Change in skeletal muscle associated with unplanned hospital admissions in adult patients: A systematic review and meta-analysis

Abstract

Objectives: The primary objective of the review was to describe change that occurs in skeletal muscle during periods of unplanned hospitalisation in adult patients. The secondary objective was to examine the relationship between both physical activity and inflammation with the change in skeletal muscle. A further objective was to investigate the effect of interventions on change in skeletal muscle during periods of unplanned hospitalisation.

Design: A systematic review and meta-analyses. Embase, MEDLINE, CINAHL, AMED, PEDro and the Cochrane Library were searched for studies that included any measures of skeletal muscle (excluding pulmonary function) at two time points during unplanned hospitalisation. Studies that were set in critical care, or included patients with acute or progressive neurological illness, were excluded.

Results: Our search returned 27,809 unique articles, of which 35 met the inclusion criteria. Meta-analyses of change between baseline and follow-up in random effects models suggested that grip strength had an average increase: standardised mean difference (SMD) = 0.10 (95% CI: 0.03; 0.16); knee extension strength had an average reduction: SMD = -0.24 (95% CI: -0.33; -0.14); and mid-arm muscle circumference had an average reduction: SMD = -0.17 (95% CI: -0.22; -0.11). Inflammation appeared to be associated with greater loss of muscle strength. There was inconclusive evidence that the level of physical activity affects change in skeletal muscle. In regard to the effect of interventions, only exercise interventions were consistently associated with improved skeletal muscle outcomes.

Conclusions: Adult patients who undergo an unplanned hospital admission may experience a small reduction in knee extension strength and mid-arm muscle mass. Prospective research is needed to clarify the contribution of confounding factors underlying the observations made in this review, with particular attention to levels of physical activity, and possible contributions from environmental factors and processes of hospital care.

Fig 1. Summary of retrieval and review of articles.

Fig 2. Change in grip strength.

In column ‘T1’ presented as mean (± SD) or median (IQR) or median [range]. NR: Not reported; COPD = Chronic obstructive pulmonary disease.

Fig 3. Change in knee extension strength.

In column ‘T1’ presented as mean (± SD) or median (lower quartile–upper quartile). COPD = chronic obstructive pulmonary disease, NR = not reported.

Fig 4. Change in mid-arm muscle mass.

In column ‘T1’ presented as mean (± SD). IBD = Inflammatory Bowel Disease.

Fig 5. Effectiveness of exercise and physiotherapy based interventions.

CG = control group, IG = intervention group, N = newtons.

Fig 6

A: Funnel plots. A: Change in grip strength; B: Change in knee extension strength.