Purpose: The effectiveness of multimodal complex treatment for Parkinson's disease (PD‐MCT) has recently attracted attention. However, there are differences in the PD‐MCT content across institutions. Therefore, we aimed to elucidate the effectiveness of PD‐MCT at our hospital and contribute to determining the optimal intensity and duration of the intervention.

Methods: This retrospective study enrolled 144 inpatients who underwent PD‐MCT at our hospital between March 2015 and June 2023. The primary endpoints were the Movement Disorder Society‐Unified Parkinson's Disease Rating Scale part III (MDS‐UPDRS part III) before and after admission to assess motor function, and the Parkinson's Disease Questionnaire‐39 summary index (PDQ‐39 SI) before admission and 1 month after discharge to assess quality of life. The PD‐MCT at our hospital was conducted during a 3‐4‐weeks hospital stay, with approximately 12 h of rehabilitation per week. After selecting participants with no missing data, 58 were selected for the MDS‐UPDRS part III comparison, and eight were selected for the PDQ‐39 comparison. The analysis was conducted using a paired t‐test for normally distributed data and a Wilcoxon signed‐rank sum test for non‐normally distributed data, with a significance level of 5%.

Results: The total score of MDS‐UPDRS part III was 34.7±13.3 before admission and 28.6±12.3 at discharge, and the PDQ‐39 SI was 34.0±13.5 before admission and 23.9±9.9 1 month after discharge, showing significant improvement (p<0.01 and p<0.05, respectively).

Conclusion: Motor function and quality of life significantly improved in this study. In particular, the improvement in the quality of life was sustained even 1 month after discharge. However, the study was retrospective, and many participants were excluded during the selection process, which may have caused a selection bias.

Introduction

Strain ratio (SR) measurement using the strain elastography function of an ultrasound diagnostic device can be used to noninvasively measure the stiffness of living tissue by calculating the ratio of strain values between the acoustic coupler and the target material. However, there are no reports on the influence of different scanning methods on SR measurements. Therefore, this study investigated the influence of different scanning methods on SR measurement, using real‐time tissue elastography and a phantom.

Methods

Independent inclusions with stiffness values of 100, 200, and 400 kPa were placed in the phantom and measured using both longitudinal and transverse scanning methods. Measurement error was used to examine the coefficient of variation.

Results

The coefficients of variation of SR, inclusion strain values, and acoustic coupler strain values were similar for both scanning methods with 100 kPa inclusions, but for the 200 and 400 kPa inclusions, the transverse scanning method showed higher values compared with the longitudinal scanning method. Elastography images showed heterogeneous strain distribution in the 200 and 400 kPa inclusions, and the strain distribution was concentrated in the center of the acoustic coupler due to the curvature of the acoustic coupler used in the transverse scanning method.

Conclusion

These results suggest that the SR measurement error increases when SR measurements are performed using the transverse scanning method compared with the longitudinal scanning method for materials with high stiffness.

[Introduction] One of the methods of community collaboration in Comprehensive Rehabilitation word is pre‐discharge home guidance. Pre‐discharge guidance is a method of assistance necessary to promote cooperation between the hospital and long‐term care insurance staff when patients return home from the hospital. The professionals related to the recovery phase rehabilitation ward need to anticipate and coordinate the target patients for whom pre‐discharge home guidance is to be provided in order to provide planned discharge support.

[Objective] To develop a model to predict the implementation of pre‐discharge visitation guidance based on data obtained at the time of admission of patients with cerebrovascular disease admitted to a recovery rehabilitation ward.

[Methods] A retrospective study was conducted by dividing patients with cerebrovascular disorders into two groups: a group receiving home guidance and a group not receiving home guidance. Receiver Operating Characteristic curves were used to calculate cutoff values, sensitivity, specificity, and area under the curve for the variables that showed significant differences by logistic regression analysis.

