Initial Calf Circumference Predicts Poor Disability Outcomes in Patients with Stroke - 06/01/25

Doi : 10.1016/j.jnha.2025.100483

Yoichi Sato ^a,^f, Takafumi Abe ^a,^f, Yosuke Kimura ^b,^f, Shu Tanaka ^c,^f, Kazuki Okuda ^d, Ayaki Shirahata ^d, Kenta Yamamoto ^d, Masafumi Nozoe ^e,^f,⁎
^a Department of Rehabilitation, Uonuma Kikan Hospital, Niigata, Japan
^b Faculty of Life Sciences, Department of Biomedical Engineering, Toyo University, Saitama, Japan
^c Major of Physical Therapy, Department of Rehabilitation, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
^d Department of Rehabilitation, Konan Medical Center, Kobe, Japan
^e Department of Physical Therapy, Faculty of Rehabilitation, Kansai Medical University, Osaka, Japan
^f HEalth Promotional Physical therapy for Stroke survivors

^⁎Corresponding author.

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Abstract

Background

Calf circumference (CC), which is easy to measure and noninvasive, may be a predictor of functional outcome in patients with acute stroke. However, the association between CC and long-term functional outcome is unclear. The purpose of this study was to investigate whether low CC is associated with functional outcome at 12 months post-stroke.

Methods

This multicenter retrospective cohort study included patients with acute stroke. Low CC was defined as less than 30 cm for men and 29 cm for women. Poor functional outcome was defined as a modified Rankin Scale (mRS) score of greater than 3 (i.e., 3-6) and the inability to return pre-stroke mRS score at 12 months post-stroke. Multivariate logistic regression analysis was performed with low CC as the independent variable and outcome as the dependent variable.

Results

This study included 445 patients (median age 75 years, 277 men). The prevalence of low CC was 26.7%. Multiple logistic regression analysis showed that low CC was significantly associated with poor functional outcome (OR = 3.036, 95% CI: 1.700-5.422, p < 0.001).

Conclusions

Low CC at admission in patients with acute stroke is associated with poor functional outcome at 12 months post-stroke. CC, which is easily measured in the acute setting, may serve as a predictor of poor outcomes. Future multicenter prospective interventional studies are needed to clarify the causal relationship between CC and functional outcome.

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Keywords : acute, calf circumference, functional outcome, stroke

Abbreviations : ADL, AWGS, BMI, CC, FOIS, GLIM, GNRI, IQR, mRS, NIHSS