Establishing minimal clinically important differences and cut-off values for the lower limb motricity index and trunk control test in older patients with acute stroke: a prospective cohort study.

OBJECTIVE: To establish the Minimal Clinically Important Differences (MCIDs) for lower limb strength measured by the Motricity Index (LLMI) and trunk function assessed by the Trunk Control Test (TCT) in the acute phase of stroke in older patients. Further, the study sought to determine the cutoff values predicting functional prognosis at discharge for both the LLMI and TCT. METHODS: This prospective cohort study was conducted for older patients (≥65 years) admitted for acute stroke, receiving guideline-based stroke care that includes early rehabilitation. The LLMI and TCT were measured within 7 days of admission and at discharge. The MCID was derived from receiving operating characteristic curves, based on a ≥ 1 point shift in the modified Rankin Scale (mRS) from admission to discharge. A good functional prognosis at discharge was defined as an mRS score of ≤ 3. RESULTS: A total of 201 older patients with acute stroke were included. The TCT achieved an MCID of 13 (area under the curve [AUC] = 0.704, 95% confidence interval [CI]: 0.633-0.775), whereas the LLMI lacked the precision to produce a significant MCID. The optimal cutoff points for predicting a good outcome were found to be an LLMI score of 65 (AUC = 0.770, 95% CI: 0.705-0.835) and a TCT score of 25 (AUC = 0.827, 95% CI: 0.768-0.887) upon admission. CONCLUSIONS: This study identified a valid MCID for the TCT, failed to do so for the LLMI, and established cutoff values for both the LLMI and TCT that can predict good outcomes in older patients with acute stroke.

The added value of frailty assessment as the premorbid stroke status on activities of daily living in patients with acute stroke, stratified by stroke severity.

BACKGROUND: The modified Rankin scale (mRS) is extensively used for premorbid evaluation in patients with stroke; however, its limited capacity to assess functional status highlights the need for additional indicators such as frailty. AIMS: This study aimed to assess the impact of the premorbid mRS score and frailty on daily living (ADL) activities at hospital discharge, focusing on varying stroke severities. METHODS: This single-centre, prospective cohort study included patients with acute stroke aged ≥60 years. Key metrics included the frailty index for frailty assessment or mRS for functional status premorbid and the functional independence measure of the motor domain (FIM-M) at discharge for ADL outcomes. The patients were categorized into mild (0-4), moderate (5-15), and severe (16-42) groups based on the National Institute of Health Stroke Scale. Multiple hierarchical linear regression analyses were performed for each group to evaluate the influence of mRS and frailty on FIM-M scores. RESULTS: In the mild stroke group, significant associations were observed with premorbid mRS3 (ß = -0.183, p = 0.004), mRS4 (ß = -0.234, p < 0.001), and frailty status (ß = -0.227, p = 0.005) and FIM-M scores. Premorbid frailty did not show a significant association with the FIM-M scores in the moderate or severe stroke group. Frailty status notably contributed to changes in R², particularly in the mild stroke group (R² change = 0.031, p = 0.002). However, such changes were not evident in the other stroke severity groups. CONCLUSION: This study emphasizes the importance of incorporating frailty assessments into premorbid evaluations, particularly when considering ADL outcomes in patients with mild stroke. Conversely, the significance of frailty in moderate-to-severe stroke was less evident.

Association of Baseline Skeletal Muscle Mass Index With Adverse Events and Rehabilitation Outcomes in Patients Admitted for Rehabilitation.

