Comparison of tendon and muscle belly vibratory stimulation in the treatment of post-stroke upper extremity spasticity: a retrospective observational pilot study.

Previous studies have reported the effects of vibratory stimulation (VS) therapy in reducing upper extremity spasticity after stroke. However, the effective location of the VS in patients with stroke remains unclear. This study aimed to determine the VS location that is most effective in reducing post-stroke finger and wrist flexor spasticity. We enrolled 27 consecutive patients with stroke and upper extremity spasticity in this retrospective observational study. The participants received stretching, tendon vibration, and muscle belly vibration for 5 min over a period of 3 days. To evaluate spasticity, we assessed the Modified Ashworth Scale score before and immediately after each treatment and immediately after voluntary finger flexion. Participants who received tendon vibration showed greater improvement in flexor tone in the fingers than participants who received stretching and muscle belly vibration (P < 0.05 and < 0.001, respectively). Participants who underwent VS showed no significant improvement in the wrist flexor tone compared to those who underwent stretching. Our results suggest that the tendon may be the most effective location for treating spasticity of the finger flexor muscles and that VS may not significantly improve spasticity of the wrist flexors more than stretching.

Muscle weakness is more strongly associated with functional outcomes in patients with stroke than sarcopenia or muscle wasting: an observational study.

BACKGROUND: Stroke-related sarcopenia is an important prognosis factor and an intervention target for improving outcomes in patients with stroke. AIM: This study aimed to identify the association between sarcopenia, possible sarcopenia, muscle weakness, muscle mass and calf circumference, and the functional outcomes 3 months after stroke. METHODS: In this single-centre prospective observational study, muscle strength, muscle mass, and calf circumference were measured in patients with acute stroke at hospital discharge. Diagnosis of sarcopenia, possible sarcopenia, muscle weakness, low muscle mass, and low calf circumference were defined according to the 2019 Asian Working Group for Sarcopenia criteria. The primary outcome measure was the modified Rankin Scale (mRS) score at 3 months, with an mRS score of 3 or higher indicating a poor outcome. Logistic regression analysis was conducted to examine independent associations between each assessment and functional outcomes. RESULTS: A total of 247 patients (median age: 73 years) were included in this study. The prevalence of sarcopenia was 28% (n = 70), and in the adjusted model, sarcopenia (aOR = 2.60, 95% CI 1.07-6.31, p = 0.034), muscle weakness (aOR = 3.40, 95% CI 1.36-8.52, p = 0.009), and low muscle mass (aOR = 2.61, 95% CI 1.04-6.52) were significantly associated with poor functional outcome. Nevertheless, other evaluations did not demonstrate an independent association with the outcome. CONCLUSION: Sarcopenia, muscle weakness, and low muscle mass were found to be independently associated with functional outcomes 3 months after stroke, and muscle weakness exhibited the strongest association with outcomes among them.

Development of the Japanese version of the awareness questionnaire for assessment of self-awareness after acquired brain injury: reliability and validity.

BACKGROUND: The evaluation of impaired self-awareness (ISA) after brain injury is not widespread in Japan, and there is a lack of Japanese assessments of self-awareness. OBJECTIVES: To translate the original version of the Awareness Questionnaire (AQ), an instrument for assessing ISA, into Japanese using a validated method and examine its reliability and validity in inpatients with stroke. METHODS: This cross-sectional, prospective study enrolled 130 participants. The double-translation process was used to develop the Japanese version of the AQ. RESULTS: Data were collected from 120 patients. High intra-rater reliability was observed for the patient (Cronbach's α = 0.824) and clinician samples (Cronbach's α = 0.933). High intra- and inter-rater reliability were found for all AQ items [interclass coefficient (ICC) (1, 1) = 0.828, ICC (2, 1) = 0.852, ICC (3, 1) = 0.848]; however, the sub-item analysis revealed only moderate reliability. Validity assessment revealed a low but significant positive correlation (r = 0.209; p < 0.05) between the Japanese version of the AQ and the Japanese version of the Self-Regulation Skills Interview and a low but significant negative correlation (r = 0.197; p < 0.05) between the Japanese version of the AQ and the Mini-Mental State Examination. CONCLUSIONS: The Japanese version of the AQ was developed and applied to stroke patients, but the concept of post-stroke ISA may differ from ISA after traumatic brain injury, highlighting the need for a stroke-specific version of the AQ.

