Dan Thomas is an ST6 working in Liverpool. He is the BGS Clinical Quality Group Trainee Rep and the Deputy Media Editor. He tweets @dan26wales
‘10 days in a hospital bed leads to 10 years’ worth of lost muscle mass in people over age 80’
I have lost count of the number of times I have quoted this fact, I use it when teaching on frailty, and I have used it when assessing people in the emergency department to explain the risks of hospital induced deconditioning. I regularly hear other Geriatricians use this fact. It is emblazoned across much of the #EndPJParalysis material, and is quoted (unreferenced) on the NHS improvement website.
There are alternative versions, sometimes the age cut off used is 75, and sometimes the harm quoted is that bed rest leads to the equivalent of ten years of life. Often the fact is used unreferenced, but when a reference is cited then it is nearly always one of the following two studies, Kortebein et al or Gill et al. Yet neither of these papers provided a robust evidence base to support the assertion – ‘10 days in a hospital bed leads to 10 years’ worth of lost muscle mass in people over age 80’.
Kortebein’s ‘Functional impact of 10 days of bed rest in healthy older adults’ has only eleven participants, of which there is no one over the age of 80! In addition all the participants are healthy and robust, unlike our usual patient cohort.
Gill’s ‘The deleterious effects of bed rest among community living older persons’, is a study carried out in community dwelling older adults (not a hospitalised group of people). It is a cohort study, so it is incorrect to extrapolate the result to conclude 10 days bed rest ‘leads’ to 10 years of lost muscle mass in hospitalised people, as it cannot prove causation, only association. Also, somewhat surprisingly in Gill’s study, people who were frail actually did better than robust people after a period of bedrest.
Acute sarcopenia or hospital induced deconditioning is an extremely important and potentially preventable condition. The #EndPJParalysis movement should be commended for raising our awareness of this problem and in galvanising the support of doctors, nurses, allied health professionals and managers internationally. However extraordinary claims require extraordinary evidence, and this serves as a reminder for us to read and appraise original research. I am not alone in having quoted an inaccurate ‘fact’ and estimates suggest that approximately 20-25% of facts cited from research articles are inaccurately quoted in the medical literature.*
*but how many of us will read the cited article to find out if this is true?!