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Handgrip strength and endurance as a predictor of postoperative morbidity in surgical patients: Can it serve as a simple bedside test?

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Abstract

Postoperative morbidity is related to preoperative nutritional status. Current methods of assessing this are cumbersome, lack sufficient accuracy to completely separate all those at risk from others, and require a laboratory backup. This study was done to evaluate handgrip manometry, a simple bedside test as an indicator of preoperative nutritional status to predict risk of postoperative complications. Normal values for maximal grip strength and endurance times were established in 496 controls. Similar values were recorded in 100 patients undergoing elective surgery preoperatively. Postoperative variables studied included complication rate and hospital stay. The efficacy of four parameters, serum albumin, clinical nutritional score based on subjective global assessment, maximal grip strength (MGS), and grip endurance time, in predicting complications were studied. It was found that age and presence of co-morbidity increased risk of complications. Of the four predictive parameters studied, it was found that MGS is better than serum albumin. Clinical scoring was superior to MGS in predicting risk of complications. MGS is a simple bedside test, which can be easily performed. It can be used as a complimentary test to clinical scoring in identifying patients at risk of complications after surgery. Patients with abnormal MGS require urgent preoperative correction to reduce the risk of complications.

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... In the last years, muscle strength has been considerate as a significant component of health regardless of age 2,3,11 and clinical condition 13 . One of the most used methods for assessing muscle strength is the handgrip strength 14 , because has a low cost and may be used in a time-efficient manner with unsophisticated equipment, mainly in clinical setting 13 . ...
... In the last years, muscle strength has been considerate as a significant component of health regardless of age 2,3,11 and clinical condition 13 . One of the most used methods for assessing muscle strength is the handgrip strength 14 , because has a low cost and may be used in a time-efficient manner with unsophisticated equipment, mainly in clinical setting 13 . For these reasons, many studies have employed handgrip strength as a tool for predicting several health outcomes in adults 11 elderly individuals 12,16,17 as well as in individuals living with HIV/aids 18 . ...
... Therefore, handgrip strength should be included as a component of the multidimensional health evaluation of children and adolescents. Most possibly, through population-based reference values of handgrip strength based on physical size and body composition 1-3 , clinicians could detect earlier low levels of physical fitness in order to prevent future health problems [1][2][3][4][5][6][7]12,13 . However, certainly, handgrip strength should not be used in isolation, especially in a clinical setting, where other markers (lipid profile, electrocardiography findings, etc.) have considerable predictive power. ...
Article
DOI: http://dx.doi.org/10.5007/1980-0037.2015v17n1p1 The objective of this study was to examine the association between hangrip strength and physical fitness in children and adolescents at different stages of sexual maturation. We measured body composition and handgrip strength in 233 children and adolescents (10 - 17 years-old), who varied in terms of pubertal status. The subjects also performed the vertical jump test, standing long jump and sit-ups, as well as tests of flexibility, agility and speed. The level of energy expenditure was assessed with the international physical activity questionnaire. Handgrip strength differed by pubertal status, regardless of gender, whereas other parameters of physical fitness differed by gender and in the sample as a whole. Handgrip strength was consistently and independently associated with all other physical fitness variables, regardless of gender; some of those were mediated by energy expenditure (i.e., speed in seconds and in meters per second for the sample as a whole). The strength of the association between handgrip strength and physical fitness ranged from 20% (vertical jump test: R2=.20; P=.001) to 47% (speed in meters per second: R2=.47; P=.001). Our results support the idea that handgrip strength is consistently associated with several distinct parameters of physical fitness, regardless of age, gender or sexual maturation, suggesting that handgrip strength could be a highly accurate, independent predictor of physical fitness.
... Hand strength has been identified as an important factor predicting not only disability in musculoskeletal diseases such as rheumatoid arthritis [1], but also bone mineral density [2,3], and the likelihood of falls and fractures in osteoporosis [4,5]. It even predicts complications and general morbidity after surgical interventions [6], general disability and future outcome in older age [7][8][9], economic consequences of diseases [10] as well as causespecific and overall mortality in elderly people [5,[11][12][13]. Arteriosclerosis is the most frequent cause of morbidity and mortality and grip strength is one of the strongest predictors of its consequences, e.g. ...
... The difference in the grip and pinch strengths measured in a person suffering from a somatic (but not mental) disorder compared to the normative value may be used to predict various prognostic outcomes and risks as indicated in the wider literature. Examples are morbidity and mortality of rheumatological affections, vascular diseases, and general predictions as listed in the introduction [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]. Furthermore, hand/grip strength measurement is an easily performed "quick bedside test" [6]. ...
... Examples are morbidity and mortality of rheumatological affections, vascular diseases, and general predictions as listed in the introduction [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]. Furthermore, hand/grip strength measurement is an easily performed "quick bedside test" [6]. Comparing clinical data to normative values allows the assessor to qualify (on average) whether the patient is at an elevated risk or not but few studies provided clinically feasible quantification of that risk. ...
Article
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Abstract Background Hand strength is an important independent surrogate parameter to assess outcome and risk of morbidity and mortality. This study aimed to determine the predictive power of cofactors and to predict population-based normative grip and pinch strength. Methods A representative population survey was used as the basis for prediction analyses (n = 978). Bivariate relationships between grip/pinch strengths of the dominate hand were explored by means of all relevant mathematical functions to maximize prediction. The resulting best functions were combined into a multivariate regression. Results Polynoms (up to the third degree) were the best predictive functions. On the bivariate level, height was best correlated to grip (46.2% explained variance) and pinch strength (37.7% explained variance) in a linear relationship, followed by sex, age, weight, and occupational demand on the hand. Multivariate regression provided predicted values close to the empirical ones explaining 76.6% of the variance for grip strength and 67.7% for pinch strength. Conclusion The five easy-to-measure cofactors sex, age, body height, categorized occupational demand on the hand, and body weight provide a highly accurate prediction of normative grip and pinch strength.
... Hand strength has been identified as an important factor predicting not only disability in musculoskeletal diseases such as rheumatoid arthritis [1], but also bone mineral density [2,3], and the likelihood of falls and fractures in osteoporosis [4,5]. It even predicts complications and general morbidity after surgical interventions [6], general disability and future outcome in older age [7][8][9], economic consequences of diseases [10] as well as causespecific and overall mortality in elderly people [5,[11][12][13]. Arteriosclerosis is the most frequent cause of morbidity and mortality and grip strength is one of the strongest predictors of its consequences, e.g. ...
... The difference in the grip and pinch strengths measured in a person suffering from a somatic (but not mental) disorder compared to the normative value may be used to predict various prognostic outcomes and risks as indicated in the wider literature. Examples are morbidity and mortality of rheumatological affections, vascular diseases, and general predictions as listed in the introduction [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]. Furthermore, hand/grip strength measurement is an easily performed "quick bedside test" [6]. ...
... Examples are morbidity and mortality of rheumatological affections, vascular diseases, and general predictions as listed in the introduction [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]. Furthermore, hand/grip strength measurement is an easily performed "quick bedside test" [6]. Comparing clinical data to normative values allows the assessor to qualify (on average) whether the patient is at an elevated risk or not but few studies provided clinically feasible quantification of that risk. ...
Article
Full-text available
Hand strength is an important independent surrogate parameter to assess outcome and risk of morbidity and mortality. This study aimed to determine the predictive power of cofactors and to predict population-based normative grip and pinch strength. A representative population survey was used as the basis for prediction analyses (n = 978). Bivariate relationships between grip/pinch strengths of the dominate hand were explored by means of all relevant mathematical functions to maximize prediction. The resulting best functions were combined into a multivariate regression. Polynoms (up to the third degree) were the best predictive functions. On the bivariate level, height was best correlated to grip (46.2% explained variance) and pinch strength (37.7% explained variance) in a linear relationship, followed by sex, age, weight, and occupational demand on the hand. Multivariate regression provided predicted values close to the empirical ones explaining 76.6% of the variance for grip strength and 67.7% for pinch strength. The five easy-to-measure cofactors sex, age, body height, categorized occupational demand on the hand, and body weight provide a highly accurate prediction of normative grip and pinch strength.
... However, the comprehensive assessment of cardiovascular reserve -most objectively using cardiopulmonary exercise testing [8] -is challenging for immobile patients, time-consuming, and costly to extend as a general screening tool to the wider, at-risk surgical population. By contrast handgrip strength is an inexpensive, objective bedside test which has established population norms [9][10][11][12][13] and has been extensively tested in a range of chronic general medical conditions [14]. It may reflect, in part, the association of impaired muscle strength with malnutrition [15] and cardiopulmonary or metabolic diseases [4][5][6][7]. ...
... Nineteen studies were identified that compared postoperative outcomes in relation to handgrip strength (Table 1), comprising 2194 patients [9][10][11][12][13]16,17,[23][24][25][26][27][28][29][30][31][32][33][34]. A wide range of surgical sub-specialties was explored. ...
... Although supplementation improved post-operative grip strength compared to the control group, it was not related to patient outcome. Only two studies ensured that investigators who evaluated postoperative morbidity also remained blinded to the pre-operative grip strength values [10,17]. A wide range of exclusion criteria were reported between studies. ...
