Determination of Body Composition in Community-Dwelling Older Adults With and Without Sarcopenia Using Data From Practical Measures.

Adequate body composition is essential for health, function, and independence in older adults. However, standard body composition assessments require complex and costly modalities, limiting their use for early detection of body composition changes and periodic follow-up. This study explored the ability of three practical measures-handgrip strength, five times sit-to-stand test, and upper limb loading during seated push-up test (ULL-SPUT)-to determine body composition in 109 older adults with and without sarcopenia. Participants (average age 76 years) were cross-sectionally measured for outcomes of the study. The ULL-SPUT and handgrip strength, but not the five times sit-to-stand test, significantly correlated with body composition (rs, r = .297-.827, p < .01). The ULL-SPUT, in combination with demographic data, could determine body composition up to 82%. Therefore, the ULL-SPUT may be a practical preliminary measure to identify older adults for whom standard body composition assessments and follow-up would prove timely and beneficial.

The determination of sarcopenia in older adults using a practical measure.

BACKGROUND: Many older adults are at risk of sarcopenia, a gradual loss of muscle mass affecting muscle strength and physical function, which can lead to adverse health consequences deteriorating their independence. However, the detection could be delayed due to the requirement of many measures, including a complex imaging modality. Thus, an exploration for a practical community- or home-based measure would be helpful to identify at-risk older adults and begin the timely management. OBJECTIVE: To explore the ability of the upper limb loading during a seated push-up test (ULL-SPUT) to determine the presence of sarcopenia in community-dwelling older adults. METHODS: Older adults (n= 110; 62 females, average age approximately 77 years) were cross-sectionally assessed for sarcopenia using standard measures (handgrip strength, appendicular skeletal muscle mass, and walking speed) and the ULL-SPUT. RESULTS: Data from standard measures indicated that 44 participants had sarcopenia. The ULL-SPUT index of < 16.9 kg/m2 for females (sensitivity = 86%, specificity = 78%, area under the receiver operating characteristic curve [AUC] = 0.85) and < 19.7 kg/m2 for males (sensitivity = 73%, specificity = 69%, AUC = 0.83) could optimally identify participants with sarcopenia. CONCLUSION: The ULL-SPUT index could be used to screen and monitor older adults with sarcopenia in various clinical, community, and home settings. This practical measure may be accomplished using a digital bathroom scale on a hard, even surface. Outcomes would identify an adult who should undergo further confirmation of sarcopenia through standard measures or the initiation of timely management to promote treatment effectiveness.

The Use of Practical Measures to Determine Body Composition of Older People.

Background: Older adults frequently experience body composition changes-decreased lean body mass (LBM) and bone mineral content (BMC), along with increased body fat mass (FM)-which affect their health and independence. However, the need for standard complex and costly imaging modalities could delay the detection of these changes and retard treatment effectiveness. Thus, this study explored the ability of practical measures, including simple muscle strength tests and demographic data, to determine the body composition of older adults. Methods: Participants (n = 111, with an average age of 77 years old) were cross-sectionally assessed for the outcomes of the study, including upper limb loading during a seated push-up test (ULL-SPUT), hand grip (HG) strength test and body composition. Results: The ULL-SPUT significantly correlated with body composition (r or rs, = 0.370-0.781; P < 0.05), particularly for female participants and was higher than that found for the HG strength test (rs = 0.340-0.614; P < 0.05). The ULL-SPUT and HG strength test, along with gender and body mass index (BMI), could accurately determine the LBM and BMC of the participants up to 82%. Conclusion: The ULL-SPUT along with gender and BMI can be used as a practical strategy to detect the LBM and BMC of older adults in various settings. Such a strategy would facilitate timely managements (i.e. standard confirmation or appropriate interventions) in various settings.

The seventh cervical vertebra is an appropriate landmark for thoracic kyphosis measures using distance from the wall.

