Publications by authors named "Michael Quittan"

58 Publications

Diagnosing sarcopenia: Functional perspectives and a new algorithm from the ISarcoPRM.

J Rehabil Med 2021 Jun 21;53(6):jrm00209. Epub 2021 Jun 21.

Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey. E-mail:

Sarcopenia is an important public health problem, characterized by age-related loss of muscle mass and muscle function. It is a precursor of physical frailty, mobility limitation, and premature death. Muscle loss is mainly due to the loss of type II muscle fibres, and progressive loss of motor neurones is thought to be the primary underlying factor. Anterior thigh muscles undergo atrophy earlier, and the loss of anterior thigh muscle function may therefore be an antecedent finding. The aim of this review is to provide an in-depth (and holistic) neuromusculoskeletal approach to sarcopenia. In addition, under the umbrella of the International Society of Physical and Rehabilitation Medicine (ISPRM), a novel diagnostic algorithm is proposed, developed with the consensus of experts in the special interest group on sarcopenia (ISarcoPRM). The advantages of this algorithm over the others are: special caution concerning disorders related to the renin-angiotensin system at the case finding stage; emphasis on anterior thigh muscle mass and function loss; incorporation of ultrasound for the first time to measure the anterior thigh muscle; and addition of a chair stand test as a power/performance test to assess anterior thigh muscle function. Refining and testing the algorithm remains a priority for future research.
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http://dx.doi.org/10.2340/16501977-2851DOI Listing
June 2021

Factors Associated with Objectively Measured Physical Activity in Patients with Seropositive Rheumatoid Arthritis.

Int J Environ Res Public Health 2020 12 3;17(23). Epub 2020 Dec 3.

Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, 1090 Vienna, Austria.

Rheumatoid arthritis (RA) is a chronic autoimmune disease, which is associated with low levels of physical activity (PA). However, the factors related to low physical activity levels have rarely been studied. In this cross-sectional study, 70 seropositive RA patients were included. Physical activity was objectively assessed with an ActiGraph GT3X+ accelerometer. In addition, body mass index, smoking status, work ability, and clinical parameters (functional disabilities, disease activity, disease duration, pain, and inflammation parameters) were measured. RA patients performed a mean of 215.2 (SD: 136.6) min a week of moderate physical activity and 9.1 (SD: 26.3) min of vigorous physical activity. The total amount of moderate and vigorous physical activity (MVPA) was associated with BMI, and functional disabilities. In addition, non-smokers and patients with better work ability did more MVPA. No association could be seen with disease activity, disease duration, pain, and inflammatory markers. After mutual adjusting of all the variables, only BMI showed a significant relationship with MVPA. RA patients perform de facto no physical activity with vigorous intensity. Factors related to low physical activity are BMI, functional disabilities, workability and smoking status, whereas due to the study design no causal and temporal link could be made.
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http://dx.doi.org/10.3390/ijerph17239008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7730293PMC
December 2020

The need for an integrative musculoskeletal approach in sarcopenia: the ISarcoPRM Kickstart.

Eur J Phys Rehabil Med 2020 Aug 15;56(4):535-536. Epub 2020 Apr 15.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

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http://dx.doi.org/10.23736/S1973-9087.20.06255-3DOI Listing
August 2020

Frailty in seropositive rheumatoid arthritis patients of working age: a cross-sectional study.

Clin Exp Rheumatol 2019 Jul-Aug;37(4):585-592. Epub 2018 Nov 19.

Department of Social and Preventive Medicine, Centre of Public Health, Medical University of Vienna, Austria.

Objectives: The prevalence of frailty has been widely researched in the elderly population. However, data about people of working age are scarce. The aim of this paper was to assess the prevalence of prefrailty and frailty in rheumatoid arthritis (RA) patients of working age, and to assess factors associated with prefrailty/frailty.

Methods: In this monocentric cross-sectional study, 100 RA patients aged 18-65 years were included. Frailty was measured with the Frailty Instrument for Primary Care of the Survey of Health, Ageing and Retirement in Europe (SHARE-FI) and disease activity with the Clinical Disease Activity Index (CDAI). In addition, disease duration (years), pain intensity (visual analogue scale) and employment status were also assessed.

Results: Fifty-five percent were robust, 30% prefrail and 15% were frail. Eighty-nine of the prefrail/frail individuals suffered from exhaustion. Compared to robust individuals, the prefrail/frail individuals had significantly higher median scores in disease activity [4.0 (Q25-Q75: 0-10) vs. 11 (Q25-Q75: 6-18)] and pain intensity [3.0 (Q25-Q75: 2.0-4.0) vs. 4.0 (Q25-Q75: 2.8-6.3)] and a higher rate of unemployment [31% vs. 53%]. In the multivariable analysis, higher disease activity (ß=0.444; p<0.001), unemployment (ß=0.243; p=0.005), higher pain intensity (ß=0.186; p=0.060) and longer disease duration (ß=0.181; p=0.020) were associated with a higher frailty score.

Conclusions: Frailty is common in RA patients, even those of working age. As the prevalence of frailty increases with age, it is important to take this syndrome into account in younger persons and to take action to counteract frailty.
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July 2019

Sleep Quality in Patients with Rheumatoid Arthritis and Associations with Pain, Disability, Disease Duration, and Activity.

J Clin Med 2018 Oct 9;7(10). Epub 2018 Oct 9.

Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria.

We aimed to assess the subjective sleep quality in patients with rheumatoid arthritis (RA) and its correlation with disease activity, pain, inflammatory parameters, and functional disability. In a cross-sectional study, patients with confirmed RA diagnosis responded to a questionnaire (consisting of socio-demographic data, the Health Assessment Questionnaire Disability Index, and the Medical Outcome Study Sleep Scale). Disease activity was assessed with the Clinical Disease Activity Index, and pain levels using the visual analogue scale. In addition, inflammatory markers (C-reactive protein, interleukin-6, and tumor necrosis factor alpha) were analyzed. Ninety-five patients were analyzed, predominantly female, with an average age of 50.59 (9.61) years. Fifty-seven percent reported non-optimal sleep duration, where functional disability (92.7% vs. 69.8%; = 0.006) and higher median pain levels (3.75 (2.3⁻6.0) vs. 2.5 (2.0⁻3.5); = 0.003) were also more prevalent. No differences in sociodemographic variables, disease duration or activity, inflammatory parameters, or use of biological and corticosteroid therapy were observed. The multivariate regression analysis showed that more intense pain was associated with a lower likelihood of optimal sleep (odds ratio (OR) = 0.68, 95% confidence interval (CI) 0.47⁻0.98, = 0.038). Patients with RA report a high prevalence of non-optimal sleep, which is linked to pain level. Clinicians need to be aware of this issue and the potential effects on health and functional status.
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http://dx.doi.org/10.3390/jcm7100336DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6210607PMC
October 2018

Work Ability and Employment in Rheumatoid Arthritis: A Cross-Sectional Study on the Role of Muscle Strength and Lower Extremity Function.

