Influence of the Body Composition of Neurological (Early) Rehabilitants on Rehabilitation Success

An optimal coverage of the required calorie requirement is a basic prerequisite for a speedy recovery. One study reports that almost every fourth patient is malnourished in German hospitals. Malnutrition is in turn associated with more complications, higher mortality and longer length of stay. The current DGEM (Deutsche Gesellschaft für Ernährungsmedizin) guideline "Clinical nutrition in intensive care" recommends a calorie intake of 24 kcal per kg body weight during the acute phase of the disease (days 1 to 7) and an increase of calorie intake to 36 kcal per kg body weight in the convalescence and rehabilitation phase.

In a recent study evaluating the weight profile of neurological, enteric-coated early rehabilitants in rehabilitation, 60.6% of patients had weight loss during rehabilitation. Men were also more likely to lose weight than women. In addition, the caloric care of "underweight patients" had a decisive influence on the neurological outcome (as measured by the early rehab barthel-index(FRBI)). For example, underweight patients who were under-served showed significantly lower improvements in FRBI than underweight patients who were over-served.

In another study, the weight of patients remained stable through the use of a nutritional assessment tool (EAT). Also the gender difference was not confirmed in the group with the EAT. The weight change in the rehabilitation course correlated significantly with the difference between the calculated and the average calories received per day. However, an effect of EAT on the frequency of complications or the neurological outcome could not be demonstrated in this study.

However, as body weight may be affected by water balance (edema) and gastrointestinal complications such as constipation, vomiting and diarrhea, consideration of body weight to check diet / nutrition status alone is insufficient. Qualitative statements such as an increase / decrease in muscle mass can not be made on the basis of the weight data. Therefore, in the planned pilot study body composition will be documented by means of bioelectric impedance analysis (BIA) in neurological (early) rehabilitants during rehabilitation. At the same time, various outcome parameters are to be recorded.

The aim of this pilot study is to identify the number and frequency of BIA measurements required to assess the status of care. On the basis of this data, a study is then to be designed to investigate the success of rehabilitation as a function of nutritional status and muscle mass.

• BIA (Diagnostic test): Bioelectrical Impedance Analysis

Primary outcomes

• Functional Status [3 minutes]: The Early Rehabilitation Barthel Index were determined upon admission and at the end of rehabilitation.
• Disabilities [3 minutes]: An ICF-Assessment of 20 items is used for determination of disabilities of activities and body functions. The severity of each item is scored from zero ("no impairment") to four ("complete impairment") upon admission and at the end of rehabilitation.
• Muscle Strenght [3 minutes]: The hand force is measured with a hand force dyometer three times on each hand upon admission and at the end of rehabilitation.
• Mobility [4 minutes]: The mobility is assed by the Rivermead Mobility Index.
• Lenght Of Stay [< 1 minute]: duration of neurological rehabilitation (in days)
• Mortality [< 1 minute]: Number of deaths
• Discharge Level [< 1 minute]: Status at discharge (discharged at home / long-term care facility, follow-up rehabilitation, death, transfer to acute hospital)

Secondary outcomes

• Bioelectrical Impedance [15 minutes]: Bioelectrical Impedances for all body segments: right arm, left arm, right leg, left leg, trunk, right body side and left body side.
• Nutritional Risk Screening (NRS 2002) [5 minutes]: Malnutrition upon admission and at discharge is assed by the Nutritional Risk Screening (NRS 2002).
• Mini Nutritional Assessment (MNA) [5 minutes]: Malnutrition upon admission and at discharge is assed by the Mini Nutritional Assessment (MNA).

Other outcomes

• Blood Pressure [1 minute]: Blood pressure (mmHg) is measured before each BIA measurement.
• Pulse [< 1 minute]: Pulse (bmp) is measured with a finger pulse oxymeter before each BIA measurement.
• Saturation [< 1 minute]: Saturation (%) is measured with a finger pulse oxymeter before each BIA measurement.
• Body Height [2 minutes]: Height is measured in a standing position with a measuring tape. In the case that the patient is not able to stand, the measurement is performed in a lying position.
• Body weight [5 minutes]: Weight (kg) is measured in the morning with clothes but without shoes.
• Hip Circumference [1 minute]: Hip circumference is measured with a measuring tape in a standing position (or lying position if the patient can not stand).
• Waist Circumference [1 minute]: Waist circumference is measured with a measuring tape in a standing position (or lying position if the patient can not stand).
• Calf Circumference [1 minute]: Calf circumference is measured with a measuring tape in a standing position (or lying position if the patient can not stand).

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* neurological disease

Exclusion Criteria:

* electrical implant as cardiac pacemaker, medications pumps, defibrillators
* pregnancy or breastfeeding period
* take part on another study within the last 30 days
* spasticity
* amputation of limbs

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• Jens D Rollnik, Prof. Dr., Study director, BDH-Klinik Hessisch Oldendorf