Background: Hyperkyphosis is frequently found nowadays due to the change in current lifestyles and age-related system decline. A simple hyperkyphosis measurement can be made easily using the perpendicular distance from the landmark to the wall. However, the existing evidence applied two different landmarks [occiput and the seventh cervical vertebra (C7)] and the measurement using rulers was susceptible to error due to their misalignment. Objective: To assess an appropriate landmark for thoracic kyphosis measurement using distance from the wall (KMD), by comparing between occiput and C7, as measured using rulers and verified using data from a specially developed machine, the so-called infrared-gun kyphosis wall distance tool (IG-KypDisT), and the Cobb angles. Methods: Community-dwelling individuals with a risk of thoracic hyperkyphosis (age ≥10 years, n=43) were cross-sectionally assessed for their thoracic hyperkyphosis using the perpendicular distance from the landmarks, occiput and C7, to the wall using rulers and IG-KypDisT. Then the Cobb angles of these participants were measured within seven days. Results: The outcomes from both landmarks differed by approximately 0.8 cm (p= 0.084). The outcomes derived from C7 were more reliable (ICCs>0.93, p<0.001), with greater concurrent validity with the radiologic data (r= 0.738, p<0.001), with the overall variance predicted by the regression models for the Cobb angles being higher than that from the occiput (47-48% from C7 and 38-39% from occiput). The outcomes derived from rulers and IG-KypDisT showed no significant differences. Conclusion: The present findings support the reliability and validity of KMD assessments at C7 using rulers as a simple standard measure of thoracic hyperkyphosis that can be used in various clinical, community, and research settings.

Seated push-up tests: Reliable and valid measures for older individuals when used by primary healthcare providers.

BACKGROUND: Body composition decline, lower limb impairments, and mobility deficits affect independence of older people. The exploration for a practical measure involving upper extremities may offer an alternative tool to be used by primary healthcare (PHC) providers for these individuals. OBJECTIVE: To explore reliability and validity of seated push-up tests (SPUTs) among older participants when used by PHC providers. METHODS: Older participants (n= 146) with an average age of > 70 years were cross-sectionally assessed using various demanding forms of SPUTs and standard measures to assess validity of the SPUTs. Reliability of the SPUTs were assessed in nine PHC raters, including an expert, health professionals, village health volunteers, and care givers. RESULTS: The SPUTs demonstrated very good agreement, with excellent rater and test-retest reliability (kappa values > 0.87 and ICCs > 0.93, p< 0.001). Moreover, the SPUT outcomes significantly correlated with lean body mass, bone mineral contents, muscle strength and mobility of older participants (r, rp⁢b=-0.270 to 0.758, p< 0.05). CONCLUSION: SPUTs are reliable and valid for older adults when used by PHC members. The incorporation of such practical measures is particularly important during this COVID-19 pandemic with limited people's hospital access.

Validity and feasibility of using a seated push-up test among community-dwelling older adults.

Background: Older individuals face a high risk of mobility and body composition decline, which can affect their independence. In light of a current uncertain healthcare situation created by the coronavirus (COVID-19) pandemic, healthcare paradigm has been shifted with increased demand for a practical measure to promote standard home healthcare services for all individuals, including older adults. Objective: This study explored the feasibility and validity of seated push-up tests (SPUTs) as clinical measures to reflect the body composition, muscle strength, and mobility among community-dwelling older individuals, aged ≥65 years (n=82). Methods: Participants were cross-sectionally assessed using SPUTs with various demanding forms, including the 1-time SPUT (1SPUT) along with its upper limb loading SPUT (ULL-SPUT), 5-time SPUT (5SPUT), 10-time SPUT (10SPUT), and 1-min SPUT (1minSPUT) and standard measures. Results: Participants who passed and failed a 1SPUT showed significant differences in the outcomes of all standard measures (p<0.05). The ULL-SPUT significantly correlated to all body composition, muscle strength, and mobility (r=0.247-0.785; p<0.05). Outcomes of 1minSPUT significantly correlated with muscle strength and mobility outcomes (r=0.306-0.526; p<0.05). Participants reported no adverse effects following the SPUTs. Conclusion: The findings suggest the use of the 1SPUT, ULL-SPUT, and 1minSPUT as practical measures to reflect the body composition, muscle strength, and mobility of older individuals, according to their functional levels. The tests may especially clinically benefit those with lower limb limitations and those in settings with limited space and equipment.

Validity and reliability of the block method for measuring thoracic hyperkyphosis.