Article
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Reduced muscle strength- commonly characterized by decreased handgrip strength compared to population norms- is associated with numerous untoward outcomes. Preoperative handgrip strength is a potentially attractive real-time, non-invasive, cheap and easy-to-perform "bedside" assessment tool. Using systematic review procedure, we investigated whether preoperative handgrip strength was associated with postoperative outcomes in adults undergoing surgery. PRISMA and MOOSE consensus guidelines for reporting systematic reviews were followed. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Clinical Trials (1980-2010) were systematically searched by two independent reviewers. The selection criteria were limited to include studies of preoperative handgrip strength in human adults undergoing non-emergency, cardiac and non-cardiac surgery. Study procedural quality was analysed using the Newcastle-Ottawa Quality Assessment score. The outcomes assessed were postoperative morbidity, mortality and hospital stay. Nineteen clinical studies (17 prospective; 4 in urgent surgery) comprising 2194 patients were identified between1980-2010. Impaired handgrip strength and postoperative morbidity were defined inconsistently between studies. Only 2 studies explicitly ensured investigators collecting postoperative outcomes data were blinded to preoperative handgrip strength test results. The heterogeneity of study design used and the diversity of surgical procedures precluded formal meta-analysis. Despite the moderate quality of these observational studies, lower handgrip strength was associated with increased morbidity (n = 10 studies), mortality (n = 2/5 studies) and length of hospital stay (n = 3/7 studies). Impaired preoperative handgrip strength may be associated with poorer postoperative outcomes, but further work exploring its predictive power is warranted using prospectively acquired, objectively defined measures of postoperative morbidity.
... 5,6 In the currently available literature, a longer length of stay has been consistently shown in patients with lower HGS. 4,[7][8][9] However, most previous studies only assessed surgical patients, and length of stay was defined without acknowledging whether the patient was discharged alive or not. In addition, the difference in HGS between sexes was not taken into account, and potential confounders were not considered. ...
... In addition, the difference in HGS between sexes was not taken into account, and potential confounders were not considered. 4,[7][8][9] The study by Kerr et al 10 stands out by having quantified the association between HGS and likelihood of discharge to usual residence in a sample of patients older than 75 years, using sex-specific cutoff points for HGS and adjusting for sex. The authors reported an approximately 30% higher likelihood of discharge to usual residence in sex-specific high HGS. ...
Article
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Background and objective: Handgrip strength is a relevant marker of functional status and is also a component of nutrition assessment. The simplicity of this measurement supports its usefulness as a tool to predict who will likely take longer to hospital discharge. The aim of this study was to quantify the association between sex-specific handgrip strength at hospital admission and time to discharge alive. We intended to include a group of diverse diagnoses and to compare medical and surgical wards, taking into account the potential confounders' effect of patients' characteristics and severity of disease. Subjects and methods: Prospective study in 2 public acute-care general hospitals in Porto, Portugal, in 2004. Handgrip strength was evaluated using a handgrip dynamometer in a probability sample of 425 patients from medical and surgical wards. The association between baseline handgrip strength and time to discharge was evaluated using survival analysis with discharge alive as the outcome and deaths and transfers being censored. Results: In medical wards, women with high admission handgrip strength had a very short hospital stay (all had been discharged by the sixth day), and among men, patients with low handgrip strength had a particularly longer stay (approximately 50% were discharged after 15 days of hospitalization). In surgical wards, an increasing length of stay with decreasing handgrip strength quartiles was also observed in both sexes. Conclusions: Lower handgrip strength at hospital admission was associated with a longer time in the hospital, in patients of both sexes, in medical and surgical wards. Although this association was explained in part by age, height, education level, cognitive status, and disease severity, its direction remained unchanged regardless of the aforementioned factors.
... Accordingly, HGS declines with increasing age [14] with lower values for women [15]. Interestingly, HGS has been shown to predict LOS among some surgical [16,17] and cancer patients [18], but it is unknown as to whether a similar association exists in abdominal surgery setting. Interestingly, LOS is an important health-care outcome of interest due to the resource intensiveness of a hospital bed. ...
Article
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Background Chronological age per se cannot be considered a prognostic risk factor for outcomes after elective surgery, whereas frailty could be. A simple and easy-to-get marker for frailty, such as handgrip strength (HGS), may support the surgeon in decision for an adequate healthcare plan. Aims The aims of this study were to: (1) determine the prevalence of frailty in an abdominal surgery setting independent of age; (2) evaluate the predictive validity of HGS for the length of hospital stay (LOS). Methods This is a retrospective study conducted in subjects who underwent abdominal surgical procedures. Only subjects with complete cognitive, functional, nutritional assessments and available measurement of HGS at admission were included. A final cohort of 108 patients were enrolled in the study. Results Subjects had a mean age of 67.8 ± 15.8 years (age range 19–93 years old) and were mostly men. According to Fried’s criteria, 17 (15.7%, 4F/13 M) were fit, 58 (23.7%; 24F/34 M) were pre-frail and 33 (30.6%; 20F/13 M) were frail. As expected, HGS significantly differed between groups having frail lower values as compared with pre-frail and fit persons (fit: 32.99 ± 10.34 kg; pre-frail: 27.49 ± 10.35 kg; frail: 15.96 ± 9.52 kg, p < 0.0001). A final regression analysis showed that HGS was significantly and inversely associated with LOS ( p = 0.020) independent of multiple covariates, including age. Discussion Most of the population undergoing abdominal surgery is pre-frail or frail. The measurement of handgrip strength is simple and inexpensive, and provides prognostic information for surgical outcomes. Muscle strength, as measured by handgrip dynamometry, is a strong predictor of LOS in a surgical setting.
... HGS can be influenced not only by malnutrition but also by muscle depletion from lack of mobility or sarcopenia secondary to inflammation or aging. Associations with malnutrition, decline, and outcomes have been reported previously, 38,58-61 with HGS being particularly useful for assessing acute changes in nutrition status 61-63 and predicting certain outcomes, 59,61,64,65 including mortality. 66 Issues to be considered when using this parameter as the sole measurement of nutrition status are level of participation, level of cognitive function, presence of musculoskeletal disease, drugs, and operator skills. ...
Article
Background: In hospitals, length of stay (LOS) is a priority but it may be prolonged by malnutrition. This study seeks to determine the contributors to malnutrition at admission and evaluate its effect on LOS. Materials and Methods: This is a prospective cohort study conducted in 18 Canadian hospitals from July 2010 to February 2013 in patients ≥ 18 years admitted for ≥ 2 days. Excluded were those admitted directly to the intensive care unit; obstetric, psychiatry, or palliative wards; or medical day units. At admission, the main nutrition evaluation was subjective global assessment (SGA). Body mass index (BMI) and handgrip strength (HGS) were also performed to assess other aspects of nutrition. Additional information was collected from patients and charts review during hospitalization. Results: One thousand fifteen patients were enrolled: based on SGA, 45% (95% confidence interval [CI], 42%-48%) were malnourished, and based on BMI, 32% (95% CI, 29%-35%) were obese. Independent contributors to malnutrition at admission were Charlson comorbidity index > 2, having 3 diagnostic categories, relying on adult children for grocery shopping, and living alone. The median (range) LOS was 6 (1-117) days. After controlling for demographic, socioeconomic, and disease-related factors and treatment, malnutrition at admission was independently associated with prolonged LOS (hazard ratio, 0.73; 95% CI, 0.62-0.86). Other nutrition-related factors associated with prolonged LOS were lower HGS at admission, receiving nutrition support, and food intake < 50%. Obesity was not a predictor. Conclusion: Malnutrition at admission is prevalent and associated with prolonged LOS. Complex disease and age-related social factors are contributors. © 2015 American Society for Parenteral and Enteral Nutrition.
... L'évaluation de la force de préhension manuelle est utilisée dans plusieurs domaines tels que la gériatrie, la pédiatrie, la neurologie… Il semble que ce test reflète plus qu'une simple mesure de la force des membres supérieurs mais pourrait avoir un pouvoir prédictif d'un état de santé global chez le sujet adulte et âgé. En effet, la revue de Bohannon (2008), basé sur 45 articles scientifiques, démontre qu'une faible force de préhension est systématiquement associée à une probabilité plus importante de mortalité prématurée (Metter et al., 2000(Metter et al., , 2002Rantanen et al., 2003), au développement d'une invalidité et à un risque accru de complications ou d'une durée de séjour prolongée suite à une hospitalisation (Mahalakshmi et al., 2004 ;Vecchiarino et al., 2004). Plusieurs travaux ont montré relation forte entre la force de préhension chez des sujets âgés non-pathologiques et la mortalité (Newman et al., 2006 ;Al. ...
Thesis
La chute constitue, aujourd’hui, une problématique de santé majeure chez la population vieillissante. Elle, engendre une cascade de complications sanitaires tel que la dépendance, l’isolement social, le décès, la dépression, etc. Par conséquent, ce travail doctoral a visé de traiter la chute via une méthodologie innovante : la théorie des système complexes. Dans un premier temps, nous nous sommes intéressés à la synchronisation interpersonnelle, donc, l’interaction entre deux systèmes complexes, et nous proposons une nouvelle méthodologie pour analyser ce phénomène. Ensuite, nous montrons que l’appariement des complexités pourrait constituer une approche adaptée pour l’étude de l’interaction interpersonnelle. De ce fait, dans un second temps, nous proposons un protocole de réhabilitation à la marche basé sur un phénomène d’appariement des complexités permettant de restaurer la complexité du système de locomotion des personnes âgées. Nous montrons qu’un entraînement régulier de 3 semaines à la marche synchronisée (sujet âgé + guide jeune), permet de restaurer la complexité de la marche chez les seniors de manière pérenne (jusqu’à 2 mois post-protocole). De plus, cette restauration de la complexité obtenue se traduit par une diminution de la peur de chuter et une amélioration de l’état de santé global des seniors.
