Prevalence of Sarcopenia in Stroke Patients

March 28, 2026 updated by: Sheng-Hui Tuan, Cishan Hospital, Ministry of Health and Welfare

Prevalence and Associated Factors of Sarcopenia in Stroke Patients: A Cross-Sectional Observational Study

The goal of this observational study is to analyze the characteristics of sarcopenia-related variables in post-acute and chronic stroke patients using various clinical measurement tools. The study also aims to examine the differences in these variables based on age groups (40-65 years and >65 years), sex, and stroke severity.

The main questions it aims to answer are:

What are the differences in sarcopenia prevalence and related indicators between post-acute care and chronic stroke patients? How do age, sex, and stroke severity affect these sarcopenia-related measurements?

Participants will include stroke patients aged 40 and older with adequate cognitive and physical function to complete sarcopenia screening and questionnaires. They will be divided into two groups:

Group 1: Chronic stroke patients (n ≥ 75) Group 2: Post-acute care stroke patients (n ≥ 25)

All participants will undergo both objective and subjective assessments, including:

Objective assessments: Body composition, quadriceps strength, quadriceps and gastrocnemius muscle thickness via ultrasound, calf circumference, dominant hand grip strength, walking speed, SARC-F questionnaire, and the Mini Nutritional Assessment.

Subjective assessment: EQ-5D health-related quality of life questionnaire. The collected data will be analyzed to compare the prevalence and characteristics of sarcopenia between the two stroke groups and across different subgroups by age and sex.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Study Objectives Sarcopenia is a progressive disease characterized by the loss of muscle mass and decline in muscle function, with a prevalence exceeding 20% among the elderly population aged 65 years and older in Taiwan. The deterioration of muscle mass and functional performance eventually leads to adverse health outcomes, including increased risk of mortality. Apart from aging, the etiology of sarcopenia involves various factors such as nutrition, physical activity, and underlying diseases. Stroke is one of the leading causes of death and disability both in Taiwan and globally. In recent years, the population of post-stroke survivors has been aging rapidly, with a trend toward earlier onset of first-ever strokes.

"Stroke-related sarcopenia" refers to sarcopenia induced by stroke or an exacerbation of pre-existing sarcopenia, which negatively impacts clinical outcomes in stroke patients. Previous studies have investigated sarcopenia-related measures in stroke survivors, such as handgrip strength and calf circumference; however, these studies often utilized a single approach. To the best of our knowledge, no comprehensive analysis of these sarcopenia-related variables has been conducted. Furthermore, muscle strength in humans begins to decline around the age of 40, and this physiological deterioration may differ by sex. Limited research has compared the various sarcopenia indicators between post-acute care (PAC) and chronic stroke patients.

The objectives of this study are as follows:

To analyze the characteristics of sarcopenia-related variables assessed using different clinical measurement tools in post-acute and chronic stroke patients.

To examine the characteristics of these variables across different age groups (40-65 years and >65 years), sexes, and stroke severity levels.

Expected Outcomes The prevalence of sarcopenia in both post-acute and chronic stroke patients is anticipated to be higher than that in the general elderly community.

Chronic stroke patients are expected to exhibit a slightly higher prevalence of sarcopenia compared to post-acute care stroke patients.

Older stroke patients (>65 years) are expected to have a higher prevalence of sarcopenia compared to younger stroke patients (40-65 years).

Methods

This study is designed as a cross-sectional observational study and will be conducted at the Ministry of Health and Welfare Qishan Hospital. Participants will include stroke patients aged 40 years or older who have sufficient cognitive and physical abilities to complete sarcopenia screening and related questionnaires. Participants will be divided into two groups:

Group 1: Chronic stroke patients (n ≥ 75) Group 2: Stroke patients recently admitted to post-acute care wards (n ≥ 25) The recruitment will follow a 3:1 allocation ratio.

All participants will undergo both objective and subjective assessments:

Objective assessments: Sarcopenia-related indicators, including body composition, quadriceps strength, muscle thickness of the quadriceps and gastrocnemius via ultrasound, calf circumference, dominant hand grip strength, walking speed, the SARC-F questionnaire, and the Mini Nutritional Assessment.

Subjective assessment: EQ-5D questionnaire to evaluate health-related quality of life.

After data collection, the data will be entered and analyzed statistically to compare the prevalence and characteristics of sarcopenia between different stroke populations (post-acute care vs. chronic stroke; older vs. younger stroke patients).

Study Type

Observational

Enrollment (Actual)

80

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Taiwan
      • Kaohsiung City, Taiwan, 842
        • CiShan hospital, MOHW

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Sampling Method

Non-Probability Sample

Study Population

Patients aged over 40 years who have been diagnosed with stroke. Diagnosis is defined as made by a relevant specialist and documented in the Cishan Hospital medical record system, with a corresponding International Classification of Diseases, 10th Revision (ICD-10) code. Both ischemic and hemorrhagic strokes are included.

