis JR. Creatinine to cystatin C ratio, a biomarker of sarcopenia measures and falls risk in community-dwelling older women. J Gerontol A Biol Sci Med Sci 2021; 77:1389-1397. [PMID: 34907424 DOI: 10.1093/gerona/glab369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The ratio of creatinine to cystatin C (Cr:Cyc) has been proposed as a biomarker of sarcopenia, as greater Cr:Cyc is typically associated with greater muscle mass. We examined the relationship between Cr:Cyc with individual sarcopenia measures, 5 y self-reported falls and 12 y fall-related hospitalizations in a prospective cohort study of 1,118 community-dwelling older women (mean age 75.2 ± 2.7 y). METHODS Serum Cr:Cyc, hand grip strength and timed-up-and-go (TUG) performance were assessed at baseline (1998), while dual-energy X-ray absorptiometry (DXA) derived ALM/Height (m) 2 was obtained in a subset of women at baseline and 1 year (n=334). Incident 5 y self-reported falls and 12-year falls-related hospitalizations were considered. RESULTS In a multivariable-adjusted model, women with the lowest Cr:Cyc (Quartile [Q] 1) had 5% (1.0 kg) weaker grip strength, as well as 3.7% (0.22 kg/m 2) and 5.5% (0.031) lower ALM adjusted for height 2 or BMI, respectively, compared to women in Q4 (all p<0.05). 329 women reported an incident fall over 5 years, and 326 fall-related hospitalizations were recorded over 12 years. Women in Q1 of Cr:Cyc had a greater relative hazard for a fall over 5 years (HR 1.50 95%CI 1.11-2.01) and fall-related hospitalization over 12 years (HR 1.53 95%CI 1.13-2.07) compared to Q4 in the multivariable-adjusted model. CONCLUSION These findings support further investigation into the use of Cr:Cyc as a muscle biomarker to help clinicians identify individuals at risk of falls for early inclusion into evidence-based primary prevention programs targeting improvements to diet and exercise.
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Affiliation(s)
- Marc Sim
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia.,Medical School, University Western Australia, Perth, WA, Australia.,Royal Perth Hospital Research Foundation, Perth, WA, Australia
| | - Jack Dalla Via
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - David Scott
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia.,Bone and Muscle Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, VIC Australia
| | - Wai H Lim
- Medical School, University Western Australia, Perth, WA, Australia.,Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Jonathan M Hodgson
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia.,Medical School, University Western Australia, Perth, WA, Australia
| | - Kun Zhu
- Medical School, University Western Australia, Perth, WA, Australia.,Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Robin M Daly
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, VIC Australia.,Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
| | - Richard L Prince
- Medical School, University Western Australia, Perth, WA, Australia.,Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
| | - Joshua R Lewis
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia.,Medical School, University Western Australia, Perth, WA, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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19
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Evaluation of and Intervention for Sarcopenia in Hepatology Departments: A Survey of Nurses in Japan. Healthcare (Basel) 2021; 9:healthcare9081021. [PMID: 34442158 PMCID: PMC8392142 DOI: 10.3390/healthcare9081021] [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: 06/13/2021] [Revised: 07/26/2021] [Accepted: 08/04/2021] [Indexed: 11/21/2022] Open
Abstract
Sarcopenia is associated with poor prognosis and decreased quality of life in patients with chronic liver disease (CLD). The present study aimed to clarify the dissemination of interventions such as evaluations, prevention efforts, and treatments for sarcopenia among patients in hepatology outpatient departments and wards in Japan, as well as examine the factors related to such dissemination. A cross-sectional study was performed involving nurses from hospitals accredited by the Japan Society of Hepatology. Participants completed a questionnaire regarding evaluations and interventions for sarcopenia in their department. Nurses from 72 outpatient departments and 162 wards provided responses to the questionnaire. Overall, 37.9% of outpatient departments and 37.6% of wards performed evaluations or interventions for sarcopenia. Outpatient departments and wards that evaluated sarcopenia or intervened held more workshops or training regarding sarcopenia than departments and wards that did not (outpatient departments: 52.0% vs. 12.2%, wards: 32.1% vs. 12.9%). Holding workshops or training regarding sarcopenia (outpatient departments; OR = 7.51, 95% confidence interval (CI): 2.12–26.6, wards; OR = 2.61, 95% CI: 1.11–6.15) was significantly associated with dissemination practices. These findings suggest that expanding knowledge of sarcopenia and developing practical skills among general nurses may aid in preventing sarcopenia among patients with CLD.