Int J Rheumatol 2018 1;2018:3756207. Epub 2018 Aug 1.

Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria.

Objective: The aim of the present study was to assess the association between muscle strength, lower extremity function, employment status, and work ability in RA patients.

Methods: One hundred seropositive RA outpatients of working age were included in this cross-sectional study. Employment status was assessed by interview and work ability by the Work Ability Index-Single Item Scale (WAS). Muscle strength was determined using dynamometer measurement of isometric hand grip and knee extensor strength. Lower extremity function was measured using the short physical performance battery (SPPB). Regression models estimate the association between unemployment, work ability and muscle strength, and lower extremity function, controlling for sociodemographic and disease-related factors.

Results: Forty-one percent of the RA patients were not gainfully employed, and their median work ability had a good WAS value (7.00 [4.00-7.00]). Patients with better knee extensor strength (OR=1.07, 95% CI [1.02-1.12) and better physical performance (OR=1.71, 95% CI [1.18-2.49]) had a significantly better chance of gainful employment. The odds for hand grip strength remained significant when adjusted for sociodemographic (OR=1.5, 95% CI [1.00-1.09]), but not for disease-specific variables. Better hand grip strength (=0.25, =0.039) and better knee extensor strength (=0.45, =0.001) as well as better lower extremity function (SPPB) (=0.51, <0.001) remained significantly associated with work ability following adjustment for sociodemographic and disease-specific variables.

Conclusions: The association of employment status and work ability with parameters of physical fitness suggests that improvement in muscle strength and lower extremity function may positively influence work ability and employment in individuals with RA.
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http://dx.doi.org/10.1155/2018/3756207DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6093007PMC
August 2018

A 'musculoskeletal look' to sarcopenia: Where do/should the physical and rehabilitation medicine physicians (physiatrists) stand?

Int J Rehabil Res 2018 06;41(2):95-96

ESPRM Special Interest Scientific Committee in Aging Persons President, European Academy of Physical and Rehabilitation Medicine, Athens, Greece.

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http://dx.doi.org/10.1097/MRR.0000000000000279DOI Listing
June 2018

Strength training increases skeletal muscle quality but not muscle mass in old institutionalized adults: a randomized, multi-arm parallel and controlled intervention study.

Eur J Phys Rehabil Med 2018 Dec 7;54(6):921-933. Epub 2018 Mar 7.

Research Platform Active Ageing, University of Vienna, Vienna, Austria.

Background: Age related loss of skeletal muscle mass is accompanied by changes in muscle quality leading to impairment of functional status.

Aim: This study investigated the effect of resistance training and nutritional supply on muscle mass and muscle quality in very old institutionalized adults.

Design: Prospective, randomized, multi-arm parallel and controlled intervention study.

Setting: This study was conducted in five retirement care facilities.

Population: This subgroup of the Vienna Active Ageing Study included 54 women and men (82.4±6.0 years) with impaired health status. Participants were randomly assigned either to elastic band resistance training (N.=16), training with nutritional supplementation (N.=21) or control group (N.=17).

Methods: Health status was assessed at baseline with functional tests, cognitive status, nutritional status, sum of medications as well as sum of diseases. Skeletal muscle mass, determined by dual-energy X-ray absorptiometry, isokinetic knee extension and flexion force and handgrip strength were assessed at baseline and after 6 months. Muscle quality of lower extremities was defined as ratio of the extensor (MQ_LE (Ext.)) or flexor strength (MQ_LE (Flex.)) to lean leg mass. Muscle quality of upper extremity was defined as ratio of handgrip strength to lean arm mass. Follow-up examinations were performed after 12 and 18 months of intervention.

Results: Muscle quality, but not muscle mass, showed significant correlations to functional tests at baseline (0.300 - 0.614, P<0.05). Resistance training significantly enhanced muscle quality of lower extremity after 6 months (MQ_LE (Ext.) +19.8%, MQ_LE (Flex.) +30.8%, P<0.05). Nutritional supplementation could not further increase the training effect. Participants with lower muscle quality at baseline benefit most from the training intervention. Skeletal muscle mass was not changed by any intervention.

Conclusions: Resistance training with elastic bands improved muscle quality in very old people. Additional nutritional supplementation was not able to further improve the effects obtained by training alone.

Clinical Rehabilitation Impact: Elastic band resistance training could be safely used to improve muscle quality even in old people with impaired health status. Weak and chronically ill participants benefit most from this training.
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http://dx.doi.org/10.23736/S1973-9087.18.04930-4DOI Listing
December 2018

Workability and Muscle Strength in Patients With Seropositive Rheumatoid Arthritis: Survey Study Protocol.

JMIR Res Protoc 2017 Mar 2;6(3):e36. Epub 2017 Mar 2.

Institute of Social Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria.

Background: Rheumatoid arthritis (RA) and other rheumatic conditions not only fundamentally affect patients' quality of life and physiological needs but are also negatively associated with work ability. The costs of poor work ability, which, in sum, are more than treatment costs, pose an economic burden to society and patients. Work ability in RA appears to be multifactorial; symptoms such as pain, swelling, and stiffness play a major role, as these directly affect functional disability. Also, RA patients typically suffer from reduced muscle strength. Lower extremity function and grip strengths especially impair their quality of life. However, the role of muscle strength and disease activity as determinants of work ability have not yet been studied.

Objective: The primary objective of this study is to compare work ability in working-age participants with seropositive RA and with high and low disease activity; the secondary objective is to evaluate the association of muscle strength, functional ability, and frailty with work ability.

