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Ondervoeding en sarcopenie bij ouderen met een kwetsbare gezondheid

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Meetinstrumenten fysiek functioneren

Publicatiedatum: 22-01-2026
Beoordeeld op geldigheid: 22-01-2026

Uitgangsvraag

Welke methode heeft de voorkeur voor het meten van fysiek functioneren als onderdeel van de diagnostiek naar sarcopenie bij oudere patiënten met een kwetsbare gezondheid op de polikliniek, afdeling geriatrie en andere ziekenhuisafdelingen?

Aanbeveling

Gebruik de 4 meter looptest (≤0.8 m/s) bij ouderen met een kwetsbare gezondheid en een vermoeden op sarcopenie om fysiek functioneren in kaart te brengen als de wens bestaat om de ernst van sarcopenie vast te stellen.

Overwegingen

Voor- en nadelen van de interventie en de kwaliteit van het bewijs

In deze literatuursamenvatting werd een observationele studie geïncludeerd die de haalbaarheid (feasibility) van verschillende fysieke functioneringstesten in kaart bracht bij 34 oudere patiënten met een kwetsbare gezondheid met een psychiatrische aandoening en/of dementie (Sperlich, 2021). Uit deze studie bleek dat de 4 meter looptest en de SPPB over het algemeen haalbaar waren in de praktijk (91,2% en 82,4%, respectievelijk). Andere functioneringstesten, zoals TUG waren minder goed haalbaar (slechts bij 67,6%). In groep patiënten die deze test niet kon afronden speelde cognitie een belangrijke rol. De bewijskracht van deze bevindingen is echter zeer laag vanwege methodologische beperkingen (risk of bias), de kleine studieomvang (imprecisie) en de specifieke patiëntenpopulatie (indirectheid).

 

Er waren geen studies die de validiteit en/of responsiviteit van fysieke functioneringstesten in kaart brachten bij ouderen met een kwetsbare gezondheid. Dit maakt de overall bewijskracht zeer laag, waarmee de literatuurconclusies weinig richting kunnen geven aan de besluitvorming. 

 

Daarom hebben we voor deze overwegingen meegenomen wat er bekend is in de algehele populatie thuiswonende ouderen.

 

In 2024 is er een review gepubliceerd over de betrouwbaarheid en validiteit van fysiek functioneren testen in thuiswonende ouderen (community-dwelling) (Exter, 2024). In deze review zijn 50 studies geïncludeerd met in totaal 19.266 thuiswonende ouderen, met een leeftijd tussen de 62,2 en 84,3 jaar oud. De short performance physical battery (SPPB), timed up and go test (TUG) en 4 meter looptest zijn hierbij geanalyseerd volgens de COSMIN-richtlijnen en GRADE methodiek.

 

Inter-rater reliability van de TUG varieerde van 0.81-0.98, intra-rater reliability van de TUG varieerde van 0.96-0.99 en test–retest reliability van de SPPB, TUG en 4 meter looptest varieerde van 0.64 tot 0.97. Er was sprake van een voldoende betrouwbaarheid (reliability) van de SPPB, TUG en 4 m looptest. De measurement error was onvoldoende te beoordelen voor de TUG en 4 meter looptest en te beoordelen als onvoldoende voor de SPPB. TUG was gegradeerd als voldoende om mobiliteitsproblemen vast te stellen. Construct validiteit, dat wil zeggen de mate waarin de test aan zijn doel beantwoordt, was onvoldoende voor de SPPB, TUG en 4 meter looptest.

 

Responsiviteit, dat wil zeggen de mogelijkheid om veranderingen in de maat vast te stellen, van de SPBB en TUG was onvoldoende, maar voldoende voor de 4 meter looptest.

 

Concluderend is het goed om voorzichtigheid te betrachten bij het interpreteren van fysiek functioneren en veranderingen hierin met deze test.

 

Prognostische validiteit van de loopsnelheid is onderzocht in een review met 34.485 thuiswonende ouderen van 65 jaar en ouder (Studenski, 2011). Hieruit bleek dat iedere 0,1 m/sec dat een oudere sneller loopt geassocieerd is met een langere overleving (pooled hazard ratio per 0.1 m/s, 0.88; 95% CI, 0.87–0.90; P<0.001). Dit is de referentie populatie die gebruikt is voor het vaststellen van het afkappunt van ≤0.8 m/s voor loopsnelheid in de EGWSOP-2 criteria voor ernstige sarcopenie.

 

In 334 geriatrische patiënten die waren opgenomen op de acute opname afdeling in het ziekenhuis blijkt ook de loopsnelheid voorspellend te zijn voor mortaliteit (HR 0.084, CI 0.018–0.382; P=0.001) (Dovjak, 2024).

 

Waarden en voorkeuren van patiënten (inclusief die van eventuele verzorgers)

Patiënten (en eventueel naasten) zullen over het algemeen de voorkeur geven aan een zo min mogelijk belastend en pijnlijk onderzoek voor het meten van het fysiek functioneren. Gebaseerd op de onderzoeken voor fysiek functioneren die in de studie zijn meegenomen voldoet met name de 4m looptest aan deze voorwaarde. Er zullen omstandigheden kunnen zijn dat de test minder goed haalbaar is bij individuele patiënten door bijvoorbeeld verminderde belastbaarheid of faalangst en dienen te worden meegewogen in de keuze voor de uit te voeren test.

 

Kosten (middelenbeslag)

Op basis van kosteneffectiviteit kan er geen duidelijke voorkeur worden uitgesproken voor een van de testen. De functietesten kunnen uitgevoerd worden wanneer er de beschikking is over een meetinstrument (stopwatch), stoel en geschikte ruimte. Wanneer ook de benodigde tijd van de onderzoeker in ogenschouw wordt genomen en de kosten die dit derhalve met zich meebrengt, gaat de voorkeur uit naar de snelst uit te voeren test, de 4m looptest.

 

Aanvaardbaarheid, haalbaarheid en implementatie

De methode voor het betrouwbaar en valide onderzoeken van het functioneren bij ouderen met een kwetsbare gezondheid en geriatrische patiënten is niet goed onderzocht. Het verschil in belasting en risico (op bijvoorbeeld letsel) bij de patiënt tussen de verschillende testen is minimaal waardoor allen aanvaardbaar zijn. Wanneer er gekeken wordt naar haalbaarheid gaat er een voorkeur uit naar een korte test, zoals de 4m looptest. Deze test kan worden afgenomen zodra de patiënt in staat is te lopen. Echter, de test is niet geschikt voor alle geriatrische patiënten op de afdeling, met name niet voor ernstig zieke patiënten. Wanneer het niet mogelijk is de 4m looptest uit te voeren als maat voor fysiek functioneren zou eventueel gekozen kunnen worden voor een ander testinstrument op basis van de specifieke patiënt karakteristieken wanneer men toch van mening is dat het van belang is de mate van fysiek functioneren vast te stellen. Op de polikliniek is de test daarentegen voor de meeste patiënten wel goed uitvoerbaar.

 

Rationale van de aanbevelingen: weging van argumenten voor en tegen de interventies

Er is weinig bewijs voor het vaststellen van de haalbaarheid, betrouwbaarheid en validiteit en responsiviteit van de testen voor het meten van fysiek functioneren in (opgenomen) ouderen met een kwetsbare gezondheid. Er is zwak bewijs dat de 4 meter looptest en de SPPB beter af te nemen zijn in ouderen met een kwetsbare gezondheid dan de TUG.

 

In de groep thuiswonende ouderen is de 4 meter looptest het beste in staat om responsiviteit te meten, en de TUG kan gebruikt worden om mobiliteitsproblemen vast te stellen. In de EWGSOP-2 definitie van sarcopenie wordt aanbevolen om de ernst van sarcopenie vast te stellen middels de SPPB, TUG of loopsnelheid. In deze module werd beperkt bewijs gevonden voor de validiteit en betrouwbaarheid van deze instrumenten.

 

De SPPB bevat drie testonderdelen, een balanstest, de five times sit-to-stand test (5tCST) en de 4 meter looptest. In deze richtlijn wordt de 5tCST gebruikt om de spierkracht vast te stellen, met andere afkapwaarden dan worden gebruikt in de SPPB. De werkgroep heeft daarom de voorkeur om fysiek functioneren te onderzoeken met de 4 meter looptest met het aanhouden van de afkapwaarde van ≤0.8 m/s, zoals aanbevolen door de EWGSOP-2.

Onderbouwing

Sarcopenia is a muscle disease associated with a loss of muscle strength, mass, and physical performance. Early detection and diagnosis of sarcopenia is important, because sarcopenia is associated with various negative health outcomes such as a decline in mobility, low physical performance, and increased morbidity and mortality during hospital admission.

