Combination of High Energy Intake and Intensive Rehabilitation Is Associated with the Most Favorable Functional Recovery in Acute Stroke Patients with Sarcopenia

Energy intake and rehabilitation time individually contribute to the improvement of activities of daily living (ADL). This study aimed to investigate the additive effect of energy intake and rehabilitation time on ADL improvement in acute stroke patients with sarcopenia. The study included 140 patients (mean age 82.6 years, 67 men) with stroke. Energy intake during the first week of hospitalization was classified as “Sufficiency” or “Shortage” based on the reported cutoff value and rehabilitation time was classified as “Long” or “Short” based on the median. The study participants were categorized into four groups based on the combination of energy intake and rehabilitation time. The primary outcome was the gain of functional independence measure (FIM) motor during hospitalization. The secondary outcomes were length of stay and home discharge rates. Multivariate analysis was performed with primary/secondary outcomes as the dependent variable, and the effect of each group on the outcome was examined. Multivariate analysis showed that “long rehabilitation time and sufficient energy intake” (β = 0.391, p < 0.001) was independently associated with the gain of FIM motor items. The combination of high energy intake and sufficient rehabilitation time was associated with ADL improvement in acute stroke patients with sarcopenia.     

系统康复指导对脑卒中偏瘫患者功能锻炼依从性的影响

目的 探讨系统康复指导对卒中偏瘫患者功能锻炼依从性的影响.方法 将88例脑卒中患者,随机分为实验组和对照组,对照组给予常规康复护理,实验组给予系统的康复指导.分别比较两组住院后15天、30天时的自理能力以及肢体功能锻炼依从性.结果 实验组的依从性显著高于对照组(P＜0.05).入院后15天时自理能力得分实验组除个人卫生外,其余均高于对照组(P＜0.05)；入院后30天自理能力实验组各项得分与总得分均高于对照组(P＜0.05).结论 系统康复指导有助于提高脑卒中偏瘫患者功能锻炼依从性,从而有利于自理能力的恢复.     

急性缺血性卒中患者进行超早期康复对功能结局的改善

目的研究在急性缺血性卒中患者中进行超早期康复治疗能否更好地改善其日常生活的独立性。方法将96名发病24h内入院的前循环急性缺血性卒中患者随机分为2组,超早期康复组在发病24h内开始接受包括下床站立活动的康复治疗;标准康复组在发病72h至7d开始康复治疗。康复治疗均由专业治疗师进行,每日1次,每次不少于30min,共14d。主要观察指标包括恢复至独立行走50m所需的天数,次要指标包括发病后30d和90d时的NIHSS评分和Bathel指数。结果超早期康复组共纳入41名患者,标准康复组55名患者。和标准康复组相比,超早期康复组恢复至独立行走50m的时间要明显缩短[(8.71±14.162)dvs(16.64±20.338)d,t=-2.138,P=0.035)]。90d时超早期康复组患者获得良好独立日常生活能力的比例(以Bathel指数达到95～100的比例表示,75.6%vs56.4%,χ2=3.891,P=0.049)更大。其余观察指标两组间无统计学差异。结论超早期康复治疗可以使缺血性卒中患者更早地恢复独立行走能力,并能改善功能结局。     

Nursing Home Residents Face Severe Functional Limitation or Death After Hospitalization for Pneumonia