Methods: This monocentric cross-sectional study will be conducted at a rheumatologic outpatient clinic and day hospital with approximately 100 seropositive RA patients aged <65 years. A clinical disease activity index as a measure for rheumatoid disease activity will be assessed during the patients' routine visits at the clinic. Work ability, frailty, and functional disability will be evaluated with (self-reported) questionnaires as well as with physical tests (Work Ability Index/Score; Health Assessment Questionnaire Disability Index; Survey of Health, Ageing, and Retirement in Europe Frailty Instrument; Short Physical Performance Battery). Muscle strength will be determined with dynamometer measurements of isometric hand grip strength and quadriceps femoris muscle contraction strength. Sleep quality (Medical Outcomes Study Sleep Scale) and sexual functioning as physiological needs will additionally be determined with self-reported questionnaires.

Results: For this study funding has already been awarded and enrollment has been completed. Data are currently being evaluated.

Conclusions: This study will evaluate the association of work ability with modifiable parameters such as muscle strength and functional ability. It will provide further insights into work ability in RA and its associated risk factors. Any evidence of association will motivate further research, and the findings might encourage interventions focused specifically on improving muscle strength and lower extremity function to positively affect work ability.

Trial Registration: ClinicalTrials.gov (NCT02581852); https://clinicaltrials.gov/ct2/show/NCT02581852 (Archived by WebCite at http://www.webcitation.org/6oNcelHtQ).
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http://dx.doi.org/10.2196/resprot.6449DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5355630PMC
March 2017

Elastic band resistance training influences transforming growth factor-ß receptor I mRNA expression in peripheral mononuclear cells of institutionalised older adults: the Vienna Active Ageing Study (VAAS).

Immun Ageing 2016 30;13:22. Epub 2016 Jun 30.

Research Platform Active Ageing, University of Vienna, Althanstraße 14, 1090 Vienna, Austria ; Department of Sports and Exercise Physiology, Centre for Sport Science and University Sports, University of Vienna, Auf der Schmelz 6, 1150 Vienna, Austria.

Background: Ageing, inactivity and obesity are associated with chronic low-grade inflammation contributing to a variety of lifestyle-related diseases. Transforming growth factor-β (TGF-β) is a multimodal protein with various cellular functions ranging from tissue remodelling to the regulation of inflammation and immune functions. While it is generally accepted that aerobic exercise exerts beneficial effects on several aspects of immune functions, even in older adults, the effect of resistance training remains unclear. The aim of this study was to investigate whether progressive resistance training (6 months) with or without nutritional supplementation (protein and vitamins) would influence circulating C-reactive protein and TGF-β levels as well as TGF-β signalling in peripheral mononuclear cells (PBMCs) of institutionalised adults with a median age of 84.5 (65.0-97.4) years.

Results: Elastic band resistance training significantly improved performance as shown by the arm-lifting test (p = 0.007), chair stand test (p = 0.001) and 6-min walking test (p = 0.026). These results were paralleled by a reduction in TGF-β receptor I (TGF-βRI) mRNA expression in PBMCs (p = 0.006), while circulating inflammatory markers were unaffected. Protein and vitamin supplementation did not provoke any additional effects. Interestingly, muscular endurance of upper and lower body and aerobic performance at baseline were negatively associated with changes in circulating TGF-β at the early phase of the study. Furthermore, drop-outs of the study were characterised not only by lower physical performance but also higher TGF-β and TGF-βRI mRNA expression, and lower miRNA-21 expression.

Conclusions: Progressive resistance training with elastic bands did not influence chronic low-grade inflammation but potentially affected TGF-β signalling in PBMCs through altered TGF-βRI mRNA expression. There appears to be an association between physical performance and TGF-β expression in PBMCs of older adults, in which the exact mechanisms need to be clarified.
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http://dx.doi.org/10.1186/s12979-016-0077-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4929754PMC
July 2016

Effects of elastic band resistance training and nutritional supplementation on muscle quality and circulating muscle growth and degradation factors of institutionalized elderly women: the Vienna Active Ageing Study (VAAS).

Eur J Appl Physiol 2016 May 1;116(5):885-97. Epub 2016 Mar 1.

Research Platform Active Ageing, University of Vienna, Althanstraße 14, 1090, Vienna, Austria.

Purpose: Regular resistance exercise training and a balanced diet may counteract the age-related muscular decline on a molecular level. The aim of this study was to investigate the influence of elastic band resistance training and nutritional supplementation on circulating muscle growth and degradation factors, physical performance and muscle quality (MQ) of institutionalized elderly.

Methods: Within the Vienna Active Ageing Study, 91 women aged 83.6 (65.0-92.2) years were randomly assigned to one of the three intervention groups (RT, resistance training; RTS, resistance training plus nutritional supplementation; CT, cognitive training). Circulating levels of myostatin, activin A, follistatin, IGF-1 and GDF-15, as well as MQ and functional parameters were tested at baseline as well as after 3 and 6 months of intervention.

Results: MQ of lower extremities significantly increased in the RT group (+14 %) and RTS group (+12 %) after 6 months. Performance improved in the RT and RTS groups for chair stand test (RT: +18 %; RTS: +15 %). Follistatin increased only in the RT group (+18 %) in the latter phase of the intervention, accompanied by a decrease in the activin A-to-follistatin ratio (-7 %). IGF-1, myostatin and GDF-15 levels were not affected by the intervention.

Conclusion: Our data confirm that strength training improves physical performance and MQ even in very old institutionalized women. This amelioration appears to be mediated by blocking muscle degradation pathways via follistatin rather than inducing muscle growth through the IGF-1 pathway. As plasma levels of biomarkers reflect an overall status of various organ systems, future studies of tissue levels are suggested.
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http://dx.doi.org/10.1007/s00421-016-3344-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4834098PMC
May 2016

Aspects of physical medicine and rehabilitation in the treatment of deconditioned patients in the acute care setting: the role of skeletal muscle.

Authors:
Michael Quittan

Wien Med Wochenschr 2016 Feb 12;166(1-2):28-38. Epub 2016 Jan 12.

