Sarcopenia, Nutritional Status, and the Association Between Rehabilitation Dose and Functional Efficiency After Inpatient Rehabilitation for First-Ever Ischemic Stroke.

OBJECTIVE: To examine the associations of rehabilitation dose, sarcopenia, and nutritional status with functional efficiency after inpatient rehabilitation for first-ever ischemic stroke. DESIGN: A single-center retrospective cohort included 1,036 adults with first-ever ischemic stroke. The outcome was Modified Barthel Index efficiency, defined as gain divided by inpatient rehabilitation days. Sarcopenia was defined as concurrent low skeletal muscle mass index and low non-paretic hand grip strength. Multivariable linear regression used HC3 robust standard errors. RESULTS: Poor functional efficiency occurred in 419 (40.4%) patients. Rehabilitation dose per 30 min/day was associated with higher efficiency (β=0.17, 95% CI 0.12 to 0.21; P<0.001). Sarcopenia was associated with lower efficiency (β=-0.22, 95% CI -0.28 to -0.15; P<0.001), whereas Geriatric Nutritional Risk Index per 5-point increase was associated with higher efficiency (β=0.05, 95% CI 0.03 to 0.07; P<0.001). The dose × sarcopenia interaction was negative (β=-0.12, 95% CI -0.20 to -0.05; P=0.001), and the dose × Geriatric Nutritional Risk Index interaction was small and positive (β=0.02, 95% CI 0.00 to 0.05; P=0.039). CONCLUSION: Rehabilitation dose, sarcopenia, and nutritional status are associated with functional efficiency after inpatient stroke rehabilitation.