 

In 2019, a European consensus was defined and published by the European Working Group on Sarcopenia in Older People 2 (EWGSOP-2). Since the EWGSOP-2 definition for sarcopenia is most commonly used in the Netherlands, it was decided to use the EWGSOP-2 definition for sarcopenia for this module. Screening for sarcopenia is necessary to detect older adults who require further investigation. In this definition, once sarcopenia is confirmed, physical performance tests are recommended to assess the severity of sarcopenia. In EWGSOP-2, gait speed, short performance physical battery (SPPB), timed up and go test (TUG) or 400 m gait speed test are recommended. For this review it was chosen to exclude 400 m gait speed test from analysis, since other patient characteristics besides physical performance are important. Other physical performance test that are being used are Hierarchical Assessment of Balance and Mobility (HABAM); Morton Mobility Index (DEMMI); Berg Balance Scale (BBS).

 

It is unclear if the physical performance tests are appropriate, relevant and feasible for identifying severity of sarcopenia in frail older people in the outpatient clinic and hospital nursing ward.

No

GRADE

No evidence was found regarding the validity of instruments for measuring physical performance in frail older people in the hospital.

No

GRADE

No evidence was found regarding the reliability of instruments for measuring physical performance in elderly and geriatric patients in the hospital.

 

Very low

GRADE

The evidence is very uncertain about the feasibility of the 4m walking test, SPPB and TUG for measuring physical performance for measuring severity of sarcopenia in frail older people in the hospital.

 

Source: Sperlich, 2021

Description of studies

Sperlich (2021) conducted a single-centre cross-sectional study over three months in a geriatric psychiatry hospital in Cologne, Germany. The patient population for this study included patients with a diagnosis of dementia (F00-F03), depression (F32 and F33) or delirium (F05) according to the ICD-10 classification. Impression of clinical frailty according to standardized criteria (Fried) was used to preliminarily include patients in the study. Immobile and bedridden patients were excluded due to their inability to perform physical performance tests. Of the 104 patients that were preliminarily included, 70 patients were excluded for a variety of reasons (details in evidence table). 34 patients were eventually included in the study, of which 19 had depression and 15 had dementia (no patients with delirium were included).

 

The EWGSOP-2 guidelines for screening and diagnostics were implemented and evaluated in this study. Different tests are recommended in the EWGSOP-2 guidelines for the three diagnostic components: muscle strength, muscle mass and physical performance. Muscle strength was measured with handgrip strength measurement and the five-times-sit-to-stand-test. Muscle mass was tested with the bioelectric impedance analysis (BIA). Physical performance was assessed using the 4m walking test, the timed-up-and-go-test, the short physical performance battery and the 400 m walking test.

 

Reported outcomes included the percentage of diagnostic tests that could be completed successfully and the prevalence rate for sarcopenia in this setting. Muscle mass measurements, as well as short and long physical performance tests were evaluated in this study. The feasibility of the tests was the main focus of this study. For tests that were not successfully completed, reasons for failure were divided into three categories: physical, cognitive and motivational. Data was then further statistically analysed. For some participants, a complete assessment was not possible, therefore the overall prevalence of sarcopenia in this study was based on extrapolation based on the percentage of patients that tested positive, which was calculated separately for each subgroup of patients. Sarcopenia was diagnosed based on the diagnostic algorithm of the EWGSOP-2 guidelines

 

Results

1. Validity (critical outcome)

Not reported in the included studies

 

3. Reliability (important outcome)

The domain reliability refers to the degree to which the measurement is free from measurement error, and it contains the measurement properties internal consistency, reliability, and measurement error. The outcome reliability was not reported in the included studies.

 

3. Feasibility (important outcome)

Sperlich (2021) reported on the feasibility of the functional tests. Muscle mass measurements with bioelectric impedance analysis could be successfully performed in all patients. Table 1 provides an overview of the feasiblity of the other functional tests. The short 4 m walking tests and the balance task (short-physical performance battery (SPPB) were generally feasible (resp. 91.2% and 92.4%). Difficulty was experienced with performance of the long physical performance tests, such as the five-times-sit-to-stand-test, the timed-up-and-go-test (TUG) (resp. 32.4% and 67.6%). It is important to note that the patients who couldn’t complete the TUG tests (due to cognitive reasons) all suffered from dementia.

 

The study found that original standardized test instructions were often insufficient for correct execution of the test. Additional explanations, repetition and demonstrations were needed for persons to be able to perform the tests. However, this study did find at least one test for each of the three diagnostic components from the EWGSOP-2 guidelines (muscle strength, muscle mass and physical performance), that could be performed successfully with the original standardized instructions.

 

The study reported on the prevalence of sarcopenia of subgroups of geriatric psychiatric patients. Using the EWGSOP-2 screening process and diagnostic algorithm, the study classified patients into three categories: no sarcopenia, sarcopenia and severe sarcopenia. Of all 34 included patients, after conducting muscle strength and muscle mass measurements, 26 patients (76,47%) were diagnosed with low physical performance. The study then used physical performance tests to diagnose these patients with either sarcopenia or severe sarcopenia. The study also conducted separate analyses of the included patient subgroups. Their analysis revealed an overall estimated prevalence rate for sarcopenia in patients with depression rated as being ‘frail’ of 36%. For patients with dementia rated as ‘frail’, this prevalence rate was 65%. All patients with dementia in this study who were diagnosed with sarcopenia (n=14) were classified as having severe sarcopenia.

 

Table 2. Results of the feasibility of functional tests with geriatric psychiatric patients, adapted from Table 1 in Sperlich (2021)

 

Not possible (reason)

Test

Possible

Physical

Cognitive

Motivational

5X STS

32.4% (11)

64.7% (22)

2.9% (1)

-

4 m walking test

91.2% (31)

-

5.9% (2)

2.9% (1)

TUG

67.6% (23)

-

29.4% (10)

2.9% (1)

SPPB (balance task)

82.4% (28)

-

14.7% (5)

2.9% (1)

Abbreviations: HGS: handgrip strength; 5X STS: 5-tives-sit-to-stand test; TUG: timed-up-and-go-test; SPPB: Short Physical Performance Battery

 

Level of evidence of the literature

1. Validity

The level of evidence regarding the outcome validity could not be graded due to lack of evidence.

 

2. Reliability

The level of evidence regarding the outcome reliability could not be graded due to lack of evidence.

 

3. Feasibility

The level of evidence regarding the criterion feasibility for tests in de diagnostic algorithm of EWGSOP-2 guidelines for sarcopenia was downgraded by three levels to very low GRADE.

 

Two levels were downgraded due to the small study population (imprecision), and one level was downgraded due to the specificity of the specificity of the study population, psychiatric patients in a single center in Germany, and therefore limited generalizability (indirectness).

A systematic review of the literature was performed to answer the following question:

What is the validity and reliability of instruments for measuring physical performance for the diagnosis of sarcopenia in frail older people in the hospital?

P: Frail older (>70 years) people in the outpatient clinic, geriatric ward, emergency department, and other hospital wards
I:

Measures for function and/or physical performance as part of the diagnosis sarcopenia: Gait speed tests: 4 meter walk test (4MWT), 5MWT, 6MWT, 10MWT
C: Other measures for function and/or physical performance as part of the diagnosis sarcopenia: SPPB; TUG; Hierarchical Assessment of Balance and Mobility (HABAM); Morton Mobility Index (DEMMI); Berg Balance Scale (BBS)
O: (Predictive) validity and reliability, feasibility, responsivity
Timing and setting: Outpatient clinic, geriatric ward, emergency department, and other hospital wards

Relevant outcome measures

The guideline development group considered validity as critical outcome measures for decision making; and reliability as important outcome measure for decision making. The measurement properties validity and reliability were defined following the taxonomy of the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) (Mokkink, 2010).

 

The working group defined the discriminate validity of the screening tools as follows:

AUC < 0.7: poor; 0.7 ≤ AUC < 0.8: acceptable; 0.8 ≤ AUC < 0.9: excellent; AUC ≥ 0.9: outstanding. The working group defined the reliability of the screening tools as follows: ICC < 0.5: poor; 0.5 ≤ ICC < 0.75: moderate; 0.75 ≥ ICC < 0.9: good; ICC≥ 0.9: excellent.

The working group also included feasibility and responsivity as relevant outcome measures for the tests.

