Frailty and the Prediction of Negative Health Outcomes: A Meta-Analysis

INTRODUCTION

Frailty is one of the most important concerns regarding our aging population. Evidence grows that the syndrome is linked to several important health outcomes. A general overview of frailty concepts and a comprehensive meta-analysis of their relation with negative health outcomes still lacks in literature, making it difficult for health care professionals and researchers to recognize frailty and the related health risks on the one hand and on the other hand to appropriately follow up the frailty process and take substantiated action. Therefore, this study aims to give an overview of the predictive value of the main frailty concepts for negative health outcomes in community-dwelling older adults.

METHODS

This review and meta-analysis assembles prospective studies regarding the relation between frailty and any potential health outcome. Frailty instruments were subdivided into frailty concepts, so as to make comprehensive comparisons. Odds ratios (ORs), hazard ratios (HRs), and relative risk (RR) scores were extracted from the studies, and meta-analyses were conducted in OpenMeta Analyst software.

RESULTS

In total, 31 articles retrieved from PubMed, Web of Knowledge, and PsycInfo provided sufficient information for the systematic review and meta-analysis. Overall, (pre)frailty increased the likelihood for developing negative health outcomes; for example, premature mortality (OR 2.34 [1.77-3.09]; HR/RR 1.83 [1.68-1.98]), hospitalization (OR 1.82 [1.53-2.15]; HR/RR 1.18 [1.10-1.28]), or the development of disabilities in basic activities of daily living (OR 2.05 [1.73-2.44]); HR/RR 1.62 [1.50-1.76]).

CONCLUSION

Overall, frailty increases the risk for developing any discussed negative health outcome, with a 1.8- to 2.3-fold risk for mortality; a 1.6- to 2.0-fold risk for loss of activities of daily living; 1.2- to 1.8-fold risk for hospitalization; 1.5- to 2.6-fold risk for physical limitation; and a 1.2- to 2.8-fold risk for falls and fractures. The analyses presented in this study can be used as a guideline for the prediction of negative outcomes according to the frailty concept used, as well as to estimate the time frame within which these events can be expected to occur.

The reliability and validity of ultrasound to quantify muscles in older adults: a systematic review

This review evaluates the reliability and validity of ultrasound to quantify muscles in older adults. The databases PubMed, Cochrane, and Cumulative Index to Nursing and Allied Health Literature were systematically searched for studies. In 17 studies, the reliability (n = 13) and validity (n = 8) of ultrasound to quantify muscles in community-dwelling older adults (≥60 years) or a clinical population were evaluated. Four out of 13 reliability studies investigated both intra-rater and inter-rater reliability. Intraclass correlation coefficient (ICC) scores for reliability ranged from -0.26 to 1.00. The highest ICC scores were found for the vastus lateralis, rectus femoris, upper arm anterior, and the trunk (ICC = 0.72 to 1.000). All included validity studies found ICC scores ranging from 0.92 to 0.999. Two studies describing the validity of ultrasound to predict lean body mass showed good validity as compared with dual-energy X-ray absorptiometry (r²  = 0.92 to 0.96). This systematic review shows that ultrasound is a reliable and valid tool for the assessment of muscle size in older adults. More high-quality research is required to confirm these findings in both clinical and healthy populations. Furthermore, ultrasound assessment of small muscles needs further evaluation. Ultrasound to predict lean body mass is feasible; however, future research is required to validate prediction equations in older adults with varying function and health.

Normal Anatomy and Compression Areas of Nerves of the Foot and Ankle: US and MR Imaging with Anatomic Correlation

The anatomy of the nerves of the foot and ankle is complex, and familiarity with the normal anatomy and course of these nerves as well as common anatomic variants is essential for correct identification at imaging. Ultrasonography (US) and magnetic resonance (MR) imaging allow visualization of these nerves and may facilitate diagnosis of various compression syndromes, such as "jogger's heel," Baxter neuropathy, and Morton neuroma. It may be difficult to distinguish the nerves from adjacent vasculature at MR imaging, and US can help in differentiation. The authors review the normal anatomy and common variants of the nerves of the foot and ankle, with use of dissected specimens and correlative US and MR imaging findings. In addition, the authors illustrate proper probe positioning, which is essential for visualizing the nerves at US. The authors' discussion focuses on the superficial and deep peroneal, sural, saphenous, tibial, medial and lateral plantar, medial and inferior calcaneal, common digital, and medial proper plantar digital nerves.