Institut für Physikalische Medizin und Rehabilitation, Karl Landsteiner Institut für Remobilisation und funktionale Gesundheit, Sozialmedizinisches Zentrum Süd - Kaiser-Franz-Josef-Spital mit Gottfried von Preyer'schem Kinderspital und Geriatriezentrum Favoriten, Kundratstrasse 3, 1100, Vienna, Austria.

Skeletal muscles are essential for movement as well as for survival. Knowledge about the organ skeletal muscle is underrepresented. Ageing and multiple chronic diseases are accompanied by loss of muscle mass, termed "muscle wasting". Nevertheless, muscles are one of the target organs within the rehabilitation process. This review highlights the role of skeletal muscles from various aspects, diagnostic procedures to quantify muscle mass and strength and, most importantly, lists countermeasures to muscle wasting. Although structured and progressive strength training is the cornerstone in the treatment of muscle wasting, several other methods exist to slow down or reverse the process of muscle wasting. Among them are neuromuscular electrical stimulation and alternative exercise modes, positioning, stretching and, as an emerging field, drug therapy.
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http://dx.doi.org/10.1007/s10354-015-0418-xDOI Listing
February 2016

Effects of a multidisciplinary programme on postural stability in patients with chronic recurrent low back pain: preliminary findings.

Eur Spine J 2016 Apr 22;25(4):1219-25. Epub 2015 Oct 22.

Department of Physical Medicine and Rehabilitation, General Hospital Linz, Linz, Austria.

Purpose: This longitudinal study investigated the effects of a multidisciplinary rehabilitation programme on postural stability in patients with low back pain. While the consequences of such rehabilitation programme have been described for pain, mobility, strength, and functional disability, the effects on postural stability have not been examined so far.

Methods: Thirty-four patients suffering from chronic low back pain were included to participate in a multidisciplinary rehabilitation programme. We assessed postural stability, pain, strength of the lumbar extensor muscles, and functional disability. The examinations were performed before the intervention, after 20 training sessions ("half-way point"), and at the end of the rehabilitation programme.

Results: All outcome measures improved significantly from baseline to the first follow-up evaluation and remained constant until completion of the rehabilitation programme.

Conclusions: A multidisciplinary outpatient rehabilitation programme may improve postural stability, muscle strength, pain, and functional disability in patients with chronic low back pain.
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http://dx.doi.org/10.1007/s00586-015-4293-3DOI Listing
April 2016

Effects of elastic band resistance training and nutritional supplementation on physical performance of institutionalised elderly--A randomized controlled trial.

Exp Gerontol 2015 Dec 2;72:99-108. Epub 2015 Sep 2.

Research Platform Active Ageing, University of Vienna, Vienna, Austria; Centre for Sport Science and University Sports, University of Vienna, Auf der Schmelz 6, 1150 Vienna, Austria. Electronic address:

Objectives: To evaluate the effects of elastic band resistance training in combination with nutrient supplementation on muscular strength and the ability to perform mobility-related activities of daily living in older adults living in retirement care facilities.

Design: Randomized controlled trial, with a 6-month intervention period.

Setting: A retirement care facility, Vienna, Austria.

Participants: One hundred and seventeen older adults (14 males (12%) and 103 females (88%)), aged 65 to 97 years (mean age: 82.8 ± 6.0), having a mini-mental state examination score ≥ 23 and no chronic diseases posing a medical contraindication to training therapy.

Intervention: Participants were randomly assigned, but stratified by sex, to one of three intervention groups: supervised resistance exercise training (RT), RT in combination with nutrient supplementation (RTS), or cognitive training group (CT). All interventions were performed two times a week for 6 months. RT was designed to train all major muscle groups using elastic bands. The nutrient supplement (rich in proteins, vitamin D, B2, B12) was distributed every morning as well as after each RT session.

Measurements: A battery of motor ability tests and functional test were performed prior to as well as following 3 months and finally after 6 months of intervention. These tests included isokinetic torque measurements of the knee extensors and flexors in concentric mode at 60 and 120°/s, isometric handgrip strength, senior arm-lifting test, chair stand test, maximum walking speed and a 6-minute walking test (6 MWT).

Results: A repeated-measures ANOVA analysis revealed significant improvements in physical function of lower (p=0.002) and upper extremities (p=0.006) for RT and/or RTS in comparison to CT. For isokinetic measurements, 6 MWT, and gait speed time effects (p<0.05) were detected without any group × time interaction effects. Dropouts showed lower performance in chair stand test (p=0.012), 6 MWT (p=0.003), and gait speed (p=0.013) at baseline than that of the finishers of the study.

Conclusion: Six months of a low intensity resistance exercise using elastic bands and own body weight is safe and beneficial in improving functional performance of institutionalised older people. Multinutrient supplementation did not offer additional benefits to the effects of RT in improving muscular performance.
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http://dx.doi.org/10.1016/j.exger.2015.08.013DOI Listing
December 2015

Reliability, validity, sensitivity and internal consistency of the ICF based Basic Mobility Scale for measuring the mobility of patients with musculoskeletal problems in the acute hospital setting: a prospective study.

BMC Musculoskelet Disord 2015 Aug 5;16:187. Epub 2015 Aug 5.

Department of Physical Medicine and Rehabilitation, Medical University of Vienna General Hospital of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.

Background: The assessment of mobility is important in the acute care setting. Existing tests suffer from limitations. The aim of the study was to examine the inter-rater reliability, the validity, the sensitivity to change, and the internal consistency of an ICF based scale.

Methods: In a prospective study inpatients in the acute care setting with restricted mobility aged above 50 years assigned to rehabilitative treatment were included. Assessment of subscales of the Functional Independence Measure (FIM) and the ICF based Basic Mobility Scale (BMS) were performed at admission and before discharge. Furthermore pain, length of stay in hospital, and post-discharge residential status were recorded. Inter-rater reliability, criterion-concurrent validity, sensitivity to change, and internal consistency were calculated. Furthermore, floor and ceiling effects were determined.

Results: One hundred twenty-five patients (79 women/46 men) were included. The BMS showed an excellent inter-rater reliability for the total BMS (ICC BMS: 0.85 (95 % CI: 0.81-0.88). The criterion-concurrent validity was high to excellent (Spearman correlation coefficient: -0.91 in correlation to FIM) and the internal consistency was good (Cronbach's alpha 0.88). The BMS proved to be sensitive to improvements in mobility (Wilcoxon's signed rank test: p < 0.0001; The effect size for the BMS was 1.075 and the standardized response mean 1.10. At admission, the BMS was less vulnerable to floor effects.

