Effect of Body Mass Index on Stroke Rehabilitation

Burke, David T.; Al-Adawi, Samir; Bell, Regina; Easley, Kirk A.; Chen, Shou; Burke, Daniel P.

doi:10.1016/j.apmr.2014.01.019

Cited by 54 publications

(44 citation statements)

References 27 publications

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“…[26,30,35] In addition, 6 studies examined further outcomes such as hemorrhagic transformation after acute ischemic stroke, recurrent vascular events, stroke rehabilitation and hospital discharge outcomes. [28,29,31,32,34,36] One study used central obesity as measurement and investigated the prognostic performance of waist-to-height ratio on mortality after acute first-ever stroke. [33]…”

Section: Resultsmentioning

confidence: 99%

“…[26,28–32,34–36] Seven of these 9 studies ascertained a favorable effect of excess body weight on non-fatal outcomes such as recurrence of stroke, myocardial infarction, or vascular death, favorable outcome defined as modified Rankin Scale (mRS) score 0–1, need for institutional care, or functional progress in stroke rehabilitation (S2 Table). [26,29,31,32,34,35,37]…”

Section: Resultsmentioning

confidence: 99%

“…[26] In line with these findings, Burke et al observed that functional progress in stroke rehabilitation was fastest in overweight patients. [32] Kim et al investigated 2679 Korean patients with ischemic stroke and also stated better 3-month functional outcomes 3 months in overweight and obese patients. [36] However, the association lost its significance after adjusting for stroke severity measured by NIHSS score at admission.…”

Section: Resultsmentioning

confidence: 99%

“…[18,25,26,33] Likewise, overweight and not obese patients had the best functional recovery in stroke rehabilitation. [32] Therefore, the results do not allow the conclusion “the fatter, the better”. Another explanation for “obesity paradox” in stroke may be that time of follow-up in cited studies (range 1 week to 11.5 years, median 30 months) was too short to detect detrimental effects of obesity.…”

Section: Discussionmentioning

confidence: 98%

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Obesity paradox in stroke – Myth or reality? A systematic review

et al. 2017

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Background and purposeBoth stroke and obesity show an increasing incidence worldwide. While obesity is an established risk factor for stroke, its influence on outcome in ischemic stroke is less clear. Many studies suggest a better prognosis in obese patients after stroke (“obesity paradox”). This review aims at assessing the clinical outcomes of obese patients after stroke by performing a systematic literature search.MethodsThe reviewers searched MEDLINE from inception to December 2015. Studies were eligible if they included outcome comparisons in stroke patients with allocation to body weight.ResultsTwenty-five studies (299’750 patients) were included and none was randomised. Ten of 12 studies (162’921 patients) reported significantly less mortality rates in stroke patients with higher BMI values. Seven of 9 studies (92’718 patients) ascertained a favorable effect of excess body weight on non-fatal outcomes (good clinical outcome, recurrence of vascular events). Six studies (85’042 patients) indicated contradictory results after intravenous thrombolysis (IVT), however. Several methodological limitations were observed in major part of studies (observational study design, inaccuracy of BMI in reflecting obesity, lacking body weight measurement, selection bias, survival bias).ConclusionMost observational data indicate a survival benefit of obese patients after stroke, but a number of methodological concerns exist. No obesity paradox was observed in patients after IVT. There is a need for well-designed randomized controlled trials assessing the effects of weight reduction on stroke risk in obese patients.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 98%

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Obesity paradox in stroke – Myth or reality? A systematic review

et al. 2017

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“…Nonetheless, in papers investigating the degree of ADL improvement, the opposite conclusion was sometimes reported. For example, regarding the relationship between body mass index and ADL improvement for stroke patients, the sector of patients experiencing the greatest ADL improvement has been variously reported to be very obese patients [2], obese patients [3], underweight and overweight patients [4], overweight patients [5], and normal-weight patients [6,7].…”

Section: Introductionmentioning

confidence: 99%

Methods for Comparing Functional Independence Measure Improvement Degree for Stroke Patients between Rehabilitation Hospitals

Tokunaga¹,

Mita²,

Tashiro³

et al. 2017

Int J Phys Med Rehabil

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When assessing the extent of improvement in Functional Independence Measure (FIM) scores for stroke patients between rehabilitation hospitals-such as Japan's Kaifukuki Rehabilitation Wards-one must note with caution that ceiling effects are present in FIM gain, defined as FIM at discharge minus FIM at admission. In cases where significant differences are present in FIM scores at admission, a variety of techniques may be used, including stratification by FIM scores at admission, FIM effectiveness, and multiple linear regression analysis. Alternative indicators of FIM improvement, which are less sensitive to FIM scores at admission than FIM effectiveness, include corrected FIM effectiveness and the deviation value of FIM gain. When comparing the FIM improvement degree among different hospitals, these methods are augmented by additional techniques, including limiting patients based on FIM scores at admission, case-control study matching FIM scores at admission, and adjustment of FIM gain by standard severity distribution. When comparing FIM improvement degree between hospitals, it is necessary to understand the advantages and disadvantages of these eight methods and analyze it taking into account the difference in patients' severity.

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The Effect of Body Mass Index on the Functional Prognosis of Traumatic Brain Injury Patients

Burke

Bell

Al‐Adawi

et al. 2019

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Background Although many studies have demonstrated that obesity is correlated with an increased risk of chronic disease, some have reported a paradox by which those in the higher weight categories actually recover better during hospitalization. This study was designed to determine whether this obesity paradox is also reflected in the recovery of patients with traumatic brain injury (TBI) undergoing care in a rehabilitation hospital. Objective To investigate the association between body mass index (BMI) and the functional progress of patients with TBI, admitted to a rehabilitation hospital. Design Retrospective cohort study. Methods The study included all patients admitted to the brain injury unit of a rehabilitation hospital over a 6‐year period. The data used for this study included patient height and weight (measured on admission) and functional independence measurements (scored on admission and discharge). Main Outcome Measures Functional independence measure (FIM) change per day, BMI category. Results For the 444 patients admitted, the overall FIM efficiency did not differ significantly by BMI (P = .93). After adjusting for age and gender, overweight and obese patients had the lowest FIM efficiency (1.04 for both groups), followed by the underweight and normal weight groups (1.11 and 1.26, respectively). Conclusion This study demonstrated that higher BMI was not significantly correlated with the rate of functional recovery among patients admitted to a rehabilitation hospital for TBI. Level of Evidence III.

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Effect of Body Mass Index on Stroke Rehabilitation

Cited by 54 publications

References 27 publications

Obesity paradox in stroke – Myth or reality? A systematic review

Obesity paradox in stroke – Myth or reality? A systematic review

Methods for Comparing Functional Independence Measure Improvement Degree for Stroke Patients between Rehabilitation Hospitals

The Effect of Body Mass Index on the Functional Prognosis of Traumatic Brain Injury Patients

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