[Results] Of the 137 patients with vascular disorders, 59 had pre‐discharge guidance and 78 did not. A standardized coefficient of -0.077 (odds ratio 0.926, 95% confidence interval 0.899-0.945) was selected for “exercise FIM" at admission as a factor predicting the implementation of pre‐discharge guidance. The cutoff value was 52.5 (sensitivity 0.932, specificity 0.397, AUC 0.833).

[Discussion] The model is useful in identifying patients with cerebrovascular disease who need home guidance based on criteria based on sensitivity and specificity, but its usefulness in selecting patients with cerebrovascular disease who do not need home guidance is limited.

【Background】

　The integration of the Plug‐in Gait model (PIGM) into the VICON Nexus three‐dimensional motion analysis system has limitations in measuring hip joint rotation angles. Consequently, a new analysis method using the anterior‐posterior axis of the femur within a motion analysis software is proposed. This method's validity and reliability are compared to those of the PIGM using a rotation angle on a two‐dimensional image as a reference.

【Methods】

　The study involved five healthy male subjects (mean age: 21 years). Measurements were synchronized between VICON Nexus (OMG Corporation) and a digital camera using a marker set of the PIGM. The motion tasks included internal and external rotations of 30° from the neutral hip flexion/extension position (0°). Each task was measured five times. For each limb position, the hip joint rotation angles were evaluated using: (1) the angle between the femur shaft and the sagittal horizontal axis of the horizontal plane image, analyzed using an image analysis software (ImageJ) (two‐dimensional image angle); (2) angle calculated using the PIGM (three‐dimensional analysis angle); and (3) angle between the femur anterior‐posterior axis and the sagittal horizontal axis of the PIGM (femur anterior‐posterior axis angle). Correlation coefficients between the parameters were computed, and the intraclass correlation coefficients (ICCs), standard error of measurement (SEM), and minimum detectable change at 95% confidence level (MDC95) were calculated for the femur anterior‐posterior axis angle.

【Results】

　No significant correlation was observed between the hip joint rotation angles obtained from two‐ and three‐dimensional analyses. In contrast, a strong positive correlation was observed between the femur anterior‐posterior axis angle and the two‐dimensional image angle. ICCs for intra‐ and inter‐rater reliability were high for both internal and external rotation positions, with SEM<0.04 and MDC95<0.12.

【Conclusion】

　The devised femur anterior‐posterior axis angle‐based method can effectively assess hip joint rotation motion.

【Introduction】 The role of psychiatric home visits has become increasingly important because constructing a “comprehensive community care system that also addresses mental disorders" has become a primary healthcare aim. The role of psychiatric home visits is significant; surveys targeting psychiatric home visits supporters have focused on nurses, but none have been conducted on occupational therapists (OT). The purpose of this study was to examine the role of OT in psychiatric home visits based on the current status of support for OTs involved in psychiatric home visits in Japan.

【Methods】 5 OTs working full‐time at a psychiatric home visits station for at least 5 years participated in this study. Interviews were collected in person or online, and interview guides were used for monitoring, medication support, employment support, support for the elderly, and support for children. The interviews were recorded on an IC recorder, and a verbatim transcript was written. The transcripts were classified by 2 OTs using the KJ method.

【Results】 The support contents were classified into support contents and support methods. The support contents were organized into International Classification of Functioning, Disability and Health (ICF) items of a similar nature. Support methods were categorized into support through communication, support using activities, and support by adjusting and utilizing the environment.

【Conclusion】 The role of OTs was to support psychiatric home visits by focusing on activities and adjusting the environment in which the activities were carried out. The role of OTs was to encourage and adjust the environment so that users of psychiatric home visits services could participate in the activities they wanted to and increase their opportunities for social engagement.

