Factors influencing the reduction in quadriceps muscle thickness in the paretic limbs of patients with acute stroke

Abstract

Background & AimsMuscle atrophy is an early event that occurs after stroke, but there are few reports on the changes in skeletal muscle thickness in acute stroke. This study aimed at investigating the factors contributing to reduced muscle thickness in patients with acute stroke. MethodsIn total, 51 patients with stroke and NIHSS >3 were included in our study. They were admitted to our hospital between July 2017 and May 2020.The quadriceps muscle thickness was measured with an ultrasound device on admission and 14 days later.The collected data included age, sex, BMI, disease type, NIHSS, and Japan Coma Scale on admission, hematoma removal, recombinant tissue plasminogen activator, endovascular thrombectomy, neuromuscular electrical stimulation, comorbidities, C-reactive protein and serum albumin levels on admission, start date of enteral nutrition, start date of oral intake, start date of weaning, start date of ambulation, and number of physiotherapy and occupational therapy units. These data were retrospectively retrieved from medical documents. Energy intake, protein intake, and energy adequacy were calculated by a dietician. Multiple regression analysis was used to identify the factors associated with reduced quadriceps muscle thickness. The independent variables were NIHSS, start date of enteral therapy, start date of oral intake, start date of mobilization, and start date of ambulation. ResultsThe rate of change in quadriceps muscle thickness of the paretic limb was -15.3% (interquartile range, -46.1–14.8%). Multiple regression analysis showed that the factors responsible for the decrease in muscle thickness on the paretic side were the start date of oral intake (β: -0.437; 95% Cl, -11.82 to -3.547) and the start date of ambulation (β: -0.342; 95% Cl, -2.405 to -0.445), with a multiple correlation coefficient of 0.615. ConclusionThe date of initiation of oral intake and the date of initiation of ambulation after acute stroke were related to the rate of reduction in muscle thickness on the paretic side. Thus, starting oral intake and ambulation training as early as possible could be important to prevent muscle atrophy. Furthermore, acquisition of swallowing ability and active ambulation training are effective in maintaining muscle mass in acute stroke.