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20
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Assessing Additional Characteristics of Muscle Function With Digital Handgrip Dynamometry and Accelerometry: Framework for a Novel Handgrip Strength Protocol. J Am Med Dir Assoc 2021; 22:2313-2318. [PMID: 34166628 DOI: 10.1016/j.jamda.2021.05.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/06/2021] [Accepted: 05/22/2021] [Indexed: 12/18/2022]
Abstract
Maximal handgrip strength (HGS) is a convenient and reliable, but incomplete, assessment of muscle function. Although low HGS is a powerful predictor of poor health, several limitations to maximal HGS exist. The predictive value of HGS is restricted because low HGS is associated with a wide range of unspecified health conditions, and other characteristics of muscle function aside from strength capacity are not evaluated. Current HGS protocol guidelines emphasize the ascertainment of maximal force, which is only a single muscle function characteristic. Muscle function is intrinsically multivariable, and assessing other attributes in addition to strength capacity will improve screenings for age-related disabilities and diseases. Digital handgrip dynamometers and accelerometers provide unique opportunities to examine several aspects of muscle function beyond strength capacity, while also maintaining procedural ease. Specifically, digital handgrip dynamometry and accelerometry can assess the rate of force development, submaximal force steadiness, fatigability, and task-specific tremoring. Moreover, HGS protocols can be easily refined to include an examination of strength asymmetry and bilateral strength. Therefore, evaluating muscle function with new HGS technologies and protocols may provide a more comprehensive assessment of muscle function beyond maximal strength, without sacrificing feasibility. This Special Article introduces a novel framework for assessing multiple attributes of muscle function with digital handgrip dynamometry, accelerometry, and refinements to current HGS protocols. Such framework may aid in the discovery of measures that better predict and explain age-related disability, biological aging, and the effects of comorbid diseases that are amenable to interventions. These additional HGS measures may also contribute to our understanding of concepts such as resilience. Using sophisticated HGS technologies that are currently available and modernizing protocols for developing a new muscle function assessment may help transform clinical practice by enhancing screenings that will better identify the onset and progression of the disabling process.
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21
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Doherty WJ, Stubbs TA, Chaplin A, Langford S, Sinclair N, Ibrahim K, Reed MR, Sayer AA, Witham MD, Sorial AK. Implementing grip strength assessment in hip fracture patients: a feasibility project. J Frailty Sarcopenia Falls 2021; 6:66-78. [PMID: 34131603 PMCID: PMC8173531 DOI: 10.22540/jfsf-06-066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 12/18/2022] Open
Abstract
Objectives: Risk stratification scores are used in hip fracture surgery, but none incorporate objective tests for low muscle strength. Grip strength testing is simple and cheap but not routinely assessed for patients with hip fracture. This project aimed to assess the feasibility of implementing grip strength testing into admission assessment of patients with hip fracture. Methods: A scalable protocol and a corresponding training programme of instructional presentations and practical assessments were designed and delivered by and for physiotherapy staff. Grip strength values were collected pre-surgery on patients with hip fracture at a single centre whilst supine in bed. Implementation of the process was evaluated using narrative, quantitative and cost measures. Results: 53 hip fracture patients with a mean age 80.6 (SD 10.4), of which 36 (67.9%) were female, were included. Testing was offered to 42/52 (81%) patients. Cognitive impairment prevented 14/42 (33%) of patients from completing testing; one patient declined testing. Of the 27 patients who completed testing, 14/27 (52%) had low grip strength as defined by EWGSOP2 criteria. The projected cost of testing for one year was £2.68-£2.82 per patient. Fidelity to the protocol was high using multiple criteria. Conclusions: Grip strength assessment is acceptable to physiotherapy staff and can be rapidly and cost-effectively implemented into hip fracture admission assessment.