... Dey (107,110,245,286,(294)(295)(296) . Outros trabalhos realizados na área da cirurgia sugerem que os baixos valores do teste HGS estão relacionados com o prognóstico das complicações pós-cirúrgicas (281,297,298) . Reduzidos valores da HGS foram associadas com o aumento da taxa de mortalidade de e o aumento da HGS leva a um aumento das reservas funcionais que protege da morbilidade e mortalidade nestes doentes (280) . ...
... Hand grip strength is used in clinical settings as an indicator of overall physical strength and health 3 . Hand strength has been identified as an important factor predicting disability in musculoskeletal diseases 4 , bone mineral density 5,6 , and the likelihood of falls and fractures in osteoporosis 7,8 .It even predicts complications and general morbidity after surgical interventions 9 ,general disability and future outcome in older age [10][11][12] . Hand grip strength can be quantified by measuring the amount of static force that the hand can squeeze around a dynamometer. ...
Article
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Background: The human hand is a very complex structure and devoted to the functions of manipulation. Hand grip strength is used in clinical settings as an indicator of overall physical strength and health. Objectives: This cross-sectional study was performed to study the association between hand grip strength and anthropometric measurements (height, weight, body mass index, hand dimensions) in healthy Indian female population. Methods and Measures: A total of 50 healthy female subjects, satisfying the selection criteria were recruited in the study. Subjects were then assessed for height, weight, body mass index (BMI), hand and forearm anthropometric measurements. The grip strength of both dominant and non-dominant hands were measured using Jamar dynamometer. Measurements followed standardized procedures and instructions. Statistical analysis: The data was analyzed by Pearson's correlation coefficients and 5% level of probability was used to indicate statistical significance. Results: In females, dominant and non-dominant grip strength have significant positive correlation (p<0.05-0.001) with height (r = 0.572, 0.570), weight (r = 0.404, 0.411), hand length(r = 0.39, 0.40), hand span (r = 0.44, 0.46), wrist circumference(r = 0.37, 0.31) and forearm girth (r = 0.39, 0.35). Conclusion: The results show that height, weight, hand length, hand span, wrist circumference and forearm girth positively correlate with hand grip strength. Hand grip strength is not associated with BMI and hand breadth in healthy Indian females.
... Among the 50 studies reviewed for different dynamometry devices, Jamar dynamometer proved to be the most used [8, 26, 32-34, 53-57] followed by modified sphygmomenometers [17, 39, 40, 44, 58] Smedly hand dynamometer [13, 32, 59, 60] Kin-Kom dynamometer [55, 61, 62] Harpenden handgrip dynamometer [6, 47, 63]. Martin Vigorimeter [65-67] and “single-spring” dynamometer [36, 38, 68]. However, it was found that not all dynamometers can be suitable for similar assessment. ...
Article
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The dynamometer was developed by American neurologists and came into general use in the late 19th century. It is still used in various ways as a diagnostic and prognostic tool in clinical settings. In this systematic review we assessed in detail the different uses of dynamometry, its reliability, different dynamometers used and the influence of rater experience by bringing together and evaluating all published literature in this field. It was found that dynamometry is applied in a wide range of medical conditions. Furthermore, the great majority of studies reported acceptable to high reliability of dynamometry. Jamar mechanical dynamometer was used most often in the studies reviewed. There were mixed results concerning the effect of rater experience. The factors influencing the results of dynamometry were identified as age, gender, body weight, grip strength, BMI, non/dominant hand, assessing upper/lower limbs, rater and patient's strength and the distance from the joint where the dynamometer is placed. This review provides an understanding of the relevance and significance of dynamometry which should serve as a starting point to guide its use in hand trauma assessment. On the basis of our findings, we suggest that hand dynamometry has a great potential, and could be used more often in clinical practice.
... Independent functioning in terms of self-reported activities of daily living (ADL) is a frequently mentioned predictor of the postoperative course [32][33][34][35]: our findings with the 'timed up-andgo' test, a capacity-based measure of ADL, confirmed its importance. In the univariate analysis, handgrip strength was significantly correlated with mortality and discharge destination, which corroborates the results of three studies evaluating handgrip strength in isolation [36][37][38]. The handgrip strength cut-off for mortality was very similar to that reported by Chen et al. for patients with oesophageal cancer [38]. ...
Article
We studied whether reported physical activity and measurements of fitness (hand, leg and inspiration) were associated with postoperative in-hospital mortality, length of stay and discharge destination in 169 patients after major oncological abdominal surgery. In multivariate analysis, adequate activity level (OR 5.5, 95% CI 1.4-21.9) and inspiratory muscle endurance (OR 5.2, 95% CI 1.4-19.1) were independently associated with short-term mortality, whereas conventional factors, such as age and heart disease, were not. Adequate activity level (OR 6.7, 95% CI 1.4-3.0) was also independently associated with discharge destination. The factors that were independently associated with a shorter length of hospital stay were as follows: absence of chronic obstructive pulmonary disease (HR 0.6, 95% CI 0.3-1.1); adequate activity level (HR 0.6, 95% CI 0.4-0.8); and inspiratory muscle strength (HR 0.6, 95% CI 0.5-0.9). For all postoperative outcomes physical activity and fitness significantly improved the predictive value compared with known risk factors, such as age and comorbidities. We conclude that pre-operative questionnaires of physical activity and measurements of fitness contribute to the prediction of postoperative outcomes.
... In the acute hospital setting, lower admission grip strength was associated with decreased likelihood of discharge home among older acutely ill medical patients [11] and patients hospitalised with pneumonia [12]. Lower grip strength has also been shown to be associated with longer length of stay among surgical [13] and cancer patients [14] in acute settings, but it is unknown as to whether a similar association exists in rehabilitation settings. This study aimed to prospectively investigate the relationship between grip strength and length of stay in older people admitted for rehabilitation. ...
Article
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identification of patients at risk of prolonged hospital stay allows staff to target interventions, provide informed prognosis and manage healthcare resources. Admission grip strength is associated with discharge outcomes in acute hospital settings. to explore the relationship between grip strength and length of stay in older rehabilitation in-patients. single-centre prospective cohort study. community hospital rehabilitation ward. one hundred and ten patients aged 70 years and over. data on age, height, weight, body mass index (BMI), co-morbidities, medication, residence, grip strength, physical function, cognitive function, frailty, falls, discharge destination and length of stay were recorded. higher grip strength was associated with reduced length of stay, characterised by an increased likelihood of discharge to usual residence among male rehabilitation in-patients (hazard ratio 1.09 (95% confidence interval 1.01, 1.17) per kilo increase in grip strength, P = 0.02) after adjustment for age and size. this is the first prospective study to show that stronger grip strength, particularly among male in-patients, is associated with a shorter length of stay in a rehabilitation ward. This is important because it demonstrates that grip strength can be discriminatory among frailer people. Further research into the clinical applications of grip strength measurement in rehabilitation settings is needed.
... Hand strength has been identified as an important factor to predict disability in musculoskeletal diseases [13] and bone mineral density [14]. It even predicts complications and general morbidity after surgical interventions [15], general disability and future outcome in older age [16], as well as cause specific and overall mortality in elderly people [17]. Handgrip strength is found to be a significant determinant of bone mineral content and bone area and has a positive correlation with lean body mass and physical activity. ...
Article
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Measurement of handgrip strength is commonly performed by physiotherapists to measure baseline deficiency in hand muscle power, to monitor progress during rehabilitation, and to document outcome after rehabilitation. The present study deals with the trends of handgrip strength (both dominant and non-dominant) of randomly selected 2167 Indian students (1101 male and 1066 female) aged 6-25 years collected from various schools, colleges and Guru Nanak Dev University, Amritsar, Punjab, India, and its correlations with demographic characteristics. Handgrip strength was measured by standard technique. In results, statistically significant differences (p<0.003-0.001) of dominant and non-dominant handgrip strength were found in all the age groups, except 6,7, 11,12,13 years between the male and female students. Both in male and female students, the increase in dominant and non-dominant handgrip strength were continuous until 13 years of age, after which male students were significantly stronger than female students. The dominant handgrip strength was found to have significantly positive correlations (p<0.05-0.01) with high and moderate socioeconomic status, height and body weight of the subjects.
... 23,24 Measurements Demographics, preoperative risk factors and measures of functional capacity and self-reported activities were prospectively recorded. Hand grip strength, a reliable measurement 25 and known to be an indicator of skeletal muscle mass and a predictor of the risk of postoperative complications, 26,27 was measured with a DigiMax hand force device (Mechatronic GmbH, Darmstadt, Germany). ...