The Association between fatigue and physical activity in patients hospitalized with subacute stroke.

BACKGROUND: Little is known about the association between fatigue and physical activity in patients hospitalized with subacute stroke. OBJECTIVES: The aim of this study was to investigate the association between fatigue and physical activity in patients hospitalized with subacute stroke. METHODS: This cross-sectional study enrolled 244 consecutive patients with stroke who were admitted to a subacute rehabilitation ward at our hospital. We assessed fatigue with the Fatigue Assessment Scale (FAS) and used an accelerometer (Active style Pro HJA750-C, OMRON) to record the mean duration of sedentary behavior, light-intensity physical activity (LIPA), and moderate-to-vigorous-intensity physical activity (MVPA). We assessed all factors at 1 month after stroke. Multivariate linear regression analysis revealed the associations between FASscore and objectively measured physical activity. RESULTS: In total, we analyzed 85 patients. The duration of the sedentary behavior was significantly associated with the FAS score (ß = 1.46, p = 0.037) and the Functional Balance Scale score (ß = -1.35, p = 0.045). The LIPA time was significantly associated only with the FBS score (ß = 1.38, p = 0.045), whereas MVPA was not associated with any variable.

Sarcopenia in patients following stroke: Prevalence and associated factors.

BACKGROUND: This study aimed to investigate the prevalence and associated factors of sarcopenia in patients following stroke during acute hospitalisation. METHODS: This single-centre prospective observational cohort study assessed skeletal muscle mass using bioelectrical impedance analysis and muscle strength of patients with acute stroke at hospital discharge. Sarcopenia was diagnosed according to the AWGS-2019 criteria. Multiple logistic regression analyses were performed to identify associated factors of post stroke sarcopenia. RESULTS: A total of 286 participants (32% female; median age, 72 years) were included in this study. The prevalence of post-stroke sarcopenia was 32.5% (n = 93). In multiple logistic regression analysis, age (adjusted odds ratio [aOR]: 1.10; 95% confidence interval [CI]: 1.05-1.05), National Institute of Health Stroke Scale (aOR: 1.15; 95% CI: 1.04-1.27), body mass index (BMI) (aOR: 0.73; 95% CI: 0.64-0.84) and Functional Oral Intake Scale (aOR: 0.67; 95% CI: 0.51-0.89) were independently associated with post-stroke sarcopenia during acute hospitalisation. CONCLUSION: Approximately one-third of acute stroke patients were diagnosed with sarcopenia at hospital discharge, and older age, severe stroke, low BMI, and poor swallowing function are associated with sarcopenia following stroke during acute hospitalisation.

Attempt to Make the Upper-Limb Item of Objective Fugl-Meyer Assessment Using 9-Axis Motion Sensors.

The Fugl-Meyer Assessment (FMA) has been used as a functional assessment of upper-limb function in stroke patients. This study aimed to create a more objective and standardized evaluation based on an FMA of the upper-limb items. A total of 30 first-ever stroke patients (65.3 ± 10.3 years old) and 15 healthy participants (35.4 ± 13.4 years old) admitted to Itami Kousei Neurosurgical Hospital were included. A nine-axis motion sensor was attached to the participants, and the joint angles of 17 upper-limb items (excluding fingers) and 23 FMA upper-limb items (excluding reflexes and fingers) were measured. From the measurement results, we analyzed the time-series data of each movement and obtained the correlation between the joint angles of each part. Discriminant analysis showed that 17 and 6 items had a concordance rate of ≥80% (80.0~95.6%) and <80% (64.4~75.6%), respectively. In the multiple regression analysis of continuous variables of FMA, a good regression model was obtained to predict the FMA with three to five joint angles. The discriminant analysis for 17 evaluation items suggests the possibility of roughly calculating FMA scores from joint angles.

