title: Obese Japanese Patients with Stroke Have Higher Functional Recovery in Convalescent Rehabilitation Wards: A Retrospective Cohort Study.
abstract: BACKGROUND
  A protective effect of excessive body mass index (BMI) on mortality or functional outcome in patients with stroke is not well established in the Asian population. This study aimed to explore whether obese patients with stroke have advantages for functional improvement in Japanese rehabilitation wards.
  
  
  METHODS
  This retrospective cohort study included consecutive patients with stroke admitted and discharged from convalescent rehabilitation wards between 2011 and 2015. Demographic data, BMI, Functional Independence Measure (FIM) score, and nutritional status were analyzed. Participants were classified into 4 groups according to BMI (underweight <18.5 kg/m(2), standard 18.5-<23 kg/m(2), overweight 23-<27.5 kg/m(2), obese ≥27.5 kg/m(2)). The primary outcome was the FIM gain, and the secondary outcome was the FIM score at discharge. Multiple regression analysis was performed to analyze the relationship between BMI and functional recovery.
  
  
  RESULTS
  In total, 897 participants (males 484, females 413; mean age 71.6 years) were analyzed and classified as underweight (134), standard (432), overweight (277), and obese (54). The median FIM gain and the FIM score at discharge were 30 and 114, respectively. The FIM gain in the obese group was significantly higher than those in the other groups. Multiple regression analysis revealed that obesity was independently correlated with the FIM gain, and those at discharge after adjusting for confounders such as age, gender, and FIM score on admission.
  
  
  CONCLUSIONS
  Obese Japanese convalescent patients with stroke may have some advantages for functional recovery in rehabilitation wards.
authors.affiliation: Department of Clinical Nutrition and Food Services, Nagasaki Rehabilitation Hospital. Electronic address: shintacks@yahoo.co.jp.
authors.forename: Shinta
authors.initials: S
authors.lastname: Nishioka
authors.affiliation: Department of Rehabilitation Medicine, Yokohama City University Medical Center.
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Wakabayashi
authors.affiliation: Department of Clinical Services, Nagasaki Rehabilitation Hospital.
authors.forename: Tomomi
authors.initials: T
authors.lastname: Yoshida
authors.affiliation: Department of Clinical Services, Nagasaki Rehabilitation Hospital.
authors.forename: Natsumi
authors.initials: N
authors.lastname: Mori
authors.affiliation: Department of Clinical Services, Nagasaki Rehabilitation Hospital.
authors.forename: Riko
authors.initials: R
authors.lastname: Watanabe
authors.affiliation: Department of Clinical Services, Nagasaki Rehabilitation Hospital.
authors.forename: Emi
authors.initials: E
authors.lastname: Nishioka
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003072:Cognition Disorders / Q000209:etiology; D003289:Convalescence; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D044342:Malnutrition / Q000150:complications; D009069:Movement Disorders / Q000209:etiology; D009752:Nutritional Status; D009765:Obesity / Q000150:complications*; D020127:Recovery of Function; D012047:Rehabilitation Centers; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation
keywords: Functional Independence Measure; Obesity paradox; convalescent rehabilitation wards; functional recovery; stroke