Skeletal Muscle Changes in the First Three Months of Stroke Recovery: A Systematic Review.
David Beckwée, Lotte Cuypers, Nina Lefeber and 8 others
PMID 35848335WHAT IT FOUND
In the first three months after stroke, muscle strength on the affected side generally increased while muscle thickness decreased.
These small-to-moderate strength gains occurred despite muscle wasting, suggesting early recovery may rely more on neural changes than muscle growth.
Key findings
01Muscle strength on the affected side generally increased in the early subacute phase, with small to moderate effect sizes.
02Despite strength gains, muscle thickness significantly decreased on both the affected and unaffected sides during the first three months.
03Lean muscle mass decreased significantly only in patients who could not walk two months post-stroke, while those who regained ambulation showed no significant loss.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
High variability between studies in measurement tools, timing of assessments, and units used made direct comparison difficult. Most studies had a high risk of sampling bias because they recruited from single centers or specific target populations. Key confounding factors like nutrition, smoking, and physical activity were often not reported or controlled for. Results are reported at the group level, masking the large individual variability in recovery trajectories seen in some data plots. Only a small number of studies provided enough data for quantitative effect size calculation; 12 studies were excluded from this analysis.
Declared interests
The work was supported by the Wetenschappelijk Fonds Willy Gepts of the UZ Brussel. Co-author E.D.K. is a Strategic Basic Research fellow funded by the Research Foundation – Flanders (FWO).
The easy way to misread this
Do not interpret the increase in muscle strength as evidence that the muscle tissue itself is growing or becoming structurally healthier. The review found that muscle thickness decreased significantly even as strength improved, suggesting the gains are likely due to neural factors rather than muscle hypertrophy.