{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T01:00:39Z","timestamp":1790643639387,"version":"4.1.0"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2015,10,1]],"date-time":"2015-10-01T00:00:00Z","timestamp":1443657600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Applied Health Research and Care in Leicestershire, Northamptonshire, and Rutland"},{"DOI":"10.13039\/501100000272","name":"NIHR","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100030827","name":"NHS","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100030827","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100015218","name":"Department of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100015218","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Hospitalization represents a major event for the patient with chronic respiratory disease. There is a high risk of readmission, which over the longer term may be related more closely to the underlying condition of the patient, such as skeletal muscle dysfunction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>We assessed the risk of hospital readmission at 1 year, including measures of lower limb muscle as part of a larger clinical trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients hospitalized with an exacerbation of chronic respiratory disease underwent measures of muscle function including quadriceps ultrasound. Independent factors influencing time to hospital readmission or death were identified. Patients were classified into four quartiles based on quadriceps size and compared.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>One hundred and ninety-one patients (mean age, 71.6 [SD, 9.1] yr) were recruited. One hundred and thirty (68%) were either readmitted or died. Factors associated with readmission or death were age (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.01\u20131.08; P\u2009=\u20090.015), Medical Research Council (MRC) dyspnea grade (OR, 4.57; 95% CI, 2.62\u20137.95; P\u2009&amp;lt;\u20090.001), home oxygen use (OR, 12.4; 95% CI, 4.53\u201333.77; P\u2009&amp;lt;\u20090.001), quadriceps (rectus femoris) cross-sectional area (Qcsa) (OR, 0.34; 95% CI, 0.17\u20130.65; P\u2009=\u20090.001), and hospitalization in the previous year (OR, 4.82; 95% CI, 2.42\u20139.58; P\u2009&amp;lt;\u20090.001). In the multivariate analyses, home oxygen use (OR, 4.80; 95% CI, 1.68\u201313.69; P\u2009=\u20090.003), MRC dyspnea grade (OR, 2.57; 95% CI, 1.44\u20134.59; P\u2009=\u20090.001), Qcsa (OR, 0.46; 95% CI, 0.22\u20130.95; P\u2009=\u20090.035), and previous hospitalization (OR, 3.04; 95% CI, 1.47\u20136.29; P\u2009=\u20090.003) were independently associated with readmission or death. Patients with the smallest muscle spent more days in hospital than those with largest muscle (28.1 [SD, 33.9] vs. 12.2 [SD, 23.5] d; P\u2009=\u20090.007).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Smaller quadriceps muscle size, as measured by ultrasound in the acute care setting, is an independent risk factor for unscheduled readmission or death, which may have value both in clinical practice and for risk stratification.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.201503-0535oc","type":"journal-article","created":{"date-parts":[[2015,6,11]],"date-time":"2015-06-11T13:11:15Z","timestamp":1434028275000},"page":"810-816","source":"Crossref","is-referenced-by-count":94,"title":["Bedside Assessment of Quadriceps Muscle by Ultrasound after Admission for Acute Exacerbations of Chronic Respiratory Disease"],"prefix":"10.1093","volume":"192","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0453-7529","authenticated-orcid":false,"given":"Neil J.","family":"Greening","sequence":"first","affiliation":[{"name":"Centre for Exercise and Rehabilitation Science, Institute of Lung Health, Leicester Respiratory Biomedical Research Unit, Department of Respiratory Medicine, Glenfield Hospital, Leicester, United Kingdom"},{"name":"Department of Infection, Inflammation and Immunity, University of Leicester, Leicester, United Kingdom; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theresa C.","family":"Harvey-Dunstan","sequence":"additional","affiliation":[{"name":"Centre for Exercise and Rehabilitation Science, Institute of Lung Health, Leicester Respiratory Biomedical Research Unit, Department of Respiratory Medicine, Glenfield Hospital, Leicester, United Kingdom"},{"name":"Department of Infection, Inflammation and Immunity, University of Leicester, Leicester, United Kingdom; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma J.","family":"Chaplin","sequence":"additional","affiliation":[{"name":"Centre for Exercise and Rehabilitation Science, Institute of Lung Health, Leicester Respiratory Biomedical Research Unit, Department of Respiratory Medicine, Glenfield Hospital, Leicester, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma E.","family":"Vincent","sequence":"additional","affiliation":[{"name":"Centre for Exercise and Rehabilitation Science, Institute of Lung Health, Leicester Respiratory Biomedical Research Unit, Department of Respiratory Medicine, Glenfield Hospital, Leicester, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mike D.","family":"Morgan","sequence":"additional","affiliation":[{"name":"Centre for Exercise and Rehabilitation Science, Institute of Lung