Medicine (Austin & Northern Health) - Theses
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ItemSarcopenia in Inpatient Rehabilitation( 2022)Sarcopenia is a disorder characterised by reduced muscle mass and strength or function. It is associated with reduced functional performance as well as increased morbidity and mortality in community dwellers and in people living in residential care. Sarcopenia is associated with increased risk of diabetes, and people with diabetes are known to have reduced muscle mass, strength and function. Sarcopenia is more prevalent in older people, but can occur in younger people as well. Inpatient rehabilitation aims to optimise people’s function, usually immediately following admission to an acute hospital. In Australia, adults of all ages and diagnostic groups are admitted to inpatient rehabilitation if clinically indicated, resulting in a broad variety of conditions in patients not limited to the geriatric population. Sarcopenia has not been investigated in this broad population undergoing inpatient rehabilitation. Since people use their muscles in order to perform the movements and physical exercises that aim to ultimately improve their functional performance, a disorder that directly affects muscle has potential to influence people’s function on admission to and progress during inpatient rehabilitation. The overall research objective of this thesis is to investigate sarcopenia in inpatient rehabilitation by examining: - the prevalence of sarcopenia, - the utility of sarcopenia screening tools, - the association of sarcopenia with people’s functional performance on admission to rehabilitation, - the association of sarcopenia with rehabilitation outcomes, while specifically focusing on potential interactions between sarcopenia, diabetes and age in relation to functional performance. This objective is achieved by conducting six studies: a systematic review and meta-analysis of the literature on sarcopenia in inpatient rehabilitation and five studies that enrolled participants among people admitted to a subacute inpatient rehabilitation unit in a metropolitan tertiary referral hospital in Melbourne, Australia. These studies are the first to characterise sarcopenia in inpatient rehabilitation without excluding any age or diagnostic groups. I found that the prevalence of sarcopenia in inpatient rehabilitation was 14.7%. I developed an original screening tool for sarcopenia which uses the combination of low grip strength and Body Mass Index as a positive screening test for sarcopenia. I found that this screening tool has the ROC area of 0.89. I was able to show that there is a significant difference in the strength of association between sarcopenia and functional performance on admission to inpatient rehabilitation between participants with and without diabetes. I found that there is a significant association in participants with diabetes, while there is no evidence of such association in participants without diabetes. I also found that there is also a significant difference in the strength of association between sarcopenia and improvement in functional performance in inpatient rehabilitation between participants older and younger than 65 years of age. In more detail, the presence of sarcopenia was associated with a greater median Functional Independence Measure change in participants older than 65 years, while there was no evidence of such an association in younger participants. I conclude that sarcopenia was prevalent in general inpatient rehabilitation population and was associated with functional performance and improvement in specific subpopulations based on age and diabetes status. The findings presented in this thesis have enriched the research into sarcopenia in inpatient rehabilitation by contributing original knowledge elements and providing suitable therapeutic targets for future research into this important field.