 

Search and select (Methods)

The databases Medline (via OVID) and Embase (via Embase.com) were searched on 4 October 2024 with relevant search terms for systematic reviews, published from 2011 onwards, about the validity and reliability of instruments for measuring function or physical performance for the diagnosis of sarcopenia in frail older people. The systematic literature search resulted in 82 hits. No systematic reviews were selected based on title and abstract screening. On 15 November 2024 an expanded search was conducted for systematic reviews and observational studies published from 2011 onwards. This search resulted in 1199 additional hits. The active learning tool ASReview (https://www.asreview.nl) was used to screen the observational studies on title and abstract by a guideline methodologist. The detailed search strategy is depicted under the tab Methods. A total of thirteen studies were selected based on this title and abstract screening in ASReview. After reading the full text, twelve studies were excluded (see the table with reasons for exclusion under the tab Methods), and one study was included.

 

Results

One study was included in the analysis of the literature (Sperlich, 2021). Important study characteristics and results are summarized in the evidence tables. The assessment of the risk of bias is summarized in the risk of bias tables.

 

The COSMIN Risk of Bias tool was used to assess the quality of single studies for each measurement property. Thereby, the worst-score-counts method was used to determine the risk of bias, this means that the lowest rating given in a box determines the final rating, i.e., the quality of the study. The result of each study on a measurement property were rated against the updated criteria for good measurement properties (Table 1). Each result was rated as either sufficient (+), insufficient (–), or indeterminate (?).

 

Table 1. Criteria for good measurement properties

Measurement property

Rating1

Criteria

Structural validity

+

CTT:

CFA: CFI or TLI or comparable measure >0.95 OR RMSEA <0.06 OR SRMR <0.082

IRT/Rasch:

No violation of unidimensionality3: CFI or TLI or comparable measure >0.95 OR RMSEA <0.06 OR SRMR <0.08

AND

no violation of local independence: residual correlations among the items after controlling for the dominant factor < 0.20 OR Q3's < 0.37

AND

no violation of monotonicity: adequate looking graphs OR item scalability >0.30

AND

adequate model fit:

IRT: χ2 >0.01

Rasch: infit and outfit mean squares ≥ 0.5 and ≤ 1.5 OR Z-standardized values > ‐2 and <2

?

CTT: Not all information for ‘+’ reported

IRT/Rasch: Model fit not reported

-

Criteria for ‘+’ not met

Internal consistency

+

At least low evidence4 for sufficient structural validity5 AND

Cronbach's alpha(s) ≥ 0.70 for each unidimensional scale or Subscale.6

?

Criteria for “At least low evidence for sufficient structural validity” not met

-

At least low evidence4 for sufficient structural validity5 AND

Cronbach’s alpha(s) < 0.70 for each unidimensional scale or Subscale.6

Reliability

+

ICC or weighted Kappa ≥ 0.70

?

ICC or weighted Kappa not reported

-

ICC or weighted Kappa < 0.70

Measurement error

+

SDC or LoA < MIC

?

MIC not defined

-

SDC or LoA > MIC

Hypotheses testing for

construct validity

+

The result is in accordance with the hypothesis7

?

No hypothesis defined (by the review team)

-

The result is not in accordance with the hypothesis

Cross‐cultural

validity\measurement

invariance

+

No important differences found between group factors (such as age, gender, language) in multiple group factor analysis OR no important DIF for group factors (McFadden's R2 < 0.02)

?

No multiple group factor analysis OR DIF analysis performed

-

Important differences between group factors OR DIF was found

Criterion validity

+

Correlation with gold standard ≥ 0.70 OR AUC ≥ 0.70

?

Not all information for ‘+’ reported

-

Correlation with gold standard < 0.70 OR AUC < 0.70

Responsiveness

+

The result is in accordance with the hypothesis OR AUC ≥ 0.70

?

No hypothesis defined (by the review team)

-

The result is not in accordance with the hypothesis OR AUC < 0.70

Test-retest reliability*

+

The p-value <0.5 and Pearson correlation coefficient (Pearson’s r) > 0.7

-

The p-value >0.5 or Pearson correlation coefficient (Pearson’s r) < 0.7

AUC: area under the curve, CFA: confirmatory factor analysis, CFI: comparative fit index, CTT: classical test theory, DIF: differential item functioning, ICC: intraclass correlation coefficient, IRT: item response theory, LoA: limits of agreement, MIC: minimal important change, RMSEA: Root Mean Square Error of Approximation, SEM: Standard Error of Measurement, SDC: smallest detectable change, SRMR: Standardized Root Mean Residuals, TLI = Tucker‐Lewis Index

* Criteria retrieved from https://www.scalestatistics.com/test-retest-reliability.html

[1] “+” = sufficient, ” –“ = insufficient, “?” = indeterminate

2 To rate the quality of the summary score, the factor structures should be equal across studies

3 unidimensionality refers to a factor analysis per subscale, while structural validity refers to a factor analysis of a (multidimensional) patient‐reported outcome measure

4 As defined by grading the evidence according to the GRADE approach

5 This evidence may come from different studies

6 The criteria ‘Cronbach alpha < 0.95’ was deleted, as this is relevant in the development phase of a PROM and not when evaluating an existing PROM.

7 The results of all studies should be taken together, and it should then be decided if 75% of the results are in accordance with the hypotheses

 

The level of evidence of the literature was evaluated as described in the COSMIN user manual for systematic reviews of patient-reported outcome measures (Prinsen, 2018). The following four factors were taken into account: (1) risk of bias (i.e., the methodological quality of the studies), (2) inconsistency (i.e., unexplained inconsistency of results across studies), (3) imprecision (i.e. total sample size of the available studies), and (4) indirectness (i.e. evidence from different populations than the population of interest in the review). The quality of evidence could be downgraded with one level (e.g., from high to moderate evidence) if there is serious risk of bias, with two levels (e.g., from high to low) if there is very serious risk of bias, or with three levels (i.e., from high to very low) if there is extremely risk of bias. The quality of the evidence could be downgraded with one or two levels for inconsistency, imprecision (-1 if total N=50-100; -2 if total N<50) and indirectness.

  1. Dovjak P, Iglseder B, Rainer A, Dovjak G, Weber M, Pietschmann P. Prediction of Fragility Fractures and Mortality in a Cohort of Geriatric Patients. J Cachexia Sarcopenia Muscle. 2024 Dec;15(6):2803-2814. doi: 10.1002/jcsm.13631. Epub 2024 Nov 8. PMID: 39513358; PMCID: PMC11634494.
  2. Exter SH, Koenders N, Wees P, Berg MGA. A systematic review of the psychometric properties of physical performance tests for sarcopenia in community-dwelling older adults. Age Ageing. 2024 Jun 1;53(6):afae113. doi: 10.1093/ageing/afae113. PMID: 38851214; PMCID: PMC11162262.
  3. Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, Bouter LM, de Vet HC. The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study. Qual Life Res. 2010 May;19(4):539-49. doi: 10.1007/s11136-010-9606-8. Epub 2010 Feb 19. PMID: 20169472; PMCID: PMC2852520.
  4. Prinsen CAC, Mokkink LB, Bouter LM, Alonso J, Patrick DL, de Vet HCW, Terwee CB. COSMIN guideline for systematic reviews of patient-reported outcome measures. Qual Life Res. 2018 May;27(5):1147-1157. doi: 10.1007/s11136-018-1798-3. Epub 2018 Feb 12. PMID: 29435801; PMCID: PMC5891568.
  5. Sperlich E, Fleiner T, Zijlstra W, Haussermann P, Morat T. Sarcopenia in geriatric psychiatry: feasibility of the diagnostic process and estimation of prevalence within a hospital context. J Cachexia Sarcopenia Muscle. 2021 Oct;12(5):1153-1160. doi: 10.1002/jcsm.12748. Epub 2021 Jun 21. PMID: 34151538; PMCID: PMC8517346.
  6. Studenski S, Perera S, Patel K, Rosano C, Faulkner K, Inzitari M, Brach J, Chandler J, Cawthon P, Connor EB, Nevitt M, Visser M, Kritchevsky S, Badinelli S, Harris T, Newman AB, Cauley J, Ferrucci L, Guralnik J. Gait speed and survival in older adults. JAMA. 2011 Jan 5;305(1):50-8. doi: 10.1001/jama.2010.1923. PMID: 21205966; PMCID: PMC3080184.

Evidence table on characteristics and results of studies on measurement properties

Study

Study characteristics

Patient characteristics

Measurement instrument (I)

Measurement instrument (C; golden standard)

Follow-up/Interpretability

Measurement properties

Comments

EWGSOP-2 Diagnostic tests

Sperlich, 2024

Instrument assessed:

EWGSOP-2 Diagnostic tests

 

Setting and Country:

Germany

 

Funding and conflicts of interest:

Source of funding for this study was not specifically declared in the article. The authors give special thanks to the

caretakers of the LVR-Hospital for their support in this study.

