Effects of energy intake on individual activities of daily living in patients with subacute stroke

This study aimed to determine the relationship between energy intake and improvement in difficult activities of daily living, such as bathing and stair climbing, in patients with subacute stroke. This retrospective cohort study included 109 inpatients with subacute stroke. The relationship between energy intake and the Barthel Index total score at discharge was examined using multiple regression analysis. Logistic regression was performed to examine the relationship between energy intake and improvement in each Barthel Index item. A propensity score summarizing grip strength on the paralyzed side, Berg Balance Scale, and revised Hasegawa Dementia Scale scores was used as an adjusted variable in logistic regression analysis. Receiver operating characteristic curves were used to calculate cutoff values for differentiating improved activities of daily living. Multiple regression analysis showed that energy intake was significantly associated with the total Barthel Index score (P < .05). In logistic regression, energy intake was associated with improvements in stair climbing (odds ratio: 1.11, 95% confidence interval [CI]: 1.03-1.20, adjusted P = .048) among the Barthel Index items. Toilet use, bathing, mobility, and dressing were not significantly associated with energy intake. The area under the curve for energy intake in differentiating improvement in stair climbing was 0.71 (95% CI: 0.60-0.81), and the cutoff value was 22.9 kcal/kg (sensitivity: 86.4% [95% CI: 77.7-95.1%]; specificity: 52.2% [38.4-66.0%]). This study contributes to predicting improvement in stair climbing and informs the consideration of nutritional intervention needs. Nurses and dietitians should frequently communicate the patient's energy intake to rehabilitation professionals, which will help with prognosis and the development of an appropriate rehabilitation plan. Activities of daily living other than stair climbing may not have been associated with energy intake, potentially due to their lower physical activity intensity. However, further research is needed to validate this observation.