Desfechos clínicos em indivíduos sarcopênicos e não sarcopênicos pós Acidente Vascular Cerebral Crônico: um estudo transversal

Abstract

Introduction: Sarcopenia is a condition characterized by low levels of muscular strength, quantity/quality and performance. When associated with cerebrovascular accident (CVA), sarcopenia can bring worse outcomes for both conditions, such as a reduction in the individuals’ functionality and an increase in their limitations and restrictions. Therefore, understanding the relationship between sarcopenia and clinical outcomes in post-stroke individuals is a way to better understand their prognosis and define appropriate treatment strategies. Objective: To compare clinical outcomes (level of physical activity, self-efficacy, frailty and mobility) in sarcopenic and non-sarcopenic individuals with chronic stroke. Methods: Cross-sectional study approved by the Research Ethics Committee of the Faculty of Medical Sciences of Minas Gerais. Chronic hemiparetic, non-aphasic, ambulatory individuals were included. Sarcopenia was screened using the SARC-CalF and diagnosed using the European Consensus on Definition and diagnosis of Sarcopenia. Individuals were considered to have some level of sarcopenia if diagnosed with probable, confirmed, or severe sarcopenia, or as non sarcopenic. The clinical outcomes investigated were: level of physical activity (Human Activity Profile), self-efficacy (Stroke Self-Efficacy Questionnaire - Brazil), frailty (Clinical Frailty Scale) and mobility (Timed Up and Go). Clinical measurements were evaluated according to the presence or absence of sarcopenia and in the paretic and non paretic hemibodies. Comparison between groups was made using Student’s T-test for independent samples (95%CI). Results: 62 individuals with a mean age of 62.6 years were included. Regarding the clinical outcomes evaluated, 43.5% of participants were considered moderately active; on average, they presented good self-efficacy (30.5±6.7); regarding the frailty level, individuals were, mostly, considered as vulnerable; and had reduced mobility (22.6 seconds ± 28.2 to complete the TUG test). There was a statistically significant difference in relation to the presence of sarcopenia on the paretic side in all measures: the level of physical activity (95% CI: 7.6 to 28.1, p = 0.001), self-efficacy (95% CI: 4.3 to 9.5, p = 0.000), frailty (95% CI: -2.0 to -0.6, p = 0.000) and mobility (95% CI: -25.5 to -3.0, p = 0.014). On the non-paretic side, there was a significant difference in relation to the presence of sarcopenia for the level of physical activity (95% CI: 1.4 to 20.2, p = 0.025), self-efficacy (95% CI: 1.2 to 8.1, p = 0.010) and frailty (95% CI: -1.8 to -0.5, p = 0.001), but not in relation to mobility (95% CI: -29.6 to 8.3, p = 0.260). Conclusion: Considering both the paretic and non-paretic sides, individuals with chronic stroke with some level of sarcopenia had lower levels of physical activity and self-efficacy and were more frail when compared to non-sarcopenic individuals. Regarding the mobility outcome and considering the paretic side, sarcopenic individuals had reduced levels when compared to those without sarcopenia. However, when considering the non-paretic side, the presence of sarcopenia did not mean worse mobility outcomes in post-stroke patients. Keywords: Stroke; Sarcopenia; Physical Activity; Self efficacy; Frailty; Mobility limitation.