Conclusions: The BMS may be used as a reliable and valid tool for the assessment of mobility in the acute care setting. It is easy to apply, sensitive to change during the hospital stay and not vulnerable to floor and ceiling effects.
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http://dx.doi.org/10.1186/s12891-015-0638-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4525726PMC
August 2015

Influence of age and physical fitness on miRNA-21, TGF-β and its receptors in leukocytes of healthy women.

Exerc Immunol Rev 2015 ;21:154-63

University of Vienna, Research Platform Active Ageing, Althanstraße 14, 1090 Vienna, Austria.

The TGF-β superfamily has been shown to play an important role in a wide range of physiological as well as pathological processes including ageing, immune modulation, atherosclerosis and cancer development. The aim of the current study was to investigate (i) whether TGF-β signalling in peripheral blood mononuclear cells (PBMCs) would differ between young and old females and (ii) whether physical performance parameters of elderly women would be related to the expression of TGF-β or its receptors. Sixteen healthy young (22-28 years; YF) and 90 healthy older (65-92 years; OF) females participated in the study. In addition to several components of health-related physical fitness, circulating CRP and TGF-β levels were determined together with the mRNA expression of TGF-β, TGF-βRI, TGF-βRII, and miRNA-21 (known to interfere with TGF-β signalling) in PBMCs. Physical fitness as determined by 6-minutes walking test (YF:median 932 (range 573-1254) m; OF:360 (114-558) m), handgrip strength (YF: 32 (24-39) kg; OF:18(10-30) kg), relative isokinetic peak torque of knee extensors (YF:1.9 (1.2- 2.3) Nm/kg; OF:1.0 (0.2-1.9) Nm/kg and flexors (YF: 1.1 (0.7- 1.5) Nm/kg; OF: 0.5 (0.2-1.0) Nm/kg was substantially lower in older women (p<0.001 for all comparisons). These changes were paralleled by an increase in hs-CRP (YF: 0.9 (0.1-4.3)mg/L; OF: 2.3 (0.3-56.7)mg/L,p<0.001). Serum levels of TGF-β and TGF-β mRNA levels from PBMCs did not differ between young and old women whereas, both TGF- βRI/GAPDH (YF: 4.07 (1.38-14.60); OF: 2.08 (0.14-28.81); p=0.020) and TGF-βRII/GAPDH levels (YF: 3.16 (1.14- 10.25); OF: 1.71 (0.51-14.86); p=0.020) were lower with respect to old age. In elderly women, only TGF-βRΙ expression correlated negatively with miRNA-21 expression in PBMCs (ρ=-0.315; p=0.004). Interestingly, hs-CRP and miRNA correlated positively with handgrip strength (ρ=0.237 and ρ=243, p<0.05), while none of the TGF-β-related parameters were related to physical performance. The results suggest that age affects TGF-β signalling in leukocytes by altering the expression levels of its receptors. These changes seem to occur independently of physical fitness of old women.
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April 2015

Serum concentrations of insulin-like growth factor-1, members of the TGF-beta superfamily and follistatin do not reflect different stages of dynapenia and sarcopenia in elderly women.

Exp Gerontol 2015 Apr 12;64:35-45. Epub 2015 Feb 12.

Centre for Sport Science and University Sports, University of Vienna, Auf der Schmelz 6, 1150 Vienna, Austria; Research Platform Active Ageing, University of Vienna, Althanstraße 14, 1090 Vienna, Austria. Electronic address:

There is a high need for blood-based biomarkers detecting age-related changes in muscular performance at an early stage. Therefore, we investigated whether serum levels of growth and differentiation factor-15 (GDF-15), activin A, myostatin, follistatin, and insulin-like growth factor-1 (IGF-1) would reflect age- and physical performance-related differences between young (22-28 years) and elderly (65-92 years) females. Isokinetic peak torque of knee extension (PTE) was measured in young females to obtain reference values for the discrimination of different stages of age-associated muscle weakness. Additionally, elderly women were screened for sarcopenia using the algorithm of the European Working Group on Sarcopenia in Older People (low muscle mass in addition to low PTE and/or low walking speed). IGF-1 levels were higher and GDF-15 levels were lower in young females in comparison to the elderly (p < 0.01), whereas members of the activin A/myostatin/follistatin axis showed similar levels across age groups. In older women, IGF-1 correlated negatively with age (ρ = -0.359, p < 0.01) and positively with muscle mass (ρ = 0.365, p < 0.01). In contrast, GDF-15 correlated positively with age (ρ = 0.388, p < 0.001) and negatively with muscle mass (ρ = -0.320, p < 0.01). However, none of the serum markers differed between women classified as non-, mildly and severely dynapenic/sarcopenic. Multiple linear regression analyses revealed that a combination of all blood-based biomarkers obtained in addition to age and fat mass moderately predicted muscle mass (+2.9%). Neither a single nor a combined set of tested biomarkers reflected the presence of dynapenia or sarcopenia in elderly women. However, due to the associations of IGF-1 and GDF-15 with correlates of muscle mass and function, these parameters remain promising candidates in a potential set of blood-based biomarkers to diagnose sarcopenia and/or dynapenia.
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http://dx.doi.org/10.1016/j.exger.2015.02.008DOI Listing
April 2015

Long-term effects of an outpatient rehabilitation program in patients with chronic recurrent low back pain.

Eur Spine J 2014 Apr 11;23(4):779-85. Epub 2014 Jan 11.

Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Vienna, Austria,

Purpose: This longitudinal study investigated long-term effects of a multidisciplinary rehabilitation program consisting of resistance and sensorimotor training, patient education, and stress management over 6 months in patients with chronic low back pain.

Methods: Ninety-six patients with chronic recurrent low back pain performed a multidisciplinary rehabilitation program. We assessed pain-free lumbar spine range of motion (ROM), strength of the lumbar extensor muscles, and pain by visual analog scale (VAS). Furthermore, the Roland-Morris (RM) questionnaire and SF-36 were used. The examinations were performed before and after rehabilitation, and a long-term follow-up was performed after 18 months.

