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This study aimed to determine the comparative effectiveness of interventions in treatment of sarcopenia. The primary outcome was the measure of treatment effect on muscle mass, and secondary outcomes were the treatment effect on muscle strength and physical performance.Systematic review and network meta-analysis (NMA).Participants with sarcopenia receiving interventions targeting sarcopenia in any setting.Data sources: Relevant RCTs were identified by a systematic search of several electronic databases, including CINAHL, Embase, MEDLINE, and the Cochrane Central Registry of Controlled Trials (CENTRAL) from January 1995 to July 2019. Duplicate title and abstract and full-text screening, data extraction, and risk of bias assessment were performed.All RCTs examining sarcopenia interventions [mixed exercise (combined aerobic and resistance exercise), aerobic exercise, resistance exercise, balance exercise, physical activity and protein or nutrition supplementation, acupuncture, whole-body vibration, protein supplement or interventions to increase protein intake, any nutritional intervention other than protein, and pharmacotherapy] were included. Comparators were standard care, placebo, or another intervention.We performed Bayesian NMA; continuous outcome data were pooled using the standardized mean difference effect size. Interventions were ranked using the surface under the cumulative ranking curve (SUCRA) for each outcome.A total of 59 RCTs were included after screening of 4315 citations and 313 full-text articles. Network meta-analysis of muscle mass outcome (including 46 RCTs, 3649 participants, 11 interventions) suggested that mixed exercise were the most effective intervention (SUCRA = 93.94%) to increase muscle mass. Physical activity and protein or nutrition supplementation, and aerobic exercise were the most effective interventions to improve muscle strength and physical performance, respectively. Overall, mixed exercise is the most effective intervention in increasing muscle mass and was one of the 3 most effective interventions in increasing muscle strength and physical performance.Mixed exercise and physical activity with nutritional supplementation are the most effective sarcopenia interventions. Most of the included studies have a high risk of bias. More robust RCTs are needed to increase the confidence of our NMA results and the quality of evidence.

The purpose of this study is to examine the feasibility, safety and outcomes of a study comparing a 6-week post-operative rehabilitation program to usual care in patients ≤60 years undergoing elective unilateral total hip arthroplasty (THA). Methods: A cohort of 24 THA patients were recruited during their 6-week postoperative visit to their surgeons. The community-based rehabilitation program, which was designed to improve function and increase activity, consisted of 12 structured exercise classes on land and water over 6 weeks. Physical activity was assessed using a Sense Wear Pro Armband (SWA). Participants completed the Hip Osteoarthritis Outcome Score (HOOS) and THA satisfaction questionnaire before and immediately after the intervention. Results: 14 participants received the augmented rehabilitation, and 10 participants were in the control group. All except one in the intervention group completed at least 80% of the sessions. The intervention group took significantly more steps/day (mean difference = 2440 steps/day, 95% CI = 1678, 4712) (p < 0.05), at the follow-up compared to baseline. The intervention group had a higher mean change of number of weekly PA bouts than the control group. Within the intervention group, all HOOS subscales were significantly higher at the follow-up compared to baseline. Conclusion: Findings provided pragmatic insight regarding the intervention and assessments of implementing an augmented rehabilitation program for elective THA.

Total hip arthroplasty (THA) in younger patients is projected to increase by a factor of 5 by 2030 and will have important implications for clinical practice, policymaking, and research. This scoping review aimed to synthesize and summarize THA implants' survival, reoperation, and wear rates and identify indications and risk factors for reoperation following THA in patients ≤55 years old.Standardized scoping review methodology was applied. We searched 4 electronic databases (Medline, Embase, CINAHL, and Web of Science) from January 1990 to May 2019. Selection criteria were patients aged ≤55 years, THA survival, reoperation, and/or wear rate reported, a minimum of 20 reoperations included, and minimum level III based on the Oxford Level of Evidence. Two authors independently reviewed the citations, extracted data, and assessed quality.Of the 2255 citations screened, 35 retrospective cohort studies were included. Survival rates for THA at 5 and 20 years were 90%-100% and 60.4%-77.7%, respectively. Reoperation rates at ≤5-year post THA ranged from 1.6% to 5.4% and increased at 10-20 years post THA (8.2%-67%). Common causes for reoperation were aseptic loosening of hip implants, osteolysis, wear, and infection. Higher reoperation and lower survival rates were seen with hip dysplasia and avascular necrosis than with other primary diagnoses.Over time, THA prosthetic survival rates decreased, and reoperation increased in patients ≤55 years. Aseptic loosening of hip implants, osteolysis, wear, and infection were the most frequent reasons for the reoperation.

Purpose: The coronavirus disease-19 (COVID-19) was declared a pandemic by the World Health Organization in March 2020. COVID-19, caused by SARS-CoV-2 has imposed a significant burden on health care systems, economies, and social systems in many countries around the world. The provision of rehabilitation services for persons with active COVID-19 infection poses challenges to maintaining a safe environment for patients and treating providers.Materials and Methods: Established frameworks were used to guide the scoping review methodology. Medline, Embase, Pubmed, CINAHL databases from inception to August 1, 2020, and prominent rehabilitation organizations’ websites were searched.Study Selection: We included articles and reports if they were focused on rehabilitation related recommendations for COVID-19 patients, treating providers, or the general population.Data Extraction: Pairs of team members used a pre-tested data abstraction form to extract data from included full-text articles. The strength and the quality of the extracted recommendations were evaluated by two reviewers using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.Results: We retrieved 6,468 citations, of which 2,086 were eligible for review, after duplicates were removed. We excluded 1,980 citations based on title and abstract screening. Of the screened full-text articles, we included all 106 studies. A summary of recommendations is presented. We assessed the overall evidence to be strong and of fair quality.Conclusion: The rehabilitation setting, and processes, logistics, and patient and healthcare provider precaution recommendations identified aim to reduce the spread of SARS-CoV-2 infection and ensure adequate and safe rehabilitation services, whether face-to-face or through teleservices. The COVID-19 pandemic is rapidly changing. Further updates will be needed over time in order to incorporate emerging best evidence into rehabilitation guidelines.

PurposeThe World Health Organization (WHO) declared severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) a pandemic in March 2020, causing almost 3.5 million coronavirus disease (COVID-19) related deaths worldwide. The COVID-19 pandemic has imposed a significant burden on healthcare systems, economies, and social systems in many countries around the world. The access and delivery of rehabilitation care were severely disrupted, and patients have faced several challenges during the COVID-19 outbreak. These challenges include addressing new functional impairments faced by survivors of COVID-19 and infection prevention to avoid the virus spread to healthcare workers and other patients not infected with COVID-19. In this scoping review, we aim to develop rehabilitation recommendations during the COVID-19 pandemic across the continuum of rehabilitation care.Materials and MethodsEstablished frameworks were used to guide the scoping review methodology. Medline, Embase, Pubmed, CINAHL databases from inception to August 1, 2020, and prominent rehabilitation organizations’ websites were searched.Study SelectionWe included articles and reports if they were focused on rehabilitation recommendations for COVID-19 survivors or the general population at the time of the COVID-19 pandemic.Data ExtractionTwo of our team members used the pre-tested data extraction form to extract data from included full-text articles. The strength and the quality of the extracted recommendations were evaluated by two reviewers using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach.ResultsWe retrieved 6,468 citations, of which 2,086 were eligible after removing duplicates. We excluded 1,980 citations based on the title and the abstract. Of the screened full-text articles, we included 106 studies. We present recommendations based on the patient journey at the time of the pandemic. We assessed the evidence to be of overall fair quality and strong for the recommendations.ConclusionWe have combined the latest research results and accumulated expert opinions on rehabilitation to develop acute and post-acute rehabilitation recommendations in response to the global COVID-19 pandemic. Further updates are warranted in order to incorporate the emerging evidence into rehabilitation guidelines.