Einsatz und Nutzen funktioneller Parameter als Endpunkte in klinischen Ernährungsstudien

Zusammenfassung

Hintergrund Eine ausreichende Muskelkraft und -funktion stellt eine Grundvoraussetzung für die Teilhabe am alltäglichen Leben und der damit verbundenen Autonomie des Patienten dar. Der diagnostische und prognostische Einsatz funktioneller Parameter zur Einschätzung von Muskelkraft und -funktion gewinnt zunehmend an Bedeutung. Hinsichtlich des Nutzens dieser Parameter als Endpunkte in klinischen Ernährungsstudien besteht allerdings noch Klärungsbedarf.

Material und Methoden Es wurde eine umfangreiche Literaturrecherche zur Extraktion und Evaluierung etablierter funktioneller Parameter in der medizinischen Literaturdatenbank Pubmed ausgeführt. Die folgenden, häufig in Ernährungsstudien angewendeten, 8 Parameter wurden detailliert aufgearbeitet und miteinander verglichen: Handgreifkraft, knee extension peak torque, Six-Minute-Walk Test (6MWT), Timed-Up-and-Go (TUG), Short Physical Performance Battery (SPPB), Physical Performance Test (PPT), Akzelerometrie und Barthel-Index.

Ergebnisse und Schlussfolgerung Die Anwendung der funktionellen Parameter hat sich insbesondere in geriatrischen Ernährungsstudien bewährt. Hier zeigten sich neben der Handgreifkraft, dem SPPB und TUG auch das knee extension peak torque, der 6MWT sowie der Barthel-Index als geeignete funktionelle Endpunkte. Lediglich der PPT zeigte keine nennenswerten Vorteile gegenüber den in dieser Arbeit evaluierten funktionellen Parametern. Außerhalb der geriatrischen Population könnte die Akzelerometrie in der Onkologie als funktioneller Endpunkt in klinischen Ernährungsstudien herangezogen werden. Innerhalb der Intensivmedizin stellt die Nutzung funktioneller Parameter hinsichtlich der erforderlichen willkürlichen Muskelkraft derzeit noch eine Herausforderung dar.

Abstract

Background A sufficient muscle strength and function is a prerequisite for an independent participation in everyday life of the patient. The diagnostic and prognostic use of functional parameters to assess muscle strength and function becomes increasingly important. However, there is still a need for clarification regarding the usefulness of these parameters as endpoints in clinical nutrition studies.

Materials and methods An extensive literature search has been carried out in Pubmed on the extraction and evaluation of established functional parameters. The following eight parameters, commonly used in nutritional studies, have been worked out in detail and compared: handgrip strength, knee extension peak torque, Six-Minute-Walk Test (6MWT), Timed-Up-and-Go (TUG), Short Physical Performance Battery (SPPB), Physical Performance Test (PPT), accelerometry and Barthel-Index.

Results and conclusion The application of these functional parameters has been proven to be particularly useful in geriatric nutrition studies. In addition to handgrip strength, SPPB and TUG, also the knee extension peak, 6MWT and Barthel-Index were found suitable functional endpoints in geriatrics. Only the PPT showed no considerable advantages over the functional parameters evaluated in this overview. In oncology patients, accelerometry could serve as a functional outcome parameter in clinical trials. In terms of the required voluntary muscle tension, the use of functional parameters is currently still a challenge in critically ill patients.

Schlüsselwörter

funktionelle Endpunkte - körperliche Aktivität - Muskelkraft - Ernährungsintervention - Mobilität

Keywords

functional outcome - physical activity - muscle strength - nutritional intervention - mobility

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