Article
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Investigation of the feasibility and preliminary effect of a short-term intensive preoperative exercise programme for elderly patients scheduled for elective abdominal oncological surgery. Single-blind randomized controlled pilot study. Ordinary hospital in the Netherlands. Forty-two elderly patients (>60 years). Patients were randomly assigned to receive a short-term intensive therapeutic exercise programme to improve muscle strength, aerobic capacity, and functional activities, given in the outpatient department (intervention group; n =22), or home-based exercise advice (control group; n=20). Parameters of feasibility, preoperative functional capacity and postoperative course. The intensive training programme was feasible, with a high compliance and no adverse events. Respiratory muscle endurance increased in the preoperative period from 259 +/- 273 to 404 +/- 349 J in the intervention group and differed significantly from that in the control group (350 +/- 299 to 305 +/- 323 J; P<0.01). Timed-Up-and-Go, chair rise time, LASA Physical Activity Questionnaire, Physical Work Capacity and Quality of Life (EORTC-C30) did not reveal significant differences between the two groups. There was no significant difference in postoperative complications and length of hospital stay between the two groups. The intensive therapeutic exercise programme was feasible and improved the respiratory function of patients due to undergo elective abdominal surgery compared with home-based exercise advice.
... Some authors have used the term ''nutritionassociated complications'' to highlight the relationship between malnutrition and these adverse events. [13][14][15][16] The nutritional status of hospitalized patients can be assessed by a variety of methods. The four widely applied traditional methods (the use of body weight loss as a marker of nutritional status, anthropometric methods of nutritional assessment, the use of plasma proteins as markers of proteinenergy malnutrition and the prognostic nutritional indexes) rely heavily on objective anthropometric measurements and laboratory test results. ...
Article
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In most hospitals in Vietnam, clinical assessment of nutritional status has yet to become part of the routine clinical history taking and physical examination. It is the aim of this study to apply subjective global assessment (SGA) of nutritional status in surgical patients in the Mekong Delta, Vietnam, to determine the incidence of malnutrition according to SGA and to know whether there was an association between SGA class and infectious complications. A prospective, cross-sectional study design was used. SGA of nutritional status was applied. Patients were rated as well nourished (A), moderately malnourished (B) or severely malnourished (C). Infectious complications (wound infection, intra-abdominal abscesses, anastomotic leakage) were recorded. Of the 438 patients assessed, 194 (44.3%) were classified as A, 126 patients (28.8%) were classified as B and 118 patients (26.9%) were classified as C. Of the 274 patients who underwent major abdominal surgery assessed, 61 patients (22.3%) were classified as A, 97 patients (35.4%) were classified as B and 116 patients (42.3%) were classified as C. Weight loss and percent weight loss, muscle wasting, loss of subcutaneous fat, functional capacity and significant gastrointestinal symptoms correlate significantly with the severity of SGA class (P<0.001). The rate of postoperative infectious complications was higher in patients classified as SGA class C (33.6%) than as class A (6%) and B (11%). A high rate of malnutrition was found, applying SGA of nutritional state in surgical patients in Vietnam. Malnutrition was associated with an increase in infectious complications. Special attention should be paid to weight loss, muscle wasting, loss of subcutaneous fat, functional capacity and gastrointestinal symptoms.
... This approach failed to identify malnutrition in surgical patients [3]. In another study [62] a scored SGA was superior to handgrip strength and endurance in predicting morbidity in surgical patients. ...
Article
Subjective global assessment is a clinical tool for assessing nutritional status that merges alterations in body composition and physiological function. Although it was first described almost two decades ago, many studies using this method have been published during the past few years. This review describes recent findings from such studies. Subjective global assessment has proved to be a good nutritional assessment and prognostic indicator in several clinical situations. Agreement between subjective global assessment and newer screening methods is not always acceptable, and it has not been validated with respect to clinical outcome. Some modifications have been suggested that may increase the sensitivity of subjective global assessment as a screening tool. A scored version of subjective global assessment for cancer patients is now being validated for use in other patient groups. This could increase its utility in nutritional intervention studies if it can be demonstrated that subtle changes in nutritional status are reflected by numerical scores in patient-generated subjective global assessment. Subjective global assessment represents a good option for assessing nutritional status in various clinical situations. As a screening tool, it better identifies established malnutrition than nutritional risk but its sensitivity is suboptimal. The scored version of subjective global assessment may have advantages and extend the usefulness of this tool even further.
... Several studies demonstrated that handgrip strength (HGS) can be used as a nutritional assessment technique that is also sensitive in evaluating short-term changes in nutritional status (Lopes et al., 1982; Windsor and Hill, 1988; Webb et al., 1989; Ades et al., 2002; Humphreys et al., 2002). Muscle strength, measured by handgrip dynamometry, has been shown to be both sensitive and specific in predicting outcome in surgical patients (Klidjian et al., 1982; Hunt et al., 1985; Kalfarentzos et al., 1989; Webb et al., 1989; Pieterse et al., 2002; Bunout et al., 2004; Mahalakshmi et al., 2004), and cirrhotic patients (A ´ lvares-da-Silva and Da Silveira 2005), as well as being associated with higher long-term mortality (Newman et al., 2006). HGS is also useful for the detection of functional status (Humphreys et al., 2002) and in the onset of activities of daily living (ADL) dependence in the elderly (Rantanen et al., 2002). ...
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To investigate if handgrip strength (HGS) could be used as a single screening procedure in identifying patients who are classified as being undernourished or nutritionally-at-risk at hospital admission. Cross-sectional study. In the second day of hospital admission, HGS was evaluated and results were compared with Nutritional Risk Screening (NRS-2002). Two public hospitals in Porto, Portugal, a university and a district one. A probabilistic sample of 50% in-patients from each hospital of 314 patients (age range of 18-96) was studied. Patients were considered eligible if they were >or=18 years old and able to give informed consent. Hand pain, upper limb deformities, incapacity to perform muscle strength measurements and pregnancy were considered further exclusion criteria. Patients identified as undernourished by NRS-2002 (37.9%) were older, shorter and lighter, with a lower functional capacity, a longer length of stay and a lower HGS (P<0.001). When comparing patients with lower HGS (first quartile) with those with the highest HGS (fourth quartile), this parameter revealed good sensitivity (86.7%) and specificity (70.2%) and a k=0.56. Multivariate analysis showed that patients with higher HGS had an independent decreased risk of being at nutritional risk (P for trend <0.001) odds ratio=0.19 (95% confidence interval=0.08-0.48). Our entire sample of hospitalized patients was -1.96 Z-score below the HGS cutoff of distribution data for healthy individuals. HGS identifies a high proportion of nutritionally-at-risk patients and can be a reliable first screening tool for nutritional risk in hospitals.
... Grip strength not only describes hand normality but is also used as an objective evaluator of upper extremities in treating hand damages (2). Furthermore, it predicts post-surgical complications and losses (3), general inabilities and aging consequences such as disability (4), increase in illness risk (5) and mortality (6). It is also used to determine job qualification of those who suffer from local hand injuries (5). ...
... That is, lower grip strength was followed by an increased likelihood of complications or increased length of stay . [26][27][28]30,[32][33][34]36,37,46 Álvares-da-Silva reported grip strength to be "the only technique that predicted a significant increase in major complications" among patients with cirrhosis . 46 Hunt et al described grip strength as the "most sensitive single parameter" predicting postoperative complications . ...
Article
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One use of clinical measures is the prediction of future outcomes. The purpose of this systematic review was to summarize the literature addressing the value of grip strength as a predictor of important outcomes. Relevant literature was located using 4 bibliographic databases, searching article reference lists, and perusing personal files. Forty-five relevant research articles were found. The research involved both healthy subjects and patients; it tended to focus on middle-aged and older adults. The primary outcome addressed was mortality/survival (24 articles), but disability (9 articles), complications and/or increased length of stay (12 articles), and other outcomes were also examined. Low grip strength was shown consistently to be associated with a greater likelihood of premature mortality, the development of disability, and an increased risk of complications or prolonged length of stay after hospitalization or surgery. Given its predictive validity and simplicity, dynamometrically measured grip strength should be considered as a vital sign useful for screening middle-aged and older adults.
... Grip strength not only describes hand normality but is also used as an objective evaluator of upper extremities in treating hand damages (2). Furthermore, it predicts post-surgical complications and losses (3), general inabilities and aging consequences such as disability (4), increase in illness risk (5) and mortality (6). It is also used to determine job qualification of those who suffer from local hand injuries (5). ...
Article
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Measuring and comparing grip and pinch strengths with their normative data is a valid method to detect intensity of the numerous damages of hand. This research was carried out with the aim of establishing normative data of grip strength and three types of pinch strengths (Tip, Key and Palmar) in healthy Iranian adults. In this cross-sectional study, the study population was formed of 1008 people (526 men and 482 women) from healthy Fars race adults of over 20 years old in five cities of Iran. American Society of Hand Therapists (ASHT) recommendations were followed to establish normative data of grip and pinch strengths. Normative data of grip and pinch strengths were developed based on sex, 12 different age groups and dominant and non-dominant hands. Jamar dynamometer and Seahan pinch gauge were used to measure grip and pinch strengths, respectively. Normative data of grip and pinch strengths were provided. Grip and pinch strengths of men were significantly stronger than women. The maximum grip strength of men was obtained in the group of 20-24 years and among women it was in the age group 35-39 years. Regardless of gender, grip and pinch strengths were declined with aging. Normative data of grip and pinch strengths were developed for Iranian population.