　This study employs a stochastic simulation model to examine the level of care adjustments required to increase the 5‐year survival rate, with the aim of extending the healthy life expectancy of individuals certified as requiring long‐term care under long‐term care insurance. To achieve this, we began by creating a hypothetical dataset comprising of 10,000 individuals, serving as a reference group for probabilistic 5‐year care needs. Additionally, a data set was generated in which the survival rate after five years was 1% higher than that of the normal group after adjusting for mortality in each year, and this was designated as the treatment group. To eliminate the risk of data instability and mitigate uncertainty‐related outliers, we generated the hypothetical data sets 100 times each and compared the results using descriptive statistics between the reference and treatment groups. The results suggest that, in order to improve the 5‐year survival rate by 1% in each level of care, the population within each level of care needs to increase by a maximum of approximately 2.1% after five years. To contribute to the establishment of a social security system that enables safe and secure living for the elderly, it is necessary to develop a prediction model using prognostic variables such as age and gender, and to evaluate its external validity, including empirical validation. Once its external validity is confirmed, the model can be applied to various studies, such as assessing the impact of specific long‐term care services on individuals requiring care and their cost‐effectiveness. Furthermore, we believe that this research will lead to better living conditions for seniors and the curbing of social security costs.

【Introduction】Normal weight obesity (NWO) occurs when a person exhibits a body mass index (BMI) in the normal range (18.5‐25.0 kg/m2) and a high‐fat percentage (≥30%). NWO is particularly common in young women, but its impact on physical functions in young women is unknow.

【Methods】A series of individual characteristics based on living condition surveys, namely, physical activity (International Physical Activity Questionnaire: IPAQ), nutrient intake (Brief Dietary History Questionnaire: BDHQ), body composition, and physical function, were determined in 33 young women (median age 20 years). Physical function parameters included chair stand test (i.e., peak reaction force per body weight; F/W, maximal rate of force development per body weight, (RFD/W), stable time) and 30‐second air stand test (CS‐30). The NWO criteria were a BMI in the normal range (18.5‐25.0 kg/m2) and a body fat percentage ≥30%.

【Results】Overall, 11 of 33 women (33%) were determined with NWO. We observed that BMI (p<0.001), total body muscle mass (p=0.04), and trunk muscle mass (p=0.001) were significantly higher in the NWO group than in the non‐NWO group. Moreover, we did not detect significant differences in lifestyle, nutrient intake, physical activity, chair stand test (F/W: p=0.438, RFD: p=0.363, stable time: p=0.877), and 30‐second air stand test (p=0.173) between NWO and non‐NWO groups.

【Conclusion】The comparison between NWO and non‐NWO groups showed no significant differences in lifestyle and physical function items. We concluded that the effects of lifestyle and physical function parameters on NWO is unclear and require further investigation.

【Background】The predictive value of tongue pressure on the prognosis of swallowing function has not been sufficiently studied, especially in patients without stroke. 【Methods】Thirty‐nine patients with dysphagia were classified as heart surgery group (17 patients), neurological disease group (11 patients), and aspiration pneumonia disused group. We examined whether there were any differences among the groups regarding the degree of improvement in tongue pressure and the median number of hospital days. 【Results】Among the disease groups, the “heart surgery group" showed a median tongue pressure of 24.4 (6.4‐26.9), length of hospitalization of 14 days (11‐15), and degree of improvement of 0 (0‐0‐0). For the neurological disease group, median tongue pressure was 15.3 (12.6‐18.4), length of stay 19 days (11‐16), and improvement 0 (‐1‐0). For the “cardiovascular group," median tongue pressure was 23.4 (20.9‐28.7), length of stay 28.5 days (20‐46), and the degree of improvement 2 (1‐2). Significant differences were seen in the median level of dysphagia tongue pressure, improvement and length of hospital stay between the three groups. Higher tongue pressure was positively associated with better FOIS (r=0.332, p<0.05). In univariate analyses, the degree of improvement in FOIS was associated with the median change in tongue pressure (p<0.01) and length of hospital stay (p<0.05). However, in multivariate analyses, improvement in FOIS was significantly associated in the “cardiovascular group" (OR=14.218, p<0.01) but not with tongue pressure values. 【Conclusion】Our results suggest that the degree of improvement of swallowing function is dependent on the disease factors causing the dysphagia.