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Intensive nutritional supplements can improve outcomes in stroke rehabilitation

From the Stroke Service (M.H.R., P.L.C.), Burke Rehabilitation Hospital, an affiliate of Weill Medical College of Cornell University; Biostatistics Unit at the Feinstein Institute for Medical Research (M. Lukin, M. Lesser), North Shore–Long Island Jewish Health System; Departments of Public Health (M. Lesser) and Neurology and Neuroscience (J.P.B.), Weill Medical College of Cornell University; and Burke Medical Research Institute (J.P.B.), New York, NY.

Address correspondence and reprint requests to Dr Rabadi, VA Medical Center, 921 NE 13th Street, Oklahoma City, OK 73104 mhrabadi{at}gmail.com

Objective: Poor nutrition is a common complication of strokes severe enough to require inpatient rehabilitation. We therefore tested whether intensive nutritional supplements given to undernourished patients from the time of their admission to a specialized stroke rehabilitation service would improve patient outcomes.

Methods: Randomized, prospective, double-blind, single center study comparing intensive nutritional supplementation to routine nutritional supplementation in 116 undernourished patients admitted to a stroke service. The analysis included the 90% of patients who were not lost to follow-up due to acute or subacute hospitalization (n = 102; 51 in each group). The nutritional supplements are commercially available and Food and Drug Administration approved. The primary outcome variable was change in total score on the Functional Independence Measure (FIM). The secondary outcome measurements included the FIM motor and cognitive subscores, length of stay (taken from day of admission), 2-minute and 6-minute timed walk tests measured at admission and on discharge, and discharge disposition (home/not home).

Results: Patients receiving intensive nutritional supplementation improved more than those on standard nutritional supplements on measures of motor function (total FIM, FIM motor subscore, 2-minute and 6-minute timed walk tests, all significant at p < 0.002). They did not, however, improve on measures of cognition (FIM cognition score). A higher proportion of patients who received the intensive nutritional supplementation went home compared to those on standard supplementation (p = 0.05).

Conclusion: Intensive nutritional supplementation, using readily available commercial preparations, improves motor recovery in previously undernourished patients receiving intensive in-patient rehabilitation after stroke.

GLOSSARY: F-M = Fugl-Myer; FIM = Functional Independence Measure; FOOD = Feed or Ordinary Diet; LOS = length of stay; NIHSS = NIH Stroke Scale.

Editorial, page 1852

e-Pub ahead of print on October 22, 2008, at www.neurology.org.

Disclosure: Neither Novartis pharmaceuticals nor the study funding source (Burke Medical Research Foundation) had any role in the design, conduct, analysis, or presentation of the results of this study. None of the authors have any commercial interests related to this study.

Received December 11, 2007. Accepted in final form May 21, 2008.

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