A case of bronchopulmonary sequestration combined with congenital pulmonary airway malformation prenatally diagnosed as having two aberrant arteries originating from the celiac artery.

We report a case of BPS combined with CPAM prenatally diagnosed as having two aberrant arteries from the celiac artery by fetal 3D-US. Although the pattern of arterial feeding vessels was extremely rare in our case, the vasculature images obtained using fetal 3D-US were comparable to those obtained using postnatal CT angiography.

Hemoglobin levels and cognitive trajectory: unveiling prognostic insights in post-stroke geriatric cohort.

PURPOSE: Evidence is scarce regarding the association between anemia and alterations in cognitive level among hospitalized older patients. We aimed to evaluate the associations between baseline hemoglobin (Hb) levels and changes in cognitive level in patients undergoing rehabilitation after stroke. METHODS: A retrospective cohort study was conducted, encompassing consecutively hospitalized post-stroke patients. Data on serum Hb levels were extracted from medical records, specifically tests conducted within 24 hours of admission. Primary outcomes included discharge scores for cognitive function assessed by the cognitive domain of the Functional Independence Measure (FIM-cognition) and the corresponding change in FIM-cognition during hospitalization. Another outcome measure was the length of hospital stay. Multivariate linear regression analyses were employed to assess the association between Hb levels at admission and the designated outcomes, adjusting for potential confounding factors. RESULTS: Data from 955 patients (mean age 73.2 years; 53.6% men) were included in the analysis. The median Hb level at admission was 13.3 [11.9, 14.5] g/dL. After fully adjusting for confounding factors, the baseline Hb level was significantly and positively associated with FIM-cognition at discharge (ß = 0.045, p = 0.025) and its gain (ß = 0.073, p = 0.025). Further, the baseline Hb level was independently and negatively associated with length of hospital stay (ß = -0.013, p = 0.026). CONCLUSION: Elevated baseline Hb levels are correlated with preserved cognitive level and shorter hospital stays in post-stroke patients. Evaluating anemia at the outset serves as a crucial prognostic indicator.

Impaired oral status is associated with sarcopenic obesity in post-stroke patients.

PURPOSE: Oral problems and muscle health are indeed significant concerns in ageing populations. However, there is limited evidence concerning the association between these issues. The study's focus was to investigate the association between oral problems and sarcopenic obesity, wherein sarcopenia and obesity coexist concurrently, in post-stroke patients. METHODS: This retrospective, observational, cross-sectional study included patients hospitalised for post-stroke rehabilitation. Oral problems were assessed using the Revised Oral Assessment Guide (ROAG). Sarcopenic obesity was diagnosed according to the European Society of Clinical Nutrition and Metabolism/European Association for the Study of Obesity criteria. Multiple linear regression analysis was used to examine the association between the ROAG and sarcopenic obesity after adjusting for confounding factors. RESULTS: A total of 760 patients were included, with a mean (SD) age of 71 (9) years, of whom 408 (54.7%) were male. The median (interquartile range, 25th and 75th percentiles) ROAG was 11 [9, 13]. Sarcopenic obesity was diagnosed in 16 (3.9%) men, 18 (5.1%) women, and 34 (4.5%) patients overall. Multivariate linear analysis showed that ROAG was significantly and positively associated with sarcopenic obesity (ß = .091, P = .023), followed by obesity alone (ß = .084, P = .044), and sarcopenia alone (ß = .081, P = .037). CONCLUSION: Oral problems were associated with sarcopenic obesity in post-stroke. Oral assessment and intervention may have a positive impact on ADL and QOL in post-stroke patients with sarcopenic obesity.

Usefulness of the GLIM criteria to predict recovery of activities of daily living in older adults with post-acute stroke.