Objective: To assess the associations of baseline skeletal muscle mass index (SMI) with adverse events and rehabilitation outcomes in patients admitted for rehabilitation. Design: A retrospective cohort study. Participants: The subjects were 409 patients (mean age, 79 years; men, 167 [41%]) undergoing rehabilitation because of neurologic disease, musculoskeletal disorders, or hospital-associated deconditioning. Patients were divided into 2 groups according to the definition of sarcopenia by the Asian Working Group for Sarcopenia: those with low SMI (<7.0 kg/m2 in men and <5.7 kg/m2 in women) and those with high SMI (≥7.0 kg/m2 in men and ≥5.7 kg/m2 in women). Interventions: Not applicable. Main Outcome Measures: The primary outcomes were adverse events including death and acute illness requiring transfer to other hospitals for specialized treatments. The secondary outcomes were rehabilitation outcomes including the efficiency scores (changes in functional independence measure [FIM] score divided by length of stay) of FIM for motor function (FIM-M) and FIM for cognitive function (FIM-C). Results: Of the 409 patients, 299 (73%) had a low SMI. The adjusted hazard ratio (95% confidence interval) of the low SMI group relative to the high SMI group for adverse events was 2.79 (1.06-7.34). There were no significant differences between the 2 groups in FIM-M efficiency scores [mean ± SD, low SMI group: 0.4 (0.58) vs high SMI group: 0.47 (0.54), P=.3] and FIM-C efficiency scores [mean ± SD, 0.05 (0.14) vs 0.06 (0.2), P=.4]. Multiple linear regression models did not show significant associations between the low SMI group and FIM-M efficiency or FIM-C efficiency scores (ß=0.064, P=.3; ß=-0.05, P=.4, respectively). Conclusion: Low baseline SMI was significantly associated with adverse events but not with rehabilitation outcomes in patients undergoing rehabilitation.

Impact of possible sarcopenia on functional prognosis in patients with acute stroke with premorbid disability.

AIM: How possible sarcopenia affects functional prognosis in patients with premorbid disability remains unclear. This study aimed to compare and investigate the impact of possible sarcopenia at admission on functional outcomes at discharge in patients with acute stroke with and without premorbid disability. METHODS: This cohort study enrolled patients who were consecutively admitted to a single center for acute stroke. Calf circumference and grip strength were measured within 7 days of admission, and possible sarcopenia was determined using the Asian Working Group for Sarcopenia 2019 criteria. The Functional Independence Measure (FIM) score at discharge during the acute phase was the primary outcome. To examine the impact of possible sarcopenia on FIM scores at discharge, patients were divided into two groups according to being with or without premorbid disability according to the modified Rankin Scale, and multiple linear regression analysis was performed in each group. RESULTS: This study included 456 patients with acute stroke (median age, 80 years). In the premorbid-disability group (n = 166), possible sarcopenia was present in 140 patients (84%). Patients without possible sarcopenia had significantly higher FIM scores at discharge compared with those with possible sarcopenia (P < 0.001). However, multiple linear regression analysis showed that possible sarcopenia was not associated with FIM scores at discharge in the premorbid-disability group (ß = -0.054, P = 0.346). CONCLUSIONS: The results of this study demonstrated that a high rate of possible sarcopenia was observed in patients with stroke with premorbid disability; however, this did not affect functional prognosis. Geriatr Gerontol Int 2024; 24: 359-363.

Muscle weakness is more strongly associated with functional outcomes in patients with stroke than sarcopenia or muscle wasting: an observational study.

BACKGROUND: Stroke-related sarcopenia is an important prognosis factor and an intervention target for improving outcomes in patients with stroke. AIM: This study aimed to identify the association between sarcopenia, possible sarcopenia, muscle weakness, muscle mass and calf circumference, and the functional outcomes 3 months after stroke. METHODS: In this single-centre prospective observational study, muscle strength, muscle mass, and calf circumference were measured in patients with acute stroke at hospital discharge. Diagnosis of sarcopenia, possible sarcopenia, muscle weakness, low muscle mass, and low calf circumference were defined according to the 2019 Asian Working Group for Sarcopenia criteria. The primary outcome measure was the modified Rankin Scale (mRS) score at 3 months, with an mRS score of 3 or higher indicating a poor outcome. Logistic regression analysis was conducted to examine independent associations between each assessment and functional outcomes. RESULTS: A total of 247 patients (median age: 73 years) were included in this study. The prevalence of sarcopenia was 28% (n = 70), and in the adjusted model, sarcopenia (aOR = 2.60, 95% CI 1.07-6.31, p = 0.034), muscle weakness (aOR = 3.40, 95% CI 1.36-8.52, p = 0.009), and low muscle mass (aOR = 2.61, 95% CI 1.04-6.52) were significantly associated with poor functional outcome. Nevertheless, other evaluations did not demonstrate an independent association with the outcome. CONCLUSION: Sarcopenia, muscle weakness, and low muscle mass were found to be independently associated with functional outcomes 3 months after stroke, and muscle weakness exhibited the strongest association with outcomes among them.

Anemia and Rehabilitation Outcomes in Patients Undergoing Convalescent Rehabilitation.

