Remote collection of physical performance measures for older people: a systematic review.

Remotely collected physical performance measures could improve inclusion of under-served groups in clinical research as well as enabling continuation of research in pandemic conditions. It is unclear whether remote collection is feasible and acceptable to older patients, or whether results are comparable to face-to-face measures. We conducted a systematic review according to a prespecified protocol. We included studies with mean participant age ≥ 60 years, with no language restriction. Studies examining the gait speed, Short Physical Performance Battery, distance walk tests, grip strength, Tinetti score, Berg balance test, sit-to-stand test and timed up and go were included. Reports of feasibility, acceptability, correlation between remote and face-to-face assessments and absolute differences between remote and face-to-face assessments were sought. Data were synthesised using Synthesis Without Meta-analysis methodology; 30 analyses from 17 publications were included. Study size ranged from 10 to 300 participants, with a mean age ranging from 61 to >80 years. Studies included a broad range of participants and conditions. Most studies had a moderate or high risk of bias. Only two studies undertook assessment of acceptability or feasibility, reporting good results. Correlation between face-to-face and remote measures was variable across studies, with no measure showing consistently good correlation. Only nine studies examined the accuracy of remote measures; in six studies, accuracy was rated as good (<5% mean difference between face-to-face and remote measures). There is a lack of robust evidence that remote collection of physical performance measures is acceptable to patients, feasible or provides comparable results to face-to-face measures.

Performance of the SarQoL quality of life tool in a UK population of older people with probable sarcopenia and implications for use in clinical trials: findings from the SarcNet registry.

BACKGROUND: The Sarcopenia Quality of Life (SarQoL) questionnaire is a disease-specific sarcopenia quality of life tool. We aimed to independently assess SarQoL with a particular focus on its suitability as a clinical trial outcome measure. METHODS: We analysed data from the UK Sarcopenia Network and Registry. Measures of physical performance and lean mass were collected at baseline. SarQoL and the Strength, Assistance, Rise, Climb - Falls (SARC-F) questionnaire (to assess functional ability) were collected at both baseline and six-month follow-up. Global changes in fitness and quality of life at 6 months were elicited on seven-point Likert scales. Internal consistency was assessed using Cronbach's alpha. Responsiveness (Cohen's d and Guyatt coefficients) and minimum clinically important differences were calculated for participants reporting slight improvement or worsening in their global scores. Concurrent validity was assessed by correlating baseline SarQoL scores with measures of physical performance and functional ability. RESULTS: We analysed data from 147 participants, 125 of whom underwent follow up assessment; mean age 78 years; 72 (49%) were women. Internal consistency was good; Cronbach's alpha was 0.944 at baseline and 0.732 at telephone follow-up. Correlation between baseline and follow-up SarQoL was weak (r = 0.27; p = 0.03). The minimum clinically important improvement ranged from 5 to 21 points giving trial sample size estimates of 25-100 participants. SarQoL scores were moderately correlated with handgrip (r = 0.37; p < 0.001), SARC-F (r = - 0.45; p < 0.001), short physical performance battery (r = 0.48; p < 0.001) and 4-m walk speed (r = 0.48; p < 0.001). CONCLUSIONS: SarQoL has acceptable performance in older UK participants with probable sarcopenia and is sufficiently responsive for use in clinical trials for sarcopenia.

Developing a UK sarcopenia registry: recruitment and baseline characteristics of the SarcNet pilot.

BACKGROUND: sarcopenia registries are a potential method to meet the challenge of recruitment to sarcopenia trials. We tested the feasibility of setting up a UK sarcopenia registry, the feasibility of recruitment methods and sought to characterise the pilot registry population. METHODS: six diverse UK sites took part, with potential participants aged 65 and over approached via mailshots from local primary care practices. Telephone pre-screening using the SARC-F score was followed by in-person screening and baseline visit. Co-morbidities, medications, grip strength, Short Physical Performance Battery, bioimpedance analysis, Geriatric Depression Score, Montreal Cognitive Assessment, Sarcopenia Quality of Life score were performed and permission sought for future recontact. Descriptive statistics for recruitment rates and baseline measures were generated; an embedded randomised trial examined the effect of a University logo on the primary care mailshot on recruitment rates. RESULTS: sixteen practices contributed a total of 3,508 letters. In total, 428 replies were received (12% response rate); 380 underwent telephone pre-screening of whom 215 (57%) were eligible to attend a screening visit; 150 participants were recruited (40% of those pre-screened) with 147 contributing baseline data. No significant difference was seen in response rates between mailshots with and without the logo (between-group difference 1.1% [95% confidence interval -1.0% to 3.4%], P = 0.31). The mean age of enrollees was 78 years; 72 (49%) were women. In total, 138/147 (94%) had probable sarcopenia on European Working Group on Sarcopenia 2019 criteria and 145/147 (98%) agreed to be recontacted about future studies. CONCLUSION: recruitment to a multisite UK sarcopenia registry is feasible, with high levels of consent for recontact.

Effect of Angiotensin System Inhibitors on Physical Performance in Older People - A Systematic Review and Meta-Analysis.

OBJECTIVE: Preclinical and observational data suggest that angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) may be able to improve physical performance in older people via direct and indirect effects on skeletal muscle. We aimed to summarize current evidence from randomised controlled trials in this area. DESIGN: Systematic review and meta-analysis. SETTING AND PARTICIPANTS: Randomized controlled trials enrolling older people, comparing ACEi or ARB to placebo, usual care or another antihypertensive agent, with outcome data on measures of physical performance. METHODS: We searched multiple electronic databases without language restriction between inception and the end of February 2020. Trials were excluded if the mean age of participants was <65 years or treatment was targeting specific diseases known to affect muscle function (for example heart failure). Data were sought on measures of endurance and strength. Standardized mean difference (SMD) treatment effects were calculated using random-effects models with RevMan software. RESULTS: Eight trials (952 participants) were included. Six trials tested ACEi, 2 trials tested ARBs. The mean age of participants ranged from 66 to 79 years, and the duration of treatment ranged from 2 months to 1 year. Trials recruited healthy older people and people with functional impairment; no trials specifically targeted older people with sarcopenia. Risk of bias for all trials was low to moderate. No significant effect was seen on endurance outcomes [6 trials, SMD 0.04 (95% CI -0.22 to 0.29); P = .77; I2 = 53%], strength outcomes [6 trials, SMD -0.02 (95% CI -0.18 to 0.14), P = .83, I2 = 21%] or the short physical performance battery [3 trials, SMD -0.04 (95% CI -0.19 to 0.11), P = .60, I2 = 0%]. No evidence of publication bias was evident on inspection of funnel plots. CONCLUSIONS AND IMPLICATIONS: Existing evidence does not support the use of ACE inhibitors or angiotensin receptor blockers as a single intervention to improve physical performance in older people.