Background: In Japan, primary screening for osteoporosis often uses methods such as dual-energy X-ray absorptiometry (DXA) and quantitative ultrasound (QUS).

Objective: The aim of this study was to assess the validity of cutoff values for diagnosing osteoporosis by comparing the measurements of heel QUS and forearm DXA with central DXA.

Subjects and Methods: Forearm DXA, heel QUS, and central DXA were performed in 100 participants with a mean age of 49 ± 12 years. The cutoff values were set as YAM < 80% for forearm DXA and a stiffness value < 82 for QUS. Osteoporosis (positive) was defined as the presence of any of these criteria. Sensitivity, specificity, and negative predictive values were calculated using the chi-square test.

Results: A negative correlation was observed between age and all measurements, with values decreasing as age increased. Using forearm DXA as a reference, the sensitivity for diagnosing osteoporosis was 19.2%, specificity was 95.9%, and negative predictive value was 77.2%. Conversely, using heel QUS as the reference, the sensitivity was 76.9%, specificity was 79.7%, and negative predictive value was 90.8%.

Discussion: In population-based screenings, heel QUS demonstrated higher sensitivity and negative predictive value compared to forearm DXA.

Conclusion: Heel QUS may be superior to forearm DXA for diagnosing osteoporosis, especially in younger individuals.

Objective: We investigated the association among health-related quality of life (HR-QOL), locomotive syndrome, and disease activity in elderly patients with rheumatoid arthritis (RA).

Methods: This study included 56 patients with RA aged ≥ 65 years who participated in the Health Achievement from Patient Perspective: Investigation on the effect of Etanercept BS1 Study (HAPPINESS). Correlation coefficients were evaluated between the scores of the EuroQol 5 Dimensions 5 Level (EQ-5D-5L) and the Geriatric Locomotive Function Scale 25 (GLFS-25), Disease Activity Score (DAS28-CRP), and Simplified Disease Activity Index (SDAI).

Results: Strong negative correlations were found between the EQ-5D-5L score and the other measures. The correlation between the EQ-5D-5L and GLFS-25 scores was significantly greater than between the EQ-5D-5L score and DAS28-CRP and SDAI scores.

Conclusion: Our results highlight the importance of focusing on locomotive syndrome in addition to disease activity to improve the HR-QOL of elderly patients with RA.

Objective: This study investigated the minimal clinically important difference (MCID) of the Japanese version of the Lower Extremity Functional Scale (LEFS) in patients with hip osteoarthritis to determine the index 3 months after the implementation of exercise therapy.

Materials and methods: The study included 69 patients diagnosed with hip osteoarthritis who visited our clinic between April 2022 and January 2023. The MCID was calculated using a distribution-based method by multiplying the standard deviation (SD) of the difference between before and 3 months after exercise therapy by 0.5. The effect size was calculated by dividing the difference between before and 3 months after exercise therapy by the SD.

Results: The MCID of the Japanese version of the LEFS 3 months after exercise therapy was 4.4 points. The proportion of patients reaching the MCID was 48%, and the effect size was 0.59.

Discussion: The MCID and effect size of the Japanese version of the LEFS indicate that it could provide an index of MCID.

Conclusion: The MCID of the Japanese LEFS in patients with hip osteoarthritis patients at 3 months after the implementation of exercise therapy was found to be 4.4 points.

Objective and Methods: This study included 43 patients (6 men, 37 women) with osteoarthritis requiring maintenance rehabilitation (MR) of locomotor rehabilitation after the standard period. Concomitant therapy performed during the standard period was continued. The efficacy of MR was evaluated using the Functional Independence Imaging Method (FIM), the 25-question Geriatric Locomotive Functional Scale (GLFS-25), the stand-up test, and the two-step test.

Results: The mean (± standard deviation) FIM scores at the start of MR and 1 month later were 124.6 ± 1.4 and 124.5 ± 1.8, respectively. Those at the start and 2 months later were 124.6 ± 1.4 and 124.6 ± 1.5, respectively. The analysis found no significant difference between the groups in paired Student's t-tests. The mean GLFS-25 scores were 14.8 ± 12.2 at the start and 12.9 ± 11.7 1 month later. Those at the start and 2 months later were 14.5 ± 12.2 and 12.9 + 11.7, respectively. These results showed a significant difference in Student's paired t-tests (p < 0.05).

