Prevalence and factors associated with sarcopenia in individuals with stroke undergoing rehabilitation: A cross-sectional study

OBJECTIVE: To determine the prevalence of sarcopenia and identify clinical and functional factors independently associated with confirmed sarcopenia in individuals with stroke undergoing rehabilitation. METHODS: This cross-sectional study enrolled 209 adults with stroke admitted for neurological rehabilitation. Sarcopenia was defined according to the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) algorithm, using SARC-CalF, handgrip strength, five-times sit-to-stand test, physical performance measures and appendicular skeletal muscle mass by dual-energy X-ray absorptiometry (DXA). Bivariate analyses and multivariable logistic regression were performed to identify factors independently associated with confirmed sarcopenia. RESULTS: Confirmed sarcopenia was identified in 55 of 209 participants (26.3%; 95% CI: 20.6% to 32.8%). Participants with sarcopenia were older and had lower body mass index (BMI), poorer physical performance, and greater motor impairment than those without sarcopenia. In the multivariable model, lower BMI (OR = 0.70; 95% CI: 0.59 to 0.83), positive SARC-CalF screening (OR = 6.37; 95% CI: 2.03 to 20.05), and lower Short Physical Performance Battery (SPPB) scores (OR = 0.83; 95% CI: 0.69 to 0.99) remained independently associated with sarcopenia. Motor impairment severity, assessed using Fugl-Meyer motor categories, was also independently associated with sarcopenia. CONCLUSION: DXA-confirmed post-stroke sarcopenia affected approximately one in four individuals undergoing rehabilitation and was independently associated with lower BMI, poorer physical performance, and greater motor impairment. These findings indicate that sarcopenia is closely linked to functional impairment after stroke and reinforce the importance of integrating muscle health and functional assessment during rehabilitation. Early identification of individuals at risk may support more individualized rehabilitation strategies and improve clinical decision-making.