Description

Inclusion Criteria:

  1. Both ischemic and hemorrhagic strokes are included. 1.1 Definition of chronic stroke patients (Group 1): Patients whose last stroke occurred more than one year prior.

    1.2 Definition of post-acute care (PAC) stroke patients (Group 2): Patients whose last stroke occurred at least 14 days prior, have been assessed by a neurologist as eligible for transfer to the PAC program, and are admitted to a PAC ward.

  2. Patients with sufficient cognitive and physical ability to complete sarcopenia-related assessments (e.g., body composition, grip strength, walking speed) and the Mini Nutritional Assessment, as judged by the principal investigator.
  3. Patients who provide informed consent after being fully informed. 3.1 Group 1 (chronic stroke patients): Consent must be obtained directly from the patient.

3.2 Group 2 (PAC stroke patients): If the patient has cognitive impairment during the PAC phase, consent may be obtained from a family member or legal representative after they have been fully informed. -

Exclusion Criteria:

  1. Patients with lower limb neurological, muscular, or skeletal injuries or disorders within six months prior to enrollment.
  2. Patients with severe cardiopulmonary diseases or other neurological conditions requiring oxygen therapy.
  3. Patients who, within one month prior to the study, have experienced major infections requiring hospitalization and antibiotic administration or other major illnesses requiring invasive treatment (e.g., cardiac catheterization). -

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Post-acute stroke patients

a stroke diagnosis made by a relevant specialist and documented in the medical record system of Cishan Hospital, with the corresponding International Classification of Diseases, 10th Revision (ICD-10) code. Both ischemic and hemorrhagic strokes are included.

Definition of post-acute care (PAC) stroke patients: Patients whose last stroke occurred at least 14 days prior, who have been assessed by a neurologist as eligible for transfer to the PAC program, and who are admitted to the PAC ward.
Diagnostic test: Objective assessments
include sarcopenia-related indicators such as body composition, quadriceps muscle strength measurement, quadriceps muscle thickness via ultrasound, gastrocnemius muscle thickness via ultrasound, calf circumference, dominant hand grip strength, walking speed, the SARC-F questionnaire, and the Mini Nutritional Assessment scale.
Diagnostic test: Subjective assessment
involves the EQ-5D questionnaire to evaluate health-related quality of life
Chronic stroke patients

a stroke diagnosis made by a relevant specialist and documented in the medical record system of Cishan Hospital, with the corresponding International Classification of Diseases, 10th Revision (ICD-10) code. Both ischemic and hemorrhagic strokes are included.

Definition of chronic stroke patients (Group 1): Patients whose last stroke occurred more than 6 months prior.
Diagnostic test: Objective assessments
include sarcopenia-related indicators such as body composition, quadriceps muscle strength measurement, quadriceps muscle thickness via ultrasound, gastrocnemius muscle thickness via ultrasound, calf circumference, dominant hand grip strength, walking speed, the SARC-F questionnaire, and the Mini Nutritional Assessment scale.
Diagnostic test: Subjective assessment
involves the EQ-5D questionnaire to evaluate health-related quality of life

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Appendicular Skeletal Muscle Mass Index
Time Frame: at enrollment
ASMMI is defined as appendicular skeletal muscle mass(kg)/height (m^2). This study utilizes BIA for body muscle mass measurement, considering the accessibility of the equipment and budget constraints.
at enrollment
Handgrip strength
Time Frame: at enrollment

In this study, grip strength is measured using a JAMAR electronic dynamometer, with a minimum scale of 0.1 pounds. The testing procedure is as follows:

The participant is seated with the shoulder in a neutral position, the upper arm relaxed alongside the body, and the elbow flexed at a 90-degree angle. The participant holds the JAMAR dynamometer with their dominant hand. They are instructed to gradually apply force, reaching their maximum grip strength within 3 seconds.

Before the test, a practice trial is provided to ensure the participant understands the procedure. The grip strength is tested twice, with a 30-second rest between trials. The average of the two trials is recorded as the final result
at enrollment
Gait speed
Time Frame: at enrollment
The testing procedure is as follows: A stopwatch is used to measure the time (in seconds) from the command "Ready, go" until the participant crosses a 6-meter distance marked on the floor. Two trials are conducted, with a 10-minute rest between each trial. Walking speed (m/s) is calculated for each trial, and the average of the two trials is used for data analysis.
at enrollment

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
maximal voluntary isometric contraction of quadriceps
Time Frame: at enrollment
In this study, the maximal voluntary isometric contraction (MVIC) strength of the dominant quadriceps muscle is measured using the MicroFET3 device (Hoggan, Health Industrial, UT, USA) under standardized posture. The average of two measurements is recorded as the participant's MVIC strength.
at enrollment
Sonographic thickness of quadriceps muscle
Time Frame: at enrollment

In this study, a portable ultrasound device, equipped with a 12 MHz linear probe, is used for measurements. All measurements are performed under the same parameter settings by a physician with years of clinical ultrasound experience.