ObjectivesPneumonia is a common cause of hospitalization for nursing home residents and has increased as a cause for hospitalization during the COVID-19 pandemic. Risks of hospitalization, including significant functional decline, are important considerations when deciding whether to treat a resident in the nursing home or transfer to a hospital. Little is known about postdischarge functional status, relative to baseline, of nursing home residents hospitalized for pneumonia. We sought to determine the risk of severe functional limitation or death for nursing home residents following hospitalization for treatment of pneumonia.DesignRetrospective cohort study.Setting and ParticipantsParticipants included Medicare enrollees aged ≥65 years, hospitalized from a nursing home in the United States between 2013 and 2014 for pneumonia.MethodsActivities of daily living (ADL), patient sociodemographics, and comorbidities were obtained from the Minimum Data Set (MDS), an assessment tool completed for all nursing home residents. MDS assessments from prior to and following hospitalization were compared to assess for functional decline. Following hospital discharge, all patients were evaluated for a composite outcome of severe disability (≥4 ADL limitations) following hospitalization or death prior to completion of a postdischarge MDS.ResultsIn 2013 and 2014, a total of 241,804 nursing home residents were hospitalized for pneumonia, of whom 89.9% (192,736) experienced the composite outcome of severe disability or death following hospitalization for pneumonia. Although we found that prehospitalization functional and cognitive status were associated with developing the composite outcome, 53% of residents with no prehospitalization ADL limitation, and 82% with no cognitive limitation experienced the outcome.Conclusions and ImplicationsHospitalization for treatment of pneumonia is associated with significant risk of functional decline and death among nursing home residents, even those with minimal deficits prior to hospitalization. Nursing homes need to prepare for these outcomes in both advance care planning and in rehabilitation efforts.     

The Sunnaas Index of Activities of Daily Living: Responsiveness and Concurrent Validity in Stroke

The aim of this study was to evaluate the responsiveness and concurrent validity of the Sunnaas Index of activities of daily living (ADL) as an instrument for measuring primary and instrumental ADL functions after stroke. Fifty-five consecutive stroke patients were scored using the Sunnaas ADL Index and the Barthel ADL Index on admission and at discharge after median 21 days inpatient rehabilitation. The results of the two indices were compared, and the Barthel Index was used as a gold standard for validity tests. The neurological impairments and motor functions of the patients were scored using the Scandinavian Stroke Scale and the Modified Motor Assessment Scale. The total score of the Sunnaas ADL Index and the subscores reflecting primary and instrumental ADL functions increased significantly (p < 0.0001) during rehabilitation. The Sunnaas score correlated significantly with the scores of the Barthel Index (Spearman correlation coefficient r = 0.83 on admission and 0.88 at discharge), the Scandinavian Stroke Scale (r = 0.81 on admission) and the Modified Motor Assessment Scale (r = 0.79 on admission and 0.76 at discharge). The Sunnaas ADL Index seems able to detect clinically important improvements of primary and instrumental ADL functions after stroke, i.e. its responsiveness is good. These results provide further evidence for the concurrent validity of the Sunnaas Index for measuring functional recovery after stroke.     

Sarcopenic Obesity Is Associated With Activities of Daily Living and Home Discharge in Post-Acute Rehabilitation

ObjectiveThe aim of this study was to evaluate the effect of sarcopenic obesity on activities of daily living and home discharge rates in adults undergoing convalescent rehabilitation. In addition, we evaluated diagnostic criteria for sarcopenic obesity to predict outcomes.DesignA retrospective cohort study.Setting and ParticipantsIn total, 971 Japanese patients in a post-acute rehabilitation hospital between 2014 and 2016.MethodsSarcopenic obesity was defined as the presence of both sarcopenia and obesity. Sarcopenia was diagnosed using muscle mass index and handgrip strength according to the criteria of the European Working Group on Sarcopenia in Older People, with the cut-off values of the Asian Working Group for Sarcopenia. Obesity was diagnosed exploratively using several definitions: percentage of body fat (FAT%), body mass index (>25 kg/m²), and fat mass index (4th quartile). Study outcomes included Functional Independence Measure-motor efficacy (score gain between admission and discharge divided by the length of stay) and the rate of home discharge. Multivariate analyses were used to determine whether sarcopenic obesity was associated with outcomes and which obesity definition was suitable for outcome prediction. P values of <.05 were considered statistically significant.ResultsAfter enrollment, 917 patients (mean age 74.7 ± 13.5 years; 59% women) were included in the final analyses. The frequency of sarcopenic obesity varied greatly depending on the sex and method of obesity diagnosis: 2.1% when body mass index >25 kg/m² was used for obesity diagnosis in men, and 40.7% when FAT% >25% was used in women. Further, FAT% >35% and FAT% >30% used in women and men, respectively, had the strongest association with Functional Independence Measure-motor efficacy. FAT% of >30% and >35% in women and >30 in men was associated with the rate of home discharge.Conclusions and ImplicationsSarcopenic obesity was negatively associated with functional improvement and home discharge in post-acute rehabilitation. Clinical thresholds for diagnosing sarcopenic obesity should include FAT% >35 and >30% in women and men, respectively, in defining obesity in this population.     