... Reductions in handgrip strength are associated with PEM and generalized muscle weakness [75À77] as well as all-cause mortality [78]. Preoperative handgrip strength has also been found to predict risk of postoperative complications [79]. Handgrip strength is useful in the serial assessment of an individual, but it can also be used for reference to age-and sex-specific norms. ...
... 12 Handgrip strength (HGS) is an objective and inexpensive bedside tool, which has established population norms and has been extensively investigated in several medical conditions. 13,14 It reflects the association of muscle strength and lean body mass with malnutrition, 15 and cardiopulmonary or metabolic diseases. 16 In a retrospective study including 43 patients with HCC, Silva et al. 17 has shown that HGS does not aid in nutritional diagnosis nor its correlation with disease severity. ...
... Grip strength is linked with outcome in surgical patients. 45,46 Grip strength cannot be assessed in heavily sedated patients and is unsuitable for use in patients with cognitive impairment, neurological, or neuromuscular diseases/conditions. Electrical stimulation of the adductor pollicis muscle has been proposed as a technique to measure involuntary muscle strength. ...
Article
Nutrition support in the intensive care unit can impact favorably on disease severity, development of complications, modulation of the immune response, and length of stay, resulting in improved outcomes (ASPEN [American Society for Parenteral and Enteral Nutrition] 2009 guideline), but determining an individual's precise nutritional requirements remains a clinical challenge. By understanding the impact of critical illness on nutrient requirements, the dietitian can estimate needs and provide nutrition support. Monitoring tolerance to individualized nutrition support helps avoid the negative consequences of under- and overfeeding. Evidence-based nutrition support guidelines and specifically tailored care plans play a significant role in optimizing nutritional management, thus improving patient outcomes and reducing health care costs.
... Handgrip strength (recorded in kilograms) will be assessed using the Jamar dynamometer (Sammons Preston, Rolyon, Bolingbrook, IL, USA) [48]. Handgrip strength has shown to be an indicator of skeletal muscle mass and a predictor of the risk of postoperative complications [49,50]. The test will be performed in upright position with the elbows stretched in a straight line downwards, starting with the dominant hand. ...
Article
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Background Of all older patients that opt for elective colorectal surgery, approximately one-third has one or more postoperative complications, particularly those patients with a low cardiorespiratory fitness (ventilatory anaerobic threshold (VAT) < 11 mL/kg/min). A physical exercise training program prior to surgery (prehabilitation) can improve their cardiorespiratory fitness. It remains to be seen whether prehabilitation also reduces postoperative complications, as most of the studies so far were rather underpowered, heterogeneous, and biased toward selection of patients with a lower risk of postoperative complications. The primary objective of this study is to evaluate the effects of a three-week prehabilitation program on 30-day postoperative complications in patients with a VAT < 11 mL/kg/min planned for elective colorectal resection for colorectal cancer or dysplasia. Methods In this multicenter prospective randomized controlled trial, patients ≥ 60 years with colorectal cancer or dysplasia grade I, II, or III, planned for elective colorectal resection in two hospitals in the Netherlands, will be recruited. Eligible patients must have a score ≤ 7 metabolic equivalents on the veterans-specific activity questionnaire, and should be able to perform a cardiopulmonary exercise test. A total of 86 patients will be randomized (block-stratified randomization) to prehabilitation (intervention group) or usual care (control group). For final inclusion, VAT should be < 11 mL/kg/min. Three times a week for 3 weeks, a 60-min supervised prehabilitation session will be completed in community physical therapy practices by the 43 patients in the prehabilitation group, consisting of moderate-to-high intensity interval training to improve cardiorespiratory fitness, and resistance training to improve peripheral muscle strength. Additionally, patients perform home exercises twice a week on a moderate intensity level. The 43 patients in the usual care group will receive usual care. DiscussionOptimizing preoperative physical fitness may decrease the postoperative complication rate, may lead to fewer reoperations, less intense clinical care, a shorter length of stay, a more effective surgical planning (process-optimization), fewer readmissions, less intense rehabilitation, shorter rehabilitation period, earlier resumption of work, enhance patient perceived health-related quality of life, and promote performance in daily life. Cost-effectiveness should therefore be expected and evaluated. Trial registrationMedical Ethics Committee Twente, Enschede, the Netherlands (NL45001.044.13, September 3, 2013); Netherlands Trial Register (NTR; NTR4032, June 14, 2013).
... Grip strength has been proposed as a useful single marker of physical frailty and biological ageing [5]. Lower grip strength is associated with higher hospitalisation costs and longer hospital stays among older people across the spectrum of clinical settings [6][7][8][9][10][11]. ...
Article
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Handgrip strength is a non-invasive marker of muscle strength and low grip strength in hospital inpatients is associated with poor healthcare outcomes including longer length of stay, increased functional limitations and mortality. Measuring grip strength is simple and inexpensive. However, grip strength measurement is not routinely used in clinical practice. The aim of this study is to evaluate the feasibility of implementing grip strength measurement into routine clinical practice Methods and design: This feasibility study is a mixed methods design combining qualitative, quantitative and economic elements and is based in the acute medical wards for older people in one hospital. The study consists of three phases: Phase 1 will define current baseline practice for the identification of inpatients at high risk of poor healthcare outcomes, their nutrition and mobility care through interviews and focus groups with staff as well as a review of patients’ clinical records. Phase 2 will focus on the feasibility of developing and implementing a training programme using Normalisation Process Theory to enable nursing and medical staff to measure and interpret grip strength values. Following the training, grip strength will be measured routinely for older patients as part of admission procedures with the use of a care plan for those with low grip strength. Finally, Phase 3 will evaluate the acceptability of grip strength measurement, its adoption, coverage and basic costs using interviews and focus groups with staff and patients, and re-examination of clinical records. Discussion: The results of this study will inform the translation of grip strength measurement from a research tool into clinical practice to improve the identification of older inpatients at risk of poor healthcare outcomes. Trial registration: Clinicaltrials.gov NCTO2447445 The full article is available on http://www.pilotfeasibilitystudies.com/content/2/1/27
... 8 The FTSTS test is a performance-based functional test evaluating the combination of functional mobility, balance, and lower leg muscle strength. 9,10 Patients are asked to stand up and sit down from a chair (43 to 47 cm in height) as quickly as possible for five times with their arms folded across their chest. The FTSTS test is easy to perform in clinical practice and is reliable in community-dwelling older people (ICC of 0.89; 95% CI of 0.79 to 0.95). ...
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Introduction: Prehabilitation aims for an optimal physical functioning level before, during, and after hospitalization for major surgery. The purpose of this case report was to illustrate the care pathway of a high-risk patient who opted for pylorus-preserving pancreaticoduodenectomy, including preparation for this procedure by participating in a community-based exercise prehabilitation program. The report describes patient examination, evaluation in decision-making for surgery, the prehabilitation program, and outcomes within the context of the Hypothesis-Oriented Algorithm for Clinicians II. Case Description: The patient was a 75-year-old woman with a history of several comorbidities and a polypoid mass in the descending segment of the duodenum. Based on the preoperative assessment, the level of physical functioning was expected to be insufficient to cope adequately with the stress of hospitalization and surgery. Intervention: A 4-week prehabilitation program, including aerobic, resistance, and functional task training in a community-based physical therapy practice. Outcomes: Prehabilitation had a beneficial impact on improving functional mobility preoperatively (timed up-and-go test score improved from 19.4 to 10.0 s, five times sit-to-stand test score improved from 30.1 to 10.1 s, and two-minute walk test distance improved from 55.0 to 107.0 m). Surgery and postoperative recovery proceeded without complications. She achieved independent physical functioning on postoperative day 6 and was discharged home on postoperative day 12. Conclusion: Preoperative risk-assessment can support clinical decision-making in a high-risk patient opting for major abdominal surgery. Furthermore, a remarkable improvement in physical functioning can be achieved by community-based prehabilitation in a high-risk surgical patient.
... Grip strength not only describes hand normality but is also used as an objective evaluator of upper extremities in treating hand damages (2). Furthermore, it predicts post-surgical complications and losses (3), general inabilities and aging consequences such as disability (4), increase in illness risk (5) and mortality (6). It is also used to determine job qualification of those who suffer from local hand injuries (5). ...
Article
Full-text available
Background: Grip and pinch strength measurement is important for objective evaluation of the function of the upper extremities in upper limbs injuries treatment and also for ergonomists as a way of optimizing the requirements of hand tool design. Objective: The present study was conducted to investigate the correlation of anthropometric and demographic factors with hand strength as well as to develop regression models for grip and three types of pinch strengths including Tip, Key and Palmar in Iranian adult population. Methods: The study population consisted of 1008 Iranian adults aged 20 to 107 years. Participants were selected using a stratified random sampling method from crowded places of the cities with the highest number of Persian ethnic group. Strength measurements were undertaken according to recommendations by the American Society of Hand Therapists (ASHT). Results: This study found a positive and significant correlation between all measured strengths and anthropometric factors. The regression equations of grip and pinch strengths were developed for dominant and non-dominant hands. Conclusions: The results of this study provided more information about correlated factors of grip and pinch strengths. The regression equations developed in this research are applicable to clinical treatment and ergonomics programs.