Fatigue and the prediction of negative health outcomes: A systematic review with meta-analysis

INTRODUCTION

Fatigue is a common complaint among older adults. Evidence grows that fatigue is linked to several negative health outcomes. A general overview of fatigue and its relationship with negative health outcomes still lacks in the existing literature. This brings complications for healthcare professionals and researchers to identify fatigue-related health risks. Therefore, this study gives an overview of the prospective predictive value of the main negative health outcomes for fatigue in community-dwelling older adults.

METHODS

PubMed, Web of Knowledge and PsycINFO were systematically screened for prospective studies regarding the relationship between fatigue and negative health outcomes resulting in 4595 articles (last search 5th March 2020). Meta-analyses were conducted in RevMan using Odds ratios (ORs), Hazard ratios (HRs) and relative risk ratios (RR) that were extracted from the included studies. Subgroup-analyses were performed based on (1) gender (male/female), (2) length of follow-up and (3) fatigue level (low, medium and high).

RESULTS

In total, thirty articles were included for this systematic review and meta-analysis encompassing 152 711 participants (age range 40-98 years), providing information on the relationship between fatigue and health outcomes. The results showed that fatigue is related to an increased risk for the occurrence of all studied health outcomes (range OR 1.299-3.094; HR/RR 1.038-1.471); for example, mortality OR 2.14 [1.74-2.63]; HR/RR 1.44 [1.28-1.62]), the development of disabilities in basic activities of daily living (OR 3.22 [2.05-5.38]), or the occurrence of physical decline (OR 1.42 [1.29-1.57]).

CONCLUSION

Overall fatigue increases the risk for developing negative health outcomes. The analyses presented in this study show that fatigue related physical decline occurs earlier than hospitalization, diseases and mortality, suggesting the importance of early interventions.

Predicting appendicular lean and fat mass with bioelectrical impedance analysis in older adults with physical function decline - The PROVIDE study

BACKGROUND & AIMS

No generalizable formulas exist that are derived from bioelectrical impedance analysis (BIA) for predicting appendicular lean mass (ALM) and fat mass (AFM) in sarcopenic older adults. Since precision of regional body composition (BC) data in multicentre trials is essential, this study aimed to: 1) develop and cross-validate soft tissue BIA equations with GE Lunar and Hologic DXA systems as their reference 2) to compare our new ALM equation to two previously published models and 3) to assess the agreement between BIA- and DXA-derived soft tissue ratios as indicators of limb tissue quality.

METHODS

Two-hundred and ninety-one participants with functional limitations (SPPB-score 4-9; sarcopenia class I or II, measured by BIA) were recruited from 18 study centres in six European countries. BIA equations, using DXA-derived ALM and AFM as the dependent variable, and age, gender, weight, impedance index and reactance as independent variables, were developed using a stepwise multiple linear regression approach.

RESULTS

Cross-validation gave rise to 4 equations using the whole sample: ALM_LUNAR (kg) = 1.821 + (0.168*height²/resistance) + (0.132*weight) + (0.017*reactance) - (1.931*sex) [R² = 0.86 and SEE = 1.37 kg] AFM_LUNAR (kg) = -6.553 - (0.093* height²/resistance) + (0.272*weight) + (4.295*sex) [R² = 0.70 and SEE = 1.53 kg] ALM_HOLOGIC (kg) = 4.957 + (0.196* height²/resistance) + (0.060*weight) - (2.554*sex) [R² = 0.90 and SEE = 1.28 kg] AFM_HOLOGIC (kg) = -4.716 - (0.142* height²/resistance) + (0.316*weight) + (4.453*sex) - (0.040*reactance) [R² = 0.73 and SEE = 1.54 kg] Both previously published models significantly overestimated ALM in our sample with biases of -0.36 kg to -1.05 kg. For the ratio of ALM to AFM, a strong correlation (r = 0.82, P < 0.0001) was found between the mean estimate from BIA and the DXA models without significant difference (estimated bias of 0.02 and 95% LOA -0.62, 0.65).