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Affiliation(s)
- William J Doherty
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Thomas A Stubbs
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Andrew Chaplin
- Department of Trauma and Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sarah Langford
- Department of Trauma and Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nicola Sinclair
- Department of Trauma and Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Kinda Ibrahim
- Academic Geriatric Medicine, NIHR Wessex Applied Research Collaboration, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Mike R Reed
- Department of Trauma and Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Avan A Sayer
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Miles D Witham
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Antony K Sorial
- Department of Trauma and Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK.,Institute for Cell and Molecular Biosciences, Newcastle University, International Centre for Life, Newcastle upon Tyne, UK
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Dodds RM, Murray JC, Granic A, Hurst C, Uwimpuhwe G, Richardson S, Brayne C, Matthews FE, Sayer AA. Prevalence and factors associated with poor performance in the 5-chair stand test: findings from the Cognitive Function and Ageing Study II and proposed Newcastle protocol for use in the assessment of sarcopenia. J Cachexia Sarcopenia Muscle 2021; 12:308-318. [PMID: 33463015 PMCID: PMC8061374 DOI: 10.1002/jcsm.12660] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/08/2020] [Accepted: 11/24/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Poor performance in the 5-chair stand test (5-CST) indicates reduced lower limb muscle strength. The 5-CST has been recommended for use in the initial assessment of sarcopenia, the accelerated loss of muscle strength and mass. In order to facilitate the use of the 5-CST in sarcopenia assessment, our aims were to (i) describe the prevalence and factors associated with poor performance in the 5-CST, (ii) examine the relationship between the 5-CST and gait speed, and (iii) propose a protocol for using the 5-CST. METHODS The population-based study Cognitive Function and Ageing Study II recruited people aged 65 years and over from defined geographical localities in Cambridgeshire, Newcastle, and Nottingham. The study collected data for assessment of functional ability during home visits, including the 5-CST and gait speed. We used multinomial logistic regression to assess the associations between factors including the SARC-F questionnaire and the category of 5-CST performance: fast (<12 s), intermediate (12-15 s), slow (>15 s), or unable, with slow/unable classed as poor performance. We reviewed previous studies on the protocol used to carry out the 5-CST. RESULTS A total of 7190 participants aged 65+ from the three diverse localities of Cognitive Function and Ageing Study II were included (54.1% female). The proportion of those with poor performance in the 5-CST increased with age, from 34.3% at age 65-69 to 89.7% at age 90+. Factors independently associated with poor performance included positive responses to the SARC-F questionnaire, physical inactivity, depression, impaired cognition, and multimorbidity (all P < 0.005). Most people with poor performance also had slow gait speed (57.8%) or were unable to complete the gait speed test (18.4%). We found variation in the 5-CST protocol used, for example, timing until a participant stood up for the fifth time or until they sat down afterwards. CONCLUSIONS Poor performance in the 5-CST is increasingly common with age and is associated with a cluster of other factors that characterize risk for poor ageing such as physical inactivity, impaired cognition, and multimorbidity. We recommend a low threshold for performing the 5-CST in clinical settings and provide a protocol for its use.
