Association of Nutrition Status and Rehabilitation Outcome in the Disuse Syndrome: a Retrospective Cohort Study / General Medicine

ABSTRACT

<b>Background:</b> To determine whether nutrition is associated with rehabilitation outcome in the disuse syndrome.<br><b>Methods:</b> A retrospective cohort study was performed in 223 inpatients admitted to a university hospital who were diagnosed by physicians in the rehabilitation department as having the disuse syndrome, and subsequently prescribed physical therapy. Malnutrition was defined as a body mass index<18.5 kg/m², hemoglobin level<10.0 g/dl, serum albumin level<3.0 g/dl, or total lymphocyte count<1200 cells/mm³. Rehabilitation outcome was defined as whether or not the ADL score improved during rehabilitation. Nutritional status was assessed at referral using the Onodera's prognostic nutritional index (PNI).<br><b>Results:</b> The study cohort included 136 men and 87 women (mean age 67.5 years; median duration between admission and referral 17 days; median rehabilitation duration 32 days). A total of 202 patients (91%) were defined as being malnourished. Mean PNI was 32.9, with the ADL score improving in 135 patients (61%) during rehabilitation. Rehabilitation outcome was better in patients with normal nutrition compared to malnourished patients (relative risk 0.72, p=0.04). Patients with a hemoglobin level>10.0 g/dl (relative risk 0.69, p=0.001), total lymphocyte count>1200 cells/mm³ (relative risk 0.78, p=0.03), or PNI>35.0 (relative risk 0.74, p=0.01) had a better rehabilitation outcome. Logistic regression analysis showed that hemoglobin level was associated independently with rehabilitation outcome (odds ratio 2.34, p=0.005).<br><b>Conclusions:</b> Malnutrition is common in patients with the disuse syndrome. Patients with low hemoglobin level and PNI at referral are more likely to have a poor rehabilitation outcome.