CONCLUSION

We propose new BIA equations allowing the estimation of appendicular lean and fat mass. Our equations allow to accurately estimate the appendicular lean/fat ratio which might provide information regarding limb tissue quality, in clinical settings. Furthermore, these BIA equations can be applied to characterize sarcopenia with Hologic and Lunar reference values for BC. Previously published BIA-based models tend to overestimate ALM in sarcopenic older adults. Users of both GE Lunar and Hologic may now benefit from these equations in field research.

The operationalization of fatigue in frailty scales: a systematic review

PURPOSE

To identify the different fatigue items in existing frailty scales.

METHODS

PubMed, Web of Knowledge and PsycINFO were systematically screened for frailty scales. 133 articles were included, describing 158 frailty scales. Fatigue items were extracted and categorized in 4 fatigue constructs: "mood state related tiredness", "general feeling of tiredness", "activity based feeling of tiredness" and "resistance to physical tiredness".

RESULTS

120 fatigue items were identified, of which 100 belonged to the construct "general feeling of tiredness" and only 9 to the construct "resistance to physical tiredness". 49,4% of the frailty scales included at least 1 fatigue item, representing 15 ± 9,3% of all items in these scales. Fatigue items have a significantly higher weight in single domain (dominantly physical frailty scales) versus multi domain frailty scales (21 ± 3.2 versus 10.6 ± 9.8%, p=<0,05).

CONCLUSION

Fatigue is prominently represented in frailty scales, covering a great diversity in fatigue constructs and underlying pathophysiological mechanisms by which fatigue relates to frailty. Although fatigue items were more prevalent and had a higher weight in physical frailty scales, the operationalization of fatigue leaned more towards psychological constructs. This review can be used as a reference for choosing a suitable frailty scale depending on the type of fatigue of interest.

Direct relationship of body mass index and waist circumference with body tissue distribution in elderly persons

OBJECTIVES

To explore the relationship of BMI and WC with muscle/adipose tissue mass ratios and with trunk adipose tissue distribution, based on an anatomical 5-compartment model, by dissection of cadavers of elderly persons.

DESIGN

Cross-sectional explorative study.

SETTING

Brussels Cadaver Analysis Study.

PARTICIPANTS

Cadavers of twenty-nine white Caucasian elderly persons (17 females and 12 males, aged 78.1±6.9 years).

MEASUREMENTS

Whole body and trunk composition were determined at the anatomical tissue-system level by direct dissection.

RESULTS

BMI and WC were significantly and positively related to absolute tissue masses in both sexes. Muscle tissue mass, adipose tissue mass and trunk internal adipose tissue mass correlated better with BMI (r-values between 0.68 and 0.89) than with WC (r-values between 0.49 and 0.71). BMI was significantly and inversely related with various muscle/adipose tissue ratios in both sexes (r-values between -0.54 and -0.68). WC correlated with muscle/adipose tissue ratios in females only (r-values between -0.55 and -0.64). BMI was also significantly related to trunk adipose tissue distribution in elderly females, but not in males. When comparing individual tissue proportions within and between adjacent BMI-classifications or WC categories, body composition varied considerably.

CONCLUSION

Our results show that BMI and WC are significantly related with adipose tissue mass and with several ratios of muscle to adipose tissue in elderly subjects. However, cautious clinical interpretation is warranted since important differences in tissue mass proportions were found in subjects with similar BMI and/or WC values.

