Yoshihiro Yoshimura1, Hidetaka Wakabayashi2, Takahiro Bise3, Fumihiko Nagano3, Sayuri Shimazu4, Ai Shiraishi5, Makio Yamaga3, Hiroaki Koga3. 1. Department of Rehabilitation Medicine, Kumamoto Rehabilitation Hospital, Kumamoto, Japan. Electronic address: Hanley.belfus@gmail.com. 2. Department of Rehabilitation Medicine, Yokohama City University Medical Center, Yokohama, Japan. 3. Department of Rehabilitation Medicine, Kumamoto Rehabilitation Hospital, Kumamoto, Japan. 4. Department of Nutritional Management, Kumamoto Rehabilitation Hospital, Kumamoto, Japan. 5. Department of Dental Office, Kumamoto Rehabilitation Hospital, Kumamoto, Japan.
Abstract
OBJECTIVE: The aim of this study was to evaluate the effect of sarcopenia on functional outcomes, including activities of daily living (ADLs); dysphagia status; and the rate of home discharge, among hospitalized adults receiving convalescent rehabilitation. METHODS: A retrospective cohort study was conducted with 898 patients newly admitted to in-hospital convalescent rehabilitation wards at a single rehabilitation hospital in Japan. Baseline sarcopenia was diagnosed using muscle mass index and handgrip strength according to the criteria of the European Working Group on Sarcopenia in Older People, with the cutoff values of the Asian Working Group for Sarcopenia. The primary outcome was ADLs, assessed by Functional Independence Measure motor (FIM-motor) score at hospital discharge. The secondary outcomes included dysphagia, assessed by the Food Intake Level Scale (FILS), at discharge, and the rate of home discharge. Three multivariate analyses revealed an association between sarcopenia and the clinical outcomes. Each analysis adjusted for the following confounders: age, sex, time from onset, premorbid ADLs, comorbidities, cognitive level, nutritional status, major drugs, and admission diagnoses. RESULTS: After enrollment, 795 patients (mean age 74.9 ± 13.2 y; 59% women) were included in the final analysis. Admission diagnoses included stroke (n = 276; 34.7%), musculoskeletal disorders (n = 382; 48.1%), and hospital-associated deconditioning (n = 137; 17.2%). Of the 795 patients examined, 402 (50.6%) had sarcopenia. The multiple linear regression analysis showed that sarcopenia was independently associated with FIM motor score at discharge in patients with all disease types (β = -0.189 [stroke], -0.240 [musculoskeletal disorders], -0.230 [hospital-associated deconditioning]; all P < 0.05), with FILS score at discharge only in patients with musculoskeletal disorders (β = -0.271, P < 0.001), but not in patients with stroke (β = -0.061, P = 0.375) or those with hospital-associated deconditioning (β = -0.131, P = 0.070). The multiple logistic regression analysis showed that sarcopenia was associated with rate of home discharge in all disease types (odds ratio [OR], 0.201; 95% confidence interval [CI], 0.067-0.597 for stroke; OR, 0.242; 95% CI, 0.076-0.772 for musculoskeletal disorders; OR, 0.121; 95% CI, 0.110-0.347 for hospital-associated deconditioning; all P < 0.05). CONCLUSIONS: Sarcopenia is associated with worse recovery of ADLs and dysphagia and a lower rate of home discharge in hospitalized adults undergoing convalescent rehabilitation. Early detection of sarcopenia and treatment by rehabilitation nutrition should be implemented in this population.
OBJECTIVE: The aim of this study was to evaluate the effect of sarcopenia on functional outcomes, including activities of daily living (ADLs); dysphagia status; and the rate of home discharge, among hospitalized adults receiving convalescent rehabilitation. METHODS: A retrospective cohort study was conducted with 898 patients newly admitted to in-hospital convalescent rehabilitation wards at a single rehabilitation hospital in Japan. Baseline sarcopenia was diagnosed using muscle mass index and handgrip strength according to the criteria of the European Working Group on Sarcopenia in Older People, with the cutoff values of the Asian Working Group for Sarcopenia. The primary outcome was ADLs, assessed by Functional Independence Measure motor (FIM-motor) score at hospital discharge. The secondary outcomes included dysphagia, assessed by the Food Intake Level Scale (FILS), at discharge, and the rate of home discharge. Three multivariate analyses revealed an association between sarcopenia and the clinical outcomes. Each analysis adjusted for the following confounders: age, sex, time from onset, premorbid ADLs, comorbidities, cognitive level, nutritional status, major drugs, and admission diagnoses. RESULTS: After enrollment, 795 patients (mean age 74.9 ± 13.2 y; 59% women) were included in the final analysis. Admission diagnoses included stroke (n = 276; 34.7%), musculoskeletal disorders (n = 382; 48.1%), and hospital-associated deconditioning (n = 137; 17.2%). Of the 795 patients examined, 402 (50.6%) had sarcopenia. The multiple linear regression analysis showed that sarcopenia was independently associated with FIM motor score at discharge in patients with all disease types (β = -0.189 [stroke], -0.240 [musculoskeletal disorders], -0.230 [hospital-associated deconditioning]; all P < 0.05), with FILS score at discharge only in patients with musculoskeletal disorders (β = -0.271, P < 0.001), but not in patients with stroke (β = -0.061, P = 0.375) or those with hospital-associated deconditioning (β = -0.131, P = 0.070). The multiple logistic regression analysis showed that sarcopenia was associated with rate of home discharge in all disease types (odds ratio [OR], 0.201; 95% confidence interval [CI], 0.067-0.597 for stroke; OR, 0.242; 95% CI, 0.076-0.772 for musculoskeletal disorders; OR, 0.121; 95% CI, 0.110-0.347 for hospital-associated deconditioning; all P < 0.05). CONCLUSIONS:Sarcopenia is associated with worse recovery of ADLs and dysphagia and a lower rate of home discharge in hospitalized adults undergoing convalescent rehabilitation. Early detection of sarcopenia and treatment by rehabilitation nutrition should be implemented in this population.