OBJECTIVE: Assessment of the association between anemia and recovery of physical disability in patients with functional impairment. DESIGN: A retrospective cohort study. SETTING: A convalescent rehabilitation ward. PARTICIPANTS: The subjects were patients undergoing convalescent rehabilitation due to neurologic disease, musculoskeletal disorders, or hospital-associated deconditioning. Patients were classified into 3 groups (no anemia; mild anemia [men: hemoglobin of 11.0-12.9 g/dL; women: hemoglobin of 11.0-11.9 g/dL]; and moderate/severe anemia [hemoglobin < 11.0 g/dL]) based on hemoglobin levels. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The study outcomes were functional independence measures for motor function (FIM-M) score at discharge, changes in the FIM-M score between hospital admission and discharge, length of stay, and FIM-M efficiency score (change in FIM-M score divided by length of stay). A linear regression model was constructed to explore the association of anemia with the FIM-M efficiency score. As a subgroup analysis, we constructed a linear regression model to explore the association of anemia with the FIM-M efficiency score in patients with or without stroke. RESULTS: Of 376 consecutive patients with a mean age of 80 years, 258 (69%) had mild or moderate/severe anemia. There were no significant differences between the 3 groups in the FIM-M score at discharge, changes in the FIM-M score, length of stay, and FIM-M efficiency score. A multiple linear regression model showed that the FIM-M efficiency score was not associated with anemia (mild anemia group: ß=-0.02, P=.8; moderate/severe anemia group: ß=-0.005, P=.9). In the subgroup analysis of patients with or without stroke, the multiple regression model also showed no significant association between anemia and FIM-M efficiency score in each group. CONCLUSIONS: Anemia on admission was common among patients in a convalescent rehabilitation ward but was not associated with improvement of FIM-M after rehabilitation.

Anorexia assessment using the Simplified Nutritional Appetite Questionnaire and its association with activities of daily living in patients with stroke.

OBJECTIVE: This study aimed to validate the assessment of anorexia in patients with acute stroke using the Simplified Nutritional Appetite Questionnaire. METHODS: This cross-sectional observational study assessed appetite using the Simplified Nutritional Appetite Questionnaire in patients with acute stroke at discharge from an acute care hospital. Additionally, the relationship between the Simplified Nutritional Appetite Questionnaire and Mini Nutritional Assessment, Mini Nutritional Assessment - Short Form scores, skeletal muscle mass, muscle strength, and activities of daily living measured using the Functional Independence Measures for the motor domain was investigated. A multiple regression analysis was conducted with the Functional Independence Measure for the motor domain as the dependent variable and the Simplified Nutritional Appetite Questionnaire and other confounding factors as explanatory variables to evaluate the association between the Simplified Nutritional Appetite Questionnaire and functional outcomes. RESULTS: Among the 234 patients with stroke analyzed in this study, the median Simplified Nutritional Appetite Questionnaire score was 15 (IQR = 13-16) points. The Simplified Nutritional Appetite Questionnaire score significantly correlated with weight change, Functional Independence Measure for the motor domain, nutritional assessment index, and energy and protein intake. However, no significant differences in body mass index, muscle mass, or muscle strength were observed. In the multiple regression analysis adjusted for confounders, the Simplified Nutritional Appetite Questionnaire score (ß = 0.106; P = 0.007) was independently associated with the Functional Independence Measure for the motor domain (adjusted R2 = 0.662). CONCLUSIONS: This study's results found a significant correlation between Simplified Nutritional Appetite Questionnaire scores and nutritional status as well as an independent association with functional outcomes in patients with stroke. These findings suggest that the Simplified Nutritional Appetite Questionnaire can be a valuable tool for evaluating anorexia in this patient population.

Sarcopenia in patients following stroke: Prevalence and associated factors.