Reproducibility, accuracy and concordance of Accutrend Plus for measuring circulating lipid concentration in adults

INTRODUCTION

The determination of lipid biomarkers by capillary sampling may be useful in the screening, diagnosis and/or personal management of hyperlipidemia and cardiovascular risk. It remains unclear whether the use of the Accutrend Plus system is appropriate. This study aimed to assess its reproducibility, accuracy and concordance for blood lipid profiling in adults.

MATERIALS AND METHODS

Fasting capillary total cholesterol (TC) and triglyceride (TG) concentration on Accutrend Plus were compared with their venous analogues obtained by a laboratory reference method in sixty-one adults (27 men and 34 women, aged 33.0 years). Supplementary capillary sampling was performed at two consecutive days taking into account macro-nutrient intake.

RESULTS

The day-to-day reproducibility of the Accutrend Plus system proved to be high for TC (ICC = 0.85, P < 0.001), but moderate for TG (ICC = 0.68, P < 0.001). Strong correlations (r > or = 0.80, P < 0.001) with the reference method were found for TC and TG. Mean difference (limits of agreement) were: 0.26 mmol/L (-0.95, 1.47) for TC, and -0.16 mmol/L (-1.29, 0.98) for TG. The concordance for subject classification according to the National Cholesterol Education Program (NCEP) guidelines was significant (P < 0.001), with substantial agreement for TC (K(w) = 0.67), and moderate agreement for TG (K(w) = 0.50).

CONCLUSIONS

Day-to-day reproducibility of the Accutrend Plus device for TC and TG is not optimal and lacks accuracy when compared to the reference laboratory method. The concordance between both methods for classifying subjects according to the NCEP is inadequate. Accutrend Plus device should not be interchangeably used as a substitution for the standard laboratory methods in the diagnosis of hyperlipidemia.

Three-dimensional kinematics of the cervical spine using an electromagnetic tracking device. Differences between healthy subjects and subjects with non-specific neck pain and the effect of age

BACKGROUND

A cross-sectional observational study of three-dimensional cervical kinematics in 35 non-specific neck pain patients and 100 asymptomatic controls. To compare qualitative and quantitative aspects of cervical kinematics between healthy subjects and subjects with non-specific neck pain and to determine the effect of age on cervical kinematics in healthy subjects.

METHODS

Three-dimensional kinematics of active lateral bending and flexion-extension of 35 patients and 100 controls were registered by means of an electromagnetic tracking system. The means of several kinematic parameters were compared using t-tests. In addition, we assessed the age-dependency of the three-dimensional kinematic parameters by stratifying the 100 control subjects in 6 age categories.

FINDINGS

Comparison of the patient group with the control group reveals no statistically significant differences in qualitative and quantitative parameters. Analysis of the effect of age showed that the range of motion decreases significantly (p < 0.01) with increasing age. In lateral bending, the ratio between axial rotation and lateral bending increases significantly (p < 0.01) among older subjects. Differences in acceleration, jerk and polynomial fit are seen between the age categories, but are not significant.

INTERPRETATION

This study demonstrates no significant differences in kinematic parameters between healthy subjects and subjects with non-specific neck pain. Healthy subjects in higher age categories demonstrate higher ratios of coupled movements and lower ranges of motion. Future research should focus on classifying patients with non-specific neck pain in order to gain a better insight on possible subgroup specific differences in kinematics. More studies on this subject are warranted.

LEVEL OF EVIDENCE

4.

Use of anthropometry for the prediction of regional body tissue distribution in adults: benefits and limitations in clinical practice

Regional body composition changes with aging. Some of the changes in composition are considered major risk factors for developing obesity related chronic diseases which in turn may lead to increased mortality in adults. The role of anthropometry is well recognized in the screening, diagnosis and follow-up of adults for risk classification, regardless of age. Regional body composition is influenced by a number of intrinsic and extrinsic factors. Therapeutic measures recommended to lower cardiovascular disease risk include lifestyle changes. The aim of this review is to systematically summarize studies that assessed the relationships between anthropometry and regional body composition. The potential benefits and limitations of anthropometry for use in clinical practice are presented and suggestions for future research given.

