Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
Department of Physiotherapy, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK.
Age Ageing. 2021 Jan 8;50(1):153-160. doi: 10.1093/ageing/afaa103.
to investigate changes in knee-extension strength and physical function in older adults during and after acute hospital admission, and the contributions of illness severity, frailty and sedentary activity to changes in knee-extension strength.
prospective repeated-measures cohort study on a sample of participants aged ≥75 recruited within 24 hours of acute hospital admission. Knee-extension, grip strength and functional mobility (de Morton Mobility Index, DEMMI) were measured at recruitment, day 7 (or discharge if earlier), and at follow-up 4-6 weeks later. During the first 7 days, continuous measurement of physical activity and daily measurements of muscle strength were taken. Participants recalled the functional ability they had 2-weeks before admission and self-reported it at follow-up (Barthel Index, BI).
sixty-five of 70 participants (median age 84 years) had at least one repeated measure of muscle strength in hospital. Knee-extension strength declined during hospitalisation by 11% (P < 0.001), but did not change post-hospitalisation (P = 0.458). Grip strength did not change during hospitalisation (P = 0.665) or from discharge to follow-up (P = 0.508). General functional ability (BI) deteriorated between 2 weeks before admission and follow-up (P < 0.001). Functional mobility (DEMMI) improved during hospitalisation (P < 0.001), but did not change post-hospitalisation (P = 0.508). A repeated-measures mixed model showed that greater loss in knee-extension strength during hospitalisation was associated with increased sedentary time, frailty and baseline strength and lower baseline inflammatory levels.
our observations add to a growing body of evidence on potential risk factors for hospital-associated deconditioning.
调查急性住院期间和之后老年人膝关节伸展力量和身体功能的变化，以及疾病严重程度、虚弱和久坐活动对膝关节伸展力量变化的影响。
这是一项前瞻性重复测量队列研究，研究对象为在急性入院 24 小时内招募的年龄≥75 岁的参与者。在招募时、第 7 天（或提前出院）以及 4-6 周后的随访时测量膝关节伸展力量、握力和功能性移动性（de Morton 移动性指数，DEMMI）。在最初的 7 天内，对身体活动进行连续测量，并每天测量肌肉力量。参与者回忆起入院前两周的功能能力，并在随访时进行自我报告（巴氏指数，BI）。
在 70 名参与者中，有 65 名（中位数年龄 84 岁）至少有一次在医院重复测量肌肉力量。膝关节伸展力量在住院期间下降了 11%（P<0.001），但在出院后没有变化（P=0.458）。握力在住院期间（P=0.665）或从出院到随访期间（P=0.508）都没有变化。一般功能能力（BI）在入院前两周和随访期间恶化（P<0.001）。功能性移动性（DEMMI）在住院期间得到改善（P<0.001），但在出院后没有变化（P=0.508）。重复测量混合模型显示，住院期间膝关节伸展力量下降较多与久坐时间增加、虚弱和基线力量降低以及基线炎症水平降低有关。
我们的观察结果增加了越来越多的关于与住院相关去适应的潜在危险因素的证据。
