Medicine (Austin & Northern Health) - Research Publications
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ItemThe Association Between Sarcopenia and Functional Improvement in Older and Younger Patients Who Completed Inpatient Rehabilitation: A Prospective Cohort Study(FRONTIERS MEDIA SA, 2021-10-21)Objective: To investigate the association between sarcopenia and functional improvement in patients older and younger than 65 years upon completion of an inpatient rehabilitation program. Design: Prospective cohort study. Participants: Adult consecutive patients who completed the inpatient rehabilitation program at a metropolitan tertiary referral hospital general inpatient rehabilitation unit. Methods: Sarcopenia status was determined using the European Working Group on Sarcopenia in Older People 2 algorithm, using muscle mass measured by BioImpedance Analysis and grip strength. Progress in rehabilitation was measured using change in the Functional Independence Measure and Goal Attainment Scaling score. To investigate the age group by sarcopenia status interaction we used quantile regression models with bootstrapped standard error estimation for functional improvement and linear regression model with robust standard error estimation for GAS score. Results: 257 participants [128 (50%) male, median age 63 years (IQR: 52-72)], 33(13%) with sarcopenia, completed inpatient rehabilitation [median length of stay 16 days (IQR: 11-27.5)]. Participants' median Functional Independence Measure change was 24 (IQR 15-33.5) and mean total Goal Attainment Scaling score was 57.6 (SD 10.2). Adjusting for admission Functional Independence Measure score, the median difference in Functional Independence Measure change between participants with and without sarcopenia was: -4.3 (95% CI: -10.6, 1.9); p = 0.17 in participants 65 years and younger, and 4.6 (95% CI: 1.0, 8.2); p = 0.01 in participants older than 65; age-by-sarcopenia interaction p = 0.02. Conclusions: Unlike younger people, older people with sarcopenia have greater functional improvement in inpatient rehabilitation than those without sarcopenia.
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ItemThe prevalence of sarcopenia in middle‐aged and older patients in post‐acute inpatient rehabilitation: a cross‐sectional study(Wiley, 2021-01)Abstract Background Despite the recommendation of European Working Group on Sarcopenia in Older People 2 (EWGSOP2) consensus statement not to exclude patients younger than 65 years, the prevalence of sarcopenia has not been investigated in younger post‐acute inpatient rehabilitation population. The objectives of this study were to: estimate the prevalence of sarcopenia in post‐acute inpatient rehabilitation population; compare the prevalence of sarcopenia in patients above and below 65 years. Methods This cross‐sectional observational study recruited adult patients admitted to an inpatient rehabilitation unit at a metropolitan tertiary referral hospital in Melbourne, Australia. Participants' sarcopenia status was determined using the EWGSOP2 algorithm based on grip strength and muscle mass. Results Between November 2016 and January 2019, 203 participants were enrolled. Participants' broad diagnostic streams included musculoskeletal, neurologic, spinal, cardiac, amputee, and deconditioning. The overall prevalence of sarcopenia was 18% [95% confidence interval (CI) 13% to 24%]. The prevalence of sarcopenia in patients younger than 65 was 14% (95% CI 8% to 22%), and the prevalence in patients 65 and older was 23% (95% CI 15% to 32%), risk difference of 9% (95% CI: −1.2% to 20%; P = 0.1). With incorporation of these results into the most recent meta‐analysis of sarcopenia in inpatient rehabilitation, the mean pooled prevalence of sarcopenia was 47% (95% CI 23% to 71%). Stratified by age, patients with sarcopenia had significantly longer preceding length of stay in the acute hospital (P = 0.015). Conclusions The overall estimated prevalence of sarcopenia in patients admitted to inpatient rehabilitation was 18%, and the estimated prevalence of sarcopenia in patients younger than 65 was 14%.
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ItemSystematic review and meta-analysis of prevalence of sarcopenia in post acute inpatient rehabilitation(Springer, 2018-04-01)Summary: Sarcopenia is associated with poor function and increased risk of falls and disability. This work reports a systematic review and meta-analysis of prevalence of sarcopenia in post acute inpatient rehabilitation. Sarcopenia is found to be present in approximately 50% of rehabilitation patients and its prevalence may vary with admission diagnosis. Purpose: To conduct a systematic review and meta-analysis of reported prevalence of sarcopenia in post acute inpatient rehabilitation. Methods: Systematic review conducted according to PRISMA guidelines (PROSPERO registration number CRD42016054135). Databases searched MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Methodology Register, and CINAHL. Studies considered the following: published January 1988–February 2017. Key terms are as follows: “sarcopenia” AND “inpatient rehabilitation” OR “rehabilitation” AND/OR “prevalence”. Abstracts and subsequently full studies reporting sarcopenia prevalence in adults admitted to rehabilitation reviewed irrespective of design, provided sarcopenia diagnosis included at least assessment of muscle mass. Random effect meta-analysis was conducted. Methodological quality assessment: Agency for Healthcare Research and Quality, US Department of Health and Human Services tool (MORE tool); Joanna Briggs Institute Prevalence Critical Appraisal Tool. Results: Four hundred twenty-six studies identified during initial search, 399 excluded after reviewing titles and abstracts, 21 full text articles reviewed, and six studies met inclusion criteria. Patient populations: after hip fracture (five studies), general deconditioning (one study). Identified sarcopenia prevalence ranged from 0.28 to 0.69. Pooled sarcopenia prevalence obtained with random effect meta-analysis: 0.56 (95% CI 0.46–0.65), heterogeneity I2 = 92.9%. Main quality shortcomings: lack of reporting of inter- and intra-rater reliability, lack of generalizability to other rehabilitation populations. Conclusions: Original research examining sarcopenia prevalence in inpatient rehabilitation is scarce. Patient populations studied to date are not representative of general rehabilitation population with regard to both age and admission diagnoses. Sarcopenia may be present in approximately half of rehabilitation patients and its prevalence may vary with admission diagnosis.