BACKGROUND: This study aimed to investigate the prevalence and associated factors of sarcopenia in patients following stroke during acute hospitalisation. METHODS: This single-centre prospective observational cohort study assessed skeletal muscle mass using bioelectrical impedance analysis and muscle strength of patients with acute stroke at hospital discharge. Sarcopenia was diagnosed according to the AWGS-2019 criteria. Multiple logistic regression analyses were performed to identify associated factors of post stroke sarcopenia. RESULTS: A total of 286 participants (32% female; median age, 72 years) were included in this study. The prevalence of post-stroke sarcopenia was 32.5% (n = 93). In multiple logistic regression analysis, age (adjusted odds ratio [aOR]: 1.10; 95% confidence interval [CI]: 1.05-1.05), National Institute of Health Stroke Scale (aOR: 1.15; 95% CI: 1.04-1.27), body mass index (BMI) (aOR: 0.73; 95% CI: 0.64-0.84) and Functional Oral Intake Scale (aOR: 0.67; 95% CI: 0.51-0.89) were independently associated with post-stroke sarcopenia during acute hospitalisation. CONCLUSION: Approximately one-third of acute stroke patients were diagnosed with sarcopenia at hospital discharge, and older age, severe stroke, low BMI, and poor swallowing function are associated with sarcopenia following stroke during acute hospitalisation.

Association Between Skeletal Muscle Mass Index and Falls in Patients With Functional Impairment.

OBJECTIVE: This study aimed to assess the association between skeletal muscle mass index and falls in patients with functional impairment. DESIGN: This retrospective cohort study was implemented at a convalescent rehabilitation ward. Patients with no measurement of skeletal muscle mass index and bed-ridden patients were excluded from this study. Patients were dichotomized into the low skeletal muscle mass index group and the high skeletal muscle mass index group. The occurrence of fall was assessed according to skeletal muscle mass index groups. RESULTS: Of the 327 included patients, 231 (71%) were assigned to the low skeletal muscle mass index group. In total, 66 patients (20%) experienced at least one fall, and a total of 102 falls occurred. The incidence of falls for the low skeletal muscle mass index group was not significantly greater than that for the high skeletal muscle mass index group (4.9 per 1000 patient-days vs. 4.5 per 1000 patient-days, P = 0.9). Low skeletal muscle mass index was not significantly associated with one or more incidents of falls (odds ratio [95% confidence intervals] = 0.6 [0.3-1.17]). CONCLUSIONS: This study found that skeletal muscle mass index was not significantly associated with falls in patients undergoing convalescent rehabilitation.

Association of Malnutrition With Physical Activity Intensity in Patients With Subacute Stroke.

OBJECTIVE: To investigate the relationship between nutritional status measured by the Global Leadership Initiative on Malnutrition (GLIM) criteria and the intensity of physical activity, and to determine the association between these factors and the activities of daily living (ADLs) in patients with subacute stroke during hospitalization. DESIGN: A cross-sectional study. SETTING: The study was conducted in the rehabilitation unit at a neurosurgical hospital. PARTICIPANTS: One hundred and twenty-eight patients with subacute stroke (N=128). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Nutritional status was assessed using GLIM criteria. Sedentary behavior (SB), light-intensity physical activity (LIPA), and moderate-to-vigorous physical activity (MVPA) were measured using an accelerometer. Multiple regression analysis was used to investigate the relationship between nutritional status and intensity of physical activity. Moreover, the association of nutritional status and physical activity intensity with ADLs was determined using multiple regression analysis and mediation analysis. RESULTS: Malnutrition was associated with SB time (B = 16.241, P=.009) and LIPA time (B = -17.656, P=.002), but not MVPA time (B = -0.472, P=.776). SB time (B = -0.063, P=.009) and LIPA time (B = 0.093, P<.001) were associated with functional independence measure for motor function, while MVPA time (B = -0.080, P=.379) was not. SB time (coefficient = -10.785, P<.001) and LIPA time (coefficient = -12.054, P<.001) were significant mediators between nutrition status and ADLs. CONCLUSIONS: Malnutrition was associated with a SB time and LIPA time, but not MVPA time, in patients with sub-acute stroke. SB and LIPA times were associated with ADLs and mediated between nutrition status and ADLs in these patients. The association of nutritional status on physical activity and ADLs should be considered in stroke rehabilitation.

Malnutrition on admission is associated with trunk function recovery but not with lower limb muscle strength recovery in patients with acute stroke: an observational cohort study.