Association of Malnutrition With Physical Activity Intensity in Patients With Subacute Stroke.

OBJECTIVE: To investigate the relationship between nutritional status measured by the Global Leadership Initiative on Malnutrition (GLIM) criteria and the intensity of physical activity, and to determine the association between these factors and the activities of daily living (ADLs) in patients with subacute stroke during hospitalization. DESIGN: A cross-sectional study. SETTING: The study was conducted in the rehabilitation unit at a neurosurgical hospital. PARTICIPANTS: One hundred and twenty-eight patients with subacute stroke (N=128). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Nutritional status was assessed using GLIM criteria. Sedentary behavior (SB), light-intensity physical activity (LIPA), and moderate-to-vigorous physical activity (MVPA) were measured using an accelerometer. Multiple regression analysis was used to investigate the relationship between nutritional status and intensity of physical activity. Moreover, the association of nutritional status and physical activity intensity with ADLs was determined using multiple regression analysis and mediation analysis. RESULTS: Malnutrition was associated with SB time (B = 16.241, P=.009) and LIPA time (B = -17.656, P=.002), but not MVPA time (B = -0.472, P=.776). SB time (B = -0.063, P=.009) and LIPA time (B = 0.093, P<.001) were associated with functional independence measure for motor function, while MVPA time (B = -0.080, P=.379) was not. SB time (coefficient = -10.785, P<.001) and LIPA time (coefficient = -12.054, P<.001) were significant mediators between nutrition status and ADLs. CONCLUSIONS: Malnutrition was associated with a SB time and LIPA time, but not MVPA time, in patients with sub-acute stroke. SB and LIPA times were associated with ADLs and mediated between nutrition status and ADLs in these patients. The association of nutritional status on physical activity and ADLs should be considered in stroke rehabilitation.

Correlations between aerobic exercise time during physiotherapy and characteristics of patients with subacute stroke: A pilot cross-sectional study.

BACKGROUND: The amount of aerobic exercise time (AET) is an important factor for improving physical function in patients with stroke. However, there is a lack of evidence regarding the factors for AET during physiotherapy, particularly in stroke patients. OBJECTIVE: To investigate the correlation between AET during physiotherapy and characteristics of patients with subacute stroke. METHODS: In this cross-sectional study, 61 hospitalized subacute stroke patients (age = 72 (11) years, (median (interquartile range)) were enrolled and their exercise intensity was measured by wearable sensors (Mio Alpha 2) worn during physiotherapy sessions. All patients were divided into two groups, non-ambulatory group (functional ambulation classification (FAC); 0-2) and ambulatory group (FAC; 3-5). The correlations between AET and patient characteristics were assessed in each group. RESULTS: There was no significant difference in AET between the ambulatory and non-ambulatory groups (9 (12) min vs 5 (10) min, p = .27, respectively). There was a significant correlation between AET and the functional independent measures (FIM) motor score in the ambulatory group (r = 0.52, p = .005), and between AET and the FIM cognitive score in the non-ambulatory group (r = 0.44, p = .008). CONCLUSION: Correlations between AET and patient characteristics were different according to ambulation capacity in patients with subacute stroke.

Association between premorbid sarcopenia and neurological deterioration in patients with acute ischemic stroke.

