Ishimoto Taisei, Fujimoto Takehiro, Hisamatsu Ken, Matsudaira Nozomi, Hayashi Hikaru, Hashimoto Risako, Toyota Yoshio, Akazawa Naoki
Department of Rehabilitation, Akahige Clinic, Koda 378, Momoyama-town, Kinokawa-city, Wakayama, 649-6123, Japan.
Department of Integrated Health Sciences, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan.
Eur Geriatr Med. 2025 Apr;16(2):615-623. doi: 10.1007/s41999-024-01145-0. Epub 2025 Jan 5.
The accuracy of determining gait independence using adductor pollicis muscle thickness (APMT) and skeletal muscle mass index (SMI) in community-dwelling older adults undergoing outpatient rehabilitation remains unclear. The purpose of this study was to compare the accuracy of determining gait independence using APMT and SMI in community-dwelling older adults undergoing outpatient rehabilitation.
This study included 98 older adults (mean age: 85.2 years). Participants received outpatient rehabilitation one to three times a week. The main outcomes were gait independence (functional independence measure gait score: 6 or 7), skeletal muscle mass index (SMI), and APMT. Receiver operating characteristic (ROC) curves of APMT and SMI for gait independence were created, and cut-off values were calculated using the Youden index. Additionally, the area under the curve (AUC) s of the APMT model and the SMI model were compared using the Delong test.
Among the 98 participants (male; 19, female; 79), 53 (54.1%) were in the gait independent group. The cut-off value of APMT calculated from the ROC curve was 13 mm; the sensitivity and specificity were 67.9% and 86.7%, respectively; and the AUC was 0.800. The cut-off value of SMI calculated from the ROC curve was 4.6 kg/m; the sensitivity and specificity were 90.6% and 26.7%, respectively; and the AUC was 0.582. The AUC for the APMT model was significantly higher than the SMI model (P < 0.001).
The results of this study show that the cut-off value of APMT for determining the gait independence was 13 mm. In addition, APMT had a higher accuracy of determining gait independence than SMI. This indicates that measuring APMT is more useful for predicting gait independence than SMI in community-dwelling older adults undergoing outpatient rehabilitation.
在接受门诊康复治疗的社区老年人中，使用拇收肌厚度（APMT）和骨骼肌质量指数（SMI）来确定步态独立性的准确性尚不清楚。本研究的目的是比较在接受门诊康复治疗的社区老年人中，使用APMT和SMI来确定步态独立性的准确性。
本研究纳入了98名老年人（平均年龄：85.2岁）。参与者每周接受一至三次门诊康复治疗。主要结局指标为步态独立性（功能独立性测量步态评分：6或7）、骨骼肌质量指数（SMI）和APMT。绘制了APMT和SMI用于步态独立性的受试者工作特征（ROC）曲线，并使用约登指数计算临界值。此外，使用德龙检验比较了APMT模型和SMI模型的曲线下面积（AUC）。
在98名参与者中（男性19名，女性79名），53名（54.1%）属于步态独立组。根据ROC曲线计算出的APMT临界值为13毫米；敏感性和特异性分别为67.9%和86.7%；AUC为0.800。根据ROC曲线计算出的SMI临界值为4.6千克/平方米；敏感性和特异性分别为90.6%和26.7%；AUC为0.582。APMT模型的AUC显著高于SMI模型（P<0.001）。
本研究结果表明，用于确定步态独立性的APMT临界值为13毫米。此外，APMT在确定步态独立性方面比SMI具有更高的准确性。这表明，在接受门诊康复治疗的社区老年人中，测量APMT比SMI更有助于预测步态独立性。