In addition, they acknowledge the support of Axel Megerle and

Simon Niemeyer in data acquisition. The authors of this

manuscript certify that they comply with the ethical guidelines for authorship and publishing in the Journal of Cachexia,

Sarcopenia and Muscle.

Esther Sperlich, Tim Fleiner, Wiebren Zijlstra, Peter

Haussermann, and Tobias Morat declare that they have no

conflict of interest.

Inclusion criteria:

Patients admitted at the Department of Geriatric Psychiatry at the

LVR-Hospital Cologne, Germany, with a diagnosis of dementia (F00–F03), depression

(F32 and F33), or delirium (F05) according to the ICD-10

Classification were included based on a clinical impression

of frailty. Written

informed consent from the patient’s legal guardian as well

as from the patient, if possible, had to be given to include a

patient.

 

34 patients were included. Out of these, n = 15 patients

(44%) suffering from dementia were included. Further, n = 19 patients (56%)

suffered from depression.

 

Exclusion criteria:

Patients with

cardiac pacemakers and amputations. Immobile and

bedridden patients were also excluded if they were unable

to walk a distance of at least 4 m.

 

70 persons had to be excluded based on

early release (n = 20), health condition (n = 17), no legal

guardian (n = 16), no interest (n = 13), or due to technical

problems with the measurement equipment (n = 4).

 

Sample size:

Total: 34

 

Age in years (mean (SD):

Total: 78.9 ± 7.7

 

Gender (% Females): 64.7% (n=22)

Name:

Handgrip strength measurement (HGS) and the

five-times-sit-to-stand-test (5×STS) were used to determine

muscle strength. Muscle mass was examined using the BIA

model seca mbca525 (seca GmbH & Co.KG., Hamburg,

Germany). The 4 m walking test, the timed-up-and-go-test

(TUG), the short physical performance battery (SPPB),

and the 400 m walking test were used to determine physical performance.

 

Version (including language if applicable):

EWGSOP-2

 



 

Not applicable

Length of follow-up: 14 weeks

 

Loss to follow-up: 20 patients were excluded due to early release

Percentage of missing items/total scores/outcome:

n/a

 

Floor effects (% of sample with the lowest score possible): 64.7% (n=22)

Ceiling effects (% of sample with the highest score possible: 23.5% (n=8)

 

Criterion validity

The 5×STS should not be the first choice for assessing

physical performance in geriatric patients.

 

The BIA was well

accepted by the patients in this study.

 

Concerning physical

fitness, the 4 m walking test was the most adequate test for

the sample.

 

The balance tasks of the SPPB showed limited feasibility,

especially in patients suffering from dementia.

 

The TUG also proved

to be unsuitable, especially for patients suffering from

dementia.

 

 

Authors’ conclusions

The feasibility analysis revealed that

the patients were not able to perform all tests due to their

cognitive and physical impairment. However, the analysis exposed at least one test for each of the components muscle strength, muscle mass, and physical performance, which the included patients were able to perform according to the original standardized instructions.

 

 

In summary, this study shows that an implementation of

sarcopenia diagnostic according to the algorithm of

EWGSOP-2 in a geriatric psychiatric hospital is possible and relevant.

 

The measurements of muscle

strength by using the HGS test, as well as the measurement

of muscle mass by BIA, are meaningful. Within the EWGSOP-2

definition, muscle strength is up to date the first determining

parameter to start the algorithm. In a second step, muscle

mass using a BIA could be investigated. Based on these

results, appropriate intervention strategies can already be determined.

 

Risk of bias tables

Risk of bias table for Sperlich (2021) - Muscle function and physical performance - criterion validity

Criterion Feasibility

Author: Sperlich 2024

Instrument: EWGSOP-2 Diagnostic Algorithm 

 

very good

adequate

doubtful

inadequate

NA

Statistical methods

 

 

 

 

 

For continuous outcomes: were correlations, or the area under the receiver operating curve calculated?

 

 

 

 

Not applicable

For dichotomous outcomes: were sensitivity and specificity determined?

 

 

 

Sensitivity and specificity NOT calculated

Not applicable

Other

 

 

 

 

 

Were there any other important flaws in the design or statistical methods of the study?

 

 

 

Other important methodological flaws:

 

Small study population in a single center during a three-month period.

 

Study population with expected confounding factors due to geriatric psychiatry comorbidity.

 

Table of excludes studies


Author, year

Title

Exclusion reason

Looijaard, 2018

Single Physical Performance Measures Cannot Identify Geriatric Outpatients with Sarcopenia

Wrong comparison

Reijnierse, 2016

Common Ground? The Concordance of Sarcopenia and Frailty Definitions

Wrong outcome measures

Seo, 2024

Development of sarcopenia assessment system using balance and gait ability: Preliminary tests in the elderly

Wrong outcome measures

De Souza Francisco, 2020

Six-minute stepper test in hospitalized elderly patients: Convergent validity, test-retest reliability and safety

Wrong population

Mueller, 2019

Continuous Digital Monitoring of Walking Speed in Frail Elderly Patients: Noninterventional Validation Study and Longitudinal Clinical Trial

Wrong population

Viana, 2013

Influence of sarcopenia and functionality indicators on the frailty profile of community-dwelling elderly subjects: a cross-sectional study

Wrong outcome measures, no reference standard

Duarte, 2024

10-Item Physical Function Scale (PF-10) as a Sarcopenia Screening Tool for Patients on Hemodialysis

Wrong Population

Beoordelingsdatum en geldigheid

Publicatiedatum  : 22-01-2026

Beoordeeld op geldigheid  : 22-01-2026

Initiatief en autorisatie

Initiatief:
  • Nederlandse Vereniging voor Klinische Geriatrie
Geautoriseerd door:
  • Koninklijk Nederlands Genootschap voor Fysiotherapie
  • Nederlandse Internisten Vereniging
  • Nederlandse Vereniging voor Klinische Geriatrie
  • Vereniging van Specialisten Ouderengeneeskunde
  • Nederlandse Vereniging van Diëtisten

Algemene gegevens

De ontwikkeling/herziening van deze richtlijnmodule werd ondersteund door het Kennisinstituut van de Federatie Medisch Specialisten (www.demedischspecialist.nl/kennisinstituut) en werd gefinancierd uit de Stichting Kwaliteitsgelden Medisch Specialisten (SKMS). De financier heeft geen enkele invloed gehad op de inhoud van de richtlijnmodule.

Samenstelling werkgroep

Voor het ontwikkelen van de richtlijnmodule is in 2023 een multidisciplinaire werkgroep ingesteld, bestaande uit vertegenwoordigers van alle relevante specialismen (zie hiervoor de Samenstelling van de werkgroep) die betrokken zijn bij de zorg voor ondervoeding en sarcopenie bij ouderen met een kwetsbare gezondheid.

 

Werkgroep

  • Dr. W.M.W.H. (Walther) Sipers, klinisch geriater, werkzaam in het Zuyderland Medisch Centrum te Heerlen- Sittard-Geleen, NVKG
  • Dr. ir. E. (Emmelyne) Vasse, diëtist-onderzoeker, werkzaam in Ziekenhuis Gelderse Vallei te Ede en bij het Lectoraat Voeding, Diëtetiek & Leefstijl aan de Hogeschool van Arnhem en Nijmegen, NVD
  • Dr. CH. (Christian) Oudshoorn, internist en klinisch geriater, werkzaam in het Erasmus MC te Rotterdam, NVKG
  • Drs. A. (Aurélie) Rutten, AIOS klinische geriatrie, werkzaam in het Zuyderland MC te Heerlen-Sittard-Geleen, NVKG
  • L. (Lichelle) Wong, MSc, AIOS klinische geriatrie, werkzaam in het Zuyderland MC te Heerlen-Sittard-Geleen, NVKG
  • Drs. S. (Simone) Verhaar, klinisch geriater, werkzaam in het Catharina Ziekenhuis te Eindhoven, NVKG
  • Dr. A.Y. (Astrid) Hagedoorn-Bijlsma, internist ouderengeneeskunde, werkzaam in het Elisabeth-TweeSteden Ziekenhuis te Tilburg, NIV
  • Prof. Dr. J. (Jos) Schols, hoogleraar ouderengeneeskunde, werkzaam bij Maastricht University te Maastricht, Verenso
  • V. (Vera) Luijckx, MSc, geriatriefysiotherapeut, werkzaam bij Surplus te West-Brabant, KNGF
  • L. (Lotte) Kunst-Haasdijk, projectleider, werkzaam als zzp’er, KNGF

Klankbordgroep

  • D.S.V.M. (Dominique) Clément, MSc, MDL-arts, werkzaam in het King’s College Hospital te Londen, NVMDL
  • Dr. I.A.M. (Ingrid) Gisbertz, MDL-arts, werkzaam bij Bernhoven te Uden, NVMDL
  • Dhr. dr. T.E. (Taco) Otto, chirurg, werkzaam in het Dijklander Ziekenhuis te Hoorn, NVvH
  • C. (Charlotte) van der Hulst, MSc, verpleegkundig specialist AGZ, werkzaam bij Brentano te Amstelveen, V&VN
  • Dr. R. (Robert) Tepaske, anesthesioloog-intensivist, werkzaam bij het Amsterdam UMC – locatie AMC te Amsterdam, NVIC

Met ondersteuning van

  • Dr. J. (Janneke) Hoogervorst-Schilp, senior adviseur, Kennisinstituut van de Federatie Medisch Specialisten
  • F. (Florien) Ham, MSc, adviseur, Kennisinstituut van de Federatie Medisch Specialisten

Belangenverklaringen

Een overzicht van de belangen van werkgroepleden en het oordeel over het omgaan met eventuele belangen vindt u in onderstaande tabel. De ondertekende belangenverklaringen zijn op te vragen bij het secretariaat van het Kennisinstituut van de Federatie Medisch Specialisten.

