Muscular Echo-Intensity of the Quadriceps by Ultrasound Is More Related to Improvement of Gait Independence than Muscle Thickness in Older Inpatients

OBJECTIVES

This study aimed to examine whether the decrease in muscular echo-intensity of the quadriceps by ultrasound in older inpatients is related to the improvement of gait independence than the increase of muscle thickness.

DESIGN

Longitudinal study.

SETTING

Hospital-based study.

PARTICIPANTS

This study included 171 inpatients aged ≥ 65 years (median age: 84.0 [77.0-88.0], 56.1% female). Patients who were able to walk independently at hospital admission were excluded from the study.

MEASUREMENTS

Improvement of gait independence during hospital stay was assessed using the change in Functional Independence Measure (FIM) gait score (i.e., FIM gait score at hospital discharge minus FIM gait score at hospital admission) and FIM gait score at hospital discharge. Muscular echo-intensity and muscle thickness of the quadriceps were assessed at hospital admission and discharge using ultrasound images, respectively. Muscular echo-intensity has been shown to be mainly related to intramuscular adipose tissue. Multiple linear regression analysis was performed to identify the factors independently associated with the change in FIM gait score and FIM gait score at discharge.

RESULTS

Change in quadriceps echo-intensity was independently and significantly associated with the change in FIM gait score (β = -0.22, p = 0.017) and FIM gait score at hospital discharge (β = -0.21, p = 0.017). In contrast, change in quadriceps thickness was not independently and significantly associated with the change in FIM gait score (β = 0.16, p = 0.050) and FIM gait score at hospital discharge (β = 0.15, p = 0.050).

CONCLUSIONS

Our study indicates that a decrease in muscular echo-intensity of the quadriceps by ultrasound is more related to the improvement of gait independence than an increase of muscle thickness in older inpatients. Intervention for intramuscular adipose tissue of the quadriceps may be important for improving gait independence in older inpatients.

Determinants of gait independence after mechanical ventilation in the intensive care unit: a Japanese multicenter retrospective exploratory cohort study

PURPOSE

Gait independence is one of the most important factors related to returning home from the hospital for patients treated in the intensive care unit (ICU), but the factors affecting gait independence have not been clarified. This study aimed to determine the factors affecting gait independence at hospital discharge using a standardized early mobilization protocol that was shared by participating hospitals.

MATERIALS AND METHODS

Patients who entered the ICU from January 2017 to March 2018 were screened. The exclusion criteria were mechanical ventilation < 48 hours, age < 18, loss of gait independence before hospitalization, being treated for neurological issues, unrecoverable disease, unavailability of continuous data, and death during ICU stay. Basic attributes, such as age, ICU length of stay, information on early mobilization while in the ICU, Medical Research Council (MRC) sum-score at ICU discharge, incidence of ICU-acquired weakness (ICU-AW) and delirium, and the degree of gait independence at hospital discharge, were collected. Gait independence was determined using a mobility scale of the Barthel Index, and the factors that impaired gait independence at hospital discharge were investigated using a Cox proportional hazard regression analysis.

RESULTS

One hundred thirty-two patients were analyzed. In the univariate analysis, age, APACHE II score, duration of mechanical ventilation, ICU length of stay, incidence of delirium, and MRC sum-score at ICU discharge were extracted as significant. In the multivariate analysis, age (p = 0.014), MRC sum-score < 48 (p = 0.021), and delirium at discharge from ICU (p < 0.0001) were extracted as significant variables.

CONCLUSIONS

We found that age and incidence of ICU-AW and delirium were significantly related to impaired gait independence at hospital discharge.

Premorbid physical activity is modestly associated with gait independence after a stroke: an exploratory study

Background

Regaining physical function after a stroke is important for independence and for performing activities of daily living. Particularly, cerebrovascular disease, which includes stroke, is not entirely avoidable. In the present study, we aimed to observe the association between premorbid physical activities and gait independence after a stroke.

Methods

Consecutive cerebrovascular stroke patients were asked to fill a questionnaire regarding their premorbid physical activities. The association between gait independence at the completion of in-hospital rehabilitation and premorbid physical activities, as well as age, stroke type, lesion size, and comorbidities, was investigated statistically.

Results

Of 130 consecutive patients with stroke who answered the questionnaire regarding their premorbid physical activities, 97 regained gait independence. Ambulation and occupational or household activities were most frequently performed by all the participants before stroke onset. Participants who acquired gait independence tended to indicate various premorbid activities compared to participants who did not recover gait independence. Estimating premorbid physical activities in metabolic equivalents suggested that moderate to vigorous activities were associated with an increased probability of post-stroke independent gait but this tendency was dismissed after multivariate analysis including age and history of stroke.

Conclusions

Premorbid physical activity is associated with gait independence after a stroke, but this association is not as strong as those of age or history of stroke.

Electronic supplementary material

The online version of this article (10.1186/s11556-018-0208-8) contains supplementary material, which is available to authorized users.