ObjectiveMany patients with coronavirus disease 2019 (COVID-19) infections were admitted to an intensive care unit (ICU). Physical impairments are common after ICU stays and are associated with clinical and patient characteristics. To date, it is unknown if physical functioning and health status are comparable between patients in the ICU with COVID-19 and patients in the ICU without COVID-19 3 months after ICU discharge. The primary objective of this study was to compare handgrip strength, physical functioning, and health status between patients in the ICU with COVID-19 and patients in the ICU without COVID-19 3 months after ICU discharge. The second objective was to identify factors associated with physical functioning and health status in patients in the ICU with COVID-19. Methods In this observational, retrospective chart review study, handgrip strength (handheld dynamometer), physical functioning (Patient-Reported Outcomes Measurement Information System Physical Function), and health status (EuroQol 5 Dimension 5 Level) were compared between patients in the ICU with COVID-19 and patients in the ICU without COVID-19 using linear regression. Multilinear regression analyses were used to investigate whether age, sex, body mass index, comorbidities in medical history (Charlson Comorbidity Index), and premorbid function illness (Identification of Seniors At Risk-Hospitalized Patients) were associated with these parameters in patients in the ICU with COVID-19. Results In total, 183 patients (N = 92 with COVID-19) were included. No significant between-group differences were found in handgrip strength, physical functioning, and health status 3 months after ICU discharge. The multilinear regression analyses showed a significant association between sex and physical functioning in the COVID-19 group, with better physical functioning in men compared with women. Conclusion Current findings suggest that handgrip strength, physical functioning, and health status are comparable for patients who were in the ICU with COVID-19 and patients who were in the ICU without COVID-19 3 months after ICU discharge. Impact Aftercare in primary or secondary care in the physical domain of postintensive care syndrome after ICU discharge in patients with COVID-19 and in patients without COVID-19 who had an ICU length of stay >48 hours is recommended. Lay Summary Patients who were in the ICU with and without COVID-19 had a lower physical status and health status than healthy people, thus requiring personalized physical rehabilitation. Outpatient aftercare is recommended for patients with an ICU length of stay >48 hours, and functional assessment is recommended 3 months after hospital discharge.
MULTIFILE
Rationale: Sarcopenia and obesity are prevalent conditions and often co-occur within the same individual. ESPEN and EASO reached consensus on the definition of sarcopenic obesity (SO), encompassing altered muscle function (MF) and altered body composition (BC). However, both handgrip strength (HGS) and the chair stand test (CST) have been suggested to determine MF. This study aimed to compare the prevalence of SO using HGS and CST in older adults with obesity.Methods: Analyses were performed on the baseline data of two pooled RCT’s (MPS, PROBE) in older adults with obesity (BMI>30kg/m2 or BMI>27 with waist circumference males >102cm, females >88cm). The SO definition of ESPEN and EASO was used. Applied cutoffs for altered MF were: HGS <27kg (males), <16kg (females); CST ≥17s (males and females). Altered BC by DXA was defined as high fat mass percentage (<60y males >29%, females >41%; ≥60y males >31%, females >43%) with low appendicular lean mass percentage (males <25.7%, females <19.4%). The prevalence of SO was determined using HGS and CST and the overlap between both definitions was calculated.Results: A total of 151 participants (age 65±6y; 59% male, BMI 33.1±4.2kg/m2) were included. Altered MF was prevalent in 5.3% (n=8) based on HGS and 14.6% (n=22) based on CST. Altered BC was prevalent in 13.9% (n=21). The prevalence of SO using HGS was 0.7% (n=1) and using CST 6.0% (n=9) with no overlap between the two definitions.Conclusion: In older adults with obesity, there was a low prevalence of SO and the prevalence was different between the use of HGS and CST to define altered MF. The low prevalence might be explained by the absence of specific cutoffs for MF in adults with obesity. Furthermore, for the early diagnosis and prevention of SO, a continuous index for SO could be useful to identify older adults at risk of SO.
Background and Purpose: Decreased muscle mass and muscle strength are independent predictors of poor postoperative recov- ery in patients with esophageal cancer. If there is an association between muscle mass and muscle strength, physiotherapists are able to measure muscle strength as an early predictor for poor postoperative recovery due to decreased muscle mass. Therefore, in this cross-sectional study, we aimed to investigate the association between muscle mass and muscle strength in predominantly older patients with esophageal cancer awaiting esophagectomy prior to neoadjuvant chemoradiation. Methods: In patients with resectable esophageal cancer eligible for surgery between March 2012 and October 2015, we used computed tomographic scans to assess muscle mass and compared them with muscle strength measures (hand- grip strength, inspiratory and expiratory muscle strength, 30 seconds chair stands test). We calculated Pearson correla- tion coefficients and determined associations by multivariate linear regression analysis. Results and Discussion: A tertiary referral center referred 125 individuals to physiotherapy who were eligible for the study; we finally included 93 individuals for statistical analysis. Mul- tiple backward regression analysis showed that gender (95% confidence interval [CI], 2.05-33.82), weight (95% CI, 0.39- 1.02), age (95% CI, −0.91 to −0.04), left handgrip strength (95% CI, 0.14-1.44), and inspiratory muscle strength (95% CI, 0.08-0.38) were all independently associated with muscle surface area at L3. All these variables together explained 66% of the variability (R2) in muscle surface area at L3 (P < .01). Conclusions: This study shows an independent association between aspects of muscle strength and muscle mass in patients with esophageal cancer awaiting surgery, and phys- iotherapists could use the results to predict muscle mass on the basis of muscle strength in preoperative patients with esophageal cancer.