Naam

Hoofdfunctie

Nevenwerkzaamheden

Persoonlijke Financiële Belangen

Persoonlijke Relaties

Extern gefinancierd onderzoek

Intell. belangen en reputatie

Overige

Datum

Restrictie

Werkgroep

Hagedoorn-Bijlsma

Internist ouderengeneeskunde bij vakgroep geriatrie in ETZ

Vicevoorzitter wetenschapscommissie van NIV en NVKG

Geen

Geen

Geen

Geen

Geen

22-08-2023

Geen

Kunst-Haasdijk

Beleidsadviseur / projectleider, KNGF/NVFG

Project beroepsprofielen, betaald als ZZP

Als ondernemer coach ik mensen naar een meer plantaardige leefstijl en geven we workshop aan teams in bedrijven op het gebied van een gezonde leefstijl.

Geen

Geen

Geen

Geen

Geen

21-08-2023

Geen

Luijckx

Werkgever: Surplus, betaalde functie.

Geriatriefysiotherapeut: Verlenen van fysiotherapeutische zorg (onderzoek, behandeling, advisering) aan ouderen met een kwetsbare gezondheid. Betaalde functie.

Lid professionele adviesraad (PAR) bij Surplus: Via de PAR aandacht voor zeggenschap binnen Surplus creëren en raad van bestuur adviseren over vakinhoudelijk beleid.

Geen

Geen

Geen

Geen

Geen

Geen

20-12-2023

Geen

Oudshoorn

Internist en kinisch geriater Erasmus MC

Geen

Geen

Geen

Geen

Geen

Geen

15-08-2023

Geen

Rutten

AIOS geriatrie Zuyderland MC

Geen

Geen

Geen

Geen

Geen

Geen

14-11-2023

Geen

Schols

Hoogleraar ouderengeneeskunde Universiteit Maastricht

*Lid van Gezondheidsraad

*Lid van Adviescommissie pakket van Zorginstituut die adviezen geeft over de toelating van dure geneesmiddelen en andere behandelingen tot het vergoedingenpakket in de ZVW en over het pakket van de Wlz --> uitgevraagd in de vergadering, dit betreft geen geneesmiddelen, voedingdinterventies of andere interventies die in de richtlijn voor zullen komen.

*Lid van RvT Vitala+ een zorgorganisatie voor geriatrische revalidatiezorg in Maastricht.

Voor deze 3 nevenfuncties geldt deelname aan vergaderingen met vacatiegeldvergoeding incl. reiskosten.

Geen

Geen

Betrokken geweest bij extern gefinancierd promotietraject op onderwerp: Samenhang tussen mondzorg, ondervoeding en dysfagie.

Project voltooid met promotie in oktober 2022. Daarmee was project afgerond.

Financier was Nutricia en financiering geschiedde op basis van officiële overeenkomst met Universiteit Maastricht.

Ik was promotor van de promovendus maar geen projectleider.

Ik heb uiteraard de reputatie van mijn universiteit hoog te houden. Verder geen specifieke zaken

Geen

21-09-2023

Geen

Sipers (voorzitter)

Klinisch geriater en opleider Zuyderland Medisch Centrum, full time werkzaam

SCEN arts, 6x/ jaar 5 dagen dienst volgens rooster. Consulten buiten werktijden om en vergoeding per daadwerkelijk uitgevoerd consult conform tarieven KNMG

Geen

Geen

Geen

Ik ben door de NVKG gevraagd om deze taak op me te nemen. Dit heeft ermee te maken daar ik reeds enige expertise heb op dit gebied en het een belangrijk thema vind in de dagelijkse zorg voor kwetsbare oudere patiënten. Mijn drijfveer is om zodoende een bijdrage te leveren aan een kwaliteit betere zorg.

Geen

28-07-2022

Geen

Vasse

Post-doc onderzoeker/projectleider - Hogeschool van Arnhem en Nijmegen, Lectoraat Voeding, Dietetiek & Leefstijl / Kenniscentrum Ondervoeding (16 uur/week, tot oktober 2024)

Projectleider - Alliantie Voeding in de Zorg (8 uur/week)

Dietist - Ziekenhuis Gelderse Vallei in Ede (oproepbasis)

Geen

Geen

Geen

Geen

Geen

Geen

20-07-2023

Geen

Verhaar

Klinisch geriater, Catharina ziekenhuis Eindhoven

Geen

Geen

Geen

Geen

Geen

Geen

03-08-2023

Geen

Wong

AIOS Zuyderland MC

Geen

Geen

Geen

Geen

Geen

Geen

17-10-2023

Geen

Klankbordgroep

Clément

Maag-, darm- en leverarts (Consultant Gastroenterologist)

King's College Hospital Londen

Geen

Geen

Geen

Geen

Geen

Geen

15-10-2023

Geen

Gisbertz

MDL arts

Bernhoven

Voorzitter Nederlands voedingsteam overleg

Lid commissie Voeding NVMDL

Geen

Geen

Geen

Geen

Geen

23-10-2023

Geen

Hulst, van der

Verpleegkundig specialist AGZ Stichting Brentano Amstelveen. Regiebehandelaar psychogeriatrisch verpleeghuis.

Geen

Geen

Geen

Geen

Geen

Geen

12-12-2023

Geen

Otto

Chirurg, Dijklander ziekenhuis, Hoorn

Geen

Geen

Geen

Geen

Geen

Geen

16-12-2023

Geen

Tepaske

Anesthesioloog-Intensivist, Intensive Care volwassenen AUMC. plv. hoofd/ WPM, plv. Opleider fellows IC (tot 1 feb 2024), Stagebegeleider AIOS. Interne, anesthesiologie, heelkunde. Begeleider Nurse practitioners profielen circulation & ventilation.

Voorzitter materialen commissie Intensive Care volwassenen

Investeringen en Europese aanbestedingen

Verder lid van de IC- werkgroepen

vv- en va-ECMO, decubitus, klinisch chemisch, peersupport, monitoring & ICT, apotheek & AMC-brede

Allen onbezoldigd:

Lid concillium IC (GIC, tot 1 feb 2024), Lid van de sectie IC van de NVA

Lid NVIC

Bezoldigd:

Docent ICverpleegkundigen, Amstel Academie, opleidingsinstituut

AmsterdamUMC, loc VUmc

 

Geen

Geen

Geen

Geen

Eenmalig vergoeding voor deelname aan masterclass 'meten van metabolisme' van Hamilton, Zwitserland

01-12-2023

Geen

Inbreng patiëntenperspectief

Er werd aandacht besteed aan het patiëntenperspectief door de Patientenfederatie Nederland en de KBO-PCOB uit te nodigen voor de schriftelijke knelpunteninventarisatie, maar beide hebben geen input gegeven. Daarnaast is de KBO-PCOB uitgenodigd voor de werkgroep, maar heeft afgezien van deelname. De conceptrichtlijn is tevens voor commentaar voorgelegd aan de Patientenfederatie Nederland en de KBO-PCOB en de eventueel aangeleverde commentaren zijn bekeken en verwerkt.

 

Kwalitatieve raming van mogelijke financiële gevolgen in het kader van de Wkkgz

Bij de richtlijnmodule is conform de Wet kwaliteit, klachten en geschillen zorg (Wkkgz) een kwalitatieve raming uitgevoerd om te beoordelen of de aanbevelingen mogelijk leiden tot substantiële financiële gevolgen. Bij het uitvoeren van deze beoordeling is de richtlijnmodule op verschillende domeinen getoetst (zie het stroomschema op de Richtlijnendatabase).

