Targeting Osteosarcopaenia and Multimorbidity for Frailty Prevention

Tan Tock Seng Hospital500 enrolled

Overview

The aging population and its accompanying burden from non-communicable chronic diseases predicts an increasing impact imposed by frailty on healthcare systems. This is due to a lack of normative data for older adults and reliable risk stratification methods to develop effective approaches to the prevention of frailty. In this study, the investigators plan to form a common dataset for phenotype identification, risk stratification of frailty and its targeted treatment plans in the at-risk and mildly frail population.

Osteosarcopaenia and multimorbidity have emerged as two key antecedent factors driving the cycle of frailty, leading to adverse outcomes. However, it remains unclear how multimorbidity and/or osteosarcopaenia act singly or in concert to influence the expression and trajectory of the frailty continuum. OPTIMA-C will develop unifying administrative and data platforms, exploring the feasibility of inclusive screening for sarcopaenia early during rehabilitation hospital stay. Early muscle ultrasound will also be utilised to determine key muscles possibly predictive of rehabilitation functional or global outcomes in the studied populations and their correlation with acute disease outcomes. Digital markers are quantified and correlations are investigated with physical, muscle and bone imaging findings.

Study Type

OBSERVATIONAL

Enrollment

500

Conditions

Stroke Traumatic Brain Injury Knee Osteoarthritis Breast Cancer

Eligibility

Sex: ALLMin age: 50 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Age ≥ 50y 2. Asian ethnicity 3. First diagnosis (stroke, Traumatic Brain Injury (TBI), knee osteoarthritis, breast cancer) 4. Living in community 5. Able to understand 1 step simple commands 6. For inpatients: (i) within 12 weeks of disease (stroke/TBI) onset, and (ii) within 2 weeks of rehabilitation ward admission 7. For outpatients: (i) \>6 months from initial diagnosis of first stroke, TBI, knee osteoarthritis or breast cancer, and (ii) at least standby assistance, modified independent or independent in ambulation with /without walking. Exclusion Criteria: 1. Nursing home or dormitory resident 2. Non-resident status in Singapore (e.g. foreign worker, tourist, temporary visit pass) 3. Impairments affecting understanding of questionnaires and tasks: e.g. severe deafness, severe visual impairment and severe /global aphasia, 4. Presence of active fractures, dislocations, non-weight bearing status, burns, unhealed wounds, active skin infections/eczema and agitated behaviour or delirium 5. Anticipated life expectancy \< 1 year 6. Presence of tracheostomy, ventilator, renal dialysis, end-organ failure 7. Patients with disorders of consciousness. 8. Pregnant or lactating participants For Knee Osteoarthritis patients only: 9. Alternative diagnosis to knee OA e.g. Referred pain from hip or spine. 10. Other forms of knee arthritis eg. Inflammatory, post traumatic 11. Previous knee arthroplasty

Outcomes

Primary Outcomes

Incidence (rates) of Frailty

Based off different outcomes determined in the study

Time frame: Through study's data collection period, up to 4 years

Severity of Frailty

Based on CFS - 9-point clinical assessment tool evaluating an individual's frailty status; maximum score: 9; higher score indicates increased frailty.

Time frame: For inpatient: Visit 1 (within 2 weeks of admission) to Visit 6 (end of 3rd year); For outpatient: Visit 1 (baseline) to Visit 4 (end of 3rd year)

Secondary Outcomes

Body Composition Analysis (BCA)

Measured using weak electrical current passed from feet to estimate proportion of muscle, fat and water mass.

Time frame: For inpatient: Visit 3 (6 months post-event) to Visit 6 (end of 3rd year); For outpatient: Visit 1 (baseline) to Visit 4 (end of 3rd year)

Short Physical Performance Battery (SPPB)

Measures 3 components: (1) 5 times chair stand test; (2) Balance test; (3) Gait speed (4m walk test). Score from 0-12 with higher score indicating greater functional capacity.

Time frame: For inpatient: Visit 1 (within 2 weeks of admission) to Visit 6 (end of 3rd year); For outpatient: Visit 1 (baseline) to Visit 4 (end of 3rd year)

Hand Grip Strength (kg)

Measured seated with arms on a table bent to 90° using a dynamometer (mean of 3 readings will be recorded)

Time frame: For inpatient: Visit 1 (within 2 weeks of admission) to Visit 6 (end of 3rd year); For outpatient: Visit 1 (baseline) to Visit 4 (end of 3rd year)

Muscle Ultrasound imaging

Determines state of muscle health of arm, thigh and jaw muscles through size, area and structural properties.

Time frame: For Inpatient: Visit 1 (within 2 weeks of admission), Visit 2 (1 week pre-discharge)

FRAIL Questionnaire

5-point questionnaire; (1-2 point) indicates pre-frail, (3-5 points) indicates frail

Time frame: For inpatient: Visit 1 (within 2 weeks of admission) to Visit 6 (end of 3rd year); For outpatient: Visit 1 (baseline) to Visit 4 (end of 3rd year)

Targeting Osteosarcopaenia and Multimorbidity for Frailty Prevention

Overview

Conditions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes

Central Contacts