Effects of Elastic Resistance Exercise on Postoperative Outcomes Linked to the ICF Core Sets for Osteoarthritis after Total Knee Replacement in Overweight and Obese Older Women with Sarcopenia Risk: A Randomized Controlled Trial

Is moderate resistance training adequate for older adults with sarcopenia? A systematic review and network meta-analysis of RCTs

BACKGROUND

Resistance training (RT) and nutritional supplementation are recommended for the management of sarcopenia in older adults. However, optimal RT intensity for the treatment of sarcopenia has not been well investigated.

METHODS

This network meta-analysis aims to determine the comparative effectiveness of interventions for sarcopenia, taking RT intensity into consideration. RT intensity was classified into light-to-moderate intensity RT(LMRT), moderate intensity RT(MRT), and moderate-to-vigorous intensity RT(MVRT) based on percentage of one repetition maximum (%1RM) and/or rating of perceived exertion.

RESULTS

A total of 50 RCTs (N = 4,085) were included after screening 3,485 articles. The results confirmed that RT with or without nutrition was positively associated with improved measures of muscle strength and physical performance. Regarding RT intensity, LMRT only demonstrated positive effects on hand grip (aerobic training + LMRT + nutrition: mean difference [MD] = 2.88; 95% credential intervals [CrI] = 0.43,5.32). MRT provided benefits on improvement in the 30-s chair stand test (repetitions) (MRT: MD = 2.98, 95% CrI = 0.35,5.59), timed up and go test (MRT: MD = -1.74, 95% CrI: = -3.34,-0.56), hand grip (MRT: MD = 2.44; 95% CrI = 0.03,5.70), and leg press (MRT: MD = 8.36; 95% CrI = 1.87,13.4). MVRT also improved chair stand test repetitions (MVRT: MD = 5.64, 95% CrI = 0.14,11.4), gait speed (MVRT + nutrition: MD = 0.21, 95% CrI = 0.003,0.48), appendicular skeletal muscle index (MVRT + nutrition: MD = 0.25, 95% CrI = 0.01,0.5), and leg press (MVRT: MD = 14.7, 95% CrI: 5.96,22.4; MVRT + nutrition: MD = 17.8, 95% CrI: 7.55,28.6).

CONCLUSION

MVRT had greater benefits on muscle mass, lower extremity strength, and physical performance compared to MRT. Increasing RT intensity may be recommended for sarcopenic older adults.

Effectiveness and therapeutic validity of physiotherapeutic exercise starting within one year following total and unicompartmental knee arthroplasty for osteoarthritis: a systematic review

BACKGROUND

To determine the effectiveness and therapeutic validity of physiotherapeutic exercise after total and unicompartmental knee arthroplasty for osteoarthritis. It was hypothesized that interventions of high therapeutic validity result in superior functional recovery after total and unicompartmental knee arthroplasty versus interventions of low therapeutic validity.

METHODS

A systematic review incorporating a comprehensive database search of five major databases relevant to the topic was conducted. Randomized controlled trials were reviewed if they included studies that compared postoperative physiotherapeutic exercise with usual care or compared two types of postoperative physiotherapeutic interventions. All included studies were assessed for risk of bias (using the Cochrane Collaboration's tool) and therapeutic validity (using the Consensus on Therapeutic Exercise Training scale). The characteristics of the included articles and their results on joint and muscle function, functional performance, and participation were extracted.

RESULTS

Of the 4343 unique records retrieved, 37 articles were included. Six of them showed good therapeutic validity, suggesting low therapeutic validity in 31 studies. Three articles showed a low risk of bias, 15 studies scored some concerns for risk of bias and 19 studies scored high risk of bias. Only one article scored well on both methodological quality and therapeutic validity.

CONCLUSION

Due to heterogeneity of outcome measures and length of follow-up, as well as limited reporting of details of the physiotherapeutic exercises and control interventions, no clear evidence was found on effectiveness of physiotherapeutic exercises after total and unicompartmental knee arthroplasty. Homogeneity in intervention characteristics and outcome measures would enhance comparability of clinical outcomes between trials. Future studies should incorporate similar methodological approaches and outcome measures. Researchers are encouraged to use the Consensus on Therapeutic Exercise Training scale as a template to prevent insufficient reporting.

The Effects of Sarcopenia on Hip and Knee Replacement Surgery: A Systematic Review

Sarcopenia is a progressive and generalized skeletal muscle disorder associated with poor outcomes and complications, including falls, fractures, physical disability, and death. The aim of this review is to assess the possible influence of sarcopenia on outcomes of sarcopenia in patients who underwent knee or hip replacement. A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Medline, EMBASE, Scopus, CINAHL, and CENTRAL bibliographic databases were searched. General study characteristics extracted were: primary author and country, year of publication, type of study, level of evidence (LOE), sample size, mean age, gender, follow-up, type of surgery, diagnosis, and outcomes. At the final screening, five articles met the selection criteria and were included in the review. Sarcopenia influences the Barthel Index (BI), which is significantly lower compared to patients without sarcopenia, which indicates that the patient is subjected to a worsening of this condition that can influence their normal life since they will become dependent on someone else. No difference in mortality rate was found was found between the studies. This systematic review addressed the possible role of sarcopenia in patients undergoing joint replacement surgery. Despite the lack of high-quality literature on this topic, a general trend in considering sarcopenia as a negative factor for quality of life in joint replacement patients was reported. However, the lack of significant results means it is not possible to report useful conclusions.

The Reliability and Validity of the Brief ICF Core Set in Patients with Chronic Obstructive Pulmonary Disease

Purpose

To analyze the reliability and validity of the Brief international classification of functioning, disability and health (ICF) core set for chronic obstructive pulmonary disease (COPD).

Patients and Methods

A cross-sectional study was conducted in four tertiary hospitals in Tianjin, China. A total of 100 patients with COPD were selected to evaluate functioning and disability involving body functions, body structures, activities and participation as well as environmental factors of the Brief ICF core set for COPD. Internal consistency was calculated by Cronbach's α. Content validity was examined using the content validity index (CVI), scale-level CVI/universal agreement, and scale-level CVI/average agreement (S-CVI/Ave). In addition, construct validity and convergent validity were also examined.

Results

The Brief ICF core set for COPD had a high internal consistency, 0.873 for the total scale, with values of 0.750, 0.640, and 0.843 for body functions, body structures, and activity and participation, respectively. The content validity was calculated by the CVI, scale-level CVI/universal agreement, and S-CVI/Ave at values of 0.80-1, 0.929, and 0.986, respectively. Meanwhile, the ICF core set for COPD had good convergent validity, correlating with the mMRC dyspnea score (r=0.690, P<0.01), and there were significant correlations between the ICF core set for COPD and COPD clinical severity grade (r=0.363, P<0.01). A four-factor model of functions and disability in the Brief ICF core set for COPD had the best fit according to confirmatory factor analysis (CFA).

Conclusion

The Brief ICF core set for COPD is a reliable and valid convenient instrument for assessing comprehensive problems in the functioning of patients with COPD, which can be used to design and to evaluate rehabilitation strategies.