Module

Uitkomst raming

Toelichting

Meetinstrumenten fysiek functioneren

Geen financiële gevolgen

Hoewel uit de toetsing volgt dat de aanbeveling(en) breed toepasbaar zijn (>40.000 patiënten), volgt uit de toetsing dat het geen nieuwe manier van zorgverlening of andere organisatie van zorgverlening betreft, het geen toename in het aantal in te zetten voltijdsequivalenten aan zorgverleners betreft en het geen wijziging in het opleidingsniveau van zorgpersoneel betreft. Er worden daarom geen financiële gevolgen verwacht.

Werkwijze

Voor meer details over de gebruikte richtlijnmethodologie verwijzen wij u naar de Richtlijnendatabase. Relevante informatie over de ontwikkeling/herziening van deze richtlijnmodules is hieronder weergegeven.

Zoekverantwoording

Zoekstrategie

Embase.com

No.

Query

Results

#1

'aged'/exp OR 'geriatrics'/exp OR 'geriatric assessment'/exp OR 'geriatric patient'/exp OR 'elderly care'/exp OR 'frailty'/exp OR 'senile dementia'/exp OR elder*:ti,ab,kw OR eldest:ti,ab,kw OR frail*:ti,ab,kw OR geriatri*:ti,ab,kw OR ((oldest NEXT/1 old*):ti,ab,kw) OR ((very NEXT/1 old*):ti,ab,kw) OR senior*:ti,ab,kw OR senium:ti,ab,kw OR septuagenarian*:ti,ab,kw OR octagenarian*:ti,ab,kw OR octogenarian*:ti,ab,kw OR nonagenarian*:ti,ab,kw OR centarian*:ti,ab,kw OR centenarian*:ti,ab,kw OR supercentenarian*:ti,ab,kw OR ((older NEXT/1 (man OR men OR male* OR woman OR women OR female*)):ti,ab,kw) OR (((old OR older) NEXT/1 (age* OR subject* OR patient* OR pts OR adult* OR population* OR person* OR people OR citizen*)):ti,ab,kw) OR ((senil* NEAR/3 (dement* OR confus* OR alzheimer*)):ti,ab,kw)

4544770

#2

'sarcopenia'/exp OR sarcopen*:ti,ab,kw OR ((('age related' OR 'ageing related' OR geriatric) NEAR/3 ('musc* atroph*' OR 'musc* declin*' OR 'musc* degenerat')):ti,ab,kw)

33787

#3

'walk test'/exp OR 'gait speed test'/exp OR 'walking speed'/exp OR 'four minute walk test'/exp OR 'five minute walk test'/exp OR 'six minute walk test'/exp OR 'six minute walk distance'/exp OR 'six minute walking distance'/exp OR 'six minute walk distance test'/exp OR 'six minute stepper test'/exp OR 'six minute walking distance test'/exp OR 'ten minute walk test'/exp OR 'ten minute walking test'/exp OR (((gait OR walk* OR stride) NEAR/3 (speed OR velocity OR rate)):ti,ab,kw) OR ((walk* NEAR/2 test*):ti,ab,kw) OR 4mwt:ti,ab,kw OR 5mwt:ti,ab,kw OR 6mwt:ti,ab,kw OR 10mwt:ti,ab,kw

82414

#4

'intermethod comparison'/exp OR 'data collection method'/exp OR 'validation study'/exp OR 'feasibility study'/exp OR 'pilot study'/exp OR 'psychometry'/exp OR 'reproducibility'/exp OR reproducib*:ab,ti OR 'audit':ab,ti OR psychometr*:ab,ti OR clinimetr*:ab,ti OR clinometr*:ab,ti OR 'observer variation'/exp OR 'observer variation':ab,ti OR 'discriminant analysis'/exp OR 'validity'/exp OR reliab*:ab,ti OR valid*:ab,ti OR 'coefficient':ab,ti OR 'internal consistency':ab,ti OR (cronbach*:ab,ti AND ('alpha':ab,ti OR 'alphas':ab,ti)) OR 'item correlation':ab,ti OR 'item correlations':ab,ti OR 'item selection':ab,ti OR 'item selections':ab,ti OR 'item reduction':ab,ti OR 'item reductions':ab,ti OR 'agreement':ab,ti OR 'precision':ab,ti OR 'imprecision':ab,ti OR 'precise values':ab,ti OR 'test-retest':ab,ti OR ('test':ab,ti AND 'retest':ab,ti) OR (reliab*:ab,ti AND ('test':ab,ti OR 'retest':ab,ti)) OR 'stability':ab,ti OR 'interrater':ab,ti OR 'inter-rater':ab,ti OR 'intrarater':ab,ti OR 'intra-rater':ab,ti OR 'intertester':ab,ti OR 'inter-tester':ab,ti OR 'intratester':ab,ti OR 'interobeserver':ab,ti OR 'inter-observer':ab,ti OR 'intraobserver':ab,ti OR 'intertechnician':ab,ti OR 'inter-technician':ab,ti OR 'intratechnician':ab,ti OR 'interexaminer':ab,ti OR 'inter-examiner':ab,ti OR 'intraexaminer':ab,ti OR 'interassay':ab,ti OR 'inter-assay':ab,ti OR 'intraassay':ab,ti OR 'intra-assay':ab,ti OR 'interindividual':ab,ti OR 'inter-individual':ab,ti OR 'intraindividual':ab,ti OR 'intra-individual':ab,ti OR 'interparticipant':ab,ti OR 'inter-participant':ab,ti OR 'intraparticipant':ab,ti OR 'kappa':ab,ti OR 'kappas':ab,ti OR 'coefficient of variation':ab,ti OR repeatab*:ab,ti OR ((replicab*:ab,ti OR 'repeated':ab,ti) AND ('measure':ab,ti OR 'measures':ab,ti OR 'findings':ab,ti OR 'result':ab,ti OR 'results':ab,ti OR 'test':ab,ti OR 'tests':ab,ti)) OR generaliza*:ab,ti OR generalisa*:ab,ti OR 'concordance':ab,ti OR ('intraclass':ab,ti AND correlation*:ab,ti) OR 'discriminative':ab,ti OR 'known group':ab,ti OR 'factor analysis':ab,ti OR 'factor analyses':ab,ti OR 'factor structure':ab,ti OR 'factor structures':ab,ti OR 'dimensionality':ab,ti OR subscale*:ab,ti OR 'multitrait scaling analysis':ab,ti OR 'multitrait scaling analyses':ab,ti OR 'item discriminant':ab,ti OR 'interscale correlation':ab,ti OR 'interscale correlations':ab,ti OR (('error':ab,ti OR 'errors':ab,ti) AND (measure*:ab,ti OR correlat*:ab,ti OR evaluat*:ab,ti OR 'accuracy':ab,ti OR 'accurate':ab,ti OR 'precision':ab,ti OR 'mean':ab,ti)) OR 'individual variability':ab,ti OR 'interval variability':ab,ti OR 'rate variability':ab,ti OR 'variability analysis':ab,ti OR ('uncertainty':ab,ti AND ('measurement':ab,ti OR 'measuring':ab,ti)) OR 'standard error of measurement':ab,ti OR sensitiv*:ab,ti OR responsive*:ab,ti OR ('limit':ab,ti AND 'detection':ab,ti) OR 'minimal detectable concentration':ab,ti OR interpretab*:ab,ti OR (small*:ab,ti AND ('real':ab,ti OR 'detectable':ab,ti) AND ('change':ab,ti OR 'difference':ab,ti)) OR 'meaningful change':ab,ti OR 'minimal important change':ab,ti OR 'minimal important difference':ab,ti OR 'minimally important change':ab,ti OR 'minimally important difference':ab,ti OR 'minimal detectable change':ab,ti OR 'minimal detectable difference':ab,ti OR 'minimally detectable change':ab,ti OR 'minimally detectable difference':ab,ti OR 'minimal real change':ab,ti OR 'minimal real difference':ab,ti OR 'minimally real change':ab,ti OR 'minimally real difference':ab,ti OR 'ceiling effect':ab,ti OR 'floor effect':ab,ti OR 'item response model':ab,ti OR 'irt':ab,ti OR 'rasch':ab,ti OR 'differential item functioning':ab,ti OR 'dif':ab,ti OR 'computer adaptive testing':ab,ti OR 'item bank':ab,ti OR 'cross-cultural equivalence':ab,ti

