Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.
Department of Physiotherapy, Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom.
PLoS One. 2019 Jan 4;14(1):e0210186. doi: 10.1371/journal.pone.0210186. eCollection 2019.
The primary objective of the review was to describe change that occurs in skeletal muscle during periods of unplanned hospitalisation in adult patients. The secondary objective was to examine the relationship between both physical activity and inflammation with the change in skeletal muscle. A further objective was to investigate the effect of interventions on change in skeletal muscle during periods of unplanned hospitalisation.
A systematic review and meta-analyses. Embase, MEDLINE, CINAHL, AMED, PEDro and the Cochrane Library were searched for studies that included any measures of skeletal muscle (excluding pulmonary function) at two time points during unplanned hospitalisation. Studies that were set in critical care, or included patients with acute or progressive neurological illness, were excluded.
Our search returned 27,809 unique articles, of which 35 met the inclusion criteria. Meta-analyses of change between baseline and follow-up in random effects models suggested that grip strength had an average increase: standardised mean difference (SMD) = 0.10 (95% CI: 0.03; 0.16); knee extension strength had an average reduction: SMD = -0.24 (95% CI: -0.33; -0.14); and mid-arm muscle circumference had an average reduction: SMD = -0.17 (95% CI: -0.22; -0.11). Inflammation appeared to be associated with greater loss of muscle strength. There was inconclusive evidence that the level of physical activity affects change in skeletal muscle. In regard to the effect of interventions, only exercise interventions were consistently associated with improved skeletal muscle outcomes.
Adult patients who undergo an unplanned hospital admission may experience a small reduction in knee extension strength and mid-arm muscle mass. Prospective research is needed to clarify the contribution of confounding factors underlying the observations made in this review, with particular attention to levels of physical activity, and possible contributions from environmental factors and processes of hospital care.
本次综述的主要目的是描述成年患者在计划外住院期间骨骼肌发生的变化。次要目的是检查身体活动和炎症与骨骼肌变化之间的关系。进一步的目的是调查干预措施对计划外住院期间骨骼肌变化的影响。
系统评价和荟萃分析。检索了 Embase、MEDLINE、CINAHL、AMED、PEDro 和 Cochrane 图书馆中在计划外住院期间两次时间点测量骨骼肌（不包括肺功能）的研究。排除了在重症监护室进行的研究或包括急性或进行性神经疾病患者的研究。
我们的搜索返回了 27809 篇独特的文章，其中 35 篇符合纳入标准。随机效应模型中基线和随访之间变化的荟萃分析表明，握力平均增加：标准化均数差（SMD）= 0.10（95%CI：0.03；0.16）；膝关节伸展力量平均下降：SMD = -0.24（95%CI：-0.33；-0.14）；和上臂中部肌肉周长平均下降：SMD = -0.17（95%CI：-0.22；-0.11）。炎症似乎与肌肉力量更大的丧失有关。关于身体活动水平是否影响骨骼肌变化的证据尚无定论。关于干预措施的效果，只有运动干预始终与改善骨骼肌结果相关。
接受计划外住院治疗的成年患者可能会经历膝关节伸展力量和上臂中部肌肉质量的轻微下降。需要前瞻性研究来阐明本综述中观察结果的潜在混杂因素的贡献，特别注意身体活动水平，以及环境因素和医院护理过程的可能贡献。