OBJECTIVE: Sarcopenia is associated with poor outcomes in patients with stroke. This study aimed to investigate the association between premorbid sarcopenia and neurological deterioration (ND) in patients with acute ischemic stroke. To the best of our knowledge, there have been no studies on this topic. METHODS: In this prospective longitudinal study, we assessed premorbid sarcopenia using the SARC-F questionnaire, and the incidence of ND was defined by an increase of ≥ 1 point on the National Institutes of Health Stroke Scale (NIHSS) or the occurrence of any new neurological symptoms/signs. Logistic regression analysis was used to investigate the relationship between premorbid sarcopenia and ND. RESULTS: Of the 290 patients enrolled, 46 and 244 patients experienced and did not experience ND 1 week after admission (ND and non-ND groups, respectively). The prevalence of sarcopenia was significantly higher in the ND group than in the non-ND group (39% vs. 17%). In the adjusted model, premorbid sarcopenia was significantly associated with ND (adjusted odds ratio: 3.06, 95% confidence interval: 1.11-8.40; p = 0.03). CONCLUSION: Premorbid sarcopenia is independently associated with ND in patients with acute ischemic stroke. Therefore, it is necessary to detect premorbid sarcopenia to predict ND in these patients.

[Evaluation of the Capacity to Produce Histamine by Histamine-Producing Bacteria during Storage at 10℃].

Histamine is produced from histidine using histidine decarboxylase of histamine-producing bacteria. However, associated histamine food poisoning demands microbiological controls. Furthermore, studies reported that histamine production by histamine-producing bacteria is affected by temperature. Therefore, to prevent histamine food poisoning, it is desirable to store foods below 4℃. However, it is challenging to maintain the storage temperature of food substances in refrigerators constantly below 4℃. Thus, we investigated histamine production capacity using seven histamine-producing bacterial strains under storage at 10℃, a more reasonable cold storage condition. Subsequently, we examined the variation of histamine production in buffers, the correlation between bacterial density and histamine production quantities, and the growth rate in broths. Results showed that similar levels of histamine were produced in buffers even after 5 days of storage under certain conditions in which histamine-producing bacteria did not grow. Moreover, bacterial density was proportional to histamine production, and the coefficient of determination was more than 0.97, and the bacterial density required to produce 200 µg/mL of histamine during storage at 10℃ was calculated to be 4×107-4×108 CFU/mL. When the initial bacterial density was 102-103 CFU/mL, psychrophilic bacteria required 2 or 3 days and mesophilic bacteria required more than 4 days to grow above 107 CFU/mL. The above results suggest that understanding the capacity of histamine-producing bacteria to produce histamine and its growth rate in foods is important for the prevention of histamine food poisoning.

[Prevalence of Foodborne Pathogens in Retail Meat in Saitama, Japan].

We investigated the prevalence of Campylobacter jejuni, Campylobacter coli, Salmonella, enterohemorrhagic Escherichia coli, enterotoxigenic Escherichia coli, Yersinia enterocolitica, and Escherichia albertii in domestic chicken and pork sold at retail stores in Saitama Prefecture, Japan. Campylobacter was detected in 35.7% (60/168) of chicken samples and 7.3% (14/190) of pork samples. C. jejuni and C. coli were predominant in chicken and pork, respectively. Salmonella was found in 58.1% (100/172) of chicken samples and 19.9% (41/206) of pork samples. Moreover, Salmonella Schwarzengrund was the major serovar observed in chicken isolates, whereas S. Typhimurium monophasic variant was in pork isolates. Furthermore, ETEC was found in 0.6% (1/160) of chicken samples and 2.4% (5/206) of pork samples. Y. enterocolitica was absent from all (83/83) chicken samples but was present in 9.3% (18/193) of pork samples, with a prevalence in pork tongues as high as 21.0% (13/62 samples). However, EHEC and E. albertii were not detected in our study. Therefore, the results of this study indicate that chicken was highly contaminated with Campylobacter sp. and Salmonella, and pork was with Y. enterocolitica serotype O3, Campylobacter sp., Salmonella, and ETEC.

Association between the coexistence of premorbid sarcopenia, frailty, and disability and functional outcome in older patients with acute stroke.