Factors predicting clinically significant functional gain and discharge to home in stroke in-patients after rehabilitation – A retrospective cohort study

ObjectiveThis study explored factors which predict stroke survivors who could achieve “clinically significant functional gain” and return home when being discharged from a local hospital after in-patient stroke rehabilitation programme.MethodsThis study included 562 inpatients with stroke who were residing at community dwellings before onset of stroke, and transferred to a convalescent hospital for rehabilitation from four acute hospitals over one year. The main outcome variables of prediction were (a) achieving “clinically significant functional gain” as measured by (a1) achievement of “minimal clinically important difference” (MCID) of improvement in Functional Independence Measure Motor Measure (FIM-MM)”, (a2) one or more level(s) of improvement in function group according to the patients’ FIM-MM, and (b) discharge to home. Sixteen predictor variables were identified and studied firstly with univariate binary logistic regression and those significant variables were then put into multivariate binary logistic regression.ResultsBased on multivariate regression, the significant predictors for “clinically significant functional gain” were: younger age <75 years old, higher Glasgow Coma Scale score at admission, with haemorrhagic stroke, intermediate FIM-MM function group. Those significant predictors for “discharge to home” were: living with family/caregivers before stroke, higher FIM score at admission, and one or more level(s) of improvement in FIM-MM function group.ConclusionsThis study identified findings consistent with overseas studies in additional to some new interesting findings. Early prediction of stroke discharge outcomes helps rehabilitation professionals and occupational therapists to focus on the use of appropriate intervention strategies and pre-discharge preparation.     

脑卒中医院-社区-家庭三级连续康复治疗的效果评价

观察脑卒中急性期后在“医院一社区一家庭三级康复治疗”、持续在大医院康复治疗和家庭康复三种方案的治疗效果及医疗费用的差异。方法：随机选取101例脑卒中患者分为三组,A组：30例,医院一社区一家庭三级康复治疗;B组：30例,持续在大医院康复治疗者。c组：41例,从综合医院内科直接进入家庭康复治疗者;5三组分别在康复治疗前与治疗后3个月、6个月采用Barthel指数、简化的Fugl—Meyer评定量表、社区康复肢体残疾功能评定表（CEDA）进行评估,比较三组同期之间ADL、运动功能改善以及回归社会情况的差异和治疗费用差异。结果：三组患者康复治疗前ADL评分、简化的Fuel—Meyer评分、CEDA评分无显著差异（P〉0．05）;康复治疗后3个月、6个月评估,A与B组比较无显著差异（P〉0．05）。A与c比较差异具有统计学意义（P〈0．05）;A与B组治疗费比较,A组明显少于B组。结论：“医院一社区一家庭三级康复治疗”与大医院康复治疗同样可以提升脑卒中患者的ADL、运动功能,减轻肢体残疾情况,治疗费用方面前者具有价廉优势。     

Ability in daily activities after early supported discharge models of stroke rehabilitation