8444229

#5

'sensitivity and specificity'/de OR sensitivity:ab,ti OR specificity:ab,ti OR 'roc curve':ab,ti OR 'receiver operator':ab,ti OR 'receiver operators':ab,ti OR likelihood:ab,ti OR 'diagnostic error'/exp OR 'diagnostic accuracy'/exp OR 'diagnostic test accuracy study'/exp OR 'inter observer':ab,ti OR 'intra observer':ab,ti OR interobserver:ab,ti OR intraobserver:ab,ti OR validity:ab,ti OR kappa:ab,ti OR reliability:ab,ti OR reproducibility:ab,ti OR ((test NEAR/2 're-test'):ab,ti) OR ((test NEAR/2 'retest'):ab,ti) OR 'reproducibility'/exp OR accuracy:ab,ti OR 'differential diagnosis'/exp OR 'validation study'/de OR 'measurement precision'/exp OR 'diagnostic value'/exp OR 'reliability'/exp OR 'predictive value'/exp OR ppv:ti,ab,kw OR npv:ti,ab,kw OR (((false OR true) NEAR/3 (negative OR positive)):ti,ab)

4435384

#6

#1 AND #2 AND #3 AND (#4 OR #5) NOT ('conference abstract'/it OR 'editorial'/it OR 'letter'/it OR 'note'/it) NOT (('animal'/exp OR 'animal experiment'/exp OR 'animal model'/exp OR 'nonhuman'/exp) NOT 'human'/exp) AND [2011-2025]/py

933

#7

'meta analysis'/exp OR 'meta analysis (topic)'/exp OR metaanaly*:ti,ab OR 'meta analy*':ti,ab OR metanaly*:ti,ab OR 'systematic review'/de OR 'cochrane database of systematic reviews'/jt OR prisma:ti,ab OR prospero:ti,ab OR (((systemati* OR scoping OR umbrella OR 'structured literature') NEAR/3 (review* OR overview*)):ti,ab) OR ((systemic* NEAR/1 review*):ti,ab) OR (((systemati* OR literature OR database* OR 'data base*') NEAR/10 search*):ti,ab) OR (((structured OR comprehensive* OR systemic*) NEAR/3 search*):ti,ab) OR (((literature NEAR/3 review*):ti,ab) AND (search*:ti,ab OR database*:ti,ab OR 'data base*':ti,ab)) OR (('data extraction':ti,ab OR 'data source*':ti,ab) AND 'study selection':ti,ab) OR ('search strategy':ti,ab AND 'selection criteria':ti,ab) OR ('data source*':ti,ab AND 'data synthesis':ti,ab) OR medline:ab OR pubmed:ab OR embase:ab OR cochrane:ab OR (((critical OR rapid) NEAR/2 (review* OR overview* OR synthes*)):ti) OR ((((critical* OR rapid*) NEAR/3 (review* OR overview* OR synthes*)):ab) AND (search*:ab OR database*:ab OR 'data base*':ab)) OR metasynthes*:ti,ab OR 'meta synthes*':ti,ab

1067084

#8

'major clinical study'/de OR 'clinical study'/de OR 'case control study'/de OR 'family study'/de OR 'longitudinal study'/de OR 'retrospective study'/de OR 'prospective study'/de OR 'comparative study'/de OR 'cohort analysis'/de OR ((cohort NEAR/1 (study OR studies)):ab,ti) OR (('case control' NEAR/1 (study OR studies)):ab,ti) OR (('follow up' NEAR/1 (study OR studies)):ab,ti) OR (observational NEAR/1 (study OR studies)) OR ((epidemiologic NEAR/1 (study OR studies)):ab,ti) OR (('cross sectional' NEAR/1 (study OR studies)):ab,ti)

8431657

#9

'case control study'/de OR 'comparative study'/exp OR 'control group'/de OR 'controlled study'/de OR 'controlled clinical trial'/de OR 'crossover procedure'/de OR 'double blind procedure'/de OR 'phase 2 clinical trial'/de OR 'phase 3 clinical trial'/de OR 'phase 4 clinical trial'/de OR 'pretest posttest design'/de OR 'pretest posttest control group design'/de OR 'quasi experimental study'/de OR 'single blind procedure'/de OR 'triple blind procedure'/de OR (((control OR controlled) NEAR/6 trial):ti,ab,kw) OR (((control OR controlled) NEAR/6 (study OR studies)):ti,ab,kw) OR (((control OR controlled) NEAR/1 active):ti,ab,kw) OR 'open label*':ti,ab,kw OR (((double OR two OR three OR multi OR trial) NEAR/1 (arm OR arms)):ti,ab,kw) OR ((allocat* NEAR/10 (arm OR arms)):ti,ab,kw) OR placebo*:ti,ab,kw OR 'sham-control*':ti,ab,kw OR (((single OR double OR triple OR assessor) NEAR/1 (blind* OR masked)):ti,ab,kw) OR nonrandom*:ti,ab,kw OR 'non-random*':ti,ab,kw OR 'quasi-experiment*':ti,ab,kw OR crossover:ti,ab,kw OR 'cross over':ti,ab,kw OR 'parallel group*':ti,ab,kw OR 'factorial trial':ti,ab,kw OR ((phase NEAR/5 (study OR trial)):ti,ab,kw) OR ((case* NEAR/6 (matched OR control*)):ti,ab,kw) OR ((match* NEAR/6 (pair OR pairs OR cohort* OR control* OR group* OR healthy OR age OR sex OR gender OR patient* OR subject* OR participant*)):ti,ab,kw) OR ((propensity NEAR/6 (scor* OR match*)):ti,ab,kw) OR versus:ti OR vs:ti OR compar*:ti OR ((compar* NEAR/1 study):ti,ab,kw) OR (('major clinical study'/de OR 'clinical study'/de OR 'cohort analysis'/de OR 'observational study'/de OR 'cross-sectional study'/de OR 'multicenter study'/de OR 'correlational study'/de OR 'follow up'/de OR cohort*:ti,ab,kw OR 'follow up':ti,ab,kw OR followup:ti,ab,kw OR longitudinal*:ti,ab,kw OR prospective*:ti,ab,kw OR retrospective*:ti,ab,kw OR observational*:ti,ab,kw OR 'cross sectional*':ti,ab,kw OR cross?ectional*:ti,ab,kw OR multicent*:ti,ab,kw OR 'multi-cent*':ti,ab,kw OR consecutive*:ti,ab,kw) AND (group:ti,ab,kw OR groups:ti,ab,kw OR subgroup*:ti,ab,kw OR versus:ti,ab,kw OR vs:ti,ab,kw OR compar*:ti,ab,kw OR 'odds ratio*':ab OR 'relative odds':ab OR 'risk ratio*':ab OR 'relative risk*':ab OR 'rate ratio':ab OR aor:ab OR arr:ab OR rrr:ab OR ((('or' OR 'rr') NEAR/6 ci):ab)))

15438437

#10

#6 AND #7 - SR

62

#11

#6 AND (#8 OR #9) NOT #10 - observationeel

795

#12

#10 OR #11

857

Ovid/Medline

#

Searches

Results

1

exp Aged/ or exp Geriatrics/ or exp "Homes for the Aged"/ or exp "Health Services for the Aged"/ or exp Geriatric Psychiatry/ or exp Geriatric Nursing/ or elder*.ti,ab,kf. or eldest.ti,ab,kf. or frail*.ti,ab,kf. or geriatri*.ti,ab,kf. or 'oldest old*'.ti,ab,kf. or 'very old*'.ti,ab,kf. or senior*.ti,ab,kf. or senium.ti,ab,kf. or septuagenarian*.ti,ab,kf. or octagenarian*.ti,ab,kf. or octogenarian*.ti,ab,kf. or nonagenarian*.ti,ab,kf. or centarian*.ti,ab,kf. or centenarian*.ti,ab,kf. or supercentenarian*.ti,ab,kf. or (older adj (man or men or male* or woman or women or female*)).ti,ab,kf. or ((old or older) adj (age* or subject* or patient* or pts or adult* or population* or person* or people or citizen*)).ti,ab,kf. or (senil* adj3 (dement* or confus* or alzheimer*)).ti,ab,kf.

 

3907167

2

exp Sarcopenia/ or sarcopen*.ti,ab,kf. or (('age related' or 'ageing related' or geriatric) adj3 ('musc* atroph*' or 'musc* declin*' or 'musc* degenerat')).ti,ab,kf.

21329

3

exp Walk Test/ or exp Walking Speed/ or ((gait or walk* or stride) adj3 (speed or velocity or rate)).ti,ab,kf. or (walk* adj2 test*).ti,ab,kf. or 4MWT.ti,ab,kf. or 5MWT.ti,ab,kf. or 6MWT.ti,ab,kf. or 10MWT.ti,ab,kf.