AIM: To investigate the effects of coexisting conditions such as premorbid sarcopenia, frailty, and disability on functional outcomes in older patients with acute stroke. METHODS: This prospective cohort study included older patients (aged ≥65 years) hospitalized for acute stroke at a single neurosurgical hospital. Premorbid sarcopenia, frailty, and disability were diagnosed using the strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) questionnaire, frailty index, and modified Rankin Scale (mRS) on admission. The primary outcome was the mRS score 3 months after stroke, and a poor outcome was defined as mRS ≥4. RESULTS: This study included 317 older patients with acute stroke (median [interquartile range] age: 76 [12] years). Premorbid sarcopenia, frailty, and disability (mRS = 2 or 3) were identified in 59 (19%), 27 (9%), and 54 (17%) patients, respectively. Two coexisting conditions were observed in 26 patients (8%), and three were observed in 18 patients (6%). Adjusted logistic regression analysis revealed that coexisting conditions were independently associated with poor outcomes (one condition, adjusted OR: 3.20 [95%CI: 0.98-10.45]; two conditions, adjusted OR: 6.57 [95%CI: 1.74-24.87]; three conditions, adjusted OR: 12.70 [95%CI: 2.65-60.91]). CONCLUSIONS: The coexistence of premorbid sarcopenia, frailty, and disability was associated with poor functional outcomes in older patients with acute stroke. Geriatr Gerontol Int 2022; 22: 642-647.

Daily steps are associated with walking ability in hospitalized patients with sub-acute stroke.

Increased physical activity is required in patients with stroke that are hospitalized in the rehabilitation unit. This study investigated the association between the daily number of steps and walking independence in order to determine the cutoff value of daily number of steps that can predict walking independence in hospitalized patients with sub-acute stroke. This cross-sectional observational study included 85 stroke patients admitted to the rehabilitation unit. The average daily number of steps was measured using Fitbit One for 4 days starting at 30 days after stroke onset. 6-min walk test, and Fugl-Meyer assessment of the lower extremities were measured The category of walking independence was classified using the Functional Ambulation Category (FAC). The subjects were divided into two groups according to the FAC score: a walking independence group (FAC ≥ 4) and a walking non-independence group (FAC ≤ 3). Logistic regression analysis was conducted to investigate the association of daily number of steps with walking independence and a receiver operating characteristic curve was used to identify the cutoff value of daily number of steps for predicting walking independence. The daily number of steps (per 1000 steps) was independently associated with walking independence (odds ratio (OR); 2.53, 95% confidence interval (CI); 1.40-5.73, p = 0.009). The cutoff value of daily number of steps for predicting independent walking was 4286 steps (area under the curve = 0.914, sensitivity of 0.731, and specificity of 0.949). The daily number of steps was associated with independent walking in hospitalized patients with sub-acute stroke. The daily number of steps may be a useful target in rehabilitation for patients with sub-acute stroke.

Care-needs Certification in the National Long-Term Care Insurance is Useful for Assessment of Premorbid Function in Older Japanese Patients with Stroke.

OBJECTIVE: To investigate the effects of premorbid long-term care insurance (LTCI) care-need certification on functional improvement during acute hospitalization in older patients with stroke. METHODS: In this single-center prospective cohort study, we assessed LTCI care-needs certification and the modified Rankin Scale (mRS) at the premorbid stage, on admission, and at hospital discharge in older patients with stroke. We also assessed adverse events during hospitalization. The main outcome was the presence of functional improvement during hospitalization (mRS on admission < mRS at discharge). Multivariate analysis was performed to investigate the relationship between functional improvement and premorbid LTCI care-need certification. RESULTS: In total, 246 older patients with stroke were enrolled in this study. There was a significant independent association between premorbid LTCI care-needs certification (care level 1 = odds ratio [OR]: 0.26, 95% CI: 0.10-0.72, p = 0.01; Care level 2 = OR: 0.27, 95% CI: 0.10-0.73, p = 0.01; care level 3-5 = OR: 0.21, 95% CI: 0.08-0.56, p = 0.002; Not applicable = reference) and functional improvement. CONCLUSIONS: Premorbid LTCI care-need certification is associated with short-term functional improvement in older patients with stroke. Assessment of premorbid LTCI care-needs certification is valid for predicting functional improvement in older patients with stroke.

