Predictive ability of hand-grip strength and muscle mass on functional prognosis in patients rehabilitating from stroke.

OBJECTIVES: This study aimed to investigate the association between muscle strength and adjusted appendicular skeletal muscle mass (ASM) in patients who have had strokes with the Functional Independence Measure (FIM) and the probability of being discharged. METHODS: A retrospective cohort study was conducted for older patients who have had strokes admitted to convalescent rehabilitation wards between January 2017 and October 2020. Hand-grip strength (HGS) was used to assess muscle strength. ASM was measured with a bioelectrical impedance analysis, and then divided by height-squared, body weight, body mass index (BMI), body fat mass (BFM), and body fat percentage (BFP) to calculate the adjusted ASM. The primary outcome was FIM at the time of discharge, and the secondary outcome was the probability of being discharged to their home. Multivariate analyses were conducted to adjust for confounding effects. RESULTS: The data of 699 participants (female: 47%; median age, 79 y) were analyzed. HGS was independently associated with FIM at the time of discharge in men (partial regression coefficient [B] = 0.482; 95% confidence interval [CI], 0.225-0.740) and women (B = 0.664; 95% CI, 0.263-1.065) and also was independently associated with being discharged to their home in men (odds ratio [OR]: 1.070; 95% CI, 1.030-1.100) and women (OR: 1.070; 95% CI, 1.000-1.130). Conversely, none of the adjusted ASM indices were associated with the outcomes. The cutoff value of HGS for discharge to home was 15.1 kg for men and 9.5 kg for women. CONCLUSIONS: In patients who have had strokes, HGS independently predicted FIM at the time of discharge and the probability of being discharged to their home. The adjusted ASM methods had less predictive value for functional and discharge outcomes.

Prevalence and Associated Factors of Coexistence of Malnutrition and Sarcopenia in Geriatric Rehabilitation.

Malnutrition and sarcopenia often coexist in rehabilitation patients, although they are often overlooked and undertreated in clinical practice. This cross-sectional study aimed to clarify the prevalence of the coexistence of malnutrition and sarcopenia (Co-MS) and its associated factors in convalescent rehabilitation wards in Japan. Consecutive patients aged ≥ 65 years in convalescent rehabilitation wards between November 2018 and October 2020 were included. Malnutrition and sarcopenia were determined by the Global Leadership Initiative on Malnutrition (GLIM) criteria and the Asian Working Group for Sarcopenia (AWGS 2019) criteria, respectively. Patients who presented both with malnutrition and sarcopenia were classified as Co-MS. Potentially associated factors included age, sex, days from onset to admission of rehabilitation wards, reason for admission, pre-morbid functional dependency, comorbidity, activities of daily living, swallowing ability, and oral function and hygiene. The prevalence of malnutrition, sarcopenia, and Co-MS was calculated. Binary logistic regression analyses were performed to compute odds ratios (ORs) and the 95% confidence interval (CI) of possible associated factors for each condition. Overall, 601 patients were eligible for the analysis (median 80 years old, 355 female patients, 70% cerebrovascular disease). Co-MS, malnutrition, and sarcopenia were found in 23.5%, 29.0%, and 62.4% of the enrolled patients, respectively. After adjustment, onset-admission interval (OR = 1.04; 95% CI = 1.02 to 1.06), hospital-associated deconditioning (OR = 4.62; 95% CI = 1.13 to 18.8), and swallowing ability (Food Intake LEVEL Scale) (OR = 0.83; 95% CI = 0.73 to 0.93) were identified as independent explanatory factors of Co-MS. In conclusion, Co-MS was prevalent in geriatric rehabilitation patients; thus, healthcare professionals should be aware of the associated factors to detect the geriatric rehabilitation patients who are at risk of both malnutrition and sarcopenia, and to provide appropriate treatments.

Effect of Improvement in Sarcopenia on Functional and Discharge Outcomes in Stroke Rehabilitation Patients.

This cross-sectional study investigated the proportion of patients' recovery from sarcopenia status and the relationship between improvement in sarcopenia (IS) and function and discharge outcome in hospitalized patients with stroke. This study included patients with stroke, aged 65 years or more, with a diagnosis of sarcopenia, who were admitted to a convalescent rehabilitation ward. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia 2019 criteria. Patients were divided according to the presence or absence of sarcopenia at discharge: IS group and non-improvement in sarcopenia (NIS) group. Among the 227 participants (mean age: 80.5 years; 125 females), 30% (69/227) of the patients were in the IS group, while 70% (158/227) were in the NIS group. The IS group showed a higher Functional Independence Measure (FIM) than the NIS group (median 112 vs. 101, p = 0.003). The results demonstrated that IS was independently associated with higher FIM (partial regression coefficient, 5.378; 95% confidence interval (CI), 0.709-10.047). The IS group had higher odds of home discharge than the NIS group (odds ratio, 2.560; 95% CI, 0.912-7.170). In conclusion, recovery from sarcopenia may be associated with better function in patients with stroke.

Validity of calf circumference for estimating skeletal muscle mass for Asian patients after stroke.

