Acute-phase weight change and functional recovery during convalescent rehabilitation in older stroke patients

Malnutrition is common among patients with stroke, and weight change is an important marker of nutritional status associated with clinical outcomes. However, the association between acute-phase weight change and functional recovery during the convalescent rehabilitation (CR) phase remains unclear, particularly in older patients. This study examined the association between acute-phase weight change and walking independence in older patients with stroke.

This retrospective cohort study included 650 patients aged ≥65 years admitted to a CR ward after acute stroke. Weight change was calculated using body weight at or before stroke onset and at CR ward admission. The primary outcome was time to walking independence. Kaplan-Meier analysis and multivariable Cox proportional hazards models were used.

During a median follow-up of 95 days, 44.9% of patients achieved walking independence. Greater acute-phase weight loss was significantly associated with a lower probability of achieving walking independence (log-rank P < 0.001). In multivariable analysis, patients with severe weight loss had a significantly lower likelihood of walking independence compared with those with slight weight loss or weight gain (hazard ratio, 0.63; 95% confidence interval, 0.46-0.85). Secondary sensitivity analyses excluding patients with prolonged acute hospitalization showed a stronger association. Restricted cubic spline analysis demonstrated a dose-response relationship between weight loss and reduced likelihood of walking independence.

Acute-phase weight loss was associated with a lower likelihood of achieving walking independence in older patients with stroke. Incorporating weight monitoring into acute-phase care may help promote functional recovery and walking independence.