Objectively measured physical activity was not associated with neighborhood walkability attributes in community-dwelling patients with stroke.

Although the built environment may affect physical activity, there is little evidence on how neighborhood walkability attributes influence post-stroke physical activity. This study aimed to explore associations between objectively measured physical activity and neighborhood walkability attributes in community-dwelling patients with stroke. This cross-sectional study recruited patients who could ambulate outside free of assistance. We assessed objectively measured physical activity comprising the number of steps taken and time spent in moderate-to-vigorous physical activity (MVPA) with an accelerometer. Neighborhood walkability attributes were evaluated using the Walk Score. Multiple linear regression analyses were used to determine whether the Walk Score was independently associated with the number of steps taken or MVPA. Eighty participants with a mean age of 65.9 ± 11.1 years were included. The participants took an average of 5900.6 ± 2947.3 steps/day and spent an average of 19.7 ± 21.7 min/day in MVPA. The mean Walk Score was 71.4 ± 17.2. Multiple linear regression analyses showed that no significant associations were found between the Walk Score and the number of steps taken or MVPA. No associations were found between objectively measured physical activity and neighborhood walkability attributes in community-dwelling patients with stroke in an Asian area.

Different association between physical activity and physical function according to walking independence in hospital-based rehabilitation program patients with sub-acute stroke.

OBJECTIVE: To investigate the association between physical activity and physical function in ambulatory independent and non-independent patients with sub-acute stroke during hospitalization. METHODS: This cross-sectional observational study included 107 patients with stroke admitted to a rehabilitation unit. The average daily number of steps taken was considered as physical activity. Physical function was assessed using the 6 min walk test (6MWT), lower limb Fugl-Meyer assessment (FMA), and Berg balance scale (BBS). Walking independence was assessed using the functional ambulation category (FAC). The subjects were divided into a walking independence group (FAC ≥ 4) and a non-independence group (FAC ≤ 3). Multiple regression analysis was used to investigate the relationship between the daily number of steps and physical function in each group. RESULTS: The daily number of steps (p < 0.001), lower limb FMA (p < 0.001), 6MWT (p < 0.001), and BBS (p < 0.001) were higher in the independent walking group than in the non-walking group. The daily number of steps in the walking independence group was significantly associated with the 6MWT (standard ß = 0.489, p = 0.039). In the non-independence group, the daily number of steps was significantly associated with the BBS (standard ß = 0.594, p < 0.001). CONCLUSION: Physical activity was associated with walking endurance in patients with ambulatory independence, even though it was associated with balance function in patients with non-ambulatory independence.

Cachexia criteria in chronic illness associated with acute weight loss in patients with stroke.

OBJECTIVES: Weight loss after a stroke is associated with poor outcomes. However, the causes of weight loss in the acute phase of a stroke are not fully understood. The purpose of this study was to investigate the relationship between acute weight changes and cachexia criteria in patients with an acute stroke. METHODS: In this prospective-cohort study, we assessed patients' body weight change during hospitalization, and investigated the five cachexia criteria (muscle strength, fatigue, anorexia, skeletal muscle mass, and abnormal biochemistry) at time of discharge in patients with an acute stroke. A patient was defined as being cachectic if ≥3 cachexia criteria were met. A multivariate analysis was performed to investigate the relationship between weight changes and cachexia criteria. RESULTS: A total of 155 patients with an acute stroke were enrolled in this study, and 30 patients (19%) were found to have weight loss (≥5% weight loss). A univariate regression analysis found that the cachexia criteria were significantly associated with weight changes (ß = -0.338; P < 0.001). The multivariate analyses after adjusting for energy intake, age, sex, body mass index at time of admission, National Institutes of Health stroke scale score, inflammatory disease, length of hospital stay, length of bed rest, and swallowing function showed that the cachexia criteria were significantly associated with weight changes (ß = -0.154; P = 0.043). CONCLUSIONS: The cachexia criteria were independently associated with acute weight loss in patients with a stroke.

