Relationship Between Body Mass Index and Rehabilitation Outcomes in Chronic Stroke

Sheffler LR, Knutson JS, Gunzler D, Chae J: Relationship between body mass index and rehabilitation outcomes in chronic stroke. Am J Phys Med Rehabil 2012;91:951-956. Objective: The aim of this study was to evaluate the relationship between body mass index (BMI) and change in motor impairment and functional mobility after a gait rehabilitation intervention in chronic stroke subjects. Design: Correlation and linear regression analyses of pretreatment and end-of-treatment Fugl-Meyer scores and modified Emory Functional Ambulation Profile scores from hemiparetic subjects (n = 108, >3 mos post stroke) who participated in a randomized controlled trial comparing two 12-wk ambulation training treatments were generated. Results: A series of linear regression models that controlled for age, sex, stroke type, interval post-stroke, and training device found the change in the Fugl-Meyer score to be significantly negatively associated with pretreatment BMI (beta = -0.207, P = 0.036) and the change in the "up and go" modified Emory Functional Ambulation Profile score to be significantly positively associated with BMI (beta = 0.216, P = 0.03). Changes in modified Emory Functional Ambulation Profile scores in floor, carpet, obstacles, or stair climbing were not significantly associated with BMI. Conclusions: Chronic stroke subjects with a higher BMI were less likely to demonstrate improvement in motor impairment and up and go functional mobility performance in response to ambulation training, irrespective of treatment intervention. Stroke rehabilitation clinicians should consider BMI when formulating rehabilitation goals. Further studies are necessary to determine whether obesity is a predictor of longer-term post-stroke motor and functional recovery.