Article
Background/objectives: There is increasing evidence showing that handgrip strength (HGS) is an indicator of nutrition status and a promising undernutrition screening tool. However, HGS cutoff values for inpatient undernutrition screening remain to be studied. The present study aims to define gender- and age-specific HGS cutoff values for undernutrition screening of hospitalized patients at admission. Subjects/methods: A cross-sectional study was conducted in a university hospital. Gender- and age-specific receiver operating characteristic curves were constructed to evaluate the performance of HGS for correctly screening undernourished patients on the basis of their classification by Patient-Generated Subjective Global Assessment. Sensitivity, specificity, areas under the curves (AUCs) and positive likelihood ratios (LRs) were calculated. Results: The study sample was composed of 712 participants between the ages of 18 and 91 years old, median (interquartile range) of 58 (22) years. For women, HGS cutoff values, sensitivities and specificities were as follows: 18-44 years, 20.2 kgf, 0.741 and 0.556; 45-64 years, 19.2 kgf, 0.795 and 0.522. For men, these values were as follows: 18-44 years, 41.7 kgf, 0.923 and 0.520; 45-64 years, 37.9 kgf, 0.817 and 0.402; ⩾65 years, 30.2 kgf, 0.736 and 0.567. The AUCs varied between 0.642 and 0.778 and LRs from 1.37 to 1.92. Conclusions: This study provides HGS cutoff values for men aged 18-91 years and for women aged 18-64 years.
Article
Intestinal pseudomyiasis caused by the larvae of the drone fly Eristalis tenax is sporadically reported and symptoms are varying. We report a ten-year-old boy with intermittent nonspecific abdominal pain. He noticed a larva in his stools which was later identified as the rat-tailed larva of Eristalis tenax. After passing the larva his symptoms subsided. No treatment was given. We aim to register the first case of human pseudomyaisis caused by E. tenax in Denmark.
Article
Malnutrition is a common problem in patients with digestive disease and is associated with impaired outcome. We investigated the effect of a three-month post-hospital nutritional intervention with high protein and energy supplements on body composition, muscle function and quality of life (QoL) in malnourished GI patients. Eighty malnourished patients with benign digestive disease were randomized to receive either oral nutritional supplements (ONS) for three months in addition to dietary counselling (DC) (ONS patients) or only dietary counselling (DC patients). Nutritional status was determined with the subjective global assessment, body composition by bioelectrical impedance and anthropometry, muscle function with hand-grip strength and peak flow. QoL was assessed by the 36-item short-form questionnaire. Age, body cell mass (BCM), muscle function, gender distribution and QoL did not differ between ONS patients (n=38) and DC patients (n=42) at baseline. Body weight and BCM improved significantly in both groups after three months. However, hand-grip strength (26.1+/-11.3-31.5+/-10.1 kg, p<0.0001) and peak flow (329.2+/-124.0-388.9+/-108.4 l /min, p=0.004) improved only in the ONS patients and remained unchanged in the DC patients. Similarly, all eight scales of the QoL improved in the ONS patients compared with merely three in the DC patients. DC patients experienced significantly more readmissions (n=20) than ONS patients (n=10) during the study period (p=0.041). A three month intervention with high protein oral supplements improves outcome in malnourished patients with digestive disease in terms of functional status, QoL and rehospitalization.
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This study compared the outcome of the Subjective Global Assessment (SGA) in preoperative surgical patients with objective measurements of muscle mass and strength and with biochemical data. A secondary aim was to test the influence of inflammatory activity on muscle strength. Two hundred seventy-four consecutive patients who were admitted for elective major abdominal surgery were assessed using the SGA, anthropometry, muscle strength, and laboratory measurements (hemoglobin, protein, albumin, C-reactive protein, and lymphocytes). Normal values for midarm muscle circumference (MAMC) and handgrip strength were obtained in a healthy control group. For all other variables, normal values available for the Vietnamese population were used. Of 274 patients (151 men, 123 women) assessed, 61 (22.3%) were classified as SGA class A (well nourished), 97 patients (35.4%) as class B (moderately malnourished), and 116 patients (42.3%) as class C (severely malnourished). There were significant differences in age, body weight, percentage of weight loss, triceps skinfold thickness, MAMC, and serum albumin across the three SGA classes. Almost all patients rated class A had normal MAMC and handgrip strength. However, a large proportion of patients rated as B or C also had normal MAMC and handgrip strength (38% of men, 50% of women). Handgrip strength per square meter correlated with serum albumin (r = 0.278, P < 0.001) and this correlation persisted when handgrip strength was controlled for MAMC (r = 0.296, P < 0.001 in men; r = 0.237, P < 0.01 in women). The SGA correctly identifies patients with normal muscle mass and strength but a substantial number of patients rated SGA B or C have normal muscle mass and strength. Muscle strength is not only positively associated with muscle mass but also negatively with inflammatory activity.
Article
Zusammenfassung Hintergrund Mangelernährung bei hospitalisierten Patienten ist ein relevantes Problem unterschätzten Ausmaßes mit negativen Auswirkungen auf das Überleben und den Behandlungserfolg bei einer Vielzahl von chirurgischen Krankheitsbildern. Zwischen dem in Leitlinien definierten Versorgungsanspruch und der klinischen Realität besteht oftmals eine Diskrepanz. Hauptursache ist die mangelhafte Etablierung ernährungsmedizinischer Strukturen als integraler Bestandteil der Regelversorgung im klinischen Alltag. Die notwendige Weiterentwicklung dieser Strukturen ist durch knappe Ressourcen, aber möglicherweise im Einzelfall auch durch mangelndes Problembewusstsein erschwert, sodass Praxisrelevanz und Machbarkeit im Hinblick auf die örtlichen Gegebenheiten die entscheidenden Kriterien für eine nachhaltige Verbesserung sind. Methoden Dargestellt wird am Beispiel eines Großklinikums, welche institutionellen und prozeduralen Maßnahmen zur Implementierung einer ernährungsmedizinischen Gesamtstrategie durchgeführt werden mussten. Es wird in die zugrunde liegende ernährungsmedizinische Methodik eingeführt sowie anhand von 4 Projekten die konkrete Implementierung im klinischen Alltag veranschaulicht. Ergebnisse Mit der hier vorgestellten Systematik konnten an einem Großklinikum innerhalb eines Jahreszeitraumes die Strukturen geschaffen werden, um Malnutrition im stationären Setting zu erfassen, eine ernährungsmedizinische Komplexbehandlung durchführen zu können und durch fortlaufende und zukünftige Projektinitiativen die Ernährungssituation hospitalisierter Patienten fortlaufend zu verbessern. Zusammenfassung Die hier dargestellte, am Universitätsklinikum Bonn erfolgreich eingeführte ernährungsmedizinische Gesamtstrategie kann als Modellerfahrung für Kliniken dienen, die eine Verbesserung der ernährungsmedizinischen Versorgungslage und damit der Behandlungsqualität bei ihren Patienten erwirken wollen.
Article
Aim Sarcopenia has a high prevalence and can be an adverse predictor in patients with chronic liver diseases (CLDs). We sought to assess the prevalence of sarcopenia and its prognostic significance in patients with CLDs at multiple centers in Japan. Methods In this retrospective study, we collated the data of 1,624 patients with CLDs (976 males). The diagnosis of sarcopenia was determined by the sarcopenia assessment criteria of the Japan Society of Hepatology. Predictors of mortality were identified using univariate and multivariate analyses. Results Muscle weakness defined and skeletal muscle loss occurred in 33.5% and 29.3% of all subjects, respectively, while sarcopenia occurred in 13.9% of all patients. Patients with sarcopenia had a poorer prognosis among all patients, patients with hepatocellular carcinoma (HCC), and those without HCC by log-rank test. The multivariate Cox proportional hazards model identified female (hazard ratio [HR], 0.59; P = 0.03), alcoholic liver disease (HR, 4.25; P < 0.01), presence of HCC (HR, 6.77; P < 0.01), Child-Pugh classes A (HR, 1.42; P < 0.05), B (HR, 2.70; P < 0.01) and C (HR, 6.30; P < 0.01), and muscle strength weakness (HR, 2.24; P < 0.01) as significant adverse predictors. The cut-off values of handgrip strength (HGS) for prognosis determined by maximally selected rank statistics were calculated as 27.8 kg for males and 18.8 kg for females, respectively. Conclusions Reduced HGS in CLDs was an independent adverse predictor, with cut-off values of 27.8 kg for males and 18.8 kg for females, respectively. This article is protected by copyright. All rights reserved.
Article
Up to 85% of all patients with cancer develop clinical malnutrition, which negatively affects patients' response to therapy, increases the incidence of treatment-related side effects and can decrease survival. Early identification of patients who are malnourished or at risk of malnutrition can promote recovery and improve prognosis. In addition, early nutritional intervention is cost effective, as it reduces complication rates and length of hospital stay. The development and use of screening and assessment tools is essential for effective nutritional intervention and management of patients with cancer. Nutritional screening aims to identify patients who are malnourished or at significant risk of malnutrition. Patients identified through screening require referral to a dietician or specialist in nutrition for an in-depth nutritional assessment, involving examination of medical, dietary, psychological and social history, physical examination, anthropometry and biochemical testing. Interventions initiated after nutritional assessment should be tailored to the individual and take into consideration the patient's prognosis. Nutritional care is a fundamental aspect of nursing practice and nurses are ideally placed to play an essential role in the early detection and screening of malnutrition in patients with cancer.
