Accuracy of sarcopenia screening tools among older adults with stroke undergoing inpatient rehabilitation

Abstract

Background Appropriate screening tools for sarcopenia are available for older adults with stroke undergoing inpatient rehabilitation, however how well these tools predict and eventually diagnose sarcopenia remain unknown. Objective To investigate the accuracy of five index tools including calf circumference (CC), the strength, assistance with walking, rising from a chair, climbing stairs and falls (SARC-F), the CC combined with SARC-F (SARC-CalF), the 5-item and 7-item Mini Sarcopenia Risk Assessment (MSRA-5 and MSRA-7) for screening sarcopenia among older adults with stroke undergoing inpatient rehabilitation according to the guideline from the Asian Working Group for Sarcopenia 2019. Methods Stroke patients aged sixty years and older who admitted for inpatient rehabilitation were included between April 2023 and June 2024. In this study, sarcopenia was defined by low skeletal muscle mass and low grip strength. Skeletal muscle mass was evaluated using a bioelectrical impedance analysis. Grip strength was assessed using a digital handheld dynamometer. The five index tests were applied. Diagnostic indices and areas under the receiver operating characteristic curves (AUC) were analyzed. Youden’s index was used to determine the optimal cut-off values for the index tests. Results One-hundred and fourteen patients with stroke were included (55.26% male) with mean age of 70.39 years. The prevalence of sarcopenia was 50.88%. The AUC with 95% confidence interval of CC, SARC-F, SARC-CalF, MSRA-5 and MSRA-7 were 0.873 (0.797–0.928), 0.653 (0.558–0.740), 0.832 (0.751–0.896), 0.641 (0.546–0.729), and 0.626 (0.530–0.715), respectively. The optimal cut-off points of the CC were < 33 cm for men, and < 32 cm for women, and the optimal cut-off point of SARC-CalF was ≥ 16. Conclusions The CC and SARC-CalF were demonstrated appropriate diagnostic performance for screening sarcopenia in older adults with stroke undergoing inpatient rehabilitation.