Effect of sarcopenia status on higher-level functional capacity in daily living among older orthopedic outpatients in Japan

Effect of sarcopenia status on higher-level functional capacity in daily living among older orthopedic outpatients in Japan | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of sarcopenia status on higher-level functional capacity in daily living among older orthopedic outpatients in Japan Yoshihito Tomita, Hiroki Nakashima, Satoshi Mizukami, Kazuhiko Arima, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4585633/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background A higher risk of disability has been reported in sarcopenia and severe sarcopenia patient groups than in the non-sarcopenia group. Here, we showed an independent association between sarcopenia and disability among older orthopedic outpatients in Japan. Methods The sample included 103 older outpatients aged ≥65 years with orthopedic diseases. Body mass index (BMI) was calculated as weight divided by height squared (kg/m 2 ). Sarcopenia was defined as low grip strength and low muscle mass. The classification of sarcopenia was based on the recommendations of the Asian Working Group for Sarcopenia. Muscle mass was evaluated using bioelectrical impedance analysis using InBody 430. Higher-level functional capacity was determined using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC), a multidimensional 13-item scale that consists of three subscales: instrumental activities of daily living, intellectual activity, and social role. The association between sarcopenia and disability was assessed using logistic regression analysis. Results The prevalence rates of sarcopenia and severe sarcopenia were 14.7% and 11.8%, respectively. Older age was associated with severe sarcopenia. The percentage of individuals with disabilities in social roles was significantly higher in the severe sarcopenia group than that in the non-sarcopenia group. After adjusting for age, sex, BMI, and comorbidity, severe sarcopenia was significantly associated with disability in social roles among orthopedic outpatients. The sarcopenia group showed no significant social role disabilities. Conclusions Sarcopenia is a serious problem facing older orthopedic outpatients. Severe sarcopenia was found to be associated with disability in social roles among older orthopedic outpatients. disability older orthopedic outpatients sarcopenia social role Figures Figure 1 Background Rosenberg defined sarcopenia (ICD-10 code M62.84) as “age-related loss of muscle mass and function”. 1 The causes of sarcopenia include aging, disuse, inadequate nutrition, endocrine and neurodegenerative diseases, and cachexia. 2 Sarcopenia increases the risk of negative health outcomes such as falls, fractures, dependency, use of hospital services, institutionalization, poor quality of life, and mortality. 3 Musculoskeletal disorders are associated with the development of sarcopenia, particularly in older orthopedic outpatients. Knee and hip pain may directly contribute to sarcopenia progression and increase the risk in older women. 4 Patients with orthopedic diseases are likely to become inactive because of pain 5 ; therefore, they may be at a higher risk of developing sarcopenia. In one study, the prevalence rates of sarcopenia were 11.5% and 16.7% in older Japanese community-dwelling men and women, respectively. 6 In another study, 40% of the patients with chronic low back pain met the criteria for sarcopenia in the outpatient department of orthopedic surgery. 7 Moreover, its prevalence in patients with rheumatoid arthritis is 37.1%. 8 Increasing evidence suggests that sarcopenia contributes to functional disabilities in older persons. 9 , 10 According to a study of patients in Western countries, in which sarcopenia was defined only by muscle mass, the likelihood of difficulty in performing instrumental activities of daily living (IADL) scale was 3.66 and 4.08 times greater in older men and women with sarcopenia, respectively, than in those without sarcopenia. 11 The disability risk has been found to be higher in the sarcopenia and severe sarcopenia groups than in the non-sarcopenia group among community-dwelling older Japanese. 12 However, the association between sarcopenia and disability has not yet been studied in older Japanese orthopedic outpatients. This study aimed to evaluate the association between sarcopenia and disability among older orthopedic outpatients in Japan. Methods Participants were recruited from orthopedic patients who visited Nishi-Isahaya Hospital and voluntarily enrolled in this observational study. Written informed consent forms were available in Japanese to ensure complete understanding, and all participants provided written informed consent before examinations. This study was approved by the Ethics Committee of Tokyo Professional University of Health Sciences (project registration number: TPU-23-029). The study sample included 109 older outpatients ≥ 65 years of age with orthopedic diseases. Our power analysis showed that the sample size was sufficient for our statistical analyzes (G*Power ver. 3.1. Test family [chi-square test], statistical test [goodness-of-fit test: contingency tables], effect size = 0.40, alpha error = 0.05, 1-beta error = 0.80, total sample size = 81). G*Power was designed as a general standalone power analysis program for statistical tests commonly used in social and behavioral research. 