More knowledge is needed about how different rehabilitation models in the municipality influence stroke survivors’ ability in activities of daily living (ADL). Objectives: To compare three models of outpatient rehabilitation; early supported discharge (ESD) in a day unit, ESD at home and traditional treatment in the municipality (control group), regarding change in ADL ability during the first three months after stroke. Methods: A group comparison study was designed within a randomized controlled trial. Included participants were tested with the Assessment of Motor and Process Skills (AMPS) at baseline and discharged directly home. Primary and secondary outcomes were the AMPS and the modified Rankin Scale (mRS). Results and conclusions: Included were 154 participants (57% men, median age 73 years), and 103 participants completed the study. There were no significant group differences in pre–post changed ADL ability measured by the AMPS. To find the best rehabilitation model to improve the quality of stroke survivors’ motor and process skills needs further research. Patients participating in the ESD rehabilitation models were, compared with traditional treatment, significantly associated with improved ADL ability measured by the mRS when controlling for confounding factors, indicating that patients with social needs and physical impairment after stroke may benefit from ESD rehabilitation models.     

乳腺常见肿瘤的良恶性彩超鉴别诊断

目的：探讨彩超在乳腺常见良恶性肿瘤鉴别诊断方面的应用价值。方法：选取120例经手术病检为乳腺良恶性肿瘤患者,依据肿块声像学特点和血流参数来鉴别诊断。结果：通过二维超声像图鉴别乳腺常见肿瘤的检出率明显低于二维超声像图结合多普勒超声血流特点鉴别疾病的检出率。与金标准手术病检结果相比,A 组二维超声像图鉴别结果的灵敏度为76.1%明显低于 B 组的92.5%,差异有统计学意义。结论：应用二维超声像图来鉴别乳腺常见肿瘤的灵敏度和特异度不高,但是应用彩色多普勒超声,结合二维超声像图和血流特点来鉴别常见乳腺肿瘤,灵敏度和特异度高,是早期乳腺常见肿瘤诊断的有效方法。     

Greater Quadriceps Muscle Mass at Post-Acute Care Admission is Associated with Better Swallowing Ability at Discharge among Adults with Stroke

ObjectivesThis study aimed to examine the relationship between muscle mass and intramuscular adipose tissue of the quadriceps at post-acute care admission and recovery of swallowing ability in patients with stroke.DesignProspective study.Setting and ParticipantsThis study was hospital-based and included 62 inpatients with stroke.MethodsThe primary outcome was swallowing ability at discharge. The swallowing ability was assessed using the Food Intake Level Scale (FILS). The FILS change was calculated by subtracting FILS at admission from FILS at discharge. Ultrasound images were acquired at admission using B-mode ultrasound imaging. Muscle mass and intramuscular adipose tissue of the quadriceps were assessed based on muscle thickness and echo intensity, respectively. The mean muscle thickness and echo intensity of the right and left quadriceps were used in the analysis. A multiple regression analysis was performed to identify the factors independently associated with the FILS at discharge and FILS change. The independent variables were the muscle thickness and echo intensity of the quadriceps, FILS at admission, age, sex, body mass index, days from stroke onset, C-reactive protein, updated Charlson comorbidity index, number of medications, unit number of rehabilitation therapy, and Barthel Index score at admission.ResultsMuscle thickness of the quadriceps was significantly and independently associated with FILS at discharge (β = 0.27) and FILS change (β = 0.40). Echo intensity of the quadriceps was not significantly and independently associated with FILS at discharge (β = 0.22) and FILS change (β = 0.31).Conclusions and ImplicationsOur results indicated that greater quadriceps muscle mass at post-acute care admission was associated with better swallowing ability at discharge in patients with stroke. Assessing muscle mass of the quadriceps at admission is important for predicting recovery of swallowing ability and interventions for quadriceps muscle mass may be effective for improving swallowing ability of patients with stroke.     

The Barthel Index and ADL Evaluation in Stroke Rehabilitation in Australia, Japan, the UK and the USA

At present many of the activities of daily living indices used in Australia lack essential characteristics of an index yielding desirable results. This study argues that the Barthel Index as modified by Shah, Vanclay and Cooper (1989a) is robust and has the required biometric and psychometric qualities. It presents evidence in support of the use of the Barthel Index as a preferred measure of the activities of daily living function to report therapeutically meaningful and valid information of patient care and stroke rehabilitation outcomes in Australia. It also presents the functional performance on the modified Barthel Index and the outcome of all 258 first stroke patients admitted for inpatient rehabilitation in Brisbane, Australia. Using the Barthel Index as a measure of activities of daily living functions, the study then compares the performances and outcomes of stroke patients between Australia, Japan, the United Kingdom and the United States of America.     

