Association between the red cell distribution width /albumin ratio and rehabilitation outcomes in subacute stroke: a retrospective study

Abstract Background The red cell distribution width–to–albumin ratio (RAR) predicts outcomes in acute ischemic stroke, yet its relevance after transition to subacute rehabilitation remains uncertain. Therefore we aimed to evaluate the association between RAR and functional recovery in subacute stroke. Methodology We retrospectively analyzed 56 individuals with ischemic stroke who were admitted to a rehabilitation unit between January 2022 and June 2025. Demographic characteristics, laboratory measures (RDW, albumin, hemoglobin, CRP), and functional assessments including the Brunnstrom Recovery Stages, Functional Ambulation Classification, Functional Independence Measure, FIM Efficiency and the Barthel Activities of Daily Living Index were recorded at both admission and discharge. Patients were stratified into low risk (RAR ≤ 0.397) and high risk (RAR > 0.397) groups. Functional gains were calculated as the difference between discharge and admission scores. Results The mean age of participants was 69.0 ± 11.8 years. Across the study, RAR itself was not correlated with functional improvements. By contrast, longer disease duration was consistently associated with poorer gains in Brunnstrom Recovery Stages, Barthel Activities of Daily Living Index, and Functional Ambulation Classification (p = 0.001), while extended hospitalization was positively related to upper extremity and hand motor recovery. Notably, the low-risk group showed a one-level Functional Ambulation Classification increase. Though not statistically significant, this gain is clinically meaningful and often translates to greater independence in community ambulation. Conclusions The red cell distribution width–to–albumin ratio was not an independent predictor of rehabilitation outcomes in subacute stroke. However, lower RAR may identify patients with greater functional responsiveness. Further studies needed.