Conclusions: Combined with FIM, the GLFS-25 is a useful scale for evaluating the MR of locomotive rehabilitation.

 We quantitatively evaluated fatty degeneration of the neck extensor muscle group in traumatic neck syndrome by MRI and examined its association with neck pain (VAS).

 In addition, the hospital anxiety and depression scale (HADS), pain catastrophizing scale (PCS), and a simplified version of the Disease Recognition Scale were evaluated for psychosocial assessment. Fatty degeneration was increased in the high VAS group with traumatic neck syndrome compared to controls, suggesting an association with pain-induced disuse muscle atrophy, suggesting that MRI assessment of fatty degeneration of the cervical multifidus muscle may be an objective imaging modality in traumatic neck syndrome.

OBJECTIVE: To evaluate the delayed union rate 3 months after injury depending on treatment selection based on the T2 high- or low-intensity area on the magnetic resonance imaging (MRI) of the vertebral body for osteoporotic vertebral fractures.

METHODS: This study included patients with spinal vertebral fractures who underwent conservative therapy for more than 3 months. MRI T2 high- or low-intensity area in the vertebral body was treated with a soft orthosis or waist-fixing belt, and the MRI T2 iso-intensity area was treated with a waist-fixing belt only. Delayed union was defined as the presence of a vacuum cleft on radiographs obtained 3 months later.

RESULTS: Among 35 patients with MRI T2 high- or low-intensity area of the vertebral body, 15 patients were treated with a soft orthosis, and 20 patients with a waist-fixing belt. The delayed union rate was 16.4% (18 of 110 cases).

DISCUSSION: The reported pseudarthrosis rate with conservative therapy was approximately 15%, and the delayed union rate in this study was similar.

CONCLUSION: Selective soft orthosis therapy based on the MRI T2 high- or low-intensity area of the vertebral body may be an option for orthotic therapy.

 The current status of the application and billing of the management fee for continued secondary fracture prevention at medical institutions affiliated to the Japanese Clinical Orthopaedic Association was investigated. Among the hospitals investigated, the percentage of hospitals that had filed reports on the application of this fee was 67.9% for Management Fee 1, 51.8% for Management Fee 2, and 64.3% for Management Fee 3. The patients referred to the hospitals most frequently arrived at the hospitals by ambulance from their home (59%). Treatment of osteoporosis had been started before admission to the hospital in only 21% of the patients. In 35% of the patients, osteoporosis treatment was not started before discharge from the hospital. Patients who had received this kind of management as inpatients were often referred to the outpatient care unit of the same hospital after discharge, indicating that the regional hospital-clinic coalition was not functioning satisfactorily. The number of patients referred to hospitals did not exceed 5 per year at many orthopedic clinics, and 33% of these clinics were not submitting their reports on the application of this fee as they did not satisfy the requirements for Management Fee 3 (pharmacist availability, internal conference system and so on). For prevention of secondary fractures following proximal femoral fracture, it is crucial to continue osteoporosis treatment and to improve the locomotive syndrome (hereinafter called “locomo”) to prevent falls and tumbling; therefore, guidance by practitioners, including by internists serving as family doctors, toward continuation of osteoporosis treatment and control of locomo is essential.

 The treatment of osteoporosis after a hip fracture is important for preventing secondary fractures. In the 2022 medical fee revision in Japan, a new fee was introduced for continued management of secondary fracture prevention. For patients undergoing surgery for primary fractures during the acute phase of hospitalization and receive osteoporosis treatment, Management Fee 1 is calculated. If osteoporosis treatment is continued at a rehabilitation facility, Management Fee 2 will be applied, followed by Management Fee 3 if the treatment is continued in an outpatient clinic.

