Prolonged length of stay and reduced functional improvement rate in malnourished stroke rehabilitation patients.

Objective: To determine associations between the nutritional status of inpatient rehabilitation (rehab) unit stroke patients and (1) length of stay (LOS) and (2) functional outcome using Modified Barthel Index (MBI). Secondary objective-to determine whether hypoalbuminemia was equally related to outcome measures. A priori hypothesis-LOS and MBI are adversely related to malnutrition. Design: Inception cohort study. Setting: Tertiary care center, Patients: 49 consecutive ''middle-band'' patients (4 declined). Main Outcome Measures: LOS and MBI at admission (T-1), 1 month (T-2) and discharge (T-3). Results: LOS was significantly related to overall rehab malnutrition, T-1 and T-2 MBI scores, T-1 dysphagia, T-1 enteral feeding (all p < .01), T-1 malnutrition, peripheral vascular disease (negative relationship), and diabetes mellitus history (all p < .05). In analysis of covariance, adjusting for T-1 MBI, overall rehab malnutrition was related to LOS (p = .011), Other covariates were not significant. T-1 malnutrition was related to lower T-2 MBI scores (p = .038). Lower T-1 MBI scores was related to T-2 malnutrition (p = .032). Diabetics (p = .005) and right hemispheric lesion patients (p = .015) had lower T-1 MBI scores. Hypoalbuminemia was unrelated to LOS or MBI scores. Although malnourished and adequately nourished functionally dependent patients improved equally in MBI scores by discharge, prolonged LOS in the malnourished lowered their functional improvement rate ([T-3 MBI - T-1 MBI]/LOS) (p = .047). Conclusions: Malnutrition was the most potentially modifiable variable relating to LOS and functional outcome. Close attention to nutrition status may help to optimize stroke patients' rehab potential and use of health care resources. (C) 1996 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation