Authors (including presenting author) :
Chau RMW(1), Chak NNT(1), Leung HC(2), Chan JSP(1), Lam CPY(1), Yeung EMP(2), Yu TKK(2)
Affiliation :
(1) Physiotherapy Department, Kowloon Hospital; (2) Department of Rehabilitation, Kowloon Hospital
Introduction :
Osteo-sarcopenia(combined condition of osteoporosis and sarcopenia) is increasingly prevalent in the local aging population, and is associated with increased fall risks, fractures, and earlier death. Target rehabilitation to address the specific healthcare needs and sustaining these ambulatory elders in the community contributes to enhanced aging and decreased healthcare utilization.
Objectives :
To identify the treatable physical traits among patients with osteo-sarcopenia in guiding the formulation of target physiotherapy intervention in managing the presenting symptoms, prophylactic fall and fracture prevention and corresponding healthcare utilization and sequential mortality.
Methodology :
A cross-sectional observational study was conducted. Subjects were diagnosed and recruited by the doctor of Osteoporosis-Clinic. Patients’ parameter included (1)Demographic characteristics,(2)handgrip-strength(HGS),(3)appendicular skeletal muscle mass index(ASMI), (4)physical performance(6-metre-walk, 5-time-chair-stand, Short-Physical-Performance-Battery(SPPB) including balancing side-by-side-stand, semi-tandem-stand, tandem-stand, 4-metre-walk-test, chair-stand-test),(5)muscle biomechanical properties and(6)sensory organization test(SOT) for balance ability.
Result & Outcome :
Nine patients aged 78.89±5.88 years old with mean body mass index of 20.68±2.88kg/m2 were recruited. 66.7% were females. The mean T scores were –2.60±0.60 and –2.99±0.80 over hip and spine respectively, and mean ASMI were 4.87±0.33kg/m2 and 6.47±0.49kg/m2 for females and males respectively. Mean HGS were 14.50±2.51kg for females and 24.33±2.52kg for males. Physical performance of six-meter-walk test was 0.92±0.33m/s, 5-time-chair-stand test was 23.70±12.95s and SPPB was 8.67±1.80points. All recruited subject met the diagnostic criterion for sarcopenia of the Asian-Working-Group-for-Sarcopenia and nearly all physical parameters were below normative values. Body weight was positively correlated with HGS(r=0.87), ASMI(r=0.92), and rectus-femoris-thickness(RFT)(r=0.67); ASMI was positively correlated with HGS(r=0.98), and RFT (r=0.76); while RFT was negatively correlated with age(r=-0.67) and positively correlated with SPPB(r=0.69)(p<0.05). Mean scores of SOT(Condition1/2/3/4/5/6) were 93.67±2.74/89.81±4.53/83.67±13.03/66.52±10.73/50.11±20.65/28.59±17.36, and ratios of Somatosensory/Visual/Vestibular/Preference were 0.96±0.03/0.71±0.11/0.53±0.21/0.80±0.12. Patients demonstrated impaired balance performance upon somatosensory and additive visual compromised conditions. Also, the lower ratio of visual and vestibular reflected the patients were insufficient in well use of “vision” and “vestibular” information for balance control. Our findings showed that with the generalized muscles atrophy, anterior thigh muscle was profoundly shrinking during aging process and lower RFT was associated with poorer physical and balance performance. Target rehabilitation with strategic inclusion of strengthening program for lower limbs’ muscles synergies and specific sensory enhancement programs for balance control should be incorporated to the global physical rehabilitation for community elders with Osteo-sarcopenia in restoring bone/muscles health and postural control for independent and safe aging in-place.