 Therefore, initiating osteoporosis treatment in acute-phase hospitals for patients with hip fractures is essential. Information regarding the initiation of osteoporosis treatment should be communicated to ensure continuation in rehabilitation facilities or outpatient clinics. Therefore, it is vital for all facilities in the regional medical community to have a common understanding of osteoporosis treatment for patients with hip fractures.

 At the time of revision of the national health insurance reimbursement rates in Fiscal 2022, a management fee for continued secondary fracture prevention was newly adopted, inviting re-awareness of the necessity of close coalition among regional medical institutions for the treatment of patients. At the Seirei Sakura Citizen Hospital (hereinafter called “our hospital”), clinical practices satisfying the requirements for application of this fee, including early implementation of surgery and start of osteoporosis treatment already during inpatient care, were introduced many years ago. To facilitate coalition with other medical institutions, our hospital has been using and applying a paper pocketbook. This pocketbook is also used for the care of patients with vertebral body fractures. A major disadvantage, however, is that use of this paper pocketbook does not enable sharing of the information about individual patients among institutions until it is brought in by the patients when they visit the medical institutions. To overcome this disadvantage, we have started a regional healthcare provider coalition using a new tool utilizing Information and Communication Technology (hereinafter called “ICT”). The use of this ICT tool ensures sharing of information among healthcare institutions, allowing each institution to access the patient's information whenever needed.

 We launched the Osteoporosis Liaison Service (OLS) activities at Sanmu Medical Center in 2015. We started our activities with a specialized osteoporosis outpatient clinic and focused on preventing secondary fractures after fragility fractures.

 Subsequently, we collaborated with city hall and other government agencies to educate residents through lectures. However, during repeated educational activities, we observed a problem with older participants repeating the course; therefore, we sought a means to deliver information to a wider audience. Currently, we focus on creating video content and conducting educational activities in schools.

 In this report, we introduce the background of our efforts and issues identified during the process. We hope that this will provide an opportunity to consider our role as a core regional hospital and the future of OLS activities as the aging population accelerates throughout Japan.

Background and Objectives: The management fee for continued secondary fracture prevention was newly adopted in April 2022. The present study was undertaken to investigate the status of submission of reports from medical institutions in Chiba Prefecture to the regulatory authority about satisfaction of the requirements for application of this fee, as well as the data on the actual billing for this fee in clinical practices, and to identify problems with this system, if any.

Subjects and Methods: We investigated the number and percentage of medical institutions that had reported satisfying the requirements for application of Management Fee 1, 2 and 3 to the Kanto-Shinetsu Regional Bureau of Health and Welfare (a local office of the Ministry of Health, Labour and Welfare), accompanied by a questionnaire survey of the problems associated with billing for this fee.

Results: A report on satisfying the requirements for Management Fee 1 had been filed by 71 (43.8%) of the 162 institutions investigated, and the actual billing had been made by 51 institutions (71.8%). The same report on satisfying the requirement for Management Fee 2 had been filed by 54 (55.7%) of the 97 institutions, with the actual billing made by 8 institutions (14.8%). In regard to satisfying the requirements for application of Management Fee 3, reports had been filed by 46 (14.2%) of the 323 institutions, and the billing was made by 7 institutions (15.2%). In the questionnaire survey, 40% of acute care hospitals and 37% of rehabilitation hospitals indicated that they had been providing information about billing for these fees.

Discussion: It seems critical to disseminate the information about this kind of management fee and to establish a system for information transmission among medical institutions.

 In April 2016, the Goseikai Osteoporosis Liaison Service was established at our hospital. Since then, we have been working on primary and secondary fracture prevention. We report on the approaches that we have adopted to date, including the introduction of continuous management for secondary fracture prevention in April 2022. Of the 81 patients who received intervention for secondary fracture prevention, 64 patients were applicable for the calculation of management fee 1, 5 patients for management fee 2, and 26 patients for management fee 3. Both management fees 1 and 2 were calculated in more than 80% of the patients.

