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Standard Operating Procedure - Single Frequency Bio-Impedantie Analyse

Leidt overgewicht of obesitas tot een verschil in mate van functioneel herstel na een totale heup artroplastiek ten opzichte van patiënten met een normaal gewicht?

Achtergrond: Coxartrose wordt vaak in het eindstadium behandeld met een Totale Heup Artroplastiek (THA). In de postoperatieve fase na een THA varieert het fysiotherapeutische beleid. Mogelijk leidt een verhoogd BMI tot een trager functioneel herstel na een THA. Een aangepast revalidatietraject zou dan van belang zijn. Vraagstelling: Is er een verschil in mate van functioneel herstel na een THA, bij patiënten met normaal gewicht, overgewicht en obesitas 12 weken en 6 maanden postoperatief? Daarnaast wordt de mate van associatie bepaald tussen BMI en de mate van functioneel herstel. Methode: In dit longitudinaal, prospectief onderzoek werden patiënten geïncludeerd in het PIUS ziekenhuis in Oldenburg; ze kregen allen eenzelfde revalidatietraject na de THA. Indeling vond plaats in 3 subgroepen, met normaal gewicht (BMI 18,5- 25 kg/m²), overgewicht (BMI 25 - 30 kg/m²) en obesitas (BMI > 30kg/m²). Mate van functioneel herstel werd objectief gemeten met de Timed Up & Go test (TUG) en de 5 Times Sit-to-Stand Test (5TSST), en subjectief met de self-reported vragenlijsten: de Hip disability and Osteoarthritis Outcome Score (HOOS) en de Short Form 36 (SF-36). Metingen werden verricht preoperatief (T0), en 12 weken (T1) en 6 maanden (T2) postoperatief. Met behulp van de Kruskall-Wallis test werden de verschilscores van de uitkomstmaten in de 3 subgroepen tussen T0-T1 en T0-T2 geanalyseerd. De mate van associatie werd berekend met de Spearman correlatiecoëfficiënt (rS). Het significantieniveau was p<0.05. Resultaten: Er werden 62 patiënten geïncludeerd. Er waren geen significante verschillen in functioneel herstel in beide tijdsintervallen tussen de groepen met een normaal gewicht (n=14), overgewicht (n=23) en obesitas (n=25); de p-waarde varieerde bij T0-T1 van p=0,069 tot p=0,962 en bij T0-T2 van p=0,068 tot p=0,931. Er werden zeer zwakke tot zwakke correlaties gevonden tussen BMI en de mate van functioneel herstel, variërend bij T0-T1 van rS=0,02 (p=0,892) bij de TUG tot rS=0,26 (p=0,041) bij ‘Algemene gezondheidsbeleving’ van de SF-36. Tussen T0-T2 varieerde de correlatiecoëfficiënt van rS=0,02 (p=0,876) bij ’Fysiek functioneren’ van de SF-36 tot rS=0,25 (p=0,053) bij ’Kwaliteit van leven’ van de HOOS.Conclusie: In deze studie werd geen verschil gevonden in de mate van functioneel herstel tussen patiënten met een normaal gewicht, overgewicht en obesitas na een THA. BMI was zwak tot zeer zwak geassocieerd met functioneel herstel na een THA tussen preoperatief en 12 weken en 6 maanden postoperatief. Implicaties voor de fysiotherapie: Tot op heden is er geen indicatie om voor groepen met overgewicht of obesitas een specifiek revalidatietraject te starten na een THA.

Malnutrition screening on hospital admission: impact of overweight and obesity on comparative performance of MUST and PG-SGA SF

BACKGROUND/OBJECTIVES: Traditional malnutrition screening instruments, including the Malnutrition Universal Screening Tool (MUST), strongly rely on low body mass index (BMI) and weight loss. In overweight/obese patients, this may result in underdetection of malnutrition risk. Alternative instruments, like the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF), include characteristics and risk factors irrespective of BMI. Therefore, we aimed to compare performance of MUST and PG-SGA SF in malnutrition risk evaluation in overweight/obese hospitalized patients.SUBJECTS/METHODS: We assessed malnutrition risk using MUST (≥1 = increased risk) and PG-SGA SF (≥4 = increased risk) in adult patients at hospital admission in a university hospital. We compared results for patients with BMI < 25 kg/m 2 vs. BMI ≥ 25 kg/m 2. RESULTS: Of 430 patients analyzed (58 ± 16 years, 53% male, BMI 26.9 ± 5.5 kg/m 2), 35% were overweight and 25% obese. Malnutrition risk was present in 16% according to MUST and 42% according to PG-SGA SF. In patients with BMI < 25 kg/m 2, MUST identified 31% as at risk vs. 52% by PG-SGA SF. In patients with BMI ≥ 25 kg/m 2, MUST identified 5% as at risk vs. 36% by PG-SGA SF. Agreement between MUST and PG-SGA SF was low (к = 0.143). Of the overweight/obese patients at risk according to PG-SGA SF, 83/92 (90%) were categorized as low risk by MUST. CONCLUSIONS: More than one-third of overweight/obese patients is at risk for malnutrition at hospital admission according to PG-SGA SF. Most of them are not identified by MUST. Awareness of BMI-dependency of malnutrition screening instruments and potential underestimation of malnutrition risk in overweight/obese patients by using these instruments is warranted.

