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Association between Pre-stroke Frailty and Clinical Outcomes: A Systematic Review and Meta-analysis
Issei Murai1, Kensuke Matsuda2, Takashi Ariie2
1Department of Rehabilitation, Takagi Hospital, Japan.
Physical Therapy Research
|January 9, 2026
Summary
Pre-stroke frailty is linked to worse outcomes after a stroke, including higher mortality and poorer functional recovery. This systematic review highlights the need to consider frailty in stroke patient care.
Area of Science:
- Neurology
- Gerontology
- Public Health
Background:
- The impact of pre-stroke frailty on patient outcomes is not well understood.
- Frailty is a condition of decreased physiological reserve, increasing vulnerability to stressors.
Purpose of the Study:
- To systematically review and synthesize evidence on the association between pre-stroke frailty and clinical outcomes.
- To examine the relationship between pre-stroke frailty and mortality, length of stay (LOS), and functional outcomes in stroke survivors.
Main Methods:
- A systematic literature search was conducted across PubMed, EMBASE, and CENTRAL.
- Included studies were assessed for risk of bias using the Quality in Prognosis Studies tool.
- Meta-analyses were performed using random effects models, and evidence certainty was evaluated using GRADE criteria.
Main Results:
- Fourteen studies involving 11,583 participants were included.
- Pre-stroke frailty was associated with increased mortality (OR: 1.11, 95% CI: 1.0-1.23).
- Associations with longer LOS and poorer functional outcomes were also observed, though evidence certainty was low.
Conclusions:
- Frailty present before a stroke may be a significant predictor of adverse clinical outcomes.
- Higher mortality, increased length of hospital stay, and diminished functional recovery are potential consequences of pre-stroke frailty.
- Further research is needed to clarify these associations due to the low certainty of the current evidence.