 Flexor pollicis longus (FPL) tendon rupture develops in a small percentage of patients after surgical volar locking plate fixation for distal radius fracture. In the patient reported herein, a 58-year-old woman, the FPL tendon ruptured after it became entrapped at the time of surgical fixation for a distal radius fracture performed one week after the injury was sustained. After the surgery, the patient complained of a limited range of motion of the thumb and was referred to a specialist outpatient clinic. A repeat surgery was performed three months after the initial surgery, and intraoperatively, the distal end of the FPL tendon was found to have become entrapped between the plate and the radius, causing rupture of the tendon. Therefore, a free tendon graft using the palmaris longus tendon was performed. Complete functional improvement was achieved over the course of the subsequent six months. We report on the precautions necessary during and after surgery for distal radius fracture and the usefulness of ultrasound examination for detailed assessment of the lesion.

 We investigated motion pain and psychological factors in 199 patients with shoulder capsulitis who had undergone physical therapy for 3 months. Catastrophic thinking interfered with the improvement of motion pain, suggesting that talking to the patients to put them at ease and detract from catastrophic thinking during physical therapy could increase the likelihood of pain improvement. It is important to have the patients focus, not only on functional improvement, but also on small changes in their activities of daily living (ADLs), to make them aware that the number of things that they can do on their own is increasing.

Background: Factors associated with improvement of the activities of daily living (ADL) in patients with a frozen shoulder have not yet been identified. Therefore, we conducted this study to explore these factors.

Study Subjects and Methods: The study was conducted in 199 patients who had been diagnosed as having a frozen shoulder at any of the hospitals of our group. Using “Shoulder 36,” a patient-based evaluation tool, we evaluated the improvement in the ADL, and performed multiple logistic regression analysis to identify factors that were significantly associated with the improvement of the ADL.

Results: The analysis identified improvement in the range of motion as a factor that was significantly associated with improvement of the ADL.

Conclusion: In order to improve the ADL in patients with a frozen shoulder, improvement of the range of motion of the joint should be an important goal of intervention.

 We report our experience with two relatively rare cases of lateral parapatellar synovial plica of the knee. Both patients, a 16-year-old man and a 41-year-old man, presented with a history of pronounced and painful knee clicking at around 30 degrees flexion of the knee from the extended position. We performed arthroscopic intervention to scrape off the raised area on the lateral capsular wall of the patellofemoral joint to the extent possible. The knee clicking and pain disappeared within 3 months of the intervention in both patients. The histopathological diagnosis of the resected tissue was synovial tissue covered by synovial lining cells in the 16-year-old patient, and hypertrophic synovial tissue with inflammatory cell infiltration in the 41-year-old patient.

Objective: To identify the psychological factors associated with improvement in activities of daily living in patients with osteoarthritis (OA) of the hip joint.

Methods: With the objective of identifying the psychological factors associated with the Lower Extremity Functional Scale (LEFS), we examined the LEFS, catastrophic thinking, Pain Self-Efficacy Questionnaire (PSEQ), and Central Sensitization Inventory (CSI) in patients with OA of the hip joints.

Results: The PSEQ and CSI were found to be significantly associated with the LEFS.

Discussion: The results suggest the need to consider interactive therapy for behavior modification and pharmacotherapy in order to improve LEFS.

Conclusion: PSEQ and CSI were significantly associated with LEFS.

 Herein, we present the results of a questionnaire survey conducted by the Japanese Clinical Orthopaedic Association (JCOA) of school children/students who were examined at a hospital after a school medical screening for locomotor organ functions in fiscal year 2022. Data were obtained from a total of 2751 children. The most common diagnosis among the surveyed children was scoliosis. Other diagnoses included Osgood-Schlatter disease, lumbar spondylolysis, herniated disc, and baseball elbow. Subsequent measures taken after the diagnosis were observation with guidance in 55.5% of the children and reference to other specialists in 3.0% of the children. Also, in fiscal year 2023, many school children/students were diagnosed as having ankle joint disorders, suggesting possible involvement of the SARS-CoV-2 virus infection.

Background: To analyze the factors related to improvement in pain during motion (motion pain) in patients with non-specific low back pain (NLBP), in order to identify the focal points.