40473

4

(instrumentation or methods).fs. or Validation Study/ or Comparative Study/ or exp Psychometrics/ or psychometr*.ti,ab,kf. or clinimetr*.mp. or clinometr*.mp. or exp Outcome Assessment, Health Care/ or outcome assessment.ti,ab,kf. or outcome measure*.mp. or exp Observer Variation/ or observer variation.ti,ab,kf. or exp Health Status Indicators/ or exp "reproducibility of results"/ or reproducib*.ti,ab,kf. or exp Discriminant Analysis/ or reliab*.ti,ab,kf. or unreliab*.ti,ab,kf. or valid*.ti,ab,kf. or coefficient.ti,ab,kf. or homogeneity.ti,ab,kf. or homogeneous.ti,ab,kf. or internal consistency.ti,ab,kf. or (cronbach* and (alpha or alphas)).ti,ab,kf. or (item and (correlation* or selection* or reduction*)).ti,ab,kf. or agreement.mp. or precision.mp. or imprecision.mp. or precise values.mp. or test-retest.ti,ab,kf. or (test and retest).ti,ab,kf. or (reliab* and (test or retest)).ti,ab,kf. or stability.ti,ab,kf. or interrater.ti,ab,kf. or inter-rater.ti,ab,kf. or intrarater.ti,ab,kf. or intra-rater.ti,ab,kf. or intertester.ti,ab,kf. or inter-tester.ti,ab,kf. or intratester.ti,ab,kf. or intra-tester.ti,ab,kf. or interobserver.ti,ab,kf. or inter-observer.ti,ab,kf. or intraobserver.ti,ab,kf. or intra-observer.ti,ab,kf. or intertechnician.ti,ab,kf. or inter-technician.ti,ab,kf. or intratechnician.ti,ab,kf. or intra-technician.ti,ab,kf. or interexaminer.ti,ab,kf. or inter-examiner.ti,ab,kf. or intraexaminer.ti,ab,kf. or intra-examiner.ti,ab,kf. or interassay.ti,ab,kf. or inter-assay.ti,ab,kf. or intraassay.ti,ab,kf. or intra-assay.ti,ab,kf. or interindividual.ti,ab,kf. or inter-individual.ti,ab,kf. or intraindividual.ti,ab,kf. or intra-individual.ti,ab,kf. or interparticipant.ti,ab,kf. or inter-participant.ti,ab,kf. or intraparticipant.ti,ab,kf. or intra-participant.ti,ab,kf. or kappa.ti,ab,kf. or kappa's.ti,ab,kf. or kappas.ti,ab,kf. or repeatab*.mp. or ((replicab* or repeated) and (measure or measures or findings or result or results or test or tests)).mp. or generaliza*.ti,ab,kf. or generalisa*.ti,ab,kf. or concordance.ti,ab,kf. or (intraclass and correlation*).ti,ab,kf. or discriminative.ti,ab,kf. or known group.ti,ab,kf. or factor analysis.ti,ab,kf. or factor analyses.ti,ab,kf. or factor structure.ti,ab,kf. or factor structures.ti,ab,kf. or dimension*.ti,ab,kf. or subscale*.ti,ab,kf. or (multitrait and scaling and (analysis or analyses)).ti,ab,kf. or item discriminant.ti,ab,kf. or interscale correlation*.ti,ab,kf. or error.ti,ab,kf. or errors.ti,ab,kf. or individual variability.ti,ab,kf. or (variability and (analysis or values)).ti,ab,kf. or (uncertainty and (measurement or measuring)).ti,ab,kf. or standard error of measurement.ti,ab,kf. or sensitiv*.ti,ab,kf. or responsive*.ti,ab,kf. or (limit and detection).ti,ab,kf. or minimal detectable concentration.ti,ab,kf. or interpretab*.ti,ab,kf. or ((minimal or minimally or clinical or clinically) and (important or significant or detectable) and (change or difference)).ti,ab,kf. or (small* and (real or detectable) and (change or difference)).ti,ab,kf. or meaningful change.ti,ab,kf. or ceiling effect.ti,ab,kf. or floor effect.ti,ab,kf. or item response model.ti,ab,kf. or irt.ti,ab,kf. or rasch.ti,ab,kf. or differential item functioning.ti,ab,kf. or dif.ti,ab,kf. or computer adaptive testing.ti,ab,kf. or item bank.ti,ab,kf. or cross-cultural equivalence.ti,ab,kf.

12011341

5

exp "Sensitivity and Specificity"/ or (sensitivity or specificity).ti,ab. or (ROC-curve or receiver-operator*).ti,ab. or (likelihood or LR*).ti,ab. or exp Diagnostic Errors/ or (inter-observer or intra-observer or interobserver or intraobserver or validity or kappa or reliability).ti,ab. or reproducibility.ti,ab. or (test adj2 (re-test or retest)).ti,ab. or "Reproducibility of Results"/ or accuracy.ti,ab. or Diagnosis, Differential/ or Validation Study/ or ((false or true) adj3 (negative or positive)).ti,ab.

3579104

6

(1 and 2 and 3 and (4 or 5)) not (comment/ or editorial/ or letter/) not ((exp animals/ or exp models, animal/) not humans/)

798

7

limit 6 to yr="2011 -Current"

790

8

meta-analysis/ or meta-analysis as topic/ or (metaanaly* or meta-analy* or metanaly*).ti,ab,kf. or systematic review/ or cochrane.jw. or (prisma or prospero).ti,ab,kf. or ((systemati* or scoping or umbrella or "structured literature") adj3 (review* or overview*)).ti,ab,kf. or (systemic* adj1 review*).ti,ab,kf. or ((systemati* or literature or database* or data-base*) adj10 search*).ti,ab,kf. or ((structured or comprehensive* or systemic*) adj3 search*).ti,ab,kf. or ((literature adj3 review*) and (search* or database* or data-base*)).ti,ab,kf. or (("data extraction" or "data source*") and "study selection").ti,ab,kf. or ("search strategy" and "selection criteria").ti,ab,kf. or ("data source*" and "data synthesis").ti,ab,kf. or (medline or pubmed or embase or cochrane).ab. or ((critical or rapid) adj2 (review* or overview* or synthes*)).ti. or (((critical* or rapid*) adj3 (review* or overview* or synthes*)) and (search* or database* or data-base*)).ab. or (metasynthes* or meta-synthes*).ti,ab,kf.

779447

9

Epidemiologic studies/ or case control studies/ or exp cohort studies/ or Controlled Before-After Studies/ or Case control.tw. or cohort.tw. or Cohort analy$.tw. or (Follow up adj (study or studies)).tw. or (observational adj (study or studies)).tw. or Longitudinal.tw. or Retrospective*.tw. or prospective*.tw. or consecutive*.tw. or Cross sectional.tw. or Cross-sectional studies/ or historically controlled study/ or interrupted time series analysis/ [Onder exp cohort studies vallen ook longitudinale, prospectieve en retrospectieve studies]

4845881

10

Case-control Studies/ or clinical trial, phase ii/ or clinical trial, phase iii/ or clinical trial, phase iv/ or comparative study/ or control groups/ or controlled before-after studies/ or controlled clinical trial/ or double-blind method/ or historically controlled study/ or matched-pair analysis/ or single-blind method/ or (((control or controlled) adj6 (study or studies or trial)) or (compar* adj (study or studies)) or ((control or controlled) adj1 active) or "open label*" or ((double or two or three or multi or trial) adj (arm or arms)) or (allocat* adj10 (arm or arms)) or placebo* or "sham-control*" or ((single or double or triple or assessor) adj1 (blind* or masked)) or nonrandom* or "non-random*" or "quasi-experiment*" or "parallel group*" or "factorial trial" or "pretest posttest" or (phase adj5 (study or trial)) or (case* adj6 (matched or control*)) or (match* adj6 (pair or pairs or cohort* or control* or group* or healthy or age or sex or gender or patient* or subject* or participant*)) or (propensity adj6 (scor* or match*))).ti,ab,kf. or (confounding adj6 adjust*).ti,ab. or (versus or vs or compar*).ti. or ((exp cohort studies/ or epidemiologic studies/ or multicenter study/ or observational study/ or seroepidemiologic studies/ or (cohort* or 'follow up' or followup or longitudinal* or prospective* or retrospective* or observational* or multicent* or 'multi-cent*' or consecutive*).ti,ab,kf.) and ((group or groups or subgroup* or versus or vs or compar*).ti,ab,kf. or ('odds ratio*' or 'relative odds' or 'risk ratio*' or 'relative risk*' or aor or arr or rrr).ab. or (("OR" or "RR") adj6 CI).ab.))

5801824

11

7 and 8 - SR

42

12

(7 and (9 or 10)) not 11 - observationeel

597

13

11 or 12

639
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