Prolonged length of stay and reduced functional improvement rate in malnourished stroke rehabilitation patients.
OBJECTIVE
To determine associations between the nutritional status of inpatient rehabilitation (rehab) unit stroke patients and (1) length of stay (LOS) and (2) functional outcome using Modified Barthel Index (MBI). Secondary objective-to determine whether hypoalbuminemia was equally related to outcome measures. A priori hypothesis-LOS and MRI are adversely related to malnutrition.


METHODS
inception cohort study.


METHODS
Tertiary care center.


METHODS
49 consecutive "middle-band" patients (4 declined).


METHODS
LOS and MRI at admission (T1), 1 month (T2), and discharge (T3).


RESULTS
LOS was significantly related to overall malnutrition, T1 and T2MBI scores, T1 dysphagia, T1 enteral feeding (all p<.01), T1 malnutrition, peripheral vascular disease (negative relationship), and diabetes mellitus history (all p<.05). In analysis of covariance, adjusting for T1 MBI, overall rehab malnutrition was related to LOS (p=.011). Other covariates were not significant. T1 malnutrition was related to lower T2 MBI scores(p=.038). Lower T1 MBI scores was related to T2 malnutrition (p=.032). Diabetics (p=.005) and right hemispheric lesion patients(p=.015) had lower T1 MBI scores. Hypoalbuminemia was unrelated to LOS and MBI scores. Although malnourished and adequately nourished functionally dependent patients improved equally in MBI scores by discharge, prolonged LOS in the malnourished lowered their functional improvement rate ([T3 MBI - T1 MBI]/LOS) (p=.047).


CONCLUSIONS
Malnutrition was the most potentially modifiable variable relating to LOS and functional outcome. Close attention to nutrition status may help to optimize stroke patients' rehab potential and use of health care resources.
Finestone
H M
HM
Department of Physical Medicine and Rehabilitation, University of Western Ontario, Canada.
Greene-Finestone
L S
LS
Wilson
E S
ES
Teasell
R W
RW
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D002561:Cerebrovascular Disorders / Q000097:blood / Q000150:complications / Q000534:rehabilitation*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009748:Nutrition Disorders / Q000209:etiology* / Q000378:metabolism; D009752:Nutritional Status; D012047:Rehabilitation Centers; D012709:Serum Albumin / Q000378:metabolism; D016896:Treatment Outcome
D012709:Serum Albumin