In-Hospital Mobilization, Physical Fitness, and Physical Functioning After Lung Cancer Surgery

BACKGROUND: Apart from clinical experience and theoretical considerations, there is a lack of evidence that the level of adherence to in-hospital mobilization protocols is related to functional recovery in patients after resection for lung cancer. The objectives of the study were to determine (1) the relationship between adherence to the in-hospital mobilization protocol and physical fitness at hospital discharge and (2) the value of physical fitness measures at discharge in predicting physical functioning 6 weeks and 3 months postoperatively.METHODS: This observational study included 62 patients who underwent surgical resection for lung cancer. Adherence to the in-hospital mobilization protocol was abstracted from patients' records. Physical fitness measures before the operation and at hospital discharge included handgrip strength, 30-second sit-to-stand test, and 6-minute walk test (6MWT). Self-reported physical functioning was assessed preoperatively and 6 weeks and 3 months postoperatively, using the Medical Outcome Study 36-Item Short Form (SF-36) Physical Function subscale (RAND Corp, Santa Monica, CA). Linear regression analyses were used to estimate the relationships of interest, adjusting for potential confounders.RESULTS: Level of adherence to the mobilization protocol was significantly and independently related to handgrip strength, sit-to-stand test, and 6MWT at discharge. Handgrip strength and 6MWT at discharge significantly predicted SF-36 Physical Function at 6 weeks and 3 months postoperatively. The sit-to-stand test only predicted SF-36 Physical Function at 6 weeks.CONCLUSIONS: Suboptimal postoperative mobilization after surgical resection for lung cancer negatively affects physical fitness at discharge. Our results underline the importance of adherence to early postoperative mobilization protocols. Measuring physical fitness at discharge may be useful to inform clinicians on elective referral of patients for postdischarge rehabilitation.

Self-reported functional status as predictor of observed functional capacity in subjects with early osteoarthritis of the hip and knee

OBJECTIVES: Patients with hip or knee osteoarthritis (OA) may experience functional limitations in work settings. In the Cohort Hip and Cohort Knee study (CHECK) physical function was both self-reported and measured performance-based, using Functional Capacity Evaluation (FCE). Relations between self-reported scores on SF-36 and WOMAC (Western Ontario and McMaster Arthritis Index, function scales) and FCE performance were studied, and their diagnostic value for clinicians in predicting observed physical work limitations was assessed.METHODS: Ninety-two subjects scored physical function on SF-36 (scale 0-100, 100 indicating the best health level) and WOMAC (scale 0-68, 68 indicates maximum restriction) and performed the FCE. Correlations were calculated between all scores. Cross-tables were constructed using both questionnaires as diagnostic tests to identify work limitations. Subjects lifting <22.5 kg on the FCE-test 'lifting-low' were labeled as having physical work limitations. Diagnostic aspects at different cut-off scores for both questionnaires were analysed.RESULTS: Statistically significant correlations (Spearman's rho 0.34-0.49) were found between questionnaire scores and lifting and carrying tests. Results of a diagnostic cross-table with cut-off point <60 on SF-36 'physical functioning' were: sensitivity 0.34, specificity 0.97 and positive predictive value (PV+) 0.95. Cut-off point > or =21 on WOMAC 'function' resulted in sensitivity 0.51, specificity 0.88 and PV+ 0.88.CONCLUSION: Low self-reported function scores on SF-36 and WOMAC diagnosed subjects with limitations on the FCE. However, high scores did not guarantee performance without physical work limitations. These results are specific to the tested persons with early OA, in populations with a different prevalence of limitations, different diagnostic values will be found. FCE may be indicated to help clinicians to assess actual work capacity.

The health-related quality of life of obese persons seeking or not seeking surgical or non-surgical treatment: a meta-analysis

Background: A meta-analysis examined differences in health-related quality of life (HRQoL) between seekers of surgical and non-surgical treatment, and non-treatment seekers, over and above differences that are explained by weight, age, and gender. Methods: Our literature search focused on the 'Impact of Weight on Quality of Life-Lite' (IWQOL-Lite) and the 'Short Form-36' (SF-36) questionnaires. Included were studies published between 1980 and April 2006 providing (pre-treatment) descriptive statistics of adult overweight or (morbid) obese persons. Excluded were elderly and ill patient groups. Results: Fifty-four articles, with a total number of nearly 100.000 participants, met the inclusion criteria. Persons seeking surgical treatment demonstrated the most severely reduced HRQoL. IWQOL-Lite scores showed larger differences between populations than SF-36 scores. After adjustment for weight, the population differences on the IWQOL disappeared. In contrast, the differences on the SF-36 between the surgical treatment seeking population and the other populations were maintained after adjustment for weight. Conclusion: The IWQOL-Lite questionnaire predominantly reflects weight-related HRQoL, whereas the SF-36 mostly reflects generic HRQoL that is determined by both weight and other factors. Our meta-analysis provides reference values that are useful when explicating or evaluating obesity-specific (IWQOL-Lite) or generic (SF-36) HRQoL, weight, and demographic characteristics of obese persons seeking or not seeking surgical or non-surgical treatment.