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Affiliation(s)
- Richard Matthew Dodds
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK.,NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne NHS Foundation Trust, Newcastle, UK
| | - James C Murray
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK.,NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne NHS Foundation Trust, Newcastle, UK
| | - Antoneta Granic
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK.,NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne NHS Foundation Trust, Newcastle, UK
| | - Christopher Hurst
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK.,NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne NHS Foundation Trust, Newcastle, UK
| | - Germaine Uwimpuhwe
- Department of Anthropology, Durham University, Durham, UK.,Durham Research Methods Centre, Durham University, Durham, UK
| | - Sarah Richardson
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK.,NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne NHS Foundation Trust, Newcastle, UK
| | - Carol Brayne
- Cambridge Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Fiona E Matthews
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Avan A Sayer
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK.,NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne NHS Foundation Trust, Newcastle, UK
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Lennox L, Linwood-Amor A, Maher L, Reed J. Making change last? Exploring the value of sustainability approaches in healthcare: a scoping review. Health Res Policy Syst 2020; 18:120. [PMID: 33050921 PMCID: PMC7556957 DOI: 10.1186/s12961-020-00601-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/07/2020] [Indexed: 12/18/2022] Open
Abstract
Background Numerous models, tools and frameworks have been produced to improve the sustainability of evidence-based interventions. Due to the vast number available, choosing the most appropriate one is increasingly difficult for researchers and practitioners. To understand the value of such approaches, evidence warranting their use is needed. However, there is limited understanding of how sustainability approaches have been used and how they have impacted research or practice. This review aims to consolidate evidence on the application and impact of sustainability approaches in healthcare settings. Methods A systematic scoping review was designed to search for peer-reviewed publications detailing the use of sustainability approaches in practice. A 5-stage framework for scoping reviews directed the search strategy, and quality assessment was performed using the Mixed Method Appraisal Tool. Searches were performed through electronic citation tracking and snowballing of references. Articles were obtained through Web of Science, PubMed and Google Scholar. Six outcome variables for sustainability were explored to ascertain impact of approaches. Results This review includes 68 articles demonstrating the application of sustainability approaches in practice. Results show an increase in the use of sustainability approaches in peer-reviewed studies. Approaches have been applied across a range of healthcare settings, including primary, secondary, tertiary and community healthcare. Approaches are used for five main purposes, namely analysis, evaluation, guidance, assessment and planning. Results outline benefits (e.g. improved conceptualisation of sustainability constructs and improved ability to interpret sustainability data) and challenges (e.g. issues with approach constructs and difficulty in application) associated with using a sustainability approach in practice. Few articles (14/68) reported the sustainability outcome variables explored; therefore, the impact of approaches on sustainability remains unclear. Additional sustainability outcome variables reported in retrieved articles are discussed. Conclusions This review provides practitioners and researchers with a consolidated evidence base on sustainability approaches. Findings highlight the remaining gaps in the literature and emphasise the need for improved rigour and reporting of sustainability approaches in research studies. To guide future assessment and study of sustainability in healthcare settings an updated list of sustainability outcome variables is proposed. Trial Registration This review was registered on the PROSPERO database CRD 42016040081 in June 2016.
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Affiliation(s)
- L Lennox
- National Institute for Health Research, Applied Research Collaboration North West London. Imperial College London, 369 Fulham Road, SW10 9NH, London, United Kingdom.
| | - A Linwood-Amor
- Ministry of Health, Environment, Culture and Housing, George Town, Grand Cayman KY1-9000, Cayman Islands
| | - L Maher
- Ko Awatea Health System Innovation and Improvement, Middlemore Hospital, 100 Hospital Road, Otahuhu, New Zealand
| | - J Reed
- Julie Reed Consultancy, 27 Molasses House, London, SW113TN, United Kingdom
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Di Monaco M, Castiglioni C, Bardesono F, Milano E, Massazza G. The handgrip strength threshold of 16 kg discriminates successful rehabilitation: A prospective short-term study of 258 women with hip fracture. Arch Gerontol Geriatr 2020; 91:104190. [PMID: 32721661 DOI: 10.1016/j.archger.2020.104190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 07/16/2020] [Accepted: 07/18/2020] [Indexed: 01/06/2023]
Abstract
AIM In 2019 the European Working Group on Sarcopenia in Older People (EWGSOP) indicated weakness as the key characteristic of sarcopenia and released the threshold of 16 kg for handgrip strength to define weakness in women. We aimed to externally validate the 16 kg cut-off point for predicting functional recovery in 258 women with subacute hip fracture admitted to our rehabilitation ward. METHODS We assessed handgrip strength by a hand-grip Jamar dynamometer at admission to inpatient rehabilitation and functional ability in activities of daily living by the Barthel index at the end of the rehabilitation course. Successful rehabilitation was defined with a Barthel index score ≥85 and highest possible recovery with a Barthel index effectiveness = 100 %. RESULTS A handgrip strength ≥16 kg significantly predicted both successful rehabilitation (χ2 = 23.5, P < 0.001) and highest possible recovery (χ2 = 31.05, P < 0.001). For the women with a handgrip strength ≥16 kg, the odds ratios to gain successful rehabilitation and highest possible recovery were 2.68 (95 % CI from 1.19 to 6.04; P = 0.018) and 2.81 (95 % CI from 1.47 to 5.37; P = 0.002), after adjustment for Barthel index scores before rehabilitation, age, hip-fracture type (either medial or lateral), cognitive impairment and 25-hydroxyvitamin D levels. CONCLUSION Our results provide an external validation of the 16 kg handgrip strength threshold recently released to discriminate functional outcomes: it significantly predicted the short-term ability to perform activities of daily living after hip fracture in women.