Results: All outcome measurements (ROM, VAS, RM, muscle strength, and SF-36 scores) improved significantly from baseline to the post-rehabilitation evaluation. These improvements were found to persist until a follow-up evaluation 18 months after cessation of the intervention.

Conclusions: Our findings confirm the results of former studies evaluating the short-term effects of multidisciplinary rehabilitation programs. In addition, our data demonstrate that well-balanced outpatient rehabilitation programs may induce persistent improvements in muscle strength, pain, function and quality of life in patients with chronic low back pain.
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http://dx.doi.org/10.1007/s00586-013-3156-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3960437PMC
April 2014

Association between ultrasound measurements of muscle thickness, pennation angle, echogenicity and skeletal muscle strength in the elderly.

Age (Dordr) 2013 Dec 2;35(6):2377-88. Epub 2013 Mar 2.

Institute of Physical Medicine and Rehabilitation, Social Medical Centre South, Kaiser Franz Joseph Hospital, Kundratstrasse 3, 1100, Vienna, Austria,

The increase of elderly in our society requires simple tools for quantification of sarcopenia in inpatient and outpatient settings. The aim of this study was to compare parameters determined with musculoskeletal ultrasound (M-US) with muscle strength in young and elderly patients. In this prospective, randomised and observer blind study, 26 young (24.2 ± 3.7 years) and 26 old (age 67.8 ± 4.8 years) patients were included. Muscle thickness, pennation angle and echogenicity of all muscles of musculus quadriceps were measured by M-US and correlated with isometric maximum voluntary contraction force (MVC) of musculus quadriceps. Reproducibility of M-US measurements as well as simple and multiple regression models were calculated. Of all measured M-US variables the highest reproducibility was found for measurements of thickness (intraclass correlation coefficients, 85-97%). Simple regression analysis showed a highly significant correlation of thickness measurements of all muscles of musculus quadriceps with MVC in the elderly and in the young. Multiple regression analysis revealed that thickness of musculus vastus medialis had the best correlation with MVC in the elderly. This study showed that measurement of muscle thickness, especially of musculus vastus medialis, by M-US is a reliable, bedside method for monitoring the extent of sarcopenia.
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http://dx.doi.org/10.1007/s11357-013-9517-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3824993PMC
December 2013

ICF Core Sets for early post-acute rehabilitation facilities.

J Rehabil Med 2011 Jan;43(2):131-8

Institute for Health and Rehabilitation Sciences, Ludwig-Maximilians-Universität München, DE-813 77 Munich, Germany.

Objective: To identify candidate categories for International Classification of Functioning, Disability and Health (ICF) Core Sets for the reporting and measurement of functioning in patients in early post-acute rehabilitation facilities.

Design: Prospective multi-centre cohort study.

Patients: Patients receiving rehabilitation interventions for musculoskeletal, neurological or cardiopulmonary injury or disease in early post-acute rehabilitation facilities.

Methods: Functioning was coded using the ICF. The criterion for selecting candidate categories for the ICF Core Sets was based on their ability to discriminate between patients with high or low functioning status. Discrimination was assessed using multivariable regression models, the independent variables being all of the ICF categories of the respective comprehensive ICF Core Set. Analogue ratings of overall functioning as reported by patients and health professionals were used as dependent variables.

Results: A total of 165 patients were included in the study (67 neurological, 37 cardiopulmonary, 61 musculoskeletal), mean age 67.5 years, 46.1% female. Selection yielded 38 cate-gories for neurological, 32 for cardiopulmonary, and 31 for musculoskeletal.

Conclusion: The present selection of categories can be considered an initial proposal, serving to identify the issues most relevant for the assessment and monitoring of functioning in patients undergoing early post-acute rehabilitation for neurological, cardiopulmonary, and musculoskeletal conditions.
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http://dx.doi.org/10.2340/16501977-0641DOI Listing
January 2011

Brief ICF Core Sets for the acute hospital.

J Rehabil Med 2011 Jan;43(2):123-30

Institute for Health and Rehabilitation Sciences, Ludwig-Maximilians-Universität München, DE-813 77 Munich, Germany.

Objective: To identify candidate categories for brief International Classification of Functioning, Disability and Health (ICF) Core Sets for the reporting and measurement of functioning in patients in the acute hospital.

Design: Prospective multi-centre cohort study.

Patients: Patients receiving rehabilitation interventions for musculoskeletal, neurological or cardiopulmonary injury or disease in acute hospitals.

Methods: Functioning and contextual factors were coded using the ICF. The criterion for selecting candidate categories for the brief ICF Core Sets was based on their ability to discriminate between patients with high or low functioning status. Discrimination was assessed using multivariable regression models, the independent variables being all of the ICF categories of the respective comprehensive ICF Core Set. Analogue ratings of overall functioning as reported by patients and health professionals were used as dependent variables.

Results: A total of 391 patients were included in the study (91 neurological, 109 cardiopulmonary, 191 musculoskeletal), mean age 63.4 years, 50.1% female. Selection yielded 33 cate-gories for neurological, 31 for cardiopulmonary, and 30 for musculoskeletal.

Conclusion: The present selection of categories can be considered an initial proposal, serving to identify the ICF cate-gories most relevant for the practical assessment and monitoring of functioning in patients with acute neurological, cardiopulmonary, and musculoskeletal conditions.
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http://dx.doi.org/10.2340/16501977-0646DOI Listing
January 2011

Validation of the comprehensive ICF Core Sets for patients in early post-acute rehabilitation facilities.

J Rehabil Med 2011 Jan;43(2):102-12

Institute for Health and Rehabilitation Sciences (IHRS), Ludwig-Maximilians-Universität München, Munich, Germany.

Objectives: To examine the relevance and completeness of the comprehensive International Classification of Functioning, Disability and Health (ICF) Core Sets for patients in post-acute rehabilitation facilities.

Design: Multi-centre cohort study.

Patients: A total of 165 patients (46% female; mean age 67.5 years) from post-acute rehabilitation facilities in 2 Austrian and 7 German hospitals.

Methods: Data on functioning were collected using the respective comprehensive post-acute ICF Core Sets. Data was extracted from patients' medical record sheets and interviews with health professionals and patients.

