Abstract
Objectives
Lower limb muscles of malnutrition stroke patients (MSP) tend to muscle atrophy more than the good nutrition patients. Muscle atrophy causes physical function (PF) and decreased activities of daily living (ADL). However, it is not clear how much the muscle atrophy in MSP affects PF and ADL. The purpose of this study was to clarify the influence of muscle atrophy of MSP on PF and ADL.
Methods
The subjects were 140 MSP who were 65 years or older. MSP was determined by assessing the Global Leadership Initiative on Malnutrition upon admission. For lower limb muscle atrophy, muscle thickness (QMT), pennation angle (QPA) and echo intensity (QEI) of the quadriceps of the affected and unaffected sides were measured using a B-mode ultrasound imaging device (SONON 300 L). PF and ADL were evaluated for Functional Independence Measure (FIM) and Short Physical Performance Battery (SPPB), respectively. All evaluation items were evaluated at admission and discharge. Statistical analysis used stepwise multiple regression analysis to identify factors individually associated with FIM and SPPB. QMT, QPA and QEI were set as the independent variables. We then entered the QMT, QPA and QEI of the paretic and non-paretic sides in another stepwise multiple regression model to avoid multicollinearity. In addition, we calculated an effect size (f2) for the multiple regression analysis. The statistical power of that analysis was based on f2, an alpha error of 0.05, the total sample size, and the number of predictor variables. Statistical significance was accepted as P < 0.05.
Results
FIM and SPPB at admission and discharge were significantly independently associated with the QMT, QPA and QEI of the affected and unaffected sides (QMT: β > 0.40, R2 > 0.43, f2 > 0.72, power > 99.5%, QPA: β > 0.38, R2 > 0.40, f2 > 0.63, power > 99.2%, QEI: β <−0.42, R2 > 0.47, f2 > 0.71, power = 99.9%). There was no multicollinearity between the independent variables in the stepwise multiple regression analyses, and the variance inflation factors ranged from 1.000 to 1.388.
Conclusions
It was suggested that muscle atrophy of MSP is a factor that decreases ADL and PF. Based on the above, it is necessary to assess atrophy in MSP and in some cases, intervention is required. In the future, we plan to develop effective treatments for atrophy in MSP.
Funding Sources
The authors declare no conflicts of interest associated with this manuscript.
Identification of the affected lower limb and unaffected side motor functions as determinants of activities of daily living performance in stroke patients using partial correlation analysis