The interrelationship between grip work, self-perceived fatigue and pre-frailty in community-dwelling octogenarians

INTRODUCTION

Low grip work and high feelings of self-perceived fatigue could be an early characteristic of decline in reserve capacity, which comes to full expression as physical frailty in a later stage. When grip work and self-perceived fatigue can be identified as characteristics differentiating between robustness and pre-frailty it might allow to identify pre-frailty earlier. Therefore, this study aimed to investigate whether the combination of grip work and self-perceived fatigue is related to pre-frailty in well-functioning older adults aged 80 and over.

METHODS

Four-hundred and five community-dwelling older adults aged 80 and over (214 robust and 191 pre-frail) were assessed for muscle endurance (grip Work corrected for body weight (GW_bw)), self-perceived fatigue (MFI-20) and frailty state (Fried Frailty Index, FFI). A Capacity to Perceived Vitality ratio (CPV) was calculated by dividing GW_bw by the MFI-20 scores. ANCOVA analysis (corrected for age and gender) was used to compare robust and pre-frail older adults, and binary logistic regressions were applied to analyze the relationship between CPV and pre-frailty status.

RESULTS

Pre-frail older adults who scored negative on the exhaustion item of the FFI still showed significantly lower GW (p < 0.001), CPV ratios (p < 0.001) and higher self-perceived fatigue (p < 0.05) compared to the robust ones. The likelihood for pre-frailty related significantly to higher age, being men and lower CPV ratios. In women, every unit increase in CPV ratio decreased the likelihood for pre-frailty by 78% (OR 0.22; 95% CI: 0.11-0.44), for men this effect was less strong (34%, OR 0.66; 95% CI: 0.47-0.93).

CONCLUSIONS

Pre-frail community-dwelling persons aged 80 years and over without clinical signs of exhaustion on the FFI still experience significantly higher fatigue levels (lower Grip Work, higher self-perceived fatigue and lower CPV levels) compared to robust ones. CPV ratio could therefore be a good tool to identify subclinical fatigue in the context of physical (pre-)frailty.

'External timing' of placebo analgesia in an experimental model of sustained pain

BACKGROUND

Research on placebo analgesia commonly focuses on the impact of information about direction (i.e., increase or decrease of pain) and magnitude of the expected analgesic effect, whereas temporal aspects of expectations have received little attention so far. In a recent study, using short-lasting, low-intensity stimuli, we demonstrated that placebo analgesia onset is influenced by temporal information. Here, we investigate whether the same effect of temporal suggestions can be found in longer lasting, high-intensity pain in a Cold Pressor Test (CPT).

METHODS

Fifty-three healthy volunteers were allocated to one of three groups. Participants were informed that the application of an (inert-)cream would reduce pain after 5 min (P5) or 30 min (P30). The third group was informed that the cream only had hydrating properties (NE). All participants completed the CPT at baseline and 10 (Test 10) and 35 min (Test 35) following cream application. Percentage change in exposure time (pain tolerance) from baseline to Test 10 (Δ10) and to Test 35 (Δ35) and changes in heart rate (HR) during CPT were compared between the three groups.

RESULTS

Δ10 was greater in P5 than in NE and P30, indicating that analgesia was only present in the group that was expecting an early onset of analgesia. Δ35 was greater in P5 and P30 compared to NE, reflecting a delayed onset of analgesia in P30 and maintained analgesia in P5. HR differences between groups were not significant.

CONCLUSIONS

Our data suggest that 'externally timing' of placebo analgesia may be possible for prolonged types of pain.

SIGNIFICANCE

Research on placebo effects mainly focuses on the influence of information about direction (i.e., increase or decrease of pain) and magnitude (i.e., strong or weak) of the expected effect but ignores temporal aspects of expectations. In our study in healthy volunteers, the reported onset of placebo analgesia followed the temporal information provided. Such 'external timing' effects could not only aid the clinical use of placebo treatment (e.g., in open-label placebos) but also support the efficacy of active drugs.

The correlation of muscle quantity and quality between all vertebra levels and level L3, measured with CT: An exploratory study

Introduction

In patients with cancer, low muscle mass has been associated with a higher risk of fatigue, poorer treatment outcomes, and mortality. To determine body composition with computed tomography (CT), measuring the muscle quantity at the level of lumbar 3 (L3) is suggested. However, in patients with cancer, CT imaging of the L3 level is not always available. Thus far, little is known about the extent to which other vertebra levels could be useful for measuring muscle status. In this study, we aimed to assess the correlation of the muscle quantity and quality between any vertebra level and L3 level in patients with various tumor localizations.

Methods

Two hundred-twenty Positron Emission Tomography (PET)-CT images of patients with four different tumor localizations were included: 1. head and neck (n = 34), 2. esophagus (n = 45), 3. lung (n = 54), and 4. melanoma (n = 87). From the whole body scan, 24 slices were used, i.e., one for each vertebra level. Two examiners contoured the muscles independently. After contouring, muscle quantity was estimated by calculating skeletal muscle area (SMA) and skeletal muscle index (SMI). Muscle quality was assessed by calculating muscle radiation attenuation (MRA). Pearson correlation coefficient was used to determine whether the other vertebra levels correlate with L3 level.

Results

For SMA, strong correlations were found between C1-C3 and L3, and C7-L5 and L3 (r = 0.72-0.95). For SMI, strong correlations were found between the levels C1-C2, C7-T5, T7-L5, and L3 (r = 0.70-0.93), respectively. For MRA, strong correlations were found between T1-L5 and L3 (r = 0.71-0.95).

Discussion

For muscle quantity, the correlations between the cervical, thoracic, and lumbar levels are good, except for the cervical levels in patients with esophageal cancer. For muscle quality, the correlations between the other levels and L3 are good, except for the cervical levels in patients with melanoma. If visualization of L3 on the CT scan is absent, the other thoracic and lumbar vertebra levels could serve as a proxy to measure muscle quantity and quality in patients with head and neck, esophageal, lung cancer, and melanoma, whereas the cervical levels may be less reliable as a proxy in some patient groups.

Critical appraisal and hazards of surface electromyography data acquisition in sport and exercise

The aim of this critical appraisal and hazards of surface electromyography (SEMG) is to enhance the data acquisition quality in voluntary but complex movements, sport and exercise in particular. The methodological and technical registration strategies deal with telemetry and online data acquisition, the placement of the detection electrodes and the choice of the most adequate normalization mode.Findings compared with the literature suggest detection quality differences between registration methods and between water and air data acquisition allowing for output differences up to 30% between registration methods and up to 25% decrease in water, considering identical measures in air and in water. Various hazards deal with erroneous choices of muscles or electrode placement and the continuous confusion created by static normalization for dynamic motion. Peak dynamic intensities ranged from 111% (in archery) to 283% (in giant slalom) of a static 100% reference. In addition, the linear relationship between integrated EMG (IEMG) as a reference for muscle intensity and muscle force is not likely to exist in dynamic conditions since it is muscle - joint angle - and fatigue dependent. Contrary to expectations, the literature shows 30% of non linear relations in isometric conditions also.SEMG in sport and exercise is highly variable and different from clinical (e.g. neurological) EMG. Choices of electrodes, registration methods, muscles, joint angles and normalization techniques may lead to confusing and erroneous or incomparable results.

Cross-sectional content analysis of clinically applied circumferences

BACKGROUND

The contours of a human body are determined by the volumes of the underlying tissues [adipose tissue (AT), muscle, bone and viscera]. Conceptually, they are assumed to be used as a concentric set of cylinders. Determination of these clinically applied circumferences in terms of relative tissue proportions has led to conflicting results. As it remains unclear what a circumference really measures or represents and how it relates to body composition (BC), the aim of this study was to determine the content of the circumferences and whether these perimeters can be used to assess segmental or whole body tissue components.

DESIGN

Subsequent to an anthropometric protocol, the five white Caucasian cadavers were fractionated into slices of 3 cm and segmental and whole BC was determined at the anatomical tissue-system level by direct dissection.

RESULTS

Only two circumferences correlated significantly with their dominating component [upper arm circumference (r = 0·98; P < 0·01) and waist circumference (WC) (r = 0·90; P < 0·05) with AT]. Two circumferences were related to a segmental tissue component [WC (r = 1·00; P < 0·001) with muscle mass of the trunk and wrist circumference (WrC) (r = 0·90; P < 0·05) with bone mass of the upper limb]. Two circumferences were related to a whole body tissue component [chest circumference (r = 0·90; P < 0·05) with whole body AT mass and WrC (r = 0·90; P < 0·05) with whole body bone mass].

CONCLUSION

The clinically applied circumferences do not measure what they pretend to measure. Of all the studied circumferences, only 2 circumferences (WC and WrC) can be used to assess segmental or whole body tissue components.

Effectiveness of local exercise therapy versus spinal manual therapy in patients with patellofemoral pain syndrome: medium term follow-up results of a randomized controlled trial

Background

Increasing evidence has shown benefits of spinal manipulations in patients with patellofemoral pain syndrome (PFPS). There is scarcity regarding medium term effects of spinal manual therapy on outcome measures in PFPS patients. Therefore, the aim of the present study was to compare the effectiveness of local exercise therapy and spinal manual therapy for knee pain, function and maximum voluntary peak force (MVPF) velocity of the quadriceps in PFPS patients.

Methods

Forty-three patients with PFPS were randomly assigned to a local exercise or spinal manual therapy group. The local exercise group received six sessions (one session per week) of supervised training of the knee-and hip muscles with mobilization of the patellofemoral joint. The spinal manual therapy group received six interventions (one intervention per week) of high velocity low thrust manipulations at the thoracolumbar region, sacroiliac joint, and/or hip. All patients were also asked to do home exercises. Maximum, minimum and current pain were measured using the visual analogue scale. Function was assessed with the anterior knee pain scale (AKPS) and MPFV was recorded using a Biodex System 3 dynamometer. Patients were assessed before intervention, after 6 weeks of intervention and after 6 weeks of follow-up. Between-group differences at assessments were analysed by way of analysis of covariance with Bonferroni correction.

Results

Pain and functionality improved more following spinal manipulative therapy than local exercise therapy. After 6 weeks of intervention the between-group difference (local versus spinal) for maximal pain was 23.4 mm [95% CI: 9.3, 37.6; effect size (ES): 1.04] and − 12.4 [95% CI: − 20.2, − 4.7; ES: 1.00] for the AKPS. At 6 weeks of follow-up the between-group difference for maximal pain was 18.7 mm [95% CI: 1.4, 36.0; ES: 0.68] and − 11.5 [95% CI: − 19.9, − 3.3; ES: − 0.87] for the AKPS.

Conclusions

This study suggests that spinal manual therapy is more effective than local exercise therapy in improving pain and function in patients with PFPS in the medium term. We suggest for future research to investigate whether combining local exercise therapy and spinal manual therapy is more effective than either single intervention on its own.

This clinical trial study was approved by the Medical Ethics Committee METC Z under registration number NL57207.096. and registered retrospectively in ClinicalTrials.gov PRS with registration ID number NCT04748692 on the 10th of February 2021.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-021-04310-9.

The validity of ultrasound-derived equation models to predict whole-body muscle mass: A systematic review

BACKGROUND & AIMS

Sarcopenia is defined as the age-related loss in muscle quantity and quality which is associated with physical disability. The assessment of muscle quantity plays a role in the diagnosis of sarcopenia. However, the methods used for this assessment have many disadvantages in daily practice and research, like high costs, exposure to radiation, not being portable, or doubtful reliability. Ultrasound has been suggested for the estimation of muscle quantity by estimating muscle mass, using a prediction equation based on muscle thickness. In this systematic review, we aimed to summarize the available evidence on existing prediction equations to estimate muscle mass and to assess whether these are applicable in various adult populations.