OBJECTIVES: The aims of this study was to determine the optimal cutoff values of non-paretic calf circumference (CC) that are indicative of low skeletal muscle mass and examine the association between a low CC and rehabilitation outcomes. METHODS: This was a retrospective cohort study that included 628 patients in convalescent rehabilitation wards in Japan. Patients in post-stroke rehabilitation who were ≥20 y of age were included. We examined the agreement between CC on the non-paretic side and a low skeletal muscle mass index (SMI) measured by bioelectrical impedance analysis. We also confirmed the correlation between sarcopenia defined by CC and handgrip strength, and sarcopenia according to Asian Working Group for Sarcopenia (AWGS) 2019 criteria. Functional Independent Measure (FIM) at discharge and discharge to home outcomes were compared between patients with a high CC and those with a low CC. RESULTS: Of the 628 patients included in the study, 408 (170 women; mean age, 72 y) were analyzed. The optimal cutoff values of CC were 33 cm for men (sensitivity and specificity, 0.798 and 0.840, respectively) and 32 cm for women (0.847 and 0.818, respectively). The sensitivity and specificity of CC-based sarcopenia against the AWGS criteria were 0.752 and 1.000 for men and 0.800 and 1.000 for women, respectively. Patients with a low CC had a significantly lower FIM and proportion of home discharge than those with a high CC. CONCLUSIONS: The optimal cutoff values of non-paretic CC for a low SMI were 33 cm for male and 32 cm for female Asian stroke rehabilitation patients. Sarcopenia can be defined using CC instead of SMI.

Sarcopenic Obesity and Activities of Daily Living in Stroke Rehabilitation Patients: A Cross-Sectional Study.

Reports investigating the relationship between sarcopenic obesity and activities of daily living in older patients with stroke were limited. This study aimed to examine the prevalence of sarcopenic obesity and its association with activities of daily living in older post-stroke patients in convalescent rehabilitation wards. This study was performed in older post-stroke patients admitted to convalescent rehabilitation wards between January 2017 and March 2019. Sarcopenia was diagnosed based on the skeletal muscle mass index and hand grip strength according to the criteria of the 2019 Asian Working Group for Sarcopenia. Obesity was diagnosed according to the body fat percentage; ≥27% in men, ≥38% in women. The primary outcome was the Functional Independence Measure (FIM) score upon admission, which was analyzed using multiple linear regression. In total, 376 participants (women 44%; mean age 77.5 years) were analyzed and classified as normal (22%), simple obesity (17%), sarcopenia without obesity (32%), and sarcopenic obesity (28%). The presence of sarcopenic obesity was independently associated with the FIM score (95% CI, -16.157 to -5.353), whereas simple obesity and sarcopenia without obesity were not. In conclusion, sarcopenic obesity was independently associated with lower activities of daily living capability in older patients with stroke.

Sarcopenia as a predictor of activities of daily living capability in stroke patients undergoing rehabilitation.

AIM: The aim of the present study was to clarify the relationship between sarcopenia, as defined by the European Working Group on Sarcopenia in Older People, and the recovery of the capability to carry out activities of daily living in convalescent stroke patients who completed a rehabilitation program. METHODS: This retrospective study included consecutive stroke patients admitted to convalescent rehabilitation wards. To determine which patients had sarcopenia, we used the European Working Group on Sarcopenia in Older People criteria. At admission, participants were classified by either the presence or absence of sarcopenia. Baseline characteristics, including the Functional Independence Measure-motor domain score (FIM-M), were retrospectively analyzed. The primary outcome to be explained was the FIM-M at discharge. A multiple linear regression analysis was used to examine how well a sarcopenia diagnosis and various baseline characteristics could predict the FIM-M score at discharge. RESULTS: In total, 267 participants (117 women) were included in this study. Of these, 129 (48.3%) were classified as definitely having sarcopenia. Participants with sarcopenia showed lower FIM-M at discharge than those without this condition (median 72 vs 89, P < 0.001). Multiple linear regression analyses exploring determinants of the FIM-M scores showed that a diagnosis of sarcopenia independently predicted them at discharge for men (B -4.957, 95% confidence interval -9.902--0.012), but not for women. CONCLUSIONS: Stroke-related sarcopenia appears to be a predictor of how well male patients can engage in activities of daily living after rehabilitation. Geriatr Gerontol Int 2019; 19: 1124-1128.

Severely Decreased Muscle Mass among Older Patients Hospitalized in a Long-Term Care Ward in Japan.

Sarcopenia is known to increase the risk of adverse outcomes, including disability, loss of independence, hospitalization, longer length of hospital stay, and mortality, but there is little data about the prevalence of sarcopenia and the factors associated with increased physical dependency and cognitive decline among older patients hospitalized in a long-term care (LTC) ward in Japan. A cross-sectional study was conducted in 79 consecutive patients (34 men, 45 women) with a median age of 81 y hospitalized in an LTC hospital. Sarcopenia was defined according to the recommended algorithm of the Asian Working Group for Sarcopenia. Skeletal muscle mass index (SMI) was assessed by using bioelectrical impedance analysis. Physical dependency and cognitive decline were evaluated by the Functional Independence Measure (FIM). Nutritional status was evaluated by using the Mini Nutritional Assessment-Short Form and daily intake of energy and protein. Multivariate analyses were applied to examine factors associated with increased physical dependency and cognitive decline. Median SMI was 4.9 kg/m2 (interquartile range [IQR], 4.0-5.3 kg/m2) in men and 3.3 kg/m2 (IQR, 2.9-3.8 kg/m2) in women, showing that all participants had an SMI below the cut-off value. Seventy participants (88.6%) were unable to perform the hand grip strength test, and all participants were unable to perform the gait speed test. Multivariate analysis showed that oral nutritional access and daily energy intake were associated both with physical and cognitive level (p<0.05).