13 All participants had sufficient cognitive function to complete the questionnaire and were asked if they had any comorbidities (heart disease, lung disease, stroke, or diabetes mellitus). Data on the diagnoses of musculoskeletal disorders (such as osteoarthritis, rheumatoid arthritis, and fractures) were collected. Pain sites (shoulder, elbow, wrist, finger, hip, knee, ankle, foot, upper back pain, middle back pain, and lower back pain) were recorded, but the severity of pain has not been assessed. Height (m) and weight (kg) were measured with the participants wearing light clothing and no shoes. Body mass index (BMI) was calculated by dividing weight by height squared (kg/m 2 ). Muscle mass was measured by bioelectrical impedance analysis (BIA) using InBody 430 (InBody Japan Inc., Tokyo, Japan). The BIA method requires participants to step onto a platform and remain in the standing position for approximately 30 seconds. Appendicular skeletal muscle mass index (AMI) was calculated as the sum of the muscle mass of the four limbs. Absolute appendicular muscle mass was converted to AMI, which was calculated by dividing the absolute appendicular muscle mass by the square of height in meters squared (kg/m 2 ). The grip strength of the dominant hand was measured using a Jamar hydraulic hand dynamometer (Jafayette Instrument Company, Inc., Jafayette, IN, USA). The best performance from two attempts was accepted. Walking speed was calculated as the time required for participants to complete a distance of 10-m at their usual pace (usual walking speed; average of two trials). Participants were classified as having sarcopenia based on their muscle mass, muscle strength, and physical performance. The classification was based on the recommendations of the Asian Working Group for Sarcopenia (AWGS). 14 These recommendations define sarcopenia as age > 60 years, low handgrip strength (< 28 kg and 18 kg in men and women, respectively) and/or slow walking speed (< 1.0 m/s), and low AMI (< 7.0 kg/m 2 and 5.7 kg/m 2 in men and women, respectively). “Sarcopenia” was defined as the presence of low muscle mass, low muscle strength or poor physical performance, while “severe sarcopenia” was defined the presence of all three conditions. “Non-sarcopenia” was defined as absence of low muscle strength, low muscle mass, and poor physical performance. We used the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) to measure participants’ high-functional capacity. 15 We used the TMIG-IC because it was developed for older Japanese individuals and has been widely used in the Japan community. 15 The TMIG-IC is a 13-item multidimensional scale consisting of three subscales: IADL (five items), Intellectual activity (four items), and Social roles (four items) (Fig. 1 ). The answer for each item was either ‘‘yes’’ (able to do, 1 point) or ‘‘no’’ (unable to do, 0 points); the maximum score was 13 points. The IADL subscale scores range from 0 to 5 points, the intellectual activity subscale scores range from 0 to 4 points, and social role subscale scores range from 0 to 4 points; higher scores reflected higher skill levels. A score of one or more below the total scores on these subscales indicated the presence of disability in the given domain. A score of 4/5 or less on the IADL or 3/4 or less on intellectual activity or social roles was considered to indicate disability in this subscale. 16 Statistical Analysis We used the Shapiro–Wilk test for normality. Comparisons of variables among the severe sarcopenia, sarcopenia, and non-sarcopenia groups were performed using one-way way ANOVA for continuous variables or Fisher’s exact test for categorical variables. The association between sarcopenia and disability was assessed using logistic regression analysis adjusted for age, sex, BMI and comorbidities. The Hosmer–Lemeshow test was used to assess the difference between the observed and predicted prevalence in the logistic regression analysis. Odds ratios (OR) and 95% confidence intervals (CIs) were calculated. Statistical significance was set at P < 0.05. All statistical analyses were performed using IBM SPSS Statistics, version 27 (IBM Corp., Armonk, NY, USA). Results Participants (n = 5) with missing values for any variable and pacemaker implantation (n = 1) were excluded from the analysis, leaving behind 103 participants for the final data analysis. The prevalence rates of musculoskeletal diseases among the participants was as follows: osteoarthritis (n = 47, 46.1%), rheumatoid arthritis (n = 4, 3.9%), fracture (n = 44, 43.1%), and other (n = 7, 6.9%). All participants experienced at least musculoskeletal pain in at least one site (Table 1 ). The common sites of pain were shoulder (n = 71, 68.9%), elbow (n = 13, 12.6%), wrist (n = 12, 11.7%), finger (n = 11, 10.7%), hip (n = 17, 16.5%), knee (n = 52, 50.5%), ankle (n = 16, 15.5%), foot (n = 11, 10.7%), upper back pain (n = 26, 25.2%), mid back pain (n = 13, 12.6%), and low back pain (n = 67, 65.0%). Table 1 Sites of pain (N = 103) Pain site n (%) Shoulder 71 (68.9) Elbow 13 (12.6) Wrist 12 (11.7) Finger 11 (10.7) Hip 17 (16.5) Knee 52 (50.5) Ankle 16(15.5) Foot 11 (10.7) Upper back 26 (25.2) Mid back 13 (12.6) Low back 67 (65.0) Table 2 shows the characteristics of participants. The mean ages and BMI were 76.8 years and 23.5 kg/m 2 , respectively. The percentages of IADL disability, intellectual activity, and social roles were 11.7%, 33.0%, and 41.7%, respectively. The prevalence rates of sarcopenia and severe sarcopenia were 14.7% (n = 15) and 11.8% (n = 12), respectively (Table 3 ). The participants with severe sarcopenia had significantly lower BMI (P = 0.001), AMI (P < 0.001), grip strength (P < 0.001), and walking speed (P < 0.001) than those with non-sarcopenia. Advanced age (P = 0.036) was associated with severe sarcopenia. The proportions of disabilities in social roles were significantly higher in the severe sarcopenia group than that in the non-sarcopenia group (P = 0.043). Table 2 Characteristics of the participants (N = 103) Mean SD Age, years 76.8 7.1 Body mass index, kg/m 2 23.5 3.9 Appendicular muscle mass index, kg/m 2 6.1 0.9 Grip strength, kg 22.5 6.5 Usual walking speed, m/s 1.1 0.2 Number % Sex, women 83 80.6 Comorbidity 1 , yes 78 75.7 Instrumental ADL 2 disability 3 , yes 12 11.7 Intellectual activity disability 4 , yes 34 33.0 Social role disability 5 , yes 43 41.7 1 Presence of heart disease, lung disease, stroke, or diabetes mellitus. 2 ADL: Activities of daily living 3 A score of 4 or less out of 5 for Instrumental ADL 2 was considered to indicate the presence of a disability. 4 A score of 3 or less out of 4 for intellectual activity was considered to indicate the presence of a disability. 5 A score of 3 or less out of 4 for social role was considered to indicate the presence of a disability. Table 3 Comparison of variables among severe sarcopenia, sarcopenia, and non-sarcopenia group (N = 103) Non-sarcopenia (n = 76) Sarcopenia (n = 15) Severe sarcopenia (n = 12) P value Mean SD 6 Mean SD 6 Mean SD 6 Age, years 76.1 6.6 76.8 6.4 81.7 8.9 0.036 Body mass index, kg/m 2 24.3 3.9 21.1 2.0 21.1 2.0 0.001 Appendicular muscle mass index, kg/m 2 6.4 0.9 5.4 0.6 5.4 0.6 < 0.001 Grip strength, kg 24.0 6.5 19.2 4.1 17.4 5.1 < 0.001 Usual walking speed, m/s 1.1 0.2 0.8 0.1 0.8 0.1 < 0.001 Number % Number % Number % Comorbidity 1 , yes 56 73.7 14 93.3 8 66.7 0.198 Instrumental ADL 2 disability 3 , yes 8 10.5 1 6.7 3 25.0 0.282 Intellectual activity disability 4 , yes 26 34.2 2 13.3 6 50.0 0.120 Social role disability 5 , yes 29 38.2 5 33.3 9 75.0 0.043 1 Presence of heart disease, lung disease, stroke, or diabetes mellitus. 2 ADL: Activities of daily living 3 A score of 4 or less out of 5 for Instrumental ADL 2 was considered to indicate the presence of a disability. 4 A score of 3 or less out of 4 for intellectual activity was considered to indicate the presence of a disability. 5 A score of 3 or less out of 4 for social role was considered to indicate the presence of a disability. 6 SD: Standard deviation, one-way ANOVA, Fisher’s exact test After adjustments for age, sex, BMI and comorbidity, severe sarcopenia group was found to be significantly associated with disability for social role (OR: 7.90, 95% CI: 1.43–43.62) in orthopedic outpatients (Table 4 ). Table 4 Association between sarcopenia status and social role disability (N = 103) Unit Sarcopenia and severe sarcopenia versus non-sarcopenia Sarcopenia versus non-sarcopenia Severe sarcopenia versus non-sarcopenia Odds(95% Confidence interval) Odds(95% Confidence interval) Odds(95% Confidence interval) Social role disability yes 1.81 (0.65–5.06) 0.92 (0.24–3.47) 7.90 (1.43–43.62) * Age 5 years 1.04 (0.97–1.12) 0.91 (0.57–1.46) 1.93 (1.10–3.37) * Sex Women 0.95 (0.26–3.43) 1.09 (0.21–5.71) 0.77 (0.12–5.11) Body mass index 3.8 † kg/m 2 0.68 (0.56–0.84) * 0.23 (0.09–0.57) * 0.18 (0.05–0.68) * Comorbidity 1 yes 3.12 (0.85–11.43) 10.11 (1.05–97.36) * 1.60 (0.29–8.92) 1 : Presence of heart disease, lung disease, stroke, or diabetes mellitus. *: P value < 0.05 † : 1 Standard deviation Logistic regression analysis Discussion Prevalence of sarcopenia Among the older orthopedic outpatients, the prevalence rates of sarcopenia and severe sarcopenia were 14.7% and 11.8%, respectively. A Japanese national cohort study reported prevalence rates of 3.4% and 1.7% for sarcopenia and severe sarcopenia, respectively, in older adults. 12 In this study, all the participants experienced musculoskeletal pain in at least one site. Pain was a significant predictor of the onset of sarcopenia over a 9-year period, 17 which may reflect avoidance of physical activity because of fear of pain. 5 Sarcopenia and severe sarcopenia are serious problems among facing orthopedic outpatients. Sarcopenia and social role Our study showed that severe sarcopenia was associated with disability in social roles among older orthopedic outpatients. Previous reports have suggested that sarcopenia is significantly associated with IADL and social role disability. 18 Thus, not only sarcopenia but also severe sarcopenia with low muscle mass, low muscle strength, and low physical performance may be associated with impairment of social roles in older adults. A longitudinal study showed that severe sarcopenia, involving low muscle mass and low physical performance, increased the risk of disability in older adults compared with that with low muscle mass alone. 12 Conversely, maintaining good social relationships may contribute to the prevention of severe sarcopenia; further longitudinal research is needed to clarify the causality between severe sarcopenia and social role disability. Sarcopenia and intellectual activity disability in IADL The prevalence of mild cognitive impairment is relatively high in patients with sarcopenia, and may be a risk factor for sarcopenia. 19 Sarcopenia is significantly associated with IADL disability in older Japanese people. 18 In an 8-year follow-up study of older Japanese people, disability in social roles was the most prevalent disability, followed by disabilities in intellectual activity and IADL. 20 Similarly, our study showed that among men and women with sarcopenia or severe sarcopenia, the percentage of disability in social roles was the highest, followed by disabilities in intellectual activity and IADL. However, this study showed no significant differences between sarcopenia and disabilities in intellectual activity and IADL. Limitations This study has several limitations. First, because this study had a cross-sectional design, we could not establish a causal relationship between sarcopenia and disability. Therefore, longitudinal studies are needed to determine causality. Second, outcomes were collected from older Japanese orthopedic outpatients. Therefore, these results cannot be extrapolated to other ethnic groups or community-dwelling populations. Third, it may be difficult to assess the severity of comorbidities in older patients. Therefore, severity was not assessed. Moreover, information on medications or pain severity was not collected. These limitations may have contributed to the underestimation of the associations reported herein. Finally, the possibility of selection bias in this single-hospital study cannot be ignored. Further multicenter studies are needed. Conclusion Sarcopenia is a serious problem in older orthopedic outpatients. Our study showed that severe sarcopenia was associated with disability in social roles among older orthopedic outpatients in Japan. Abbreviations IADL: instrumental activities of daily living BMI: Body mass index BIA: Bioelectrical impedance analysis AMI: Appendicular skeletal muscle mass index AWGS: Asian Working Group for Sarcopenia TMIG-IC: Tokyo Metropolitan Institute of Gerontology Index of Competence Declarations Authors’ contributions YT, HN, SM, KAr, YK, YA, MK, and KAo designed the study. YT collected and analyzed the data and drafted the manuscript. KAo supervised and assisted with data collection and analysis, and manuscript preparation. YT, HN, SM, KAr, YK, YA, MK, and KAo advised on the study design and data analysis and edited the manuscript. All authors read and approved the final manuscript. Acknowledgments The authors thank all the participants. The authors wish to express their gratitude to the medical staff and colleagues at the Nishi-Isahaya Hospital for supporting this study through their kind cooperation. This research was supported by a Japan Society for the Promotion of Science Grant-in-Aid for Scientific Research (KAKENHI Grant Numbers JP19K16245 and 23K14277). Funding statement This research was supported by a Japan Society for the Promotion of Science Grant-in-Aid for Scientific Research (KAKENHI Grant Numbers JP19K16245 and 23K14277). Conflict of Interest Statement The authors declare that they have no competing interests. Data availability statement The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Ethics approval and consent to participate All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The participants were enrolled voluntarily in the study. 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Transition to sarcopenia and determinants of transitions in older adults: a population-based study. J Gerontol A Biol Sci Med Sci. 2014;69:751–8. Tanimoto Y, Watanabe M, Sun W et al. Association between sarcopenia and higher-level functional capacity in daily living in community-dwelling elderly subjects in Japan. Arch Gerontol Geriatr. 2012;55 e9–13. Yang Y, Xiao M, Leng L et al. A systematic review and meta-analysis of the prevalence and correlation of mild cognitive impairment in sarcopenia. J Cachexia Sarcopenia Muscle. 2023;14:45–56. Fujiwara Y, Shinkai S, Kumagai S et al. Longitudinal changes in higher-level functional capacity of an older population living in a Japanese urban community. Arch Gerontol Geriatr. 2003;36:141–53. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4585633","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":318862906,"identity":"5f6458d7-b221-4f59-b1db-190d5a9d2153","order_by":0,"name":"Yoshihito 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16:16:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":643588,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4585633/v1/ee5173c4-a998-44c2-9061-3e2dd28b0ad8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effect of sarcopenia status on higher-level functional capacity in daily living among older orthopedic outpatients in Japan","fulltext":[{"header":"Background","content":"\u003cp\u003eRosenberg defined sarcopenia (ICD-10 code M62.84) as “age-related loss of muscle mass and function”.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e The causes of sarcopenia include aging, disuse, inadequate nutrition, endocrine and neurodegenerative diseases, and cachexia.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Sarcopenia increases the risk of negative health outcomes such as falls, fractures, dependency, use of hospital services, institutionalization, poor quality of life, and mortality.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eMusculoskeletal disorders are associated with the development of sarcopenia, particularly in older orthopedic outpatients. Knee and hip pain may directly contribute to sarcopenia progression and increase the risk in older women.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Patients with orthopedic diseases are likely to become inactive because of pain\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e; therefore, they may be at a higher risk of developing sarcopenia. In one study, the prevalence rates of sarcopenia were 11.5% and 16.7% in older Japanese community-dwelling men and women, respectively.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e In another study, 40% of the patients with chronic low back pain met the criteria for sarcopenia in the outpatient department of orthopedic surgery.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Moreover, its prevalence in patients with rheumatoid arthritis is 37.1%.\u003csup\u003e8\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIncreasing evidence suggests that sarcopenia contributes to functional disabilities in older persons.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e According to a study of patients in Western countries, in which sarcopenia was defined only by muscle mass, the likelihood of difficulty in performing instrumental activities of daily living (IADL) scale was 3.66 and 4.08 times greater in older men and women with sarcopenia, respectively, than in those without sarcopenia.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e The disability risk has been found to be higher in the sarcopenia and severe sarcopenia groups than in the non-sarcopenia group among community-dwelling older Japanese.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e However, the association between sarcopenia and disability has not yet been studied in older Japanese orthopedic outpatients. This study aimed to evaluate the association between sarcopenia and disability among older orthopedic outpatients in Japan.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e "},{"header":"Methods","content":"\u003cp\u003eParticipants were recruited from orthopedic patients who visited Nishi-Isahaya Hospital and voluntarily enrolled in this observational study. Written informed consent forms were available in Japanese to ensure complete understanding, and all participants provided written informed consent before examinations. This study was approved by the Ethics Committee of Tokyo Professional University of Health Sciences (project registration number: TPU-23-029).\u003c/p\u003e\u003cp\u003eThe study sample included 109 older outpatients ≥ 65 years of age with orthopedic diseases. Our power analysis showed that the sample size was sufficient for our statistical analyzes (G*Power ver. 3.1. Test family [chi-square test], statistical test [goodness-of-fit test: contingency tables], effect size = 0.40, alpha error = 0.05, 1-beta error = 0.80, total sample size = 81). G*Power was designed as a general standalone power analysis program for statistical tests commonly used in social and behavioral research.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e All participants had sufficient cognitive function to complete the questionnaire and were asked if they had any comorbidities (heart disease, lung disease, stroke, or diabetes mellitus). Data on the diagnoses of musculoskeletal disorders (such as osteoarthritis, rheumatoid arthritis, and fractures) were collected. Pain sites (shoulder, elbow, wrist, finger, hip, knee, ankle, foot, upper back pain, middle back pain, and lower back pain) were recorded, but the severity of pain has not been assessed.