Health, Leicester Respiratory Biomedical Research Unit, Department of Respiratory Medicine, Glenfield Hospital, Leicester, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sally J.","family":"Singh","sequence":"additional","affiliation":[{"name":"Centre for Exercise and Rehabilitation Science, Institute of Lung Health, Leicester Respiratory Biomedical Research Unit, Department of Respiratory Medicine, Glenfield Hospital, Leicester, United Kingdom"},{"name":"Department of Infection, Inflammation and Immunity, University of Leicester, Leicester, United Kingdom; and"},{"name":"School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael C.","family":"Steiner","sequence":"additional","affiliation":[{"name":"Centre for Exercise and Rehabilitation Science, Institute of Lung Health, Leicester Respiratory Biomedical Research Unit, Department of Respiratory Medicine, Glenfield Hospital, Leicester, United Kingdom"},{"name":"School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2015,10,1]]},"reference":[{"key":"2026032100143791600_bib1","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1136\/thorax.57.10.847","article-title":"Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease","volume":"57","author":"Donaldson","year":"2002","journal-title":"Thorax"},{"key":"2026032100143791600_bib2","doi-asserted-by":"crossref","first-page":"1418","DOI":"10.1164\/ajrccm.157.5.9709032","article-title":"Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease","volume":"157","author":"Seemungal","year":"1998","journal-title":"Am J Respir Crit Care Med"},{"key":"2026032100143791600_bib3","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1136\/thoraxjnl-2012-202103","article-title":"The DECAF score: predicting hospital mortality in exacerbations of chronic obstructive pulmonary disease","volume":"67","author":"Steer","year":"2012","journal-title":"Thorax"},{"key":"2026032100143791600_bib4","doi-asserted-by":"crossref","first-page":"1128","DOI":"10.1056\/NEJMoa0909883","article-title":"Susceptibility to exacerbation in chronic obstructive pulmonary disease","volume":"363","author":"Hurst","year":"2010","journal-title":"N Engl J Med"},{"key":"2026032100143791600_bib5","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1136\/thx.2006.062026","article-title":"Quadriceps strength predicts mortality in patients with moderate to severe chronic obstructive pulmonary disease","volume":"62","author":"Swallow","year":"2007","journal-title":"Thorax"},{"key":"2026032100143791600_bib6","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1183\/09031936.97.10020417","article-title":"Muscle weakness is related to utilization of health care resources in COPD patients","volume":"10","author":"Decramer","year":"1997","journal-title":"Eur Respir J"},{"key":"2026032100143791600_bib7","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1136\/thx.2008.103986","article-title":"Ultrasound measurement of rectus femoris cross-sectional area and the relationship with quadriceps strength in COPD","volume":"64","author":"Seymour","year":"2009","journal-title":"Thorax"},{"key":"2026032100143791600_bib8","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.1001\/jama.2013.278481","article-title":"Acute skeletal muscle wasting in critical illness","volume":"310","author":"Puthucheary","year":"2013","journal-title":"JAMA"},{"key":"2026032100143791600_bib9","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1186\/1465-9921-13-119","article-title":"Ultrasound assessment of lower limb muscle mass in response to resistance training in COPD","volume":"13","author":"Menon","year":"2012","journal-title":"Respir Res"},{"key":"2026032100143791600_bib10","doi-asserted-by":"crossref","first-page":"g4315","DOI":"10.1136\/bmj.g4315","article-title":"An early rehabilitation intervention to enhance recovery during hospital admission for an exacerbation of chronic respiratory disease: randomised controlled trial","volume":"349","author":"Greening","year":"2014","journal-title":"BMJ"},{"key":"2026032100143791600_bib11","first-page":"51","article-title":"Methods of measuring muscle strength and fatigue","volume":"63","author":"Edwards","year":"1977","journal-title":"Physiotherapy"},{"key":"2026032100143791600_bib12","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/S0954-6111(06)80166-6","article-title":"The St George\u2019s Respiratory Questionnaire","volume":"85","author":"Jones","year":"1991","journal-title":"Respir Med"},{"key":"2026032100143791600_bib13","first-page":"165","article-title":"British Thoracic Society; Association of Respiratory Technicians and Physiologists. Guidelines for the measurement of respiratory function: recommendations of the British Thoracic Society and the Association of Respiratory Technicians and Physiologists","volume":"88","year":"1994","journal-title":"Respir Med"},{"key":"2026032100143791600_bib14","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1136\/thx.47.12.1019","article-title":"Development of a shuttle walking test of disability in patients with chronic airways obstruction","volume":"47","author":"Singh","year":"1992","journal-title":"Thorax"},{"key":"2026032100143791600_bib15","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1136\/thx.54.3.213","article-title":"The endurance shuttle walk: a new field test for the assessment