Prevalence of Malnutrition Diagnosed with GLIM Criteria and Association with Activities of Daily Living in Patients with Acute Stroke.

BACKGROUND: Malnutrition is associated with a poor functional outcome in patients with stroke. However, the prevalence of malnutrition diagnosed with the Global Leadership Initiative on Malnutrition (GLIM) criteria or its association with activity of daily living (ADL) in patients with acute stroke have not been reported. OBJECTIVE: To investigate the prevalence of the malnutrition diagnosed with the GLIM criteria and its association with ADL or discharge destination in patients with acute stroke. MATERIALS AND METHODS: In this cross-sectional study, we diagnosed malnutrition with the GLIM criteria and the European Society for Clinical Nutrition and Metabolism (ESPEN) criteria and assessed ADL by functional independence measure motor domain (FIM-M) score in patients with acute stroke. Multivariate regression analysis was used to investigate the relationship between FIM-M score or home discharge and malnutrition defined with GLIM or ESPEN criteria. RESULTS: A total of 115 acute stroke patients (39 females; median age: 72 years) were enrolled in this study. The prevalence of malnutrition according to GLIM-criteria and ESPEN-criteria was 28.7% and 16.5%, respectively. Multivariate analyses for FIM-M score after adjusting for potential confounders showed that GLIM criteria and ESPEN criteria were independently associated with FIM-M score (ß = -0.238, p < 0.001; ß = -0118, p = 0.040, respectively). A multivariate analysis for discharge destination found that only malnutrition from the GLIM criteria was significantly associated with home discharge (OR = 0.08, 95% confidential interval = 0.01-0.69, p = 0.02). CONCLUSIONS: Malnutrition with the GLIM criteria is negatively associated with ADL and is also associated with discharge destination in patients with acute stroke.

Relationship between pre-stroke frailty status and short-term functional outcome in older patients with acute stroke-A mediation analysis.

AIM: The aim of this study was to investigate the effects of pre-stroke frailty status on short-term functional outcome in older patients with acute stroke. METHODS: In this prospective longitudinal study, we assessed the pre-stroke frailty status (robust, prefrail, or frail) by the Frailty Screening Index, disease severity by the National Institutes of Stroke Scale (NIHSS), and short-term functional outcome by the modified Rankin Scale (mRS) at discharge from acute hospital in patients with older stroke. We considered poor functional outcome to be a mRS >2. Logistic regression analysis and mediation analysis were used to investigate the relationships among pre-stroke frailty status, disease severity, length of stay (LOS), and short-term functional outcome. RESULTS: A total of 232 patients were enrolled in this study. The NIHSS and LOS were significantly different between groups (p<0.001, p = 0.01, respectively), but there was no relationship between frailty status and short-term functional outcome (p = 0.22). Based on the logistic regression analyses after adjusting for potential confounders, the NIHSS (odds ratio (OR): 1.75, 95% confidence interval (CI): 1.44-2.14, p<0.001) and LOS (OR: 1.07, 95%CI: 1.03-1.11) were independently associated with a poor functional outcome. In the mediation analysis, the NIHSS (ß=0.137, p<0.001) and LOS (ß=0.09, p<0.004) were significant mediators between pre-stroke frailty status and poor functional outcome. CONCLUSIONS: The relationship between pre-stroke frailty status and short-term functional outcome was mediated by disease severity and LOS in older patients with acute stroke.