\u003c/p\u003e\u003cp\u003eHeight (m) and weight (kg) were measured with the participants wearing light clothing and no shoes. Body mass index (BMI) was calculated by dividing weight by height squared (kg/m\u003csup\u003e2\u003c/sup\u003e). Muscle mass was measured by bioelectrical impedance analysis (BIA) using InBody 430 (InBody Japan Inc., Tokyo, Japan). The BIA method requires participants to step onto a platform and remain in the standing position for approximately 30 seconds. Appendicular skeletal muscle mass index (AMI) was calculated as the sum of the muscle mass of the four limbs. Absolute appendicular muscle mass was converted to AMI, which was calculated by dividing the absolute appendicular muscle mass by the square of height in meters squared (kg/m\u003csup\u003e2\u003c/sup\u003e).\u003c/p\u003e\u003cp\u003eThe grip strength of the dominant hand was measured using a Jamar hydraulic hand dynamometer (Jafayette Instrument Company, Inc., Jafayette, IN, USA). The best performance from two attempts was accepted. Walking speed was calculated as the time required for participants to complete a distance of 10-m at their usual pace (usual walking speed; average of two trials). Participants were classified as having sarcopenia based on their muscle mass, muscle strength, and physical performance. The classification was based on the recommendations of the Asian Working Group for Sarcopenia (AWGS).\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e These recommendations define sarcopenia as age \u0026gt; 60 years, low handgrip strength (\u0026lt; 28 kg and 18 kg in men and women, respectively) and/or slow walking speed (\u0026lt; 1.0 m/s), and low AMI (\u0026lt; 7.0 kg/m\u003csup\u003e2\u003c/sup\u003e and 5.7 kg/m\u003csup\u003e2\u003c/sup\u003e in men and women, respectively). “Sarcopenia” was defined as the presence of low muscle mass, low muscle strength or poor physical performance, while “severe sarcopenia” was defined the presence of all three conditions. “Non-sarcopenia” was defined as absence of low muscle strength, low muscle mass, and poor physical performance.\u003c/p\u003e\u003cp\u003eWe used the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) to measure participants’ high-functional capacity.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e We used the TMIG-IC because it was developed for older Japanese individuals and has been widely used in the Japan community.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e The TMIG-IC is a 13-item multidimensional scale consisting of three subscales: IADL (five items), Intellectual activity (four items), and Social roles (four items) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The answer for each item was either ‘‘yes’’ (able to do, 1 point) or ‘‘no’’ (unable to do, 0 points); the maximum score was 13 points. The IADL subscale scores range from 0 to 5 points, the intellectual activity subscale scores range from 0 to 4 points, and social role subscale scores range from 0 to 4 points; higher scores reflected higher skill levels. A score of one or more below the total scores on these subscales indicated the presence of disability in the given domain. A score of 4/5 or less on the IADL or 3/4 or less on intellectual activity or social roles was considered to indicate disability in this subscale.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eWe used the Shapiro–Wilk test for normality. Comparisons of variables among the severe sarcopenia, sarcopenia, and non-sarcopenia groups were performed using one-way way ANOVA for continuous variables or Fisher’s exact test for categorical variables. The association between sarcopenia and disability was assessed using logistic regression analysis adjusted for age, sex, BMI and comorbidities. The Hosmer–Lemeshow test was used to assess the difference between the observed and predicted prevalence in the logistic regression analysis. Odds ratios (OR) and 95% confidence intervals (CIs) were calculated. Statistical significance was set at P \u0026lt; 0.05. All statistical analyses were performed using IBM SPSS Statistics, version 27 (IBM Corp., Armonk, NY, USA).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eParticipants (n\u0026thinsp;=\u0026thinsp;5) with missing values for any variable and pacemaker implantation (n\u0026thinsp;=\u0026thinsp;1) were excluded from the analysis, leaving behind 103 participants for the final data analysis. The prevalence rates of musculoskeletal diseases among the participants was as follows: osteoarthritis (n\u0026thinsp;=\u0026thinsp;47, 46.1%), rheumatoid arthritis (n\u0026thinsp;=\u0026thinsp;4, 3.9%), fracture (n\u0026thinsp;=\u0026thinsp;44, 43.1%), and other (n\u0026thinsp;=\u0026thinsp;7, 6.9%). All participants experienced at least musculoskeletal pain in at least one site (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The common sites of pain were shoulder (n\u0026thinsp;=\u0026thinsp;71, 68.9%), elbow (n\u0026thinsp;=\u0026thinsp;13, 12.6%), wrist (n\u0026thinsp;=\u0026thinsp;12, 11.7%), finger (n\u0026thinsp;=\u0026thinsp;11, 10.7%), hip (n\u0026thinsp;=\u0026thinsp;17, 16.5%), knee (n\u0026thinsp;=\u0026thinsp;52, 50.5%), ankle (n\u0026thinsp;=\u0026thinsp;16, 15.5%), foot (n\u0026thinsp;=\u0026thinsp;11, 10.7%), upper back pain (n\u0026thinsp;=\u0026thinsp;26, 25.2%), mid back pain (n\u0026thinsp;=\u0026thinsp;13, 12.6%), and low back pain (n\u0026thinsp;=\u0026thinsp;67, 65.0%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSites of pain (N\u0026thinsp;=\u0026thinsp;103)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain site\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShoulder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e71 (68.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElbow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13 (12.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWrist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12 (11.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFinger\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11 (10.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHip\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17 (16.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52 (50.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnkle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16(15.