of endurance capacity in chronic obstructive pulmonary disease","volume":"54","author":"Revill","year":"1999","journal-title":"Thorax"},{"key":"2026032100143791600_bib16","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1053\/j.ajkd.2014.10.019","article-title":"Progressive resistance exercise training in CKD: a feasibility study","volume":"66","author":"Watson","year":"2015","journal-title":"Am J Kidney Dis"},{"key":"2026032100143791600_bib17","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1183\/09031936.00170111","article-title":"Quadriceps wasting and physical inactivity in patients with COPD","volume":"40","author":"Shrikrishna","year":"2012","journal-title":"Eur Respir J"},{"key":"2026032100143791600_bib18","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1183\/09031936.00104909","article-title":"The prevalence of quadriceps weakness in COPD and the relationship with disease severity","volume":"36","author":"Seymour","year":"2010","journal-title":"Eur Respir J"},{"key":"2026032100143791600_bib19","doi-asserted-by":"crossref","first-page":"1298","DOI":"10.1183\/09031936.00088113","article-title":"The 4-metre gait speed in COPD: responsiveness and minimal clinically important difference","volume":"43","author":"Kon","year":"2014","journal-title":"Eur Respir J"},{"key":"2026032100143791600_bib20","doi-asserted-by":"crossref","first-page":"1772","DOI":"10.1001\/jama.297.16.1772-b","article-title":"Effect of 10 days of bed rest on skeletal muscle in healthy older adults","volume":"297","author":"Kortebein","year":"2007","journal-title":"JAMA"},{"key":"2026032100143791600_bib21","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1136\/thorax.58.9.752","article-title":"Muscle force during an acute exacerbation in hospitalised patients with COPD and its relationship with CXCL8 and IGF-I","volume":"58","author":"Spruit","year":"2003","journal-title":"Thorax"},{"key":"2026032100143791600_bib22","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1016\/S0140-6736(99)07042-7","article-title":"Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation: a randomised controlled trial","volume":"355","author":"Griffiths","year":"2000","journal-title":"Lancet"},{"key":"2026032100143791600_bib23","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1136\/thx.2006.060145","article-title":"Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study","volume":"61","author":"Garcia-Aymerich","year":"2006","journal-title":"Thorax"},{"key":"2026032100143791600_bib24","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1378\/chest.129.3.536","article-title":"Physical activity and hospitalization for exacerbation of COPD","volume":"129","author":"Pitta","year":"2006","journal-title":"Chest"},{"key":"2026032100143791600_bib25","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1136\/thoraxjnl-2013-204227","article-title":"Pulmonary rehabilitation following hospitalisation for acute exacerbation of COPD: referrals, uptake and adherence","volume":"69","author":"Jones","year":"2014","journal-title":"Thorax"},{"key":"2026032100143791600_bib26","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1177\/1479972314562208","article-title":"Implementation of physical activity programs after COPD hospitalizations: lessons from a randomized study","volume":"12","author":"Benzo","year":"2015","journal-title":"Chron Respir Dis"},{"key":"2026032100143791600_bib27","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1177\/1479972314565360","article-title":"Non-adherence to peri-exacerbation pulmonary rehabilitation: the people have spoken","volume":"12","author":"Greening","year":"2015","journal-title":"Chron Respir Dis"},{"key":"2026032100143791600_bib28","doi-asserted-by":"crossref","first-page":"1428","DOI":"10.1183\/09031936.00150314","article-title":"An official European Respiratory Society\/American Thoracic Society technical standard: field walking tests in chronic respiratory disease","volume":"44","author":"Holland","year":"2014","journal-title":"Eur Respir J"},{"key":"2026032100143791600_bib29","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1111\/j.1440-1843.2011.02089.x","article-title":"Comparing peak and submaximal cardiorespiratory responses during field walking tests with incremental cycle ergometry in COPD","volume":"17","author":"Hill","year":"2012","journal-title":"Respirology"}],"container-title":["American Journal of Respiratory and Critical Care Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ajrccm\/article-pdf\/192\/7\/810\/67284227\/ajrccm_192_7_810.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajrccm\/article-pdf\/192\/7\/810\/67284227\/ajrccm_192_7_810.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T04:14:47Z","timestamp":1774066487000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajrccm\/article\/192\/7\/810\/8504743"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,10,1]]},"references-count":29,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2015,10,1]]},"published-print":{"date-parts":[[2015,10,1]]}},"URL":"https:\/\/doi.org\/10.1164\/rccm.201503-0535oc","relation":{},"ISSN":["1073-449X","1535-4970"],"issn-type":[{"value":"1073-449X","type":"print"},{"value":"1535-4970","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2015,10]]},"published":{"date-parts":[[2015,10,1]]}}}