OBJECTIVES: The usefulness of malnutrition diagnosed using the Global Leadership Initiative on Malnutrition (GLIM) criteria as a predictor of recovery of activities of daily living is unclear. This study aimed to investigate whether baseline malnutrition diagnosed using the GLIM criteria was predictive of recovery of activities of daily living in older patients with post-acute stroke. MATERIALS AND METHODS: A retrospective cohort study was conducted in patients aged ≥70 years with post-acute stroke. The outcome was activities of daily living measured using the motor domain of the Functional Independence Measure (FIM-motor) score at discharge. Participants were classified as malnourished or non-malnourished according to the GLIM criteria. Multivariate linear regression analyses were performed to determine whether baseline malnutrition diagnosed using the GLIM criteria was predictive of the FIM-motor score at discharge. The analysis was adjusted for clinically relevant covariates associated with rehabilitation outcomes after stroke. RESULTS: A total of 236 patients (mean age, 80.0 years; female, 54.2%) were included in the analysis. On admission, 83 (35.2%) patients were diagnosed with malnutrition. Multivariate linear regression analyses showed that malnutrition diagnosed using the GLIM criteria was predictive of the FIM-motor score at discharge (ß = -0.347, P < 0.001). CONCLUSIONS: Identifying malnutrition using the GLIM criteria is useful for predicting recovery of activities of daily living in older patients with post-acute stroke.

Potentially inappropriate medications are negatively associated with functional recovery in patients with sarcopenia after stroke.

BACKGROUND: Evidence is scarce for potentially inappropriate medications (PIMs) in rehabilitation medicine. AIM: To examine the effect of PIMs on functional recovery in older patients with sarcopenia after stroke. METHODS: We conducted a retrospective cohort study in a post-acute rehabilitation hospital. All patients diagnosed with sarcopenia aged ≥ 65 years among all post-stroke patients hospitalized from 2015 to 2020 were included. PIMs were defined based on the 2019 Beers criteria. Sarcopenia was diagnosed using handgrip strength (HG) and skeletal muscle mass index (SMI), according to the criteria of the Asian Working Group for Sarcopenia 2019. The outcomes included functional independence measure motor (FIM-motor), HG, and SMI values at discharge. Multiple linear regression analyses were used to determine whether PIMs used at admission were independently associated with outcomes. RESULTS: Of the eligible patients, 361 were 65 years or older, of whom 196 (mean age 81.0 years, 44.4% male) presented with sarcopenia and were included in the analysis. Of these, 131 (66.8%) were prescribed PIMs at admission. The most frequently prescribed PIMs were proton pump inhibitors, antipsychotics, benzodiazepines, and nonsteroidal anti-inflammatory drugs. The number of PIMs on admission was independently associated with FIM-motor (ß = - 0.132, P = 0.001) and HG (ß = - 0.091, P = 0.048) at discharge, but not with SMI (ß = - 0.055, P = 0.256). CONCLUSIONS: High admission PIMs prescription numbers are negatively associated with favorable discharge functional status and muscle strength in older patients with sarcopenia after stroke.

Use of Antipsychotics is Negatively Associated with Muscle Strength in Older Adults with Sarcopenia after Stroke.

OBJECTIVE: The use of antipsychotics has been shown to affect activities of daily living during rehabilitation but reports regarding their effects on older patients with sarcopenia are insufficient. We aimed to examine the effect of the use of antipsychotics on muscle strength and muscle mass in older patients with sarcopenia undergoing convalescent rehabilitation after stroke. METHODS: This retrospective cohort study was conducted at a rehabilitation hospital between 2015 and 2020. The study outcomes included skeletal muscle mass index and hand grip strength at discharge. Multivariate analyses were used to determine whether the use of antipsychotics at admission and at 4 weeks after admission were independently associated with the study outcomes, after adjusting for potential confounders. RESULTS: Of the 619 stroke patients admitted, 196 (mean age 81 years; 44.4% men) had sarcopenia at admission and were included in the final analysis. The median hand grip strength and median skeletal muscle mass index values were 12.5 (5.9-17.9) kg and 5.1 (4.5-6.0) kg/m2, respectively. In the multivariate analyses, the use of antipsychotics at 4 weeks post-admission was independently associated with hand grip strength at discharge (ß = -0.125, p = 0.008), which was not the case when used at admission. Furthermore, the use of antipsychotics at admission and at 4 weeks after admission were not significantly associated with the skeletal muscle mass index at discharge. CONCLUSIONS: The use of antipsychotics in older patients with sarcopenia after stroke was negatively associated with handgrip strength at discharge.

Phase Angle as an Indicator of Baseline Nutritional Status and Sarcopenia in Acute Stroke.

OBJECTIVES: This study aimed to investigate whether phase angle is an indicator of malnutrition and sarcopenia in acute-phase stroke patients. MATERIALS AND METHODS: We conducted a retrospective observational study of stroke patients in a single acute-care hospital. The phase angle was measured within 5 days after admission, and the correlation between nutritional status and sarcopenia index was investigated. The cut-off point that distinguishes malnutrition and sarcopenia was evaluated using the receiver operating characteristic curve. The effects of the geriatric nutritional risk index (GNRI) and sarcopenia on the phase angle were examined using multivariate linear regression analysis. RESULTS: A total of 211 stroke patients (140 men) with a median age of 74 (65-83) were included in the analysis. Malnutrition was present in 38 (18.0%) patients, and 65 (30.8%) had sarcopenia. The phase angle significantly correlated with GNRI, grip strength, skeletal muscle musss index, and calf circumference in both men and women. The cut-off points for discriminating malnutrition were 5.05 for men and 3.96 for women, while the cut-off points for discriminating sarcopenia were 5.28 for men and 4.62 for women. Multivariate linear regression analysis showed that the GNRI and sarcopenia were independently related to the phase angle. CONCLUSIONS: Phase angle is a useful indicator for distinguishing malnutrition and sarcopenia in patients with acute stroke.

Impact of trunk and appendicular skeletal muscle mass on improving swallowing function in acute stroke patients.

OBJECTIVES: To investigate the effect of trunk and appendicular skeletal muscle mass on the swallowing function at discharge in acute stroke patients. MATERIALS AND METHODS: This retrospective cohort study included patients hospitalized after acute strokes. Skeletal muscle mass was measured by bioelectrical impedance analysis within 5 days of admission. The primary outcome was swallowing function at acute hospital discharge, assessed using the Functional Oral Intake Scale (FOIS). Secondary outcomes were Functional Independence Measure-eating (FIM-eating) scores and length of hospital stay. RESULTS: Data from 231 patients (age 72.2 years; 151 men) were included in the analysis. The median trunk muscle mass index (TMI) was 8.2 and 6.8 kg/m2 in men and women, respectively. The median appendicular skeletal muscle mass index (ASMI) was 7.7 and 5.7 kg/m2 in men and women, respectively. The high TMI group had higher FIM-eating scores at discharge in each sex (p < 0.001). The high ASMI group had higher FOIS (p = 0.039 and 0.048) and FIM-eating scores at discharge (p = 0.046 and 0.047) in men and women, respectively. On multivariate analysis, TMI was independently associated with FIM-eating scores (ß = 0.330, p < 0.001); ASMI was independently associated with FOIS (ß = 0.229, p = 0.039) and FIM-eating scores (ß = 0.111, p = 0.032). CONCLUSIONS: Skeletal muscle mass had site-specific impacts on swallowing function and eating activities. This finding may contribute to the design of more individualized rehabilitation programs.

Muscle Strength Gain is Positively Associated with Functional Recovery in Patients with Sarcopenic Obesity After Stroke.

OBJECTIVE: Evidence regarding the effect of sarcopenic obesity on recovery in stroke patients is scarce in rehabilitation medicine. The aim of this study was to examine the association between changes in muscle strength and functional outcomes in patients with sarcopenic obesity undergoing rehabilitation after stroke. MATERIALS AND METHODS: This study was a retrospective cohort study of stroke patients, consecutively admitted to post-acute rehabilitation wards of a single hospital, of which, only those diagnosed with sarcopenic obesity at admission were included in the final analysis. Bioimpedance analysis was used to measure skeletal muscle mass and body fat mass. Sarcopenic obesity was defined as the presence of both sarcopenia and obesity. Sarcopenia was diagnosed using muscle mass index and handgrip strength. Obesity was diagnosed using body fat percentage (men ≥30%, women ≥35%). The evaluated outcomes were Functional Independence Measure (FIM)-motor score at discharge and its gain. Multiple regression analysis was used to verify whether changes in hand grip strength during hospitalization were associated with functional outcomes. RESULTS: Sixty-two patients (29 men) with a mean age of 78 years, were analyzed. The mean change in the hand grip strength was 3.9 kg. In multiple regression analysis, changes in the hand grip strength were significantly associated with FIM-motor at discharge (ß = 0.34, P < 0.01) and FIM-motor gain (ß = 0.58, P < 0.01). CONCLUSIONS: Muscle strength gain was associated with improved functional recovery in stroke patients with sarcopenic obesity.

Clinical impact of functional independent measure (FIM) on 180-day readmission and mortality in elderly patients hospitalized with acute decompensated heart failure.