Results: Most of the categories of the comprehensive ICF Core Sets describing impairments, limitations or restrictions occurred in a considerable proportion of the study population. The most outstanding limitations and restrictions of the patients were problems with sleep and blood vessel functions, walking and moving and self-care. Twenty-six aspects of functioning not previously covered by the comprehensive ICF Core Sets were ranked as relevant.

Conclusion: Most categories of the comprehensive ICF Core Set for patients in post-acute rehabilitation facilities were confirmed. No significant gaps in the established set could be identified.
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http://dx.doi.org/10.2340/16501977-0659DOI Listing
January 2011

Brief ICF Core Set for patients in geriatric post-acute rehabilitation facilities.

J Rehabil Med 2011 Jan;43(2):139-44

Institute for Health and Rehabilitation Sciences, Ludwig-Maximilians-Universität München, DE-813 77 Munich, Germany.

Objective: To identify candidate categories for International Classification of Functioning, Disability and Health (ICF) Core Sets for the reporting and clinical measurement of functioning in older patients in early post-acute rehabilitation facilities.

Design: Prospective multi-centre cohort study.

Patients: Older patients receiving rehabilitation interventions in early post-acute rehabilitation facilities.

Methods: Functioning was coded using the ICF. The criterion for selecting candidate categories for the brief ICF Core Sets was based on their ability to discriminate between patients with high or low functioning status. Discrimination was assessed using multivariable regression models, the independent variables being all of the ICF categories of the respective comprehensive ICF Core Set. Analogue ratings of overall functioning as reported by patients and health professionals were used as dependent variables.

Results: A total of 209 patients were included in the study, mean age 80.4 years, 67.0% female. Selection yielded a total of 29 categories for the functioning part and 9 categories for the contextual part of the ICF.

Conclusion: The present selection of categories can be considered an initial proposal, serving to identify the issues most relevant for the clinical assessment and monitoring of functioning in older patients undergoing early post-acute rehabilitation.
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http://dx.doi.org/10.2340/16501977-0618DOI Listing
January 2011

Validation of the comprehensive ICF Core Set for patients in geriatric post-acute rehabilitation facilities.

J Rehabil Med 2011 Jan;43(2):102-12

Institute for Health and Rehabilitation Sciences (IHRS), Ludwig-Maximilians-Universität München, Munich, Germany.

Objective: To examine the relevance and completeness of the comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for patients in geriatric post-acute rehabilitation facilities.

Design: Multi-centre cohort study.

Patients: A total of 209 patients (67% female, mean age 80.4 years) in geriatric wards of 2 Austrian and 3 German hospitals.

Methods: Data on functioning were collected using the respective comprehensive ICF Core Set. Data were extracted from patients' medical record sheets and interviews with health professionals and patients.

Results: Most of the categories of the comprehensive ICF Core Set describing impairments, limitations or restrictions occurred in a considerable proportion of the study population. The most outstanding limitations and restrictions of the patients were problems with walking and moving around, and difficulties with self-care. Fourteen aspects of functioning not previously covered by the comprehensive ICF Core Set were reported as relevant.

Conclusion: Most categories of the comprehensive ICF Core Set could be confirmed. Limitations in categories of intellectual and seeing functions appeared less frequently than might have been expected for a population of older hospitalized people. Some additional categories not covered by the present version of the comprehensive ICF Core Set emerged from the interviews and should be considered for inclusion in the final version.
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http://dx.doi.org/10.2340/16501977-0617DOI Listing
January 2011

Effects of neuromuscular electrical stimulation on muscle layer thickness of knee extensor muscles in intensive care unit patients: a pilot study.

J Rehabil Med 2010 Jun;42(6):593-7

Joint and Bone Center (Center for Diagnosis, Research and Therapy of Musculoskeletal Disorders), Medical University of Vienna, Vienna, Austria.

Objective: It is known that patients in the intensive care unit show an enormous loss of muscle mass. Neuromuscular electrical stimulation is effective in enhancing strength and endurance in immobilized patients. The aim of this study was to evaluate the effects of neuromuscular electrical stimulation on muscle layer thickness of knee extensor muscles in intensive care unit patients.

Design: Randomized, controlled, double-blind, pilot trial.

Patients: Thirty-three patients, male to female ratio 26:7, mean age 55 years (standard deviation 15).

Methods: After enrolment in the study, intensive care unit patients (main diagnoses: polytrauma, cardiovascular diseases, transplantation, pneumonia, cancer) were stratified (based on the length of their stay in hospital) into 2 groups: 17 acute patients (< 7 days) and 16 long-term patients (> 14 days). Both groups were randomized to a stimulation group or a sham-stimulation group. Neuromuscular electrical stimulation was applied to knee extensor muscles for a period of 4 weeks (session time 30-60 minutes, 5 days/week). Ultrasound measurements were performed before and after the stimulation period to quantify muscle layer thickness of knee extensor muscles.

Results: Only stimulated long-term patients (+4.9%) showed a significant (p = 0.013) increase in muscle layer thickness compared with sham-stimulated patients (-3.2%).

Conclusion: Neuromuscular electrical stimulation appears to be a useful adjunct to revert muscle wasting in intensive care unit long-term patients; however, larger studies with a larger sample size are needed to confirm these promising, but preliminary, results.
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http://dx.doi.org/10.2340/16501977-0564DOI Listing
June 2010

Health-related quality of life in patients with osteopenia or osteoporosis with and without fractures in a geriatric rehabilitation department.

Wien Med Wochenschr 2009 May;159(9-10):235-40

Department of Rheumatology, Sozialmedizinisches Zentrum Süd - Kaiser-Franz-Josef-Spital mit Gottfried von Preyer'schem Kinderspital, Vienna, Austria.

Background: Health-related quality of life (HRQOL) is an important aspect in the management of patients with osteoporosis. The objective of this study was to estimate differences in HRQOL in women and men with osteopenia and osteoporosis with and without a fracture history and to assess HRQOL with a generic and disease-specific instrument.

Methods: Women and men were recruited from a geriatric rehabilitation department. Osteopenia or osteoporosis was diagnosed by Dual X-Ray Energy Absorptiometry (DXA). HRQOL was evaluated with the generic SF-36 questionnaire and the quality of life questionnaire of the International Osteoporosis Foundation (QUALEFFO-41). All subjects were instructed to complete these questionnaires. The level of pain was documented with a VAS (Visual Analogue Scale).