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Affiliation(s)
- Marco Di Monaco
- Osteoporosis Research Center, Division of Physical and Rehabilitation Medicine, Presidio Sanitario San Camillo, Fondazione Opera San Camillo, Torino, Italy.
| | - Carlotta Castiglioni
- Osteoporosis Research Center, Division of Physical and Rehabilitation Medicine, Presidio Sanitario San Camillo, Fondazione Opera San Camillo, Torino, Italy
| | - Francesca Bardesono
- Division of Physical and Rehabilitation Medicine, Department of Surgical Sciences, University, Torino, Italy
| | - Edoardo Milano
- Osteoporosis Research Center, Division of Physical and Rehabilitation Medicine, Presidio Sanitario San Camillo, Fondazione Opera San Camillo, Torino, Italy
| | - Giuseppe Massazza
- Division of Physical and Rehabilitation Medicine, Department of Surgical Sciences, University, Torino, Italy
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Jaafari F, Delavari S, Bazrafkan L. Evaluation of the geriatric curriculum implemented at Shiraz University of Medical Sciences, Iran, since 2017: A qualitative study. F1000Res 2019. [DOI: 10.12688/f1000research.16040.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: Recently, there has been an increase in life expectancy due to improvements in nutrition, health, and sanitation. The aim of this study was to evaluate the geriatric curriculum in the field of general medicine at Shiraz University of Medical Sciences (SUMS), Iran to improve the quality of services provided to this population in the community. Methods: This was a qualitative study. Six educational hospitals and ambulatory centers of Shiraz University of Medical Sciences participated in this study. Within these centers, 15 medical education faculty members and educational experts, 6 medical students, 6 elderly patients and 6 nurses working in the university related to the geriatric field were selected using purposive sampling. Data were gathered through semi-structured interviews, focus group discussion and field observations in the teaching hospital and ambulatory setting of SUMS from June 2017 to May 2018. Based on the qualitative research, the data underwent conventional content analysis and the main themes were developed from this. Results: Three main themes were extracted from the data: effective clinical education, geriatrics curriculum challenges and promotion strategies for geriatric medicine. Subcategories that emerged were a competent curriculum teacher, a challenging program, management of resources, promotion of the program, and the revision required in the curriculum, which were related to other concepts and described in the real-world situation of the geriatric curriculum in the university, as observed in field observations. Conclusions: This study identified three concepts as main themes that can be used to explain how to implement a geriatric curriculum in a medical university. The main contributing factor to different views of the participants was identified as the revision required to the curriculum for integrative care in a geriatric patient. This should be taken into consideration while planning any programs and decisions aimed at education of medical students on this topic.