Prevalence of Malnutrition Assessed by the GLIM Criteria and Association with Activities of Daily Living in Older Residents in an Integrated Facility for Medical and Long-Term Care

Malnutrition is associated with poor functional outcomes in residents in long-term care facilities. The integrated facility for medical and long-term care (IFMLC) is a new Japanese long-term care facility where medical services can be provided. This study aimed to investigate the prevalence of malnutrition diagnosed based on the Global Leadership Initiative on Malnutrition (GLIM) criteria and its association with activities of daily living (ADL) in older residents in IFMLC. In this cross-sectional study of older residents, we diagnosed mild and severe malnutrition using the GLIM criteria and assessed ADLs using the Barthel index (BI). Multivariate regression analysis was used to investigate the relationship between BI score and GLIM-defined malnutrition. A total of 117 older residents (84 women; median age, 88 years) were analyzed in this study. The prevalence values of mild and severe malnutrition were 29% and 18%, respectively. Multivariate analyses for the BI score after adjusting for potential confounders showed that mild and severe malnutrition were independently associated with BI score (B = −6.113, p < 0.046; B = −8.411, p = 0.015, respectively). GLIM-defined malnutrition is negatively associated with ADLs in older residents in IFMLC.     

早期康复干预对脑卒中患者的疗效观察

目的：观察神经内科病房开展早期康复干预对脑卒中肢体功能及日常生活能力的影响。方法：将120例脑卒中患者随机分为康复组和治疗组，在常规治疗基础上，康复组给予早期康复干预。治疗前后采用简式Fugl-Meyer指数、Barthel指数评定对两组患者进行康复效果评定。结果：1个月后两组患者的肢体功能及日常生活能力均有明显改善（P〈O．01），但康复组的效果优于治疗组（P〈0．05）。结论：神经科病房开展早期康复干预不仅有利于脑卒中患者肢体功能的恢复，而且对日常生活能力有促进作用。     

Outcomes of nonagenarian patients after rehabilitation following hip fracture surgery

ObjectiveHip fractures (HF) are a growing cause of death and disability among older people, especially in the very old. Although the incidence of these events increases with age and nonagenarians represent a population at high risk, few studies selectively focused on these patients and on their potential to recover gait ability after HF. The aim of this study was to describe the clinical, biological, cognitive, and functional characteristics of a population of HF patients aged 90 years or older, to examine their functional recovery in gait (with or without aids), in-hospital mortality and destination at discharge, and, finally, to assess their 1-year survival according to the functional status achieved at discharge.DesignRetrospective study.SettingDepartment of Rehabilitation and Aged Care.ParticipantsSeventy-six nonagenarians admitted to a department of rehabilitation after HF surgery.MeasurementPatients underwent a multidimensional assessment on admission and at discharge. Outcome measures at discharge were the global scores of Tinetti and the Barthel Index, the score at the transferring and walking subitems of the Barthel Index, and the independence to walk with or without aids. Furthermore, we assessed the rate of discharge to home after rehabilitation and the rate of in-hospital death. Logistic regressions were used to assess clinical variables associated with the inability to walk at discharge. Postdischarge 12-month survival was assessed with Kaplan Meyer analysis and compared with Cox proportional hazard regression models, adjusted for confounders.InterventionA standardized rehabilitation treatment of 2 sessions (40 minutes per session) daily from Monday to Friday and of 1 session on Saturday that included exercises of strengthening, transfers, postural and gait training, and adaptive equipment training.ResultsFive patients died during their admission to the department. Among the 71 survivors, 84.5% were able to walk at discharge with an assistive device, either a cane or a walker. Comorbidity and prefracture Barthel Index global score were the only 2 variables associated with the failure to be independent in walking at discharge. At 1 year, mortality was significantly higher for those patients who did not recover walking ability after rehabilitation.ConclusionA large proportion of nonagenarians are able to achieve independence in walking ability (with assistive device) after rehabilitation following HF surgery. The achievement of this ability after rehabilitation is also an important prognostic factor for 1-year survival.     