Study subjects and methods: The study was conducted in 73 patients who visited our clinic between June 2022 and January 2023, were diagnosed as having NLBP, and underwent exercise therapy. We examined the relationship between the magnitude of improvement in motion pain and the results of each psychological assessment.

Results: The magnitude of improvement in motion pain was found to be associated with the magnitude of improvement in the scores on catastrophic thinking, self-efficacy, and central sensitization.

Conclusions: Exercise therapy in patients with motion pain should take into account the patient's catastrophic thinking, self-efficacy, and central sensitization.

 Surgical treatments for osteoarthritis of the knee include total knee arthroplasty (TKA) and high tibial osteotomy (HTO). We have often encountered cases where time to independent walking after HTO is delayed as compared with that after TKA. Therefore, we conducted a multiple regression analysis to investigate whether the time to independent walking with two crutches, a cane, or without a cane after HTO was influenced by any factors, such as the age, BMI, knee extension muscle strength, and pain. The results showed a correlation only between pain and the time to independent walking with a cane. This suggests that intervention for pain management is necessary for independent walking with a cane.

 The study was conducted in 16 patients with gouty arthritis of the knee at our clinic; uric acid crystals had been detected in the joint fluid of 17 knees during the previous eight years. The medical history at the initial visit revealed that many of these patients had been diagnosed as having gout in the past, but had discontinued treatment midway. The mean duration of the gout attacks was relatively short (8.8 ± 3.2 days). Some of the patients experienced recurrent attacks. The white blood cell (WBC) counts in the joint fluid were high, but showed a wide distribution. Also, the WBC counts were lower in the gout patients than in the pseudogout patients, suggestive of a lower degree of inflammation in the former patients.

 We found that in patients receiving autologous protein solution (APS) injection for knee osteoarthritis, no significant relationship was observed between the magnitude of improvement of the pain and change in the width of the joint space on X-ray images. This finding suggests that APS does not suppress arthropathic changes even if it improves pain. On the other hand, magnetic resonance (MR) imaging showed a significant relationship between increase or decrease in the amount of joint fluid and the magnitude of improvement of pain. Therefore, we contend that the analgesic effect of APS may be mediated by its anti-inflammatory actions, resulting in suppression of joint edema, that is, synovitis.

 We summarized the trends and characteristics of red flag cases we encountered during physical therapy. This study was conducted in a total of 11,897 patients who underwent physical therapy at our clinic. Their outpatient medical records were examined retrospectively. Of the patients, we identified 15 patients as red flag cases. The underlying diseases included malignant tumors, orthopedic diseases, and neurological diseases. The patients with malignant tumors complained of pain at rest, and the rest of the patients complained of a variety of symptoms. For patients with symptoms that are unlikely to be caused by musculoskeletal diseases, it is important to intervene appropriately in a timely manner, taking into account the possibility of their being red flags.

 In order to realize medical safety in medical institutions specialized in orthopedics, the author reported the necessity of proper management of physicians' working hours, taking into account 10 civil lawsuits involving physicians who died of overwork or committed suicide due to excessive overtime work. In addition, the author also conducted a questionnaire survey to determine “whether excessive overwork might also lead to medical errors,” and found that excessive overwork is not a cause of misdiagnosis and/or medical errors.

 The minimal clinically important difference (MCID) after 3 months of exercise therapy in the score on the Roland-Morris Disability Questionnaire (RDQ) was calculated in 70 patients with non-specific low back pain. The MCID was 2.1, with an effect size of 1.0. The MCID is an indicator of the magnitude of a clinically useful change. It can be used to explain the effects of treatment in patients and as a rough guide of improvement.

 We compared the data of 234 knees that were injected with autologous protein solution (APS), including the peripheral blood white blood cell and platelet counts before the injection, adverse reactions after the injection, and the degree of improvement and changes in the numerical rating scale (NRS) scores for pain after the injection. Before the comparison, the knees were classified into 3 groups according to the amount of APS prepared from the patients' blood. The results showed significant improvement of the NRS scores in all three groups, with no significant differences among the three groups. Thus, the occurrence of adverse reactions or the treatment effectiveness did not differ depending upon the amount of APS prepared from the patients' blood.

Introduction: We examined the psychological factors affecting the improvement in pain during walking (walking pain) in patients with osteoarthritis of the knee (knee OA) who underwent exercise therapy.

Study subjects: The study was conducted in 126 patients diagnosed as having knee OA.

Methods: Walking pain measured by the score on a Visual Analogue Scale (VAS) was evaluated, along with the scores on the short-form Central Sensitization Inventory (CSI), Pain Self-Efficacy Questionnaire (PSEQ), and Pain Catastrophizing Scale (PCS) scores, 3 months after the start of exercise therapy. The magnitude of improvement was calculated by subtracting the baseline scores from the scores recorded after 3 months of exercise therapy. Then, a multiple regression analysis was performed to identify the psychological factors affecting the magnitude of improvement in walking pain as measured by the score on the VAS.

Results: The results suggested that the magnitude of improvement in walking pain measured by VAS was associated with the magnitude of improvement in the score on the PCS.

 Piano performance requires delicate and quick hand movements. Therefore, in patients with hand injuries, occupational therapy is required for maximal improvement of the dexterity of the hands and fingers. Furthermore, it is necessary to support the player until a satisfactory quality of performance is restored and concerns about recurrence are eliminated. The focus of this report is disease of the thumb carpometacarpal joint (CM joint), which is common among pianists. In this article, we report a case of a pianist who underwent abduction osteotomy of the thumb CM joint, along with the progress of her occupational therapy.

 We evaluated the minimal clinically important difference (MCID) in walking pain after 3 months of exercise therapy in 69 patients with hip osteoarthritis (HOA). The MCID in walking pain measured by the Visual Analogue Scale (VAS) was 15 mm, with an effect size of 0.38. A reduction by 15 mm in the severity of walking pain measured by VAS after 3 months of exercise therapy could be one of the useful indices. However, the effect size of the MCID was small, and further study is needed in the future.

 We present the case of a professional cellist who complained of pain radiating from the right neck to the right upper extremity and was successfully treated by exercise therapy. Due to the nature of cello playing, cellists have a tendency to abduct their right shoulder when playing high notes. This is associated with increased posterior pelvic tilt and thoracic kyphosis. Improved strength of the posture-maintaining muscles allowed the scapula to move more freely, leading to symptom remission. Exercise therapy for musculoskeletal problems in musicians based on an understanding of the characteristics of the musical instrument they play is important for the treatment of musculoskeletal disorders related musical instrument performance.

Objective: To investigate the usefulness of assessment by Shoulder 36 (Sh36) in patients with shoulder capsulitis, in order to evaluate whether the minimal clinically important difference (MCID) for assessing clinically effective changes can be achieved in the scores.

Methods: The MCID in Sh36 was calculated in 188 patients with shoulder capsulitis.

Results: The MCID achievement rate ranged from 9% to 24%.

Discussion: The range of differences in the score on Sh36 was too small to evaluate clinically effective changes.

Conclusion: It was difficult to calculate the MCID in Sh36.

 We attempted to develop a self-training method for improving the act of belt-tying in patients with shoulder joint diseases. Twenty-five healthy subjects performed the hand-behind-back movement in a sitting position, and the maximum hand-behind-back range of motion was measured. The distance from the spinous process of the seventh cervical vertebra to the tip of the thumb was evaluated before and after the intervention. All four types of static stretches (10 and 20 seconds) and dynamic stretches (10 and 20 times) in a resting sitting position, using a towel were significantly effective. However, there were no significant differences among the four types of stretches. We recommend self-training using towels.

 In patients with knee osteoarthritis (OA), we analyzed the changes over time for 3 months in the scores on the assessment scales to determine the timing at which the pain severity and activities of daily living (ADL) began to show alleviation/improvement after the start of exercise therapy. The severity of pain during walking began to reduce at 1 month after the start of exercise therapy, while the ADL began to improve at 2 months after the start of exercise therapy.