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Bohannon RW. Grip Strength: An Indispensable Biomarker For Older Adults. Clin Interv Aging 2019; 14:1681-1691. [PMID: 31631989 PMCID: PMC6778477 DOI: 10.2147/cia.s194543] [Citation(s) in RCA: 406] [Impact Index Per Article: 81.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 09/13/2019] [Indexed: 12/20/2022] Open
Abstract
Grip strength has been proposed as a biomarker. Supporting this proposition, evidence is provided herein that shows grip strength is largely consistent as an explanator of concurrent overall strength, upper limb function, bone mineral density, fractures, falls, malnutrition, cognitive impairment, depression, sleep problems, diabetes, multimorbidity, and quality of life. Evidence is also provided for a predictive link between grip strength and all-cause and disease-specific mortality, future function, bone mineral density, fractures, cognition and depression, and problems associated with hospitalization. Consequently, the routine use of grip strength can be recommended as a stand-alone measurement or as a component of a small battery of measurements for identifying older adults at risk of poor health status.
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Affiliation(s)
- Richard W Bohannon
- Department of Physical Therapy, Campbell University, Lillington, NC, USA
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27
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Response: Muscle strength and function rather than muscle mass in sarcopenia. Eur J Appl Physiol 2019; 119:1673-1674. [PMID: 31053926 DOI: 10.1007/s00421-019-04156-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
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Howarth T, Davison B, Singh G. Grip strength among Indigenous and non-Indigenous Australian adults: a longitudinal study of the effects of birth size and current size. BMJ Open 2019; 9:e024749. [PMID: 30944132 PMCID: PMC6500337 DOI: 10.1136/bmjopen-2018-024749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Indigenous Australians are born smaller than non-Indigenous Australians and are at an increased risk of early onset of frailty. This study aimed to identify the relationship between birth size, current size and grip strength, as an early marker of frailty, in Indigenous and non-Indigenous young adults. DESIGN Cross sectional data from two longitudinal studies: Aboriginal birth cohort (Indigenous) and top end cohort (non-Indigenous). SETTING Participants reside in over 40 urban and remote communities across the Northern Territory, Australia. PARTICIPANTS Young adults with median age 25 years (IQR 24-26); 427 participants (55% women), 267 (63%) were remote Indigenous, 55 (13%) urban Indigenous and 105 (25%) urban non-Indigenous. OUTCOME MEASURES Reliable birth data were available. Anthropometric data (height, weight, lean mass) and grip strength were directly collected using standardised methods. Current residence was classified as urban or remote. RESULTS The rate of low birthweight (LBW) in the non-Indigenous cohort (9%) was significantly lower than the Indigenous cohort (16%) (-7%, 95% CI -14 to 0, p=0.03). Indigenous participants had lower grip strength than non-Indigenous (women, -2.08, 95% CI -3.61 to -0.55, p=0.008 and men, -6.2, 95% CI -9.84 to -2.46, p=0.001). Birth weight (BW) was associated with grip strength after adjusting for demographic factors for both women (β=1.29, 95% CI 0.41 to 2.16, p=0.004) and men (β=3.95, 95% CI 2.38 to 5.51, p<0.001). When current size (lean mass and body mass index [BMI]) was introduced to the model BW was no longer a significant factor. Lean mass was a positive indicator for grip strength, and BMI a negative indicator. CONCLUSIONS As expected women had significantly lower grip strength than men. Current size, in particular lean mass, was the strongest predictor of adult grip strength in this cohort. BW may have an indirect effect on later grip strength via moderation of lean mass development, especially through adolescence and young adulthood.
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Affiliation(s)
- Timothy Howarth
- Child Health, Menzies School of Health Research, Casuarina, Northern Territory, Australia
| | - Belinda Davison
- Child Health, Menzies School of Heath Research, Institute of Advanced Studies, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Gurmeet Singh
- Child Health, Menzies School of Heath Research, Institute of Advanced Studies, Charles Darwin University, Darwin, Northern Territory, Australia
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29
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Ibrahim K, Howson FFA, Culliford DJ, Sayer AA, Roberts HC. The feasibility of assessing frailty and sarcopenia in hospitalised older people: a comparison of commonly used tools. BMC Geriatr 2019; 19:42. [PMID: 30770722 PMCID: PMC6377779 DOI: 10.1186/s12877-019-1053-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 01/31/2019] [Indexed: 12/13/2022] Open
Abstract
Background Frailty and sarcopenia are common amongst hospitalised older people and associated with poor healthcare outcomes. Widely recognised tools for their identification are the Fried Frailty Phenotype, its self-report version the FRAIL Scale, and the European Working Group on Sarcopenia in Older People (EWGSOP) criteria. We studied the feasibility of using these tools in a hospital setting of acute wards for older people. Methods Patients aged 70+ years admitted to acute wards at one English hospital were prospectively recruited. The Fried Frailty Phenotype was assessed through measured grip strength, gait speed and questions on unintentional weight loss, exhaustion and physical activity. The 5-item self-reported FRAIL scale questionnaire covering the same domains was completed. Agreement between the two tools was reported using the Cohen kappa statistic. The EWGSOP criteria (gait speed, grip strength and muscle mass) were assessed by additional bedside measurement of muscle mass with bioelectrical impedance. Results Two hundred thirty three participants (median age 80 years, 60% men) were recruited. Most (221, 95%) had their grip strength measured: 4 (2%) were unable and data were missing for 8 (3%). Only 70 (30%) completed the gait speed assessment: 153 (66%) were unable with missing data on 10 (4%). 113 (49%) participants had the bioelectrical impedance assessment. Muscle mass measurement was not possible for 84 (36%) participants: 25 patients declined, 21 patients were unavailable, 22 results were technically invalid, and 16 had clinical contra-indications. Data on 36 (15%) were missing. Considering inability to complete grip strength or gait speed assessments as low values, data for the Fried Frailty Phenotype was available for 218 (94%) of participants; frailty was identified in 105 (48%). 230 (99%) patients completed the FRAIL scale; frailty was identified among 77 (34%). There was moderate agreement between the two frailty tools (Kappa value of 0.46, 95%CI: 0.34 to 0.58). Complete data for the EWGOSP criteria were only available for 124 (53%) patients of whom 40 (32%) had sarcopenia. Conclusion It was feasible to measure grip strength and complete the FRAIL scale among older inpatients in hospital. Measuring gait speed and muscle mass to identify sarcopenia was challenging in the acute setting. Trial registration ISRCTN registry (ID ISRCTN16391145) on 30.12.14.
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Affiliation(s)
- Kinda Ibrahim
- Academic Geriatric Medicine, University of Southampton, Southampton, UK.,National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, University of Southampton, Southampton, UK
| | - Fiona F A Howson
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - David J Culliford
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, University of Southampton, Southampton, UK
| | - Avan A Sayer
- Academic Geriatric Medicine, University of Southampton, Southampton, UK.,AGE Research Group, Institute of Neuroscience, Newcastle University, Newcastle, UK.,NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle, UK
| | - Helen C Roberts
- Academic Geriatric Medicine, University of Southampton, Southampton, UK. .,National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, University of Southampton, Southampton, UK. .,University Hospital Southampton NHS Foundation Trust, Southampton, UK.
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Bohannon RW. Considerations and Practical Options for Measuring Muscle Strength: A Narrative Review. BIOMED RESEARCH INTERNATIONAL 2019; 2019:8194537. [PMID: 30792998 PMCID: PMC6354207 DOI: 10.1155/2019/8194537] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/15/2018] [Accepted: 01/03/2019] [Indexed: 12/17/2022]
Abstract
Muscle strength impairments are related to mobility limitations and other untoward outcomes. This narrative review, therefore, describes considerations relative to the definition and measurement of muscle strength. Thereafter, practical options for measuring muscle strength are described and their clinimetric properties are delineated. Information provided herein may help students, clinicians, and researchers select the strength tests best suited to their research needs and limitations.
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Affiliation(s)
- Richard W. Bohannon
- Department of Physical Therapy, College of Pharmacy and Health Sciences, Campbell University, Lillington, NC, USA
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