Enhanced Medical Rehabilitation Increases Therapy Intensity and Engagement and Improves Functional Outcomes in Postacute Rehabilitation of Older Adults: A Randomized-Controlled Trial

ObjectivesFor millions of disabled older adults each year, postacute care in skilled nursing facilities is a brief window of opportunity to regain enough function to return home and live independently. Too often this goal is not achieved, possibly because of therapy that is inadequately intense or engaging. This study tested Enhanced Medical Rehabilitation, an intervention designed to increase patient engagement in, and intensity of, daily physical and occupational therapy sessions in postacute-care rehabilitation.DesignRandomized controlled trial of Enhanced Medical Rehabilitation versus standard-of-care rehabilitation.SettingPostacute care unit of a skilled nursing facility in St Louis, MO.ParticipantsTwenty-six older adults admitted from a hospital for postacute rehabilitation.InterventionBased on models of motivation and behavior change, Enhanced Medical Rehabilitation is a set of behavioral skills for physical and occupational therapists that increase patient engagement and intensity, with the goal of improving functional outcome, through (1) a patient-directed, interactive approach, (2) increased rehabilitation intensity, and (3) frequent feedback to patients on their effort and progress.MeasurementsTherapy intensity: assessment of patient active time in therapy sessions. Therapy engagement: Rehabilitation Participation Scale. Functional and performance outcomes: Barthel Index, gait speed, and 6-minute walk.ResultsParticipants randomized to Enhanced Medical Rehabilitation had higher intensity therapy and were more engaged in their rehabilitation sessions; they had more improvement in gait speed (improving from 0.08 to 0.38 m/s versus 0.08 to 0.22 in standard of care, P = .003) and 6-minute walk (from 73 to 266 feet versus 40 to 94 feet in standard of care, P = .026), with a trend for better improvement of Barthel Index (+43 points versus 26 points in standard of care, P = .087), compared with participants randomized to standard-of-care rehabilitation.ConclusionHigher intensity and patient engagement in the postacute rehabilitation setting is achievable, with resultant better functional outcomes for older adults. Findings should be confirmed in a larger randomized controlled trial.     

Successful Geriatric Rehabilitation: Effects on Patients’ Outcome of a National Program to Improve Quality of Care,the SINGER Study

Objective

To determine whether the implementation of a national program to improve quality of care in geriatric rehabilitation (GR) in the Netherlands improves successful GR in terms of independence in activities of daily living (ADL), discharge destination, and length of stay.

Are higher total serum cholesterol levels associated with better long-term motor function after ischemic stroke?

Abstract

Objectives

The objective of the study was to investigate the prognostic role of total cholesterol (TC) level on the long-term motor function after ischemic stroke.

Methods

One hundred and fourteen patients with ischemic stroke were included and divided into high total cholesterol (HTC; TC ≧5.18 mmol/l or ≧200 mg/dl) and low total cholesterol (LTC; TC <5.18 mmol/l or <200 mg/dl) groups. The motor outcome was evaluated using the motor score of the Fugl–Meyer assessment (MFMA) at 2 weeks (baseline), 1, 3, 6, and 12 months after stroke. Prognostic factors on the repeated measurements of the MFMA were investigated using the linear mixed regression model.