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFoot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11 (10.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUpper back\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26 (25.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMid back\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13 (12.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow back\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e67 (65.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the characteristics of participants. The mean ages and BMI were 76.8 years and 23.5 kg/m\u003csup\u003e2\u003c/sup\u003e, respectively. The percentages of IADL disability, intellectual activity, and social roles were 11.7%, 33.0%, and 41.7%, respectively. The prevalence rates of sarcopenia and severe sarcopenia were 14.7% (n\u0026thinsp;=\u0026thinsp;15) and 11.8% (n\u0026thinsp;=\u0026thinsp;12), respectively (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The participants with severe sarcopenia had significantly lower BMI (P\u0026thinsp;=\u0026thinsp;0.001), AMI (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), grip strength (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and walking speed (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) than those with non-sarcopenia. Advanced age (P\u0026thinsp;=\u0026thinsp;0.036) was associated with severe sarcopenia. The proportions of disabilities in social roles were significantly higher in the severe sarcopenia group than that in the non-sarcopenia group (P\u0026thinsp;=\u0026thinsp;0.043).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of the participants (N\u0026thinsp;=\u0026thinsp;103)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody mass index, kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAppendicular muscle mass index, kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrip strength, kg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUsual walking speed, m/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex, women\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidity\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e, yes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInstrumental ADL\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e disability\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e, yes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntellectual activity disability\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e, yes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial role disability\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e, yes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Presence of heart disease, lung disease, stroke, or diabetes mellitus.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e ADL: Activities of daily living\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e A score of 4 or less out of 5 for Instrumental ADL\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e was considered to indicate the presence of a disability.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e A score of 3 or less out of 4 for intellectual activity was considered to indicate the presence of a disability.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e A score of 3 or less out of 4 for social role was considered to indicate the presence of a disability.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of variables among severe sarcopenia, sarcopenia, and non-sarcopenia group (N\u0026thinsp;=\u0026thinsp;103)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNon-sarcopenia\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;76)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eSarcopenia\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eSevere sarcopenia\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;12)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSD\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSD\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSD\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e81.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody mass index, kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAppendicular muscle mass index, kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrip strength, kg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUsual walking speed, m/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidity\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e, yes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e93.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e66.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.198\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInstrumental ADL\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e disability\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e, yes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e25.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.282\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntellectual activity disability\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e, yes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e50.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.120\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial role disability\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e, yes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e75.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.043\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Presence of heart disease, lung disease, stroke, or diabetes mellitus.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e ADL: Activities of daily living\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e A score of 4 or less out of 5 for Instrumental ADL\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e was considered to indicate the presence of a disability.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e A score of 3 or less out of 4 for intellectual activity was considered to indicate the presence of a disability.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e A score of 3 or less out of 4 for social role was considered to indicate the presence of a disability.