 Data from scoliosis screening and musculoskeletal examination of inhabitants of Ube City and Sanyo Onoda City during the 12-year period from 2009 to 2021 were reviewed. Until 2012, only a small percentage of examinees (about 0.1%) received referral to undergo secondary screening for scoliosis, but thereafter, after the introduction of a scoliosis questionnaire and the accompanying musculoskeletal examination, it rose to about 3%. Of the examinees judged as requiring secondary screening, 75%, on average, actually underwent the secondary screening. On musculoskeletal examination, abnormalities were often detected in low back flexion/extension and crouching motions, with a similar tendency observed throughout the review period. The average percentage of examinees judged as requiring further workup was 0.4%, and 54% of the patients, on average, actually underwent a specialist's workup.

 In patients with knee osteoarthritis (OA), the minimum clinically important change (MCID) in the score on the Lower Extremity Functional Scale-Japanese Version (LEFS) after 3 months of exercise therapy was analyzed. The MCID in the score on LEFS calculated in 127 patients with knee OA was 5.2 (effect size, 0.44). Thus, the effect size of the MCID in the score on LEFS was small and further investigation is warranted.

 Acceleration training (AT) has been reported to be useful for improving the range of motion in patients with shoulder periarthritis. We evaluated whether the addition of AT to exercise therapy with guided voluntary training would lead to further improvement in these patients or not. Eighteen patients with shoulder periarthritis were divided into an intervention group and a control group, and each group received exercise therapy (once a week, 4 sessions in total) with voluntary training; in addition, the intervention group also received AT. The range of flexion of the shoulder joint improved similarly in both groups.

 The efficacy of stretching combined with acceleration training (AT) was evaluated in healthy adults by comparing the magnitude of changes in the range of motion of the hip joint between a group that underwent the AT + stretching and a group that underwent stretching alone. The magnitude of changes in the range of hip flexion and composite angle differed significantly between the two groups, suggesting the potential usefulness of introducing an exercise regimen involving AT for patients who have undergone total hip replacement.

Objectives: To analyze the psychological factors associated with improvement in the activities of daily living (ADL) in patients with non-specific low back pain.

Methods: We analyzed the association of the ADL with the severity of pain at rest, severity of pain during motion, central sensitization, score on the pain catastrophizing scale, and sense of self-efficacy in 73 patients diagnosed as having non-specific low back pain.

Results: The magnitude of improvement in the ADL was associated with the magnitude of alleviation in pain during motion and improvement in the sense of self-efficacy.

Discussion: To achieve improvement in the ADL, the severity of pain during motion and the sense of self-efficacy need to be alleviated or improved.

Conclusions: One of the psychological factors shown to be associated with improvement in the ADL was improvement in the sense of self-efficacy.

 At the time of Revision of Medical Fee in fiscal 2022, evaluation using the Functional Independence Measure (FIM) was set as a mandatory step for certain types of rehabilitation. We attempted to verify the validity of FIM as an indicator for judging responses to outpatient locomotor rehabilitation. In 55 patients with low back pain, changes after a 2-month continuous outpatient rehabilitation program in the scores of four measures/scales, i.e., the Numerical Rating Scale (NRS), FIM, Locomo 25, and JOA back pain evaluation questionnaire (JOABPEQ), were compared. The comparison revealed that FIM was not a sufficiently satisfactory scale to detect changes over time in the patient's condition after the intervention and therefore inadequate for verifying the efficacy of outpatient locomotor rehabilitation.

 In patients with knee osteoarthritis who had undergone exercise therapy, we analyzed the psychological factors associated with improvement in the activities of daily living (ADL). The results revealed that the improvement in the ADL was associated with the magnitude of improvement in the score on the pain catastrophizing scale (PCS), suggesting that approaches to improving the PCS are also needed during exercise therapy.

 The minimal clinically important difference (MCID) for pain during walking was investigated in patients with knee osteoarthritis (OA). In 127 patients diagnosed as having knee OA, the severity of pain was evaluated on a Visual Analogue Scale (VAS) before and 3 months after the start of exercise therapy. The MCID of the VAS score for pain during walking was 14 mm, and the effect size was large, at 0.9. These results suggest that the MCID can serve as an indicator of the goal of alleviation of pain during walking after 3 months of exercise therapy.