Activities of daily living (ADL) are important prognostic factors for heart failure. The functional independent measure (FIM) has emerged as a comprehensive valid measure of ADL from both physical and cognitive perspectives. This study aimed to investigate the prognostic impact of the FIM score on clinical outcomes in hospitalized patients with acute decompensated heart failure (ADHF). We retrospectively analyzed 473 ADHF patients, with available pre-discharge FIM scores, admitted to our institution between May 2018 and May 2020. Primary outcome measures, defined as a composite of 180-day all-cause deaths and readmissions, were compared among three tertiles. The median FIM score was 102 (interquartile range: 85-115). Tertile 1 corresponded to an FIM score > 111 (n = 154), Tertile 2 to that of 90-111 (n = 167), and Tertile 3 to that of < 90 (n = 152). During follow-up, 28 deaths and 114 readmissions occurred. Patients with lower FIM scores were associated with a graded increase in the risk of primary outcome measure (p = 0.001). Even after multivariable adjustment, the results remained significant [Tertile 1 vs 3; adjusted hazard ratio: 3.28 (95% confidence interval: 1.72-6.56), p < 0.001; Tertile 2 vs 3; 2.32 (1.27-4.47), p = 0.006]. FIM scores were significantly associated with readmission or death within 180 days of discharge in hospitalized ADHF patients.

Improvement in Oral Health Enhances the Recovery of Activities of Daily Living and Dysphagia after Stroke.

OBJECTIVE: Oral problems affect rehabilitation outcomes. This study aimed to examine the association between improvement in oral health and functional outcomes in patients after stroke. MATERIALS AND METHODS: This retrospective cohort study included post-acute rehabilitation patients who presented with oral problems at admission. Oral problems were assessed using the Revised Oral Assessment Guide (ROAG). The ROAG score change during hospitalization was calculated by subtracting the score at admission from the score at discharge; oral problems were defined as "improved", when the score change value was lower than the median value. Study outcomes were the activities of daily living assessed by the motor domain of the Functional Independence Measure (FIM-motor) scores and dysphagia as assessed by the Food Intake Level Scale (FILS). Multivariate regression analyses were used to determine whether improved oral problems were associated with study outcomes. P-values of <0.05 were considered statistically significant. RESULTS: This study included 300 patients (mean age, 72.0 years; 51.7% men). The median [IQR] baseline ROAG score and its change value during hospitalization were 11 [10, 14] and -1[-3, 0] points, respectively. Multivariate analyses showed that improved oral problems was independently associated with FIM-motor score (ß = 0.144, p = 0.001) and FILS score (ß = 0.227, p < 0.001) at discharge, after adjusting for potential confounders. CONCLUSIONS: Improvement in oral health was positively associated with recovery of the ADL and dysphagia after stroke. Early detection of oral problems and oral treatment should be implemented in these patients to maximize functional recovery.

Impact of Phase Angle on Physical Function in Patients with Acute Stroke.

OBJECTIVE: Phase angle, an assessment of muscle quality, might be a possible predictor of physical function in patients with an acute stroke; however, the evidence for the same is limited. Therefore, this study aimed to investigate whether phase angle is associated with improved physical function at discharge. METHODS: In this observational cohort study, we determined the phase angle in patients with an acute stroke using a portable, noninvasive multifrequency bio-impedance device. The primary objective was the assessment of physical function using the Functional Independence Measure motor (FIM-motor) at discharge in the acute phase. The secondary outcome was home discharge. Multiple regression analysis was used to determine the association between phase angle, FIM-motor score, and home discharge. RESULTS: The study included 129 patients (78 men; mean age 75.2 years). Multiple linear regression analysis showed that the phase angle was independently associated with FIM-motor score at discharge in all models (Model 1: ß= 0.27, p < 0.001; Model 2: ß = 0.234, p < 0.001; Model 3: ß = 0.201, p = 0.017). However, multiple logistic regression analysis showed that the phase angle was not associated with home discharge (p = 0.464). CONCLUSIONS: The phase angle at the onset of a stroke, is an independent predictor of physical function at discharge in the acute phase. Our findings highlight the importance of determining the phase angle in patients with an acute stroke.

Elevated Creatinine-Based Estimated Glomerular Filtration Rate is Associated with Increased Risk of Sarcopenia, Dysphagia, and Reduced Functional Recovery after Stroke.

