老年癌症患者的老年综合评估损伤及其与不同握力阈值和简短体能状况量表各组成部分的关联。
Impairments in geriatric assessment and their associations with different grip strength cutoffs and components of the Short Physical Performance Battery among older adults with cancer.
作者信息
Cobbing Saul, Alibhai Shabbir M H, Jin Rana, Monginot Susie, Papadopoulos Efthymios
机构信息
Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
出版信息
J Geriatr Oncol. 2025 Apr;16(3):102201. doi: 10.1016/j.jgo.2025.102201. Epub 2025 Feb 15.
INTRODUCTION
The grip strength test is often used during geriatric assessment (GA) to assess muscle strength in older adults. However, it is unclear which grip strength cutoffs are most relevant to older adults in the context of GA. Physical performance during GA is often assessed via the Short Physical Performance Battery (SPPB). Whether the SPPB is superior to two of its individual components (4-m gait speed and the 5-chair stand test) for identifying GA abnormalities is unknown. The objectives of this study were (i) to identify which grip strength thresholds are associated with impairments in GA domains and with an abnormal GA overall and (ii) to examine whether total SPPB score is a stronger indicator of an abnormal GA and each of its domains than 4-m gait speed and the 5-chair stand test.
MATERIALS AND METHODS
This was a retrospective cohort study of older adults with cancer aged ≥65 years who had undergone a GA prior to treatment. Grip strength and the SPPB were completed during GA. We examined three different grip strength cutoffs: (i) European Working Group on Sarcopenia in Older People 2 (EWGSOP2); (ii) the Foundation for the National Institutes of Health (FNIH); and (iii) the Sarcopenia Definitions and Outcomes Consortium (SDOC). Low SPPB was defined as a score of ≤9 out of 12 points. A score of ≤3 out of 4 points was used to identify abnormalities in the 4-m gait speed and 5-chair stand test. Multivariable logistic regression was used to address the study objectives.
RESULTS
A total of 475 participants (mean age: 80.7 years, 42.9 % female) were included. The FNIH grip strength criteria had a higher discriminative ability of an abnormal GA (area under the curve [AUC] = 0.646) than the EWGSOP2 and the SDOC criteria. Compared to the SPPB and the 5-chair stand test, the 4-m gait speed was the strongest indicator of an abnormal GA (AUC = 0.737). The addition of low grip strength improved the performance of the SPPB (AUC Δ = +0.05) and gait speed (AUC Δ = +0.04) for identifying an abnormal GA.
DISCUSSION
Low grip strength per the FNIH and slow gait speed are of clinical relevance during GA.
引言
握力测试常用于老年评估（GA）中，以评估老年人的肌肉力量。然而，在GA背景下，尚不清楚哪些握力临界值与老年人最为相关。GA期间的身体表现通常通过简短身体表现量表（SPPB）进行评估。SPPB在识别GA异常方面是否优于其两个单独的组成部分（4米步速和5次起坐测试）尚不清楚。本研究的目的是：（i）确定哪些握力阈值与GA各领域的损伤以及整体GA异常相关；（ii）检验SPPB总分是否比4米步速和5次起坐测试更能有力地表明GA异常及其各个领域。
材料与方法
这是一项对年龄≥65岁、在治疗前接受过GA的老年癌症患者的回顾性队列研究。在GA期间完成握力测试和SPPB。我们研究了三种不同的握力临界值：（i）老年肌肉减少症欧洲工作组2（EWGSOP2）；（ii）美国国立卫生研究院基金会（FNIH）；（iii）肌肉减少症定义与结果联盟（SDOC）。低SPPB被定义为12分中得分≤9分。4分中得分≤3分用于识别4米步速和5次起坐测试中的异常情况。采用多变量逻辑回归来实现研究目的。
结果
共纳入475名参与者（平均年龄：80.7岁，42.9%为女性）。与EWGSOP2和SDOC标准相比，FNIH握力标准对GA异常具有更高的判别能力（曲线下面积[AUC]=0.646）。与SPPB和5次起坐测试相比，4米步速是GA异常的最强指标（AUC=0.737）。低握力的加入提高了SPPB（AUC增量=+0.05）和步速（AUC增量=+0.04）识别GA异常的性能。
讨论
在GA期间，FNIH定义的低握力和缓慢步速具有临床相关性。
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