Results: 173 women and 49 men at a mean age of 79.3 +/- 8.5 years were enrolled. 85 participants reported a history of vertebral or hip fractures. The QUALEFFO score was 49.8 +/- 19.2 in patients with osteopenia, but significantly higher in osteoporotic patients without fractures (mean 58.1 +/- 13.3; p < 0.05). In osteoporotic patients with a fracture history the mean QUALEFFO score was significantly higher still, i.e. 63.8 +/- 13.6 (p < 0.05). The mean SF-36 summation scores of osteopenic patients and osteoporotic patients without fractures were similar (314 +/- 117 and 312 +/- 99, respectively). Osteoporotic patients with a fracture history showed lower mean scores (276 +/- 88; p < 0.05). VAS scores did not differ significantly.

Conclusions: Osteoporosis has a considerably greater impact on HRQOL than osteopenia. Patients with a history of vertebral or hip fractures have a significantly poorer quality of life. These differences should be taken into account when prioritizing health care management.
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http://dx.doi.org/10.1007/s10354-009-0655-yDOI Listing
May 2009

Neuromuscular electrical stimulation reduces skeletal muscle protein degradation and stimulates insulin-like growth factors in an age- and current-dependent manner: a randomized, controlled clinical trial in major abdominal surgical patients.

Ann Surg 2009 May;249(5):738-43

Institute of Physical Medicine and Rehabilitation, Social Medical Centre South-Kaiser Franz Joseph Hospital, Vienna, Austria.

Objective: To investigate the effect of neuromuscular electrical stimulation (NMES) on skeletal muscle metabolism after major abdominal surgery.

Summary Background Data: Protein catabolism associated with surgical interventions leads to reduced muscle strength, increased clinical complications and prolonged convalescence. Immobilization is suggested as a major stimulus for muscle wasting. This study investigates the potency of NMES on skeletal muscle growth factors and degradation processes in surgical patients.

Methods: This observer blind study included 26 patients after major abdominal surgery mainly due to cancer aged 60 +/- 10 years. Starting on the first postoperative day, 1 randomly assigned thigh of each patient was treated on 4 consecutive days with NMES, whereas the other leg was used as sham-stimulated control. Thereafter, muscle biopsies from both legs were performed. Differences in mRNA level, protein expression, and enzyme activity between legs were analyzed by cross-over analysis of variance (Clinical Trial Registration Number: NCT00635440).

Results: NMES significantly increased total RNA content and total sarcoplasmatic protein content. NMES significantly reduced ubiquitin-conjugated sarcoplasmatic proteins and proteasome activity. The mechano growth factor mRNA level correlated positively with the applied current and negatively with the body mass index of the patients. The increase in insulin like growth factor-1Ea mRNA after NMES correlated negatively with the age of the patients.

Conclusions: This study shows that NMES significantly increases total RNA content and reduces protein degradation in postoperative patients. Moreover, the induction of growth factors by NMES reveals dependency on body mass index, age, and applied current. We conclude that NMES is a useful clinical tool to reduce protein catabolism in postoperative patients.
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http://dx.doi.org/10.1097/SLA.0b013e3181a38e71DOI Listing
May 2009

Muscle wasting in intensive care patients: ultrasound observation of the M. quadriceps femoris muscle layer.

J Rehabil Med 2008 Mar;40(3):185-9

Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Vienna, Austria.

Objective: Patients in intensive care exhibit a high degree of loss of muscle mass. Appropriate instruments are needed to document muscle wasting in these patients. The aim of this pilot study was to describe muscle wasting in patients in the intensive care unit.

Design: Two-fold study setting: prospective longitudinal and cross-sectional single-blind.

Patients: A total of 118 patients in the intensive care unit (length of stay 1-98 days; male:female ratio 88:30; age 55 +/- 17 years) were included in a two-fold study setting.

Methods: Muscle layer thickness of the M. quadriceps femoris was documented using ultrasound measurement at well-defined points. Seventeen pilot-patients were measured twice; at baseline and after 28 days. In another group of 101 patients, muscle layer thickness was determined once after a random length of stay. The results of both groups were compared and correlated.

Results: In both groups, M. quadriceps femoris thickness showed a significant negative correlation with length of stay in the intensive care unit (p < 0.01). Furthermore, muscle wasting in intensive care patients could be described using a logarithmic function.

Conclusion: Loss of muscle mass shows a negative correlation with length of stay, and seems to be higher during the first 2-3 weeks of immobilization/intensive care unit stay. Ultrasound is a valid and practical measurement tool for documenting muscle mass (e.g. muscle layer thickness) as part of the daily routine at an intensive care unit.
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http://dx.doi.org/10.2340/16501977-0139DOI Listing
March 2008

Aerobic capacity, muscle strength and health-related quality of life before and after orthotopic liver transplantation: preliminary data of an Austrian transplantation centre.

J Rehabil Med 2006 Sep;38(5):322-8

Department of Physical Medicine, Medical University of Vienna, Austria.

Objective: Patients before orthotopic liver transplantation usually show a reduced physical performance status, which impacts on their daily life and social participation. This pilot study aimed to evaluate endurance capacity, muscle strength, and quality of life before and after orthotopic liver transplantation in patients in an Austrian transplantation centre.

Subjects: Fifteen patients (male/female = 10:5) were included in the pilot study.

Methods: Exercise testing, strength testing of knee extensor muscles and of handgrip, and quality of life (SF-36 health survey) were assessed before and after orthotopic liver transplantation (after 1-2 months).

Results: The oxygen uptake at the anaerobic threshold (VO2AT) and isokinetic strength testing of quadriceps femoris muscle did not change significantly from baseline, before transplantation to follow-up after orthotopic liver transplantation. Before orthotopic liver transplantation, quality of life was hampered concerning functional status, emotional role, vitality, and general health perception. Significant improvements of social functioning (p=0.032), vitality (p=0.006), mental health (p=0.004) and general health perception (p=0.002) could be found for this study population after orthotopic liver transplantation.

Conclusion: The results of this pilot study including a population of an Austrian transplantation centre indicate deficits of physical performance as well as reduced quality of life in patients before and after orthotopic liver transplantation.
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http://dx.doi.org/10.1080/16501970600680288DOI Listing
September 2006