The measurement of the quadriceps muscle is conducted with participants in a supine position, with both lower limbs extended and fully relaxed. The probe is placed at the midpoint of the line connecting the anterior superior iliac spine (ASIS) and the superior border of the patella (see illustration on the left). The thickness of the quadriceps muscle is defined as the sum of the thickness of the rectus femoris and vastus intermedius muscles, measured in a transverse scan.
at enrollment
Sonographic thickness of gastrocnemius muscle
Time Frame: at enrollment

In this study, a portable ultrasound device, equipped with a 12 MHz linear probe, is used for measurements. All measurements are performed under the same parameter settings by a physician with years of clinical ultrasound experience.

The measurement of the gastrocnemius muscle is performed with participants in a prone position, both legs extended and relaxed, with the feet hanging off the edge of the examination table. The examiner places the ultrasound probe close to the skin, ensuring the probe beam is perpendicular to the skin surface. The medial cross-sectional area of the medial head of the gastrocnemius muscle is identified, with the largest cross-sectional area selected as the standard imaging plane, and the corresponding skin surface location is marked.

Measurements include:

  1. Fat thickness (FT): The distance from the superficial fascia to the skin.
  2. Muscle thickness (MT): The distance from the superficial fascia to the deep fascia.
at enrollment
Calf Circumference
Time Frame: at enrollment

The measurement of calf circumference (CC) is conducted bilaterally, including the paretic and non-paretic sides of stroke patients. Participants are positioned in either a seated or supine posture, with the knees and hips flexed at 90°, and the feet naturally placed on the floor or bed, with the ankles relaxed. The examiner faces the participant and identifies the largest circumference of the calf on both sides.

A flexible tape measure is used to measure CC, ensuring it is positioned perpendicular to the axis of the calf. The measurement error is kept below 0.1 cm. To minimize the influence of edema, measurements are performed in the morning. Each leg is measured twice, and the highest value is recorded.
at enrollment
Sarcopenia risk assessed by the Strength, Assistance with walking, Rise from a chair, Climb stairs, and Falls (SARC-F) questionnaire
Time Frame: at enrollment

Sarcopenia risk was assessed using the Strength, Assistance with walking, Rise from a chair, Climb stairs, and Falls (SARC-F) questionnaire, a 5-item screening tool based on participant self-reported responses. Each item is scored from 0 to 2, with a total score ranging from 0 to 10.

Higher scores indicate a greater risk of sarcopenia, and a score ≥4 suggests probable sarcopenia. The SARC-F questionnaire is designed for use in clinical and community settings without requiring specialized equipment, making it suitable for large-scale screening.

The total SARC-F score was analyzed as a continuous variable.
at enrollment
Mini Nutritional Assessment
Time Frame: at enrollment

Nutritional status was assessed using the Mini Nutritional Assessment (MNA), an 18-item standardized tool evaluating dietary intake, anthropometric measurements, and general health status. The total score ranges from 0 to 30.

Based on established cutoffs, scores ≥24 indicate normal nutritional status, scores between 17 and 23.5 indicate risk of malnutrition, and scores <17 indicate malnutrition.

The total MNA score was analyzed as a continuous variable.
at enrollment
Health-related quality of life assessed by the EuroQol 5-Dimension 3-Level (EQ-5D-3L) index score
Time Frame: at enrollment

Health-related quality of life was assessed using the EuroQol 5-Dimension 3-Level (EQ-5D-3L) questionnaire, which evaluates five domains: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression.

An EQ-5D index score was calculated using the Taiwan-specific value set. The index score ranges from -0.111 to 1.000, with higher scores indicating better health-related quality of life.

The EQ-5D index score was analyzed as a continuous variable.
at enrollment
Health-related quality of life assessed by the EuroQol 5-DimensionVisual Analogue Scale (EQ-5D-VAS)
Time Frame: at enrollment

EQ-5D-VAS, in which participants rate their overall health status on a scale from 0 to 100.

A score of 0 represents the worst imaginable health state, and a score of 100 represents the best imaginable health state.

The EQ-5D VAS score was analyzed as a continuous variable, with higher scores indicating better perceived health status.
at enrollment

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Cishan Hospital, Ministry of Health and Welfare

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

May 5, 2025

Primary Completion (Actual)

October 4, 2025

Study Completion (Actual)

March 1, 2026

Study Registration Dates

First Submitted

March 20, 2026

First Submitted That Met QC Criteria

March 20, 2026

First Posted (Actual)

March 25, 2026

Study Record Updates

Last Update Posted (Actual)

April 2, 2026

Last Update Submitted That Met QC Criteria

March 28, 2026

Last Verified

March 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • CHIS11402

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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