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Introduction: Reliable muscle strength measurement of individual muscle groups is time-consuming and so it would be convenient to have a single, quick and simple tool as an indicator of the general muscle strength. Handgrip strength might be an adequate measurement for generalised muscle strength. It has a low cost and may be used in a time-efficient manner in clinical setting. Aim: To determine if a handgrip dynamometer test is a valid predictor of both muscular strength and endurance and to provide a gender specific reference charts for handgrip and establish correlation between BMI and handgrip. Materials and Methods: It was a cross-sectional study, conducted from October 2017 to March 2018. Participants included 30 college students, 10 males and 20 females of 18 to 25 year age group. BMI of all subjects were measured. Handgrip strength was measured by adjustable handgrip dynamometer. Horizontal Jump Test (HJT) and Vertical Jump Test (VJT) were used to measure lower limb muscle strength. To evaluate the strength of the trunk, one minute curl-ups test was used. Aerobic power was measured by VO2 max Cooper’s test. Results: Significant correlation found between handgrip strength and HJT (r=0.8226, r2 =0.6767, p
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Hand-grip strength, which can be measured easily and objectively using a dynamometer, is predictive of multiple outcomes among a variety of subjects. Although the literature is not fully consistent, it tends to support grip strength as a predictor of postoperative complications, mortality, and functional decline. Hand-grip dynamometry may merit broader application as a screening procedure.
Article
Study Design This is a cross-sectional observational study. Introduction Reference equations for describing hand-grip strength across the age span were derived from the 2011 NIH Toolbox norming study. Purpose of the Study This project was undertaken to cross-validate reference equations by evaluating its predicting power on a separate, independent data set from the 2011-2014 National Health and Nutrition Examination Survey (NHANES) study. Methods Observed hand-grip strength data for both hands from 13,676 non-institutionalized participants were obtained from the NHANES study. Best values (best from 3 trials) and the mean values (averaged from 3 trials) were determined for each hand. Using the age (yr), height (m), and weight (kg) from each participant, we computed the predicted grip strength values for their dominant and nondominant hands using the reference equations. For validation, three predictability measures: the correlation coefficient, residuals, and accuracy, were used along with the Bland-Altman plot. Results The predicted values highly correlated with observed values (r =0.90, ICC = 0.89), indicating a good agreement. In predicting best values, means (SD) of residuals (i.e., observed - predicted) were 1.41 (5.57) and 1.03 (5.44) kg for dominant and nondominant hands, respectively. In predicting mean values, means (SD) of residuals were -0.23 (5.42) and -0.54 (5.31) kg for dominant and nondominant hands, respectively. Root mean square error (RMSE) ranged from 4.10 (in predicting female's mean values of the nondominant hand) to 6.74 (in predicting male's best values of the dominant hand). Overall, about 5.56% fell outside of the 95% confidence interval of the prediction. Conclusions Results provided the preliminary predicting performance of the reference equations derived from the NIH Toolbox study.
Article
Background: Malnutrition at admission, using various parameters, is associated with 30-day readmission. However, the association between 30-day readmission and nutritional parameters at discharge has not been studied. Method: From a large cohort study (n = 1022), 413 patients with a length of stay of ≥7 days who had information on readmission and discharge location were included into the analysis. Their nutritional status at discharge was assessed by subjective global assessment, body mass index, albumin, nutritional risk index and handgrip strength. Data on demography, diagnoses and Charlson comorbidity index (CCI) were also collected. Missing data was handled using multiple imputations by chained equations. Association of nutrition related measures with 30 day readmission was tested in logistic regression models. Results: Of the 413 patients, 86 (20.8%) were readmitted within 30 days. The proportion of readmitted patients was higher for medical (42.2%) versus surgical patients (25.6%) (p = 0.005) and disease severity was higher in the readmission group with (median (q1, q3) CCI of 3 (2, 6) versus 2(1, 4) for no readmission (p = 0.009). Among the nutritional parameters assessed at discharge, only handgrip strength was significantly associated with 30-day readmission both in unadjusted and adjusted models. Stronger handgrip was associated with decreased chances for readmission where adjusted OR (95% CI) per unit increase were 0.95 (0.92, 0.99). Handgrip strength was not associated with disease severity assessed by CCI (p = 0.14) but was significantly associated with SGA (SGA A and B significantly different from SGA C: both p-values <0.001) after adjusting for age and gender. Conclusion: Lower handgrip at discharge was associated with 30-day readmission. This assessment may be useful to detect patients at risk of readmission to better individualize discharge planning including nutrition care.
Article
There are several methods for assessment of nutritional status whose utility varies with age and health status. Changes of nutritional status have implications on muscle function and handgrip strength (HGS) can be used to diagnose malnutrition. HGS is usually quantified with manual dynamometers and this is a valid, simple and objective method. The main determinants of HGS are sex, age, height, body mass index, physical activity level, occupation and cognitive status. A decrease in HGS is consistently associated with a worse functional status, with increased postoperative complications, length of hospital stay and mortality.
Article
This retrospective analysis of hip fracture patients with and without muscle atrophy/weakness (MAW) revealed that those with MAW had significantly higher healthcare utilization and costs compared with hip fracture patients without MAW. Examine the demographics, clinical characteristics, and healthcare resource utilization and costs of hip fracture patients with and without MAW. Using a large US claims database, individuals who were newly hospitalized for hip fracture between 1 Jan 2006 and 30 September 2009 were identified. Patients aged 50-64 years with commercial insurance (Commercial) or 65+ years with Medicare supplemental insurance (Medicare) were included. The first hospitalization for hip fracture was defined as the index stay. Patients were categorized into three cohorts: patients with medical claims associated with MAW over the 12 months before the index stay (pre-MAW), patients whose first MAW claim occurred during or over the 12 months after the index stay (post-MAW), and patients without any MAW claim (no-MAW). Multivariate regressions were performed to assess the association between MAW and healthcare costs over the 12-month post-index period, as well as the probability of re-hospitalization. There were 26,122 Medicare (pre-MAW, 839; post-MAW, 2,761; no-MAW, 22,522) and 5,100 Commercial (pre-MAW, 132; post-MAW, 394; no-MAW, 4,574) hip fracture patients included in this study. Controlling for cross-cohort differences, both the pre-MAW and post-MAW cohorts had significantly higher total healthcare costs (Medicare, $7,308 and $18,753 higher; Commercial, $18,679 and $25,495 higher) than the no-MAW cohort (all p < 0.05) over the 12-month post-index period. The post-MAW cohort in both populations was also more likely to have any all-cause or fracture-related re-hospitalization during the 12-month post-index period. Among US patients with hip fractures, those with MAW had higher healthcare utilization and costs than patients without MAW.
Article
Background: Undernutrition status at hospital admission is related to increased hospital costs. Handgrip strength (HGS) is an indicator of undernutrition, but the ability of HGS to predict hospitalization costs has yet to be studied. Objective: To explore whether HGS measurement at hospital admission can predict patient's hospitalization costs. Subjects/methods: A prospective study was conducted in a university hospital. Inpatient's (n=637) HGS and undernutrition status by Patient-Generated Subjective Global Assessment were ascertained. Multivariable linear regression analysis, computing HGS quartiles by sex (reference: fourth quartile, highest), was conducted in order to identify the independent predictors of hospitalization costs. Costs were evaluated through percentage deviation from the mean cost, after adjustment for patients' characteristics, disease severity and undernutrition status. Results: Being in the first or second HGS quartiles at hospital admission increased patient's hospitalization costs, respectively, by 17.5% (95% confidence interval: 2.7-32.3) and 21.4% (7.5-35.3), which translated into an increase from €375 (58-692) to €458 (161-756). After the additional adjustment for undernutrition status, being in the first or second HGS quartiles had, respectively, an economic impact of 16.6% (1.9-31.2) and 20.0% (6.2-33.8), corresponding to an increase in hospitalization expenditure from €356 (41-668) to €428 (133-724). Conclusions: Low HGS at hospital admission is associated with increased hospitalization costs of between 16.6 and 20.0% after controlling for possible confounders, including undernutrition status. HGS is an inexpensive, noninvasive and easy-to-use method that has clinical potential to predict hospitalization costs.
