Japanese Journal of Comprehensive Rehabilitation Science
Online ISSN : 2185-5323
ISSN-L : 2185-5323
Volume 4
Displaying 1-15 of 15 articles from this issue
Original Article
  • Kohei Yamada, Izumi Kondo, Kenichi Ozaki, Yasunori Sumi, Yoshinobu Tan ...
    Article type: Original Article
    2013 Volume 4 Pages 1-6
    Published: 2013
    Released on J-STAGE: June 01, 2013
    JOURNAL FREE ACCESS
    Supplementary material
    Yamada K, Kondo I, Ozaki K, Sumi Y, Tanaka Y. Evaluation of food texture by a questionnaire utilizing oropharyngeal sensation. Jpn J Compr Rehabil Sci2013; 4: 1-6.
    Purpose: With the objective to develop a standardized sensory test for food texture, which allows simple diet evaluation using oropharyngeal sensation in clinical and domiciliary settings, we added items to an existing questionnaire and evaluated the reliability and criterion-related validity of the new instrument.
    Methods: Twenty healthy adult volunteers were instructed to chew and swallow test foods adjusted to three grades of food property using the enzyme homogeneous permeation or freeze-dry method, and then respond to a questionnaire containing nine items.
    Results: The highest κ, which is the statistic value for reliability, was 0.523 for question 1 and the lowest κ was 0.281 for question 2. For criterion-related validity, a significant relationship was observed between multiple questionnaire items and "hardness stress" (p < 0.05), whereas almost no significant correlation was observed between the questionnaire items and "adhesiveness" or "cohesiveness" (p ≥ 0.05).
    Conclusion: Criterion-related validity was confirmed for several questionnaire items in relation to "hardness stress". Future studies are required to explore questionnaire items related to "adhesiveness" and "cohesiveness" and to improve the reliability of the instrument.
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  • Toshio Teranishi, Izumi Kondo, Genichi Tanino, Hiroyuki Miyasaka, Hiro ...
    Article type: Original Article
    2013 Volume 4 Pages 7-13
    Published: 2013
    Released on J-STAGE: June 01, 2013
    JOURNAL FREE ACCESS
    Supplementary material
    Teranishi T, Kondo I, Tanino G, Miyasaka H, Sakurai H, Kaga J, Suzuki Y, Matsushima A, Kawakita M, Sonoda S. An analysis of falls occurring in a convalescence rehabilitation ward — a decision tree classification of fall cases for the management of basic movements —. Jpn J Compr Rehabil Sci 2013; 4:7-13.
    Purpose: A simple and discriminative method for evaluating the ability to maintain balance, the Standing test for Imbalance and DisEquilibrium (SIDE), was developed for fall risk management. As a preliminary step toward clinical application of the SIDE, this study aimed to determine a method of assessing the expected fall risk by analyzing fall cases using a decision tree classification for the management of basic movements.
    Subjects and method: The subjects of this study were 513 patients who had been discharged from a convalescence rehabilitation ward over a one-year period (from January 1, 2010 to December 31, 2010). In cases when a fall occurred, we investigated the period from hospitalization and the classification of the patient, which was made with a decision tree describing the permitted activities of the patient and the management of the activities. The frequency of fall occurrence was determined by considering the number of patients who fell during every 15-day period during hospitalization.
    Results: One hundred twenty patients fell during hospitalization. In total, 163 falls occurred. The incidence of falls was 4.65‰. Thirty patients suffered multiple falls. The falls occurred significantly more frequently during the first 15 days after admission. From classification by the decision tree, 62 falls occurred while the patients were being managed using physical restraints and/or sensors, 55 falls occurred during unpredictable actions of patients when the patients were not using physical restraints or sensors, and 26 falls occurred during permitted activities of patients.
    Conclusion: Simple assessments of balance and adherence are necessary to reduce the occurrence of patient falls during the early period after admission.
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Brief Reports
  • Kyoko Furusato, Taeko Nagao, Masao Taketani, Hisato Nakazono, Noguchi ...
    Article type: Brief Reports
    2013 Volume 4 Pages 14-16
    Published: 2013
    Released on J-STAGE: June 01, 2013
    JOURNAL FREE ACCESS
    Supplementary material
    Furusato K, Nagao T, Taketani M, Nakazono H, Noguchi D, Watanabe S. Algorithm for initiation of medication self-management training based on FIM (AIMS-F) in stroke patients. Jpn J Compr Rehabil Sci 2013; 4: 14-16.
    Objective: Medication management is an important factor for the prevention of deterioration or recurrence of cerebral infarction. Aiming at early achievement of independence in medication, we developed a new algorithm for initiating medication self-management training based on the Functional independence Measure (FIM) scale, which we abbreviated as AIMS-F.
    Methods: Stroke patients who ultimately achieved independence in medication management were analyzed retrospectively. The patients were divided into two groups: a group that required self-help devices for management and a group that was able to manage with medication bags, at the initiation of training. From the scores of five items in the FIM scale (bladder control, bowel control, grooming, memory, and social interaction), the choice of the optimal initiation method (self-help devices or medication bags) was predicted. Logistic regression analysis was conducted to find the cutoff point at which training can be initiated with medication bags.
    Results: The receiver operating characteristic curve (ROC) that fitted the logistic model had an area under the curve (AUC) of 82%. The cutoff point of the total score of five FIM items was 32. At this cutoff, sensitivity was 85% and specificity was 64%.
    Conclusion: This study demonstrated the usefulness of AIMS-F to standardize the initiation of medication self-management training. By introducing the AIMS-F, the timing and the method of initiating medication self-management training are clearly indicated, which may provide a standardized approach that allows early achievement self-management.
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Original Article
  • Takayuki Yoshikawa, Yoichi Shimada, Naohisa Miyakoshi, Toshiki Matsuna ...
    Article type: Original Ariticle
    2013 Volume 4 Pages 17-21
    Published: 