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e SD: Standard deviation, one-way ANOVA, Fisher\u0026rsquo;s exact test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAfter adjustments for age, sex, BMI and comorbidity, severe sarcopenia group was found to be significantly associated with disability for social role (OR: 7.90, 95% CI: 1.43\u0026ndash;43.62) in orthopedic outpatients (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation between sarcopenia status and social role disability (N\u0026thinsp;=\u0026thinsp;103)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eUnit\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSarcopenia and severe sarcopenia versus non-sarcopenia\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSarcopenia versus non-sarcopenia\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSevere sarcopenia versus non-sarcopenia\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOdds(95% Confidence interval)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOdds(95% Confidence interval)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eOdds(95% Confidence interval)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSocial role disability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.81 (0.65\u0026ndash;5.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.92 (0.24\u0026ndash;3.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e7.90 (1.43\u0026ndash;43.62) *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.04 (0.97\u0026ndash;1.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.91 (0.57\u0026ndash;1.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.93 (1.10\u0026ndash;3.37) *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.95 (0.26\u0026ndash;3.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.09 (0.21\u0026ndash;5.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.77 (0.12\u0026ndash;5.11)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBody mass index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.8\u003csup\u003e\u0026dagger;\u003c/sup\u003e kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.68 (0.56\u0026ndash;0.84) *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.23 (0.09\u0026ndash;0.57) *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.18 (0.05\u0026ndash;0.68) *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eComorbidity\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.12 (0.85\u0026ndash;11.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e10.11 (1.05\u0026ndash;97.36) *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.60 (0.29\u0026ndash;8.92)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e: Presence of heart disease, lung disease, stroke, or diabetes mellitus.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e*: P value\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003e: 1 Standard deviation\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eLogistic regression analysis\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePrevalence of sarcopenia\u003c/p\u003e \u003cp\u003eAmong the older orthopedic outpatients, the prevalence rates of sarcopenia and severe sarcopenia were 14.7% and 11.8%, respectively. A Japanese national cohort study reported prevalence rates of 3.4% and 1.7% for sarcopenia and severe sarcopenia, respectively, in older adults.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e In this study, all the participants experienced musculoskeletal pain in at least one site. Pain was a significant predictor of the onset of sarcopenia over a 9-year period,\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e which may reflect avoidance of physical activity because of fear of pain.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Sarcopenia and severe sarcopenia are serious problems among facing orthopedic outpatients.\u003c/p\u003e \u003cp\u003eSarcopenia and social role\u003c/p\u003e \u003cp\u003eOur study showed that severe sarcopenia was associated with disability in social roles among older orthopedic outpatients. Previous reports have suggested that sarcopenia is significantly associated with IADL and social role disability.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e Thus, not only sarcopenia but also severe sarcopenia with low muscle mass, low muscle strength, and low physical performance may be associated with impairment of social roles in older adults. A longitudinal study showed that severe sarcopenia, involving low muscle mass and low physical performance, increased the risk of disability in older adults compared with that with low muscle mass alone.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e Conversely, maintaining good social relationships may contribute to the prevention of severe sarcopenia; further longitudinal research is needed to clarify the causality between severe sarcopenia and social role disability.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eSarcopenia and intellectual activity disability in IADL\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe prevalence of mild cognitive impairment is relatively high in patients with sarcopenia, and may be a risk factor for sarcopenia.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e Sarcopenia is significantly associated with IADL disability in older Japanese people.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e In an 8-year follow-up study of older Japanese people, disability in social roles was the most prevalent disability, followed by disabilities in intellectual activity and IADL.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e Similarly, our study showed that among men and women with sarcopenia or severe sarcopenia, the percentage of disability in social roles was the highest, followed by disabilities in intellectual activity and IADL. However, this study showed no significant differences between sarcopenia and disabilities in intellectual activity and IADL.