筋肉量・筋力・身体機能測定の信頼性・妥当性

地域在住高齢者の筋肉量・筋力・身体機能測定の信頼性・妥当性に関する系統的レビューを紹介します。

VMijnarends DM, Meijers JM, Halfens RJ, Ter Borg S, Luiking YC, Verlaan S, Schoberer D, Cruz Jentoft AJ, van Loon LJ, Schols JM. Validity and Reliability of Tools to Measure Muscle Mass, Strength, and Physical Performance in Community-Dwelling Older People: A Systematic Review. J Am Med Dir Assoc. 2012 Dec 28. pii: S1525-8610(12)00398-2. doi: 10.1016/j.jamda.2012.10.009. [Epub ahead of print]

結果ですが、筋肉量測定は、MRI、CT、4-compartment modelがゴールドスタンダードです。他にはDEXAやBIAが使用されますが、BIAの信頼性に関するデータはありません。

筋力・身体機能測定は、握力、歩行速度、short physical performance battery（SPPB）がゴールドスタンダードです。結論として、在宅高齢者ではBIA、握力、歩行速度、SPPBが最も信頼性、妥当性、実現可能性が高いという結論です。

BIAによる筋肉量評価はゴールドスタンダードではありませんが、在宅というセッティングでは実現可能性を考慮して最適という結論としています。言い方を変えると、在宅でも身体計測のみでは不十分でBIAで筋肉量を評価しなさいということですね。

今後、サルコペニア研究を行ううえでベースとなる論文になると思います。入院患者ではMRI、CT、4-compartment modelで、在宅ではBIAで筋肉量を評価することが求められます。握力、歩行速度、SPPBはどちらでも必須ですね。

Abstract

BACKGROUND:

This study critically appraises the measurement properties of tools to measure muscle mass, strength, and physical performance in community-dwelling older people. This can support the selection of a valid and reliable set of tools that is feasible for future screening and identification of sarcopenia.

METHODS:

The databases PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane were systematically searched (January 11, 2012). Studies were included if they investigated the measurement properties or feasibility, or both, of tools to measure muscle mass, strength, and physical performance in community-dwelling older people aged ≥60 years. The consensus-based standards for the selection of health status measurement instruments (COSMIN) checklist was used for quality appraisal of the studies.

RESULTS:

Sixty-two publications were deemed eligible, including tools for muscle mass (n = 16), muscle strength (n = 15), and physical performance (n = 31). Magnetic resonance imaging, computed tomography, and a 4-compartment model were used as gold standards for muscle mass assessment. Other frequently used measures of muscle mass are dual-energy x-ray and the bioelectrical impedance (BIA); however, reliability data of the BIA are lacking. Handheld dynamometry and gait speed or a short physical performance battery provide a valid and reliable measurement of muscle strength and physical performance, respectively.

CONCLUSIONS:

It can be concluded that several tools are available for valid and reliable measurements of muscle mass, strength, and performance in clinical settings. For a home-setting BIA, handheld dynamometry and gait speed or a short physical performance battery are the most valid, reliable, and feasible. The combination of selected instruments and its use for the screening and identification of sarcopenia in community-dwelling older people need further evaluation.