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Updated: Apr 7, 2026
Motor Dual-Tasks for Gait Analysis and Evaluation in Post-Stroke Patients
Published on: March 11, 2021
Muscle loss must be interpreted in the context of fluid imbalance: a dual-parameter model predicts functional
Kota Amakasu1,2, Tatsuro Inoue3, Araki Saito2,4
1Department of Rehabilitation, Shinrakuen Hospital, Niigata, Japan.
Aim:
To examine whether the coexistence of elevated extracellular water-to-total body water ratio (ECW/TBW) and low appendicular lean soft tissue index (ALSTI), a combined fluid-muscle phenotype, predicted poorer functional independence at hospital discharge.
Findings:
The coexistence of high ECW/TBW and low ALSTI was associated with poorer functional independence at hospital discharge, whereas low ALSTI alone was not.
Message:
The interpretation of ALSTI in patients with acute stroke should consider ECW/TBW and that ALSTI with ECW/TBW is clinically useful in predicting prognosis.
Purpose:
We aimed to examine whether the coexistence of elevated extracellular water-to-total body water ratio (ECW/TBW) and low appendicular lean soft tissue index (ALSTI), a combined fluid-muscle phenotype, predicted poorer functional independence at hospital discharge.
Methods:
Patients aged ≥65 years with an acute stroke between 2021 and 2024 were included. Baseline body composition was measured using bioelectrical impedance analysis within one week of rehabilitation initiation. High ECW/TBW was defined as ≥0.400, and low ALSTI as <7.0 kg/m2 for males and <5.7 kg/m2 for females. Functional independence at discharge was assessed using the modified Rankin Scale (mRS), with scores of 0-2 defined as independent and 3-6 defined as non-independent. Multivariate logistic regression analysis was used to examine the effects of the coexistence of high ECW/TBW and low ALSTI on functional independence.
Results:
In total, 560 patients were included in the analysis. The number of patients with high ECW/TBW and low ALSTI was 227 (49.4%). Multivariate logistic regression analysis showed that the coexistence of high ECW/TBW and low ALSTI at baseline was a significant associated with non-independence at discharge (odds ratio (OR) = 3.82, 95% confidence interval (CI) 2.00-7.32, P < 0.001), but low ALSTI alone was not (OR = 1.73, 95% CI 0.92-3.22, P = 0.086).
Conclusions:
Baseline coexistence of high ECW/TBW and low ALSTI, highlighting the importance of considering fluid imbalance in addition to muscle mass, was associated with for non-independence at hospital discharge in patients with acute stroke.
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