Association of Nutrition Status and Rehabilitation Outcome in the Disuse Syndrome: a Retrospective Cohort Study

Abstract

Background To determine whether nutrition is associated with rehabilitation outcome in the disuse syndrome. Methods A retrospective cohort study was performed in 223 inpatients admitted to a university hospital who were diagnosed by physicians in the rehabilitation department as having the disuse syndrome, and subsequently prescribed physical therapy. Malnutrition was defined as a body mass index<18.5 kg/m2, hemoglobin level<10.0 g/dl, serum albumin level<3.0 g/dl, or total lymphocyte count<1200 cells/mm3. Rehabilitation outcome was defined as whether or not the ADL score improved during rehabilitation. Nutritional status was assessed at referral using the Onodera's prognostic nutritional index (PNI). Results The study cohort included 136 men and 87 women (mean age 67.5 years; median duration between admission and referral 17 days; median rehabilitation duration 32 days). A total of 202 patients (91%) were defined as being malnourished. Mean PNI was 32.9, with the ADL score improving in 135 patients (61%) during rehabilitation. Rehabilitation outcome was better in patients with normal nutrition compared to malnourished patients (relative risk: 0.72, p = 0.04). Patients with a hemoglobin level>10.0 g/dl (relative risk: 0.69, p = 0.001), total lymphocyte count>1200 cells/mm3 (relative risk: 0.78, p = 0.03), or PNI>35.0 (relative risk: 0.74, p = 0.01) had a better rehabilitation outcome. Logistic regression analysis showed that hemoglobin level was associated independently with rehabilitation outcome (odds ratio 2.34, p = 0.005). Conclusions Malnutrition is common in patients with the disuse syndrome. Patients with low hemoglobin level and PNI at referral are more likely to have a poor rehabilitation outcome.