OBJECTIVES: To evaluate the associations between estimated glomerular filtration rate (eGFR) and sarcopenia and functional outcomes after stroke. METHODS: This retrospective cohort study included hospitalized patients after stroke. Data on serum creatinine-based eGFR were extracted from medical records. Primary outcome was the presence of sarcopenia at admission, diagnosed based on both low skeletal muscle mass and strength criteria as per the AWGS 2019. Other outcomes included the Food Intake Level Scale (FILS) score (measure of dysphagia, FILS score <7) at discharge and the Functional Independence Measure-motor (FIM-motor) score at discharge and its change from the baseline. Multivariate analyses were performed to determine the association between eGFR and outcomes. RESULTS: Data from 813 patients (mean age 73.5 years; 51.9% men) were included in the analysis. The median eGFR was 65.1 ml/min/1.73 m2, and about 41% of patients had an eGFR less than 60 ml/min/1.73 m2 at the baseline. Sarcopenia was observed in 47.4% of patients. In the multivariate analyses, baseline eGFR was positively associated with sarcopenia at admission (odds ratio [OR]=1.016, 95% confidence interval [CI]: 1.005-1.027, p = 0.003), the presence of dysphagia at discharge (OR=1.016, 95% CI: 1.001-1.031, p = 0.045), and negatively associated with FIM-motor score at discharge (ß= -0.046, p = 0.047) and its gain (ß= -0.067, p = 0.037). CONCLUSIONS: Elevated creatinine-based eGFR is associated with sarcopenia, dysphagia, and adverse rehabilitation outcomes after stroke. Our findings highlight the limitations of assessing renal function using creatinine levels in patients with sarcopenia: therefore, future studies using cystatin C are needed to validate our findings.

Hemoglobin Improvement is Positively Associated with Functional Outcomes in Stroke Patients with Anemia.

OBJECTIVES: The aim of this study was to evaluate the associations between hemoglobin improvement and functional outcomes in anemic patients after stroke. METHODS: This retrospective cohort study included consecutive hospitalized post-stroke patients with anemia. Data on serum hemoglobin level were extracted from medical records. The "change in hemoglobin levels" was defined as the pre-discharge hemoglobin level minus the baseline hemoglobin level. Study outcomes included the Functional Independence Measure-motor (FIM-motor) efficacy, and length of stay. Multivariate analyses were used to determine whether the change in hemoglobin levels was independently associated with study outcomes, after adjusting for potential confounders. RESULTS: Of the 637 patients admitted, 194 stroke patients (mean age 75.4 years; 53.6% women) presented anemia at baseline and were included in the analysis. The mean (SD) baseline hemoglobin level was 11.2 (0.9) g/dL and the median (IQR) change was 0.4 (0.1-1.1) g/dL. In multivariate analyses, the change in hemoglobin levels was positively associated with the FIM-motor efficacy (ß = 0.114, p = 0.031), and negatively associated with length of stay (ß = -0.059, p = 0.039). Moreover, the baseline hemoglobin level was independently associated with the FIM-motor efficacy (ß = 0.267, p = 0.001). CONCLUSIONS: A lower baseline hemoglobin level is negatively associated with functional recovery, and hemoglobin improvement is positively associated with functional recovery and shorter hospital stay in stroke patients with anemia. Anemia should be assessed at baseline as a prognostic indicator and, if treatable, treated appropriately to maximize outcomes in these patients.

Association of impaired oral health status with chronic kidney disease in post-acute rehabilitation.

BACKGROUND: Despite the growing interest in oral health and chronic disease in geriatric medicine, the evidence of an association between the two variables is limited. OBJECTIVES: This study sought to examine the association between oral health status and chronic kidney disease (CKD) in this setting. MATERIALS AND METHODS: This retrospective study included consecutive post-acute patients in a rehabilitation hospital. Oral health status was evaluated using the Revised Oral Assessment Guide (ROAG). Renal function or CKD stage was assessed by measurement of the estimated glomerular filtration rate (eGFR). Multivariate logistic regression analysis was used to determine which subcategories of ROAG were independently associated with advanced CKD stages (vs. early CKD stages). Multiple linear regression analysis was used to clarify whether eGFR on admission was independently associated with ROAG score after adjusting for potential confounders. RESULTS: A total of 1056 (mean age 70 years; 52% women) were included in the analysis. Slight and moderate-to-severe oral health problems were detected in 57.7% and 15.4% of patients, respectively. Patients with oral problems had a more severe stage of CKD (P = .036) and a lower eGFR (P = .028). Among subitems of ROAG, tongue (OR = 1.40, P = .041), saliva (OR = 1.72, P = .039) and oral cavity mucosa (OR = 1.37, P = .013) status was independently associated with the presence of CKD stages 3, 4 and 5. Furthermore, eGFR was independently associated with ROAG score (ß = -0.180, P = .034) after adjusting for possible confounders. CONCLUSIONS: Impaired oral health status is common and closely associated with CKD in post-acute inpatients.

Dysphagia is associated with poor physical function in patients with acute heart failure: a prospective cohort study.

BACKGROUND: Dysphagia is an important clinical problem in older adults with heart failure. Moreover, evidence is scarce regarding the prevalence and impact of dysphagia on physical function in these patients. AIMS: This study examined the association of dysphagia and physical function in patients undergoing cardiac rehabilitation following heart failure. METHODS: This prospective cohort study included consecutive 149 (mean age 78.6 years, 72 women) inpatients in an acute-care hospital. Outcomes included the Food Intake Level Scale (FILS) and Barthel Index (BI) as indicators of dysphagia status and physical function, respectively. Multivariate analyses were used to determine whether FILS scores on admission and at the point of heart failure stabilization were associated with BI at discharge. RESULTS: Of the 149 patients, 14 (9.4%) had dysphagia at the time of stabilization of heart failure. Patients with dysphagia (FILS score < 7) were significantly older, more demented, exhibited lower muscle mass and strength, walked shorter distances, and had lower energy and protein intakes, longer length of stay, and lower BI scores (all, p < 0.05) compared to those without dysphagia. Multiple regression analyses showed that FILS score was independently associated with BI at discharge (ß = 0.364, p < 0.001). CONCLUSIONS: Dysphagia was associated with declined physical function in patients undergoing cardiac rehabilitation following heart failure. Early detection and management of dysphagia can promote timely functional recovery in these patients.

Shorter Interval between Onset and Admission to Convalescent Rehabilitation Wards Is Associated with Improved Outcomes in Ischemic Stroke Patients.

As Japan's population ages, there is a growing interest in regional health care coordination. Our study aimed to evaluate whether the interval between onset and admission to convalescent rehabilitation wards (onset-admission) was associated with outcomes in ischemic stroke patients. We conducted a retrospective cohort study in a single rehabilitation hospital. Ischemic stroke patients consecutively admitted to the wards were eligible to enroll. Outcomes included Functional Independence Measure (FIM)-motor gain, the Food Intake Level Scale (FILS) and a discharge rate to home. FIM assesses functional independence, including motor (FIM-motor) and cognitive domains, and is a measure of activities of daily living (ADLs). The FIM-motor gain indicates the difference between the FIM-motor scores at admission and discharge. FILS is a 10-point observer-rated scale to measure swallowing. After enrollment, 481 patients (mean age 74.4 years; 45.7% women) were included. The median [interquartile range] onset-admission interval was 13 [10-20] days and the median National Institute of Health Stroke Scale score, a measure of stroke severity, was 8 [3-13]. In multivariate analysis, the onset-admission interval was independently associated with FIM-motor gain (ß = -0.107, p = 0.024), FILS score at discharge (ß = -0.159, p = 0.041), and the rate of discharge to home (odds ratio: 0.946, p = 0.032). In conclusion, a shorter interval between stroke onset and admission to convalescent rehabilitation wards contributes to improved outcomes, including ADLs, dysphagia, and a discharge rate to home, in ischemic stroke patients, regardless of stroke severity.

Muscle mass gain is positively associated with functional recovery in patients with sarcopenia after stroke.