METHODS

The databases PubMed, PsycINFO, and Web of Science were used to search for studies predicting total or appendicular muscle mass using ultrasound. The methodological quality of the included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies, version 2 (QUADAS-2) and the quality assessment checklist (QA) designed by Pretorius and Keating (2008).

RESULTS

Twelve studies were included in this systematic review. The participants were between 18 and 79 years old. Magnetic Resonance Imaging and dual-energy X-ray absorptiometry were used as reference methods. The studies generally had low risk of bias and there were low concerns regarding the applicability (QUADAS-2). Nine out of eleven studies reached high quality on the QA. All equations were developed in healthy adults.

CONCLUSIONS

The ultrasound-derived equations in the included articles are valid and applicable in a healthy population. For a Caucasian population we recommend to use the equation of Abe et al., 2015. While for an Asian population, we recommend to use the equation of Abe et al., 2018, for the South American population, the use of the equation of Barbosa-Silva et al., 2021 is the most appropriate.

Reliability of Muscle Quantity and Quality Measured With Extended-Field-of-View Ultrasound at Nine Body Sites

OBJECTIVE

Measuring muscle quantity and quality is very important because the loss of muscle quantity and quality is associated with several adverse effects specifically in older people. Ultrasound is a method widely used to measure muscle quantity and quality. One problem with ultrasound is its limited field of view, which makes it impossible to measure the muscle quantity and quality of certain muscles. In this study, we aimed to evaluate the intra- and inter-rater reliability of extended-field-of-view (EFOV) ultrasound for the measurement of muscle quantity and quality in nine muscles of the limbs and trunk.

METHODS

Two examiners took two ultrasound EFOV images with a linear probe from each of the muscle sites. The intraclass correlation coefficient (ICC) was used, and the standard error of measurement and coefficient of variation were calculated.

RESULTS

Intra-rater reliability was good to excellent (ICC = 0.2-1.00) for all muscle measurements. The inter-rater reliability for most of the muscle measurements was good to excellent (ICC = 0.82-0.98). Inter-rater reliability was moderate (0.58-0.72) for some muscle quantity measurements of the tibialis anterior, gastrocnemius, rectus femoris, biceps femoris and triceps brachii muscles.

CONCLUSION

Muscle quantity and quality can be measured reliably using EFOV US.

MR imaging-anatomical correlation of the metatarsophalangeal joint of the hallux: Ligaments, tendons, and muscles

OBJECTIVE

To perform an MR imaging-anatomical correlation to elucidate the anatomy of muscles, tendons, and ligaments about the hallux as seen on MR imaging.

MATERIALS AND METHODS

Four fresh and 4 embalmed cadaver specimens were used for this study. The embalmed specimens and one fresh specimen were dissected by three investigators. The fresh specimens were preserved deep frozen. They were thawed and imaged with a 3 T MR system. Proton density weighted images were obtained. The specimens were refrozen and sectioned with a band saw into 3 mm thick slices.

RESULTS

Musculotendinous structures were equally well seen in the fresh and embalmed specimens. The capsular ligaments could best be studied in the fresh specimens. Proximal to the sesamoids the following muscle and tendon anatomy was delineated: the abductor hallucis tendon inserted on the medial sesamoid bone together with the medial belly of the flexor digitorum brevis; the adductor hallucis (transverse and oblique heads) inserted on the lateral sesamoid together with the lateral head of the flexor hallucis brevis. At the level of the sesamoid bones and distally, the ligaments making up the plantar plate were delineated, including the presesamoid band, the flexor hallucis longus pulley, the sesamometatarsal ligaments, the sesamophalangeal ligaments, and the capsular ligaments.

CONCLUSION

MRI allows for accurate assessment of the complex anatomy of the hallux. At the level proximal to the sesamoids the muscle and tendon insertions are well demonstrated. At the level of the sesamoids and distally, the ligaments making up 'the plantar plate' are well demonstrated.