OBJECTIVE: This study aimed to investigate the concurrent validity of the block method as compared with the gold standard (Cobb's method). An additional aim was to examine the intra- and inter-rater reliability of expert and novice assessors using the block method. METHODS: In a cross-sectional study, we enrolled 62 participants with hyperkyphosis aged ≥10 years, with hyperkyphosis defined as one or more blocks. The participants were stratified by age (<60 years and ≥60 years). To determine concurrent validity, and kyphosis was assessed in all the participants using the block method and Cobb's method. Finally, 15 participants were included in a reliability study. To determine intra- and inter-rater reliability, each participant was assessed twice, 7 days apart, by one expert and one novice using the block method. RESULTS: The concurrent validity of the block method and gold standard method showed moderate correlation (rs = 0.53, P < .001). However, after stratifying the participants by age (<60 years and ≥60 years), there was small to moderate correlation (rs = 0.42, P = .006, and rs = 0.64, P = .002, respectively). The intra- and inter-rater reliability of the expert and novice assessors was excellent (ICC3,1 = 0.82-0.97, P < .001). CONCLUSIONS: The findings showed small correlation in those <60 and moderate correlation in those ≥60 years, and reported excellent reliability. The block method can be used by novices with strong reliability. This method is a practical technique for early screening hyperkyphosis in the elderly.

Is the occiput-wall distance valid and reliable to determine the presence of thoracic hyperkyphosis?

BACKGROUND: Hyperkyphosis may be frequently found nowadays due to the change in current lifestyles of sustained flexion postures and age-related system decline. The occiput-wall distance (OWD) is a practical measure that is commonly used to screen and monitor thoracic hyperkyphosis in epidemiologic studies. However, there was no clear evidence to support the clinical utility of the tool as compared to the data from direct standard measures. OBJECTIVES: To investigate psychometric properties-including validity, reliability, and appropriate cut-off point-of the OWD to determine the presence of thoracic hyperkyphosis, as compared to a standard Cobb's method. DESIGN: Observational study. METHODS: This study was conducted in ninety-nine participants, aged 10 years and above who had different degrees of thoracic hyperkyphosis from several communities. All participants were assessed for their severity of thoracic hyperkyphosis using the OWD, and 14 participants were involved in a reliability study. Within 7 days later, all participants were at a hospital to complete a radiographic examination. RESULTS: Outcomes from OWD had good concurrent validity with the Cobb angles (r = 0.683, P < 0.001) and excellent rater reliability when assessed by well-trained health professionals (ICCs > 0.9, P < 0.001). The OWD of at least 6.5 cm had the best diagnostic properties to determine the presence of thoracic hyperkyphosis (sensitivity = 71.4%, specificity = 76.6%, and area under the curve = 0.846). CONCLUSION: The findings support validity and reliability of OWD, and offer a clear cut-off point to determine the presence of thoracic hyperkyphosis for clinical utility in various settings.

Reliability of novice physiotherapists for measuring Cobb angle using a digital method.

BACKGROUND: The Cobb's method is the most accurate and reliable method for kyphosis measurement. Conventionally, a sagittal Cobb angle was commonly derived from a lateral plain film. With computer technology, a digital method is widely used in common clinical settings, but the existing reliability data involved only experienced raters. OBJECTIVES: To assess the interrater and intrarater reliability of a digital Cobb's method using novice physiotherapists. METHODS: Fifteen participants, with an occiput wall distance of more than 0 cm, were interviewed and assessed for their demographics. Then they were filmed for lateral spinal radiography over the area of thoracic spine in a standing position, and the Cobb angle was analyzed by four raters, including an expert physician and three novice physiotherapists, using a SurgimapSpine programme. RESULTS: The average Cobb angles among the four raters showed no significant difference (p = 0.984). Outcomes of their measurements had excellent intrarater and interrater reliability [intraclass correlation coefficient (ICC3,3) = 0.995-0.997] with a small range of standard errors of the measurement (<1°). CONCLUSION: A digital Cobb's method had excellent reliability when used by a novice health professional rater. The findings confirm the ease of using this method to detect and monitor kyphosis in general hospitals, clinics, or research facilities.