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eLimitations\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, because this study had a cross-sectional design, we could not establish a causal relationship between sarcopenia and disability. Therefore, longitudinal studies are needed to determine causality. Second, outcomes were collected from older Japanese orthopedic outpatients. Therefore, these results cannot be extrapolated to other ethnic groups or community-dwelling populations. Third, it may be difficult to assess the severity of comorbidities in older patients. Therefore, severity was not assessed. Moreover, information on medications or pain severity was not collected. These limitations may have contributed to the underestimation of the associations reported herein. Finally, the possibility of selection bias in this single-hospital study cannot be ignored. Further multicenter studies are needed.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eSarcopenia is a serious problem in older orthopedic outpatients. Our study showed that severe sarcopenia was associated with disability in social roles among older orthopedic outpatients in Japan.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eIADL: instrumental activities of daily living\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBMI: Body mass index\u003c/p\u003e\n\u003cp\u003eBIA: Bioelectrical impedance analysis\u003c/p\u003e\n\u003cp\u003eAMI: Appendicular skeletal muscle mass index\u003c/p\u003e\n\u003cp\u003eAWGS: Asian Working Group for Sarcopenia\u003c/p\u003e\n\u003cp\u003eTMIG-IC: Tokyo Metropolitan Institute of Gerontology Index of Competence\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYT, HN, SM, KAr, YK, YA, MK, and KAo designed the study. YT collected and analyzed the data and drafted the manuscript. KAo supervised and assisted with data collection and analysis, and manuscript preparation. YT, HN, SM, KAr, YK, YA, MK, and KAo advised on the study design and data analysis and edited the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank all the participants. The authors wish to express their gratitude to the medical staff and colleagues at the Nishi-Isahaya Hospital for supporting this study through their kind cooperation. This research was supported by a Japan Society for the Promotion of Science Grant-in-Aid for Scientific Research (KAKENHI Grant Numbers JP19K16245 and 23K14277).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was supported by a Japan Society for the Promotion of Science Grant-in-Aid for Scientific Research (KAKENHI Grant Numbers JP19K16245 and 23K14277).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest Statement \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The participants were enrolled voluntarily in the study. Written consent forms were available in Japanese to ensure a comprehensive understanding, and each participant provided written informed consent. This study was approved by the Ethics Committee of Tokyo Professional University of Health Sciences (project registration number: TPU-23-029).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eRosenberg IH. Summary comments. \u003cem\u003eAm J Clin Nutr. \u003c/em\u003e1989;50:1231\u0026ndash;3.\u003c/li\u003e\n\u003cli\u003eCruz-Jentoft AJ, Baeyens JP, Bauer JM \u003cem\u003eet al.\u003c/em\u003e Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. \u003cem\u003eAge Ageing. \u003c/em\u003e2010;39:412\u0026ndash;23.\u003c/li\u003e\n\u003cli\u003eYeung SSY, Reijnierse EM, Pham VK \u003cem\u003eet al.\u003c/em\u003e Sarcopenia and its association with falls and fractures in older adults: A systematic review and meta-analysis. \u003cem\u003eJ Cachexia Sarcopenia Muscle. \u003c/em\u003e2019;10:485\u0026ndash;500.\u003c/li\u003e\n\u003cli\u003eScott D, Blizzard L, Fell J, Jones G. Prospective study of self-reported pain, radiographic osteoarthritis, sarcopenia progression, and falls risk in community-dwelling older adults. \u003cem\u003eArthritis Care Res (Hoboken) . \u003c/em\u003e2012;64:30\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eVlaeyen JWS, Linton SJ. 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Here, we showed an independent association between sarcopenia and disability among older orthopedic outpatients in Japan.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sample included 103 older outpatients aged ≥65 years with orthopedic diseases. Body mass index (BMI) was calculated as weight divided by height squared (kg/m\u003csup\u003e2\u003c/sup\u003e). Sarcopenia was defined as low grip strength and low muscle mass. The classification of sarcopenia was based on the recommendations of the Asian Working Group for Sarcopenia. Muscle mass was evaluated using bioelectrical impedance analysis using InBody 430. Higher-level functional capacity was determined using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC), a multidimensional 13-item scale that consists of three subscales: instrumental activities of daily living, intellectual activity, and social role. The association between sarcopenia and disability was assessed using logistic regression analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe prevalence rates of sarcopenia and severe sarcopenia were 14.7% and 11.8%, respectively. Older age was associated with severe sarcopenia. The percentage of individuals with disabilities in social roles was significantly higher in the severe sarcopenia group than that in the non-sarcopenia group. After adjusting for age, sex, BMI, and comorbidity, severe sarcopenia was significantly associated with disability in social roles among orthopedic outpatients. The sarcopenia group showed no significant social role disabilities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSarcopenia is a serious problem facing older orthopedic outpatients. Severe sarcopenia was found to be associated with disability in social roles among older orthopedic outpatients.\u003c/p\u003e","manuscriptTitle":"Effect of sarcopenia status on higher-level functional capacity in daily living among older orthopedic outpatients in Japan","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-18 18:22:24","doi":"10.21203/rs.3.rs-4585633/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7ff9fddf-06db-4e62-a4d7-6aaa7860562c","owner":[],"postedDate":"July 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-12-26T16:08:28+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-18 18:22:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4585633","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4585633","identity":"rs-4585633","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}