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Background: The human hand is a very complex structure and devoted to the functions of manipulation. Hand grip strength is used in clinical settings as an indicator of overall physical strength and health. Objectives: This cross-sectional study was performed to study the association between hand grip strength and anthropometric measurements (height, weight, body mass index, hand dimensions) in healthy Indian female population. Methods and Measures: A total of 50 healthy female subjects, satisfying the selection criteria were recruited in the study. Subjects were then assessed for height, weight, body mass index (BMI), hand and forearm anthropometric measurements. The grip strength of both dominant and non-dominant hands were measured using Jamar dynamometer. Measurements followed standardized procedures and instructions. Statistical analysis: The data was analyzed by Pearson's correlation coefficients and 5% level of probability was used to indicate statistical significance. Results: In females, dominant and non-dominant grip strength have significant positive correlation (p<0.05 -0.001) with height (r = 0.572, 0.570), weight (r = 0.404, 0.411), hand length(r = 0.39, 0.40), hand span (r = 0.44, 0.46), wrist circumference(r = 0.37, 0.31) and forearm girth (r = 0.39, 0.35). Conclusion: The results show that height, weight, hand length, hand span, wrist circumference and forearm girth positively correlate with hand grip strength. Hand grip strength is not associated with BMI and hand breadth in healthy Indian females.
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Rheumatoid arthritis (RA) is an aggressive articular autoimmune disease that causes deformities and disability. The temporomandibular joint (TMJ) might be affected by this disease. Few controlled studies have evaluated bite force (BF) and oro-facial manifestations of this disease. To characterise oro-facial alterations in patients with RA, correlate these results with clinical and disease activity parameters and correlate BF with hand strength (HS). A cross-sectional study of 150 women was performed, (75 RA patients (RA group) and 75 healthy individuals (control group). The presence of articular sounds, pain on palpation of masseter, temporal and TMJ lateral pole, changes in occlusion, range of mandibular motion, measurement of BF in the incisor and molar regions and assessment of HS were evaluated. In relation to oro-facial evaluation there were statistical differences between the groups. There was correlation between BF and HS, in the RA group, this correlation was consistent in patients with natural teeth. Patients with RA had lower scores (P < 0·05) in the HAQ, DASH and OHIP-14 questionnaires than the control group. Inverse correlations were found between BF and HAQ, but not between BF and DAS-28, DASH and OHIP-14 questionnaires in the RA group. The women with RA presented more signs and symptoms in the oro-facial region and had a lower BF than the women in the control group. BF was inversely correlated with the overall function (evaluated by the HAQ) in the patients with RA, and there were correlations between BF and HS in the RA patients and in the control group. © 2014 John Wiley & Sons Ltd.
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A mechanical hand grip dynamometer was used to derive age- and sex-related standard grip strengths from 247 healthy volunteers between 16 and 95 yr old. Preoperative grip strength was measured in 90 patients and related to postoperative complication rates. A grip strength of 85% standard for age and sex was found to be the most effective cut-off for prediction of postoperative complications in terms of sensitivity and specificity, predicting 74% of the complications (p less than 0.05). Specificity is improved over previously published standards related to sex alone especially when assessing the elderly patient (50% vs 21%). A grip strength below the recommended cut-off for age and sex suggests that the patient is in a high-risk group and demands further investigation of nutritional status. Studies of pre-operative nutritional support for the at risk group need to be undertaken.
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Presented and described in detail is a clinical technique called subjective global assessment (SGA), which assesses nutritional status based on features of the history and physical examination. Illustrative cases are presented. To clarify further the nature of the SGA, the method was applied before gastrointestinal surgery to 202 hospitalized patients. The primary aim of the study was to determine the extent to which our clinician's SGA ratings were influenced by the individual clinical variables on which the clinicians were taught to base their assessments. Virtually all of these variables were significantly related to SGA class. Multivariate analysis showed that ratings were most affected by loss of subcutaneous tissue, muscle wasting, and weight loss. A high degree of interobserver agreement was found (kappa = 0.78, 95% confidence interval 0.624 to 0.944, p less than 0.001). We conclude that SGA can easily be taught to a variety of clinicians (residents, nurses), and that this technique is reproducible.
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We studied 202 patients admitted to two major teaching hospitals for planned gastrointestinal surgery to assess the ability of several techniques of nutritional assessment to predict major postoperative complications (infection and/or wound problems). Subjective global assessment (SGA) and albumin were both of predictive value, and combinations of these variables were useful in differentiating low-risk from high-risk patients. Transferrin, creatinine-height index, percent ideal weight, percent body fat, and total lymphocyte count were not useful in predicting complications. We conclude that SGA and albumin are useful "nutritional assessment techniques" for patients undergoing major gastrointestinal surgery if the purpose of such an assessment is to predict postoperative "nutrition-associated complications." The second major finding of this study was the unexpectedly low rate of complications (10%) which was found in both hospitals. We suggest that these low complication rates may be more generalizable to patient populations derived from a wide community base, rather than those described in other studies in which veterans or patients of lower socioeconomic status comprised the sample.
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A number of indicators of surgical risk were measured in 218 patients awaiting major gastrointestinal surgery. The indices chosen had been used by others to identify high risk patients and they were compared with each other and with two clinical assessments of risk, one by the operating surgeon and the other by an independent clinician who performed a complete physical examination. Anthropometric indices did not pick out patients who were significantly at high risk but the plasma proteins (albumin, pre-albumin, transferrin) identified subgroups of high risk patients, about a third of whom developed major postoperative complications. Although some nutritional indicators which use plasma proteins for the computation selected patients who were significantly more at risk, some (20-30 per cent) of the patients with low levels of plasma proteins (particularly those who were septic) did not have depleted fat or muscle protein stores. Although the surgeons were able correctly to identify only a small number of very high risk patients the results showed that a carefully performed clinical examination was able to do this as effectively as the plasma proteins. It is suggested that something more than a global assessment by the operating surgeon is required to identify high risk patients. A careful assessment of medical risk noting in particular cardiorespiratory disease and pre-existing sepsis, as well as nutritional state, is as effective as any other currently used indicator of risk.
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This study evaluates hand grip strength as an indicator of nutritional status and a predictor of postoperative complications. Hand grip strength and other parameters of nutritional status, namely, midarm muscle circumference, forearm muscle circumference, triceps skinfold, percentage ideal body weight, serum albumin, and percent usual weight were determined preoperatively in 205 patients. Complications occurred in 28 patients (14%). Patients with at least one abnormal nutritional parameter had a higher incidence of postoperative complications. Their length of total and postoperative hospitalization was greater by 6.2 and 4.6 days, respectively (p less than 0.01). Grip strength was the most sensitive single parameter, but forearm muscle circumference and percentage ideal body weight were the most specific indices. Hand grip strength is a simple measure of nutritional status and an accurate prognostic indicator that requires further clinical evaluation.
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Herein we describe a methodology which can be used to evaluate the predictive accuracy of nutritional assessment techniques. We use this methodology to compare seven techniques of nutritional assessment in terms of their ability to predict one nutrition associated hospital complication (infection) by dividing a sample of 59 surgical patients into high risk and low risk groups. One technique was subjective global assessment (SGA) of the patient's nutritional status on admission to hospital. Five techniques were single objective measurements (albumin, transferrin, delayed cutaneous hypersensitivity, anthropometry, and creatinine-height index). The 7th technique was the prognostic nutritional index. The best combination of sensitivity (0.82) and specificity (0.72) was found with SGA. The second best combination (0.88 and 0.45) was found by using either the prognostic nutritional index or creatinine-height index. We also found that combining the five objective measurements with SGA into a single index did not increase the discriminatory (or predictive) power over that of SGA alone in a clinically significant way. We conclude that a larger study comparing these approaches should be undertaken to confirm these findings and to develop methods which improve the predictive properties of SGA.
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This study compared changes in muscle strength after major elective abdominal surgery in young and old patients, and related these changes to body composition and nitrogen balance. The breakdown of muscle protein, erosion of lean tissue, and negative nitrogen balance are characteristic metabolic responses to surgical illness. With a substantial loss of muscle mass typical of advancing age, the authors postulated that older patients would be weaker during acute surgical illness and less able to maintain muscle function and meet metabolic demands. Active, community-dwelling individuals undergoing major abdominal procedures who were 70 years of age or older or 50 years of age or younger were studied. Total body water (TBW) was determined preoperatively by deuterium oxide dilution. Maximal voluntary handgrip, respiratory muscle strength, and visual analog pain scores were measured preoperatively and on postoperative days 2, 4, and 6. All urine was collected postoperatively for 7 days for determination of total nitrogen, creatinine, and cortisol. The young (age, 36 +/- 9 years [mean +/- standard deviation]; n = 20) and old groups (age, 77 +/- 5 years; n = 20) were similar regarding weight, sex distribution, nutritional status, surgical procedures and anesthesia, and postoperative urine cortisol values. Age group, time after operation, and interaction effects were significant for each strength variable (all p < 0.005 by analysis of variance). Older patients had lower preoperative strength (29% to 41%) and mean 24-hour urine creatinine (27%). Postoperative strength was decreased most markedly on postoperative day 2, with similar proportional changes in the two age groups but lower absolute levels in the older patients. The rate of recovery of strength was substantially less rapid and complete in older patients. Older patients had less postoperative pain and received much less parenteral narcotic than younger patients. Postoperative urine nitrogen was similar in each group. Recovery of strength was not related to malignancy, preoperative strength, muscle mass (urine creatinine), lean body mass (TBW), sex, malignancy, pain, or narcotic administration. Older patients are weaker preoperatively than younger patients; their strength falls to lower levels after surgery and their postoperative recovery of strength is impaired. The lesser preoperative strength of older patients is due in large part but not totally to diminished muscle mass. Their impaired postoperative recovery appears to be related to more acute factors, such as muscle energetics or substrate availability.