Results

The TC, basal ganglion lesion, baseline MFMA, first-time stroke, and follow-up time were identified as significant predictors for serial MFMA scores. The HTC group had higher MFMA scores than the LTC group by 2.72 units (95% confidence interval (CI): 0.17, 5.27, P = 0.037). An elevation of one unit of baseline MFMA led to a 0.86 increase (95% CI: 0.82, 0.90, P < 0.001) of subsequent MFMA scores. Subjects with basal ganglion lesions had lower MFMA scores by ?3.55 (95% CI: ?5.97, ?1.14, P = 0.004).

Discussion

Higher total cholesterol at the acute phase of ischemic stroke is a favorable prognostic factor for long-term motor function.     

Delirium Superimposed on Dementia Strongly Predicts Worse Outcomes in Older Rehabilitation Inpatients

ObjectiveDelirium superimposed on dementia (DSD) is common in many settings. Nonetheless, little is known about the association between DSD and clinical outcomes. The study aim was to evaluate the association between DSD and related adverse outcomes at discharge from rehabilitation and at 1-year follow-up in older inpatients undergoing rehabilitation.DesignProspective cohort study.SettingHospital rehabilitation unit.ParticipantsA total of 2642 patients aged 65 years or older admitted between January 2002 and December 2006.MeasurementsDementia predating rehabilitation admission was detected by DSM-III-R criteria. Delirium was diagnosed with the DSM-IV-TR. The primary outcome was that of walking dependence (Barthel Index mobility subitem score of <15) captured as a trajectory from discharge to 1-year follow-up. A mixed-effects multivariate logistic regression model was used to analyze the association between DSD and outcome, after adjusting for relevant covariates. Secondary outcomes were institutionalization and mortality at 1-year follow-up, and logistic regression models were used to analyze these associations.ResultsThe median age was 77 years (interquartile range: 71–83). The prevalence of DSD was 8%, and the prevalence of delirium and dementia alone were 4% and 22%, respectively. DSD at admission was found to be significantly associated with almost a 15-fold increase in the odds of walking dependence (odds ratio [OR] 15.5; 95% Confidence Interval [CI] 5.6–42.7; P < .01). DSD was also significantly associated with a fivefold increase in the risk of institutionalization (OR 5.0; 95% CI 2.8–8.9; P < .01) and an almost twofold increase in the risk of mortality (OR 1.8; 95% CI 1.1–2.8; P = .01).ConclusionsDSD is a strong predictor of functional dependence, institutionalization, and mortality in older patients admitted to a rehabilitation setting, suggesting that strategies to detect DSD routinely in practice should be developed and DSD should be included in prognostic models of health care.     

Dietary intake,nutritional status and rehabilitation outcomes of stroke patients in hospital

Background: Nutrition affects rehabilitation through its influence on physical and mental functioning, although little attention has been paid to effects on rehabilitation outcomes. The present study aimed to describe nutritional status and food consumption in stroke patients within 2 weeks of hospital admission and before discharge, as well as to investigate the effects of nutritional and dietary factors on rehabilitation outcomes. Methods: One hundred patients from a consecutive cohort admitted to a metropolitan hospital with acute stroke were recruited and assessed by a single researcher, with 38 reassessed at discharge. Nutritional status was assessed using Mini‐Nutritional Assessment and anthropometric indices and dietary intake was assessed by 1‐day weighed dietary records. Rehabilitation outcomes were changes in Barthel index scores and the rehabilitation efficiency index. Results: Few (n = 9; 10%) consumed ≥100% of the estimated average requirement (EAR) for energy within 2 weeks of admission and 13 (33%) had energy intakes <50% of EAR before discharge. A small but increasing proportion (7% at admission, 13% at discharge) were identified as being malnourished across the inpatient stay. Younger age, lower Barthel index and a higher energy intake in the early stages of admission predicted the extent and rate of restoration of functional abilities by discharge (F = 7.503, P = 0.001; F = 14.558, P < 0.001). Conclusions: Given a general finding of nutritional deterioration identified for these patients, as well as the identification of energy intake as a modifiable influence on the extent and rate of recovery, there is clearly scope for the multidisciplinary development of nutritional support for stroke patients to improve rehabilitation outcomes.