 In some patients with an initial diagnosis of ankle sprain, osteochondral injury is only detected after magnetic resonance imaging (MRI). Therefore, we investigated whether patients with ankle sprain experiencing pain during loading that necessitated the use of crutches might have osteochondral injury. Of the 19 patients who visited our clinic for ankle sprain with difficulty in walking, 9 patients had osteochondral injury. The possibility of osteochondral injury should be borne in mind in patients with ankle sprain who complain of difficulty in walking.

Objective: To investigate the minimum clinically important difference (MCID) in the visual analog scale (VAS) score for pain in patients with shoulder periarthritis, in order to identify the indices of MCID after exercise therapy.

Methods: The MCID was calculated using a distribution method. The standard deviation (SD) of the difference between before and 3 months after exercise therapy was multiplied by 0.5, and the resulting value was defined as the MCID.

Results: The MCID in the VAS score for pain on movement was 14.1 mm; the effect size was large.

Conclusion: The MCID of the VAS score for pain on movement after exercise therapy was determined to be 14.1 mm.

 We surveyed the status of hospital visits by patients to receive denosumab treatment during the COVID-19 pandemic. Of the 462 patients scheduled to continue treatment, 404 (87.4%) patients made hospital visits, while 58 (12.6%) failed to make hospital visits to receive the drug. The reasons for the failure to make hospital visits included those specific to the COVID-19 pandemic, such as self-quarantine for fear of becoming infected and stay-at-home requests by the facilities. We explained the disadvantages of treatment suspension due to cessation of hospital visits and provided support to the patients for continuing their osteoporosis treatment. This led us to realize the importance of the Osteoporosis Liaison Service (OLS), a multidisciplinary collaboration system, even during the COVID-19 pandemic.

 We examined the validity of the Functional Independence Measure (FIM) as an index to evaluate the effectiveness of outpatient musculoskeletal rehabilitation (musculo-rehab) for patients with shoulder joint disease. We compared the magnitude of changes in the FIM and scores on Shoulder 36 (Sh36) and numerical rating scale (NRS) after two months of continuous outpatient visits to our clinic in 47 patients with shoulder pain. Changes over time were observed in the scores on the Sh36 and NRS, but not in the FIM. The results suggest that FIM is not a sufficiently reliable index to evaluate the effectiveness of musculo-rehab for shoulder joint disease.

 We investigated the effects of the flexion angle of the knee on Osteoarthritis Outcome Score (KOOS) in patients with knee osteoarthritis (OA). We enrolled 148 patients with OA of the knee who were receiving outpatient treatment at our clinic and divided into two groups according to the mean value of the knee flexion angle: a “good” flexion angle group with the angle equal to or above the mean and a “poor” flexion angle group with the angle below the mean. We then compared the KOOS between the two groups. The “good” group showed significantly higher scores on all the KOOS subscales than the “poor” group.

 The minimal clinically important difference (MCID) of the visual analogue scale (VAS) score for pain after 3 months of exercise therapy was determined in 70 patients with non-specific low back pain. The MCID of the VAS score was 15 mm (effect size: 0.7) for pain on movement and 14 mm (effect size: 0.4) for resting pain. MCID is an indicator of the magnitude of a clinically useful change. It may be used as an index of the efficacy of 3 months of exercise therapy.

 In Kure City, Hiroshima Prefecture, a program was developed for preventing progression of osteoporosis to the severe stage and has been implemented in cooperation with the medical association, dental association, pharmaceutical association, and the city office since fiscal 2017. At the same time, a collaborative network for preventing osteonecrosis of the jaw was also started. The incidence rate of osteonecrosis of the jaw caused by bisphosphonates and denosumab used in the treatment of osteoporosis was about 0.1%. Both incidence rates of clinical vertebral fractures and proximal femur fractures were found to have decreased in fiscal 2021 as compared with fiscal 2017.