OBJECTIVES: The aim of this study was to determine the effects of malnutrition on trunk function and lower leg muscle strength in patients with acute stroke upon hospitalization. METHODS: This prospective cohort study included hospitalized patients with acute stroke. Nutritional status was assessed using the Global Leadership Initiative on Malnutrition criteria. Trunk function and lower leg muscle strength were assessed using the trunk control test (TCT) and Motricity Index (MI), respectively, on admission and at discharge. Logistic regression analysis was performed to examine the relationship between malnutrition and poor improvement in TCT and MI scores at discharge. RESULTS: Patients (N = 241) with acute stroke (median age 79 y) were included in this study. In adjusted logistic regression analysis, malnutrition was independently associated with poor TCT score improvement (adjusted odds ratio, 3.82; 95% confidence interval, 1.11-13.20; P = 0.03). In contrast, malnutrition was not independently associated with poor MI score improvement (adjusted odds ratio, 0.86; 95% confidence interval, 0.30-2.52; P = 0.79). CONCLUSION: Malnutrition on admission leads to poor trunk function, but not lower leg muscle strength, in patients with acute stroke.

Physical Activity as Measured by Accelerometers Predicts Functional Improvement in Older Patients Undergoing Hospital Rehabilitation.

This prospective cohort study aimed to investigate the association between physical activity (PA) as measured using accelerometers, and functional improvement measured using a short physical performance battery in older patients undergoing rehabilitation. After admission to the rehabilitation hospital, patients were categorized into quartile groups based on their level of PA measured using accelerometers. The primary outcome was physical function measured using the short physical performance battery at hospital discharge. A total of 204 patients were included in the analysis. After adjusting for confounding factors, light-intensity PA (p < .001) and moderate-to-vigorous-intensity PA (p < .001) were associated with a short physical performance battery at hospital discharge. In conclusion, PA at admission is positively associated with functional improvement in older patients undergoing hospital rehabilitation.

Relationship of Functional Outcome With Sarcopenia and Objectively Measured Physical Activity in Patients With Stroke Undergoing Rehabilitation.

This study aimed to investigate the relationship of Functional Independence Measure for motor function (FIM-M) with sarcopenia, and physical activity in patients with stroke undergoing rehabilitation. This cross-sectional study included patients with stroke at a single convalescent rehabilitation hospital. Sarcopenia was diagnosed based on the Asia Working Group for Sarcopenia 2019 criteria. Physical activity was measured as the duration of light-intensity physical activity and moderate to vigorous physical activity using a triaxial accelerometer. Of 80 patients (median age: 72.0 years), 46 (57.5%) were diagnosed with sarcopenia. In multivariate linear regression analysis, FIM-M score was significantly associated with sarcopenia (ß = -0.15, p = .043) and light-intensity physical activity (ß = 0.55, p < .001). In another model, FIM-M score was significantly associated with moderate to vigorous physical activity (ß = 0.27, p = .002) but not with sarcopenia. This study demonstrated that FIM-M was partially associated with sarcopenia and associated with physical activity regardless of intensity in patients with stroke.

Correlations between aerobic exercise time during physiotherapy and characteristics of patients with subacute stroke: A pilot cross-sectional study.

BACKGROUND: The amount of aerobic exercise time (AET) is an important factor for improving physical function in patients with stroke. However, there is a lack of evidence regarding the factors for AET during physiotherapy, particularly in stroke patients. OBJECTIVE: To investigate the correlation between AET during physiotherapy and characteristics of patients with subacute stroke. METHODS: In this cross-sectional study, 61 hospitalized subacute stroke patients (age = 72 (11) years, (median (interquartile range)) were enrolled and their exercise intensity was measured by wearable sensors (Mio Alpha 2) worn during physiotherapy sessions. All patients were divided into two groups, non-ambulatory group (functional ambulation classification (FAC); 0-2) and ambulatory group (FAC; 3-5). The correlations between AET and patient characteristics were assessed in each group. RESULTS: There was no significant difference in AET between the ambulatory and non-ambulatory groups (9 (12) min vs 5 (10) min, p = .27, respectively). There was a significant correlation between AET and the functional independent measures (FIM) motor score in the ambulatory group (r = 0.52, p = .005), and between AET and the FIM cognitive score in the non-ambulatory group (r = 0.44, p = .008). CONCLUSION: Correlations between AET and patient characteristics were different according to ambulation capacity in patients with subacute stroke.

Association between premorbid sarcopenia and neurological deterioration in patients with acute ischemic stroke.

OBJECTIVE: Sarcopenia is associated with poor outcomes in patients with stroke. This study aimed to investigate the association between premorbid sarcopenia and neurological deterioration (ND) in patients with acute ischemic stroke. To the best of our knowledge, there have been no studies on this topic. METHODS: In this prospective longitudinal study, we assessed premorbid sarcopenia using the SARC-F questionnaire, and the incidence of ND was defined by an increase of ≥ 1 point on the National Institutes of Health Stroke Scale (NIHSS) or the occurrence of any new neurological symptoms/signs. Logistic regression analysis was used to investigate the relationship between premorbid sarcopenia and ND. RESULTS: Of the 290 patients enrolled, 46 and 244 patients experienced and did not experience ND 1 week after admission (ND and non-ND groups, respectively). The prevalence of sarcopenia was significantly higher in the ND group than in the non-ND group (39% vs. 17%). In the adjusted model, premorbid sarcopenia was significantly associated with ND (adjusted odds ratio: 3.06, 95% confidence interval: 1.11-8.40; p = 0.03). CONCLUSION: Premorbid sarcopenia is independently associated with ND in patients with acute ischemic stroke. Therefore, it is necessary to detect premorbid sarcopenia to predict ND in these patients.

Effects of muscle mass and muscle quality estimated by phase angle on functional outcomes in older patients undergoing rehabilitation: A prospective cohort study.

BACKGROUND: Both skeletal muscle mass and muscle quality are important predictors of poor prognosis in older patients. However, the effects of muscle mass and muscle quality estimated by the phase angle (PhA) on functional outcomes in older patients undergoing rehabilitation have yet to be reported. This study aimed to investigate whether appendicular skeletal muscle index (SMI) and muscle quality estimated by PhA were independently associated with activities of daily living (ADL) and physical function in older patients undergoing rehabilitation. METHODS: This prospective cohort study included older patients in a subacute rehabilitation hospital (n = 443). Baseline SMI and PhA were measured using bioelectrical impedance analysis, and low SMI or low PhA were determined using each cutoff value. The primary outcomes were ADL abilities measured using the functional independence measure for motor function (FIM-M) score and physical function measured using the short physical performance battery (SPPB) score at hospital discharge. Association between low SMI and low PhA and FIM-M or SPPB scores at discharge were determined using multiple regression analysis adjusted for confounding factors. RESULTS: There were significant differences between the normal- and low-PhA groups in the FIM-M and SPPB scores at discharge (P < 0.001). In multiple regression analysis, low PhA was independently associated with FIM-M (ß = -0.109, P = 0.013) and SPPB scores (ß = 0.535, P < 0.001) at discharge; however, low SMI was not independently associated with these functional outcomes. CONCLUSION: Decreased muscle quality estimated by the PhA was independently associated with poor ADL abilities and poor physical function in older patients undergoing rehabilitation.

Association of medial gastrocnemius adiposity with poststroke severe malnutrition and functional performance of activities of daily living in older patients: A prospective analysis.

BACKGROUND: Relationships among medial gastrocnemius intramuscular adipose tissue, nutrition status, and functional outcomes of patients after a stroke are unknown. This study was conducted to determine the relationship between nutrition status and gastrocnemius intramuscular adipose tissue and whether medial gastrocnemius intramuscular adipose tissue affects functional outcomes of older patients after a stroke. METHODS: This prospective cohort study included 217 patients with stroke. Nutrition status was evaluated by the Global Leadership Initiative on Malnutrition. The medial gastrocnemius intramuscular adipose tissue was assessed using ultrasound echographic intensity. Multivariate linear regression analysis was used to determine the relationship between nutrition status at admission and medial gastrocnemius intramuscular adipose tissue. Furthermore, we examined the influence of medial gastrocnemius intramuscular adipose tissue on the Functional Independence Measure (FIM)-motor score at discharge and FIM-motor efficiency, which indicates FIM-motor changes during the hospital stay. RESULTS: Severe malnutrition had a positive influence on medial gastrocnemius intramuscular adipose tissue on the nonparalyzed side (ß = 0.175; P = 0.044). Additionally, the medial gastrocnemius intramuscular adipose tissue on the nonparalyzed side was negatively correlated with the FIM-motor score at discharge (ß = -0.102; P = 0.005) and FIM-motor efficiency (ß = -0.273; P = 0.005). CONCLUSIONS: This study clarified the factors that contribute to a higher medial gastrocnemius intramuscular adipose tissue content on the nonparalyzed side and the effect of the higher adipose tissue content on functional outcomes.

Current practice and barriers in the implementation of ultrasound-based assessment of muscle mass in Japan: A nationwide, web-based cross-sectional study.

Muscle mass is an important factor for surviving an illness. Ultrasound has gained increased attention as a muscle mass assessment method because of its noninvasiveness and portability. However, data on the frequency of ultrasound-based muscle mass assessment are limited, and there are some barriers to its implementation. Hence, a web-based cross-sectional survey was conducted on healthcare providers in Japan, which comprised four parts: 1) participant characteristics; 2) general muscle mass assessment; 3) ultrasound-based muscle mass assessment; and 4) the necessity of, interest in, and barriers to its implementation. Necessity and interest were assessed using an 11-point Likert scale, whereas barriers were assessed using a 5-point Likert scale, in which "Strongly agree" and "Agree" were counted for the analysis. Of the 1,058 responders, 1,026 participants, comprising 282 physicians, 489 physical therapists, 84 occupational therapists, 120 nurses, and 51 dieticians, were included in the analysis. In total, 93% of the participants were familiar with general muscle mass assessment, and 64% had conducted it. Ultrasound-based muscle mass assessment was performed by 21% of the participants. Necessity and interest scored 7 (6-8) and 8 (7-10), respectively for ultrasound-based muscle mass assessment. The barriers to its implementation included lack of relevant education (84%), limited staff (61%), and absence of fixed protocol (61%). Regardless of the necessity of and interest in ultrasound-based muscle mass assessment, it was only conducted by one-fifth of the healthcare providers, and the most important barrier to its implementation was lack of education.

Effects of a multidisciplinary intervention to promote physical activity in patients with stroke undergoing rehabilitation: study protocol for the ActivePAS pilot randomised controlled trial.

Introduction: Physical activity after stroke is related to functional recovery and outcomes. To optimise physical activity adapted to a patient's walking ability and characteristics, multidisciplinary support and interventions are required. The Activate Physical Activity for Stroke pilot randomised controlled trial aims to assess the safety and feasibility of a multidisciplinary intervention that promotes physical activity in patients who had a stroke undergoing rehabilitation. Methods and analysis: This single-centre, randomised controlled trial will enrol 32 patients who had a stroke undergoing rehabilitation. Patients who had a stroke with the ability to walk 50 m with at least hand assistance, regardless of the use of braces or walking aids, and aged≥20 years will be randomly allocated to a multidisciplinary intervention group or control group. Patients in the intervention group will receive instructions for the self-monitoring of hospitalised physical activity and support to promote physical activity by multidisciplinary staff. The primary outcome of the present study is the safety (adverse events) and feasibility (retention and completion rates) of the multidisciplinary intervention. We assess physical activity using a triaxial accelerometer (UW-204NFC, A&D Company) as one of the secondary outcomes. Ethics and dissemination: The present study has been approved by the Research Ethics Committee of Konan Women's University and the Ethics Committee of Nishi-Kinen Port Island Rehabilitation Hospital. We will disseminate the results of the present study through a peer-reviewed manuscript and presentations at international conferences. Trial registration number: UMIN000046731.

Association of Objectively Measured Physical Activity with Physical Function in Patients with Sarcopenia during Hospitalized Rehabilitation.

This study aimed to investigate the association between objectively measured physical activity and functional improvement in hospitalized patients with sarcopenia. In this retrospective cohort study, physical activity (light-intensity physical activity [LIPA]; moderate-to-physical activity [MVPA]) was measured using a triaxial accelerometer in patients with sarcopenia undergoing rehabilitation on hospital admission. The primary outcome was physical function measured with the SPPB and activity of daily living (ADL) measured with the functional independence measure scores for motor function (FIM-M) at hospital discharge. Multiple regression analysis was per-formed to investigate the relationship between the objectively measured physical activity and functional outcomes. A total of 182 patients with sarcopenia (aged 81; interquartile range (IQR) 13 years) were included in this study. In the multiple regression analysis, LIPA was associated with the SPPB score at discharge (ß = 0.180, p = 0.015) but not with FIM-M at discharge. MVPA was not associated with SPPB or FIM-M scores at discharge. In conclusion, LIPA on admission is independently associated with physical function, but not ADL, in patients with sarcopenia undergoing hospitalized rehabilitation.