OBJECTIVE: Intervention for treating sarcopenia is of great concern in clinical settings. The aim of this study was to investigate the relationship between changes in skeletal muscle mass and functional outcomes in patients with sarcopenia after stroke. METHODS: A retrospective cohort study of stroke patients with sarcopenia consecutively admitted to a single center's convalescent rehabilitation wards was conducted from 2015 to 2018. Sarcopenia was defined as a loss of skeletal muscle mass index (SMI) with bioelectrical impedance and decreased muscle strength as measured by handgrip strength; cut-off values were adopted from the 2019 Asian Working Group for Sarcopenia. Changes in SMI during hospitalization were measured. Outcomes included the motor domain of Functional Independence Measure at discharge and its gain. Multivariate analysis determined whether the changes in SMI were associated with these outcomes. RESULTS: During the study period, 272 stroke patients were enrolled. Of those, 120 patients (44%) (mean age 79 years, 70 females) were diagnosed with sarcopenia. The mean (SD) for changes in SMI was 0.2 (0.5) kg/m2. Multiple linear regression analysis showed that changes in SMI were significantly associated with Functional Independence Measure - motor at discharge (ß=0.175, P=0.003) and Functional Independence Measure - motor gain (ß=0.247, P=0.003). CONCLUSIONS: Muscle mass gain may be positively associated with functional recovery in patients with sarcopenia after stroke. Exercise and nutritional therapy to increase skeletal muscle mass, in addition to conventional stroke rehabilitation, is needed for these patients.

Low Hemoglobin Levels are Associated with Sarcopenia, Dysphagia, and Adverse Rehabilitation Outcomes After Stroke.

OBJECTIVE: The aim of our study was to evaluate the associations between baseline hemoglobin (Hb) levels and sarcopenia and outcomes in patients undergoing rehabilitation after stroke. METHODS: This retrospective cohort study included consecutive hospitalized post-stroke patients. Data on serum Hb level were extracted from medical records on tests performed within 24 h of admission. Primary outcome was the presence of sarcopenia at admission, diagnosed based on both low skeletal muscle mass and strength criteria per recently updated Asian Working Group for Sarcopenia 2019 guidelines. Other outcomes included the Functional Independence Measure-motor (FIM-motor) score at discharge and its change from baseline, and the Food Intake Level Scale (FILS) score (measure of dysphagia, FILS score < 7) at discharge. Multivariate analyses were used to determine the association between Hb levels at admission and outcomes of interest, adjusted for potential confounders. RESULTS: Data from 598 patients (mean age 72.1 years; 52.7% men) were included in the analysis. The mean Hb level at admission was 13.2 g/dL, and 86 (27.3%) men and 102 (36.0%) women had low Hb levels, i.e., 13.0 g/dL and 12.0 g/dL, respectively. In multivariate analyses, the baseline Hb level was independently associated with sarcopenia (odds ratio [OR]: 0.794, 95% confidence interval [CI]: 0.677-0.930, p = 0.004), FIM-motor score (ß = 0.096, p = 0.045) at discharge and its change from baseline (ß = 0.191, p = 0.018), and dysphagia (OR: 0.762, 95% CI: 0.595-0.961, p = 0.041) at discharge. CONCLUSION: Baseline low Hb levels were associated with sarcopenia, poorer recovery of physical function, and dysphagia in patients undergoing rehabilitation after stroke.

Low Muscle Mass is Associated with Walking Function in Patients with Acute Ischemic Stroke.

BACKGROUND: Muscle mass might be a possible predictor for walking function in patients with stroke; however, evidence is limited. OBJECTIVE: To investigate whether skeletal muscle mass is associated with walking function at discharge during the acute phase. METHODS: In this observational cohort study, we assessed skeletal muscle mass in patients with acute ischemic stroke using the noninvasive and portable multifrequency bio-impedance device. This device can easily be used in bedridden patients. Appendicular skeletal muscle mass was converted to skeletal muscle index (SMI) standardizing by height squared (kg/m2). The primary outcome was walking function assessed by the modified Rankin Scale score at acute phase hospital discharge. Logistic regression analysis was used to determine the association between skeletal muscle mass and walking function. RESULTS: Of the 107 patients enrolled, low SMI (SMI: male <7.0 kg/m2, female <5.7 kg/m2) was identified in 29.9% (19.7% in men, 48.6% in women). Logistic regression analysis showed that low SMI [OR: 4.02, 95% confidence interval (CI): 1.38-11.7, p = 0.001] independently associated with walking function at discharge. Further, patients with mild and moderate severity had significant difficulty in walking when they had low SMI (p = 0.039). CONCLUSIONS: Low skeletal muscle mass at the onset of ischemic stroke is an independent predictor of walking function at discharge during the acute phase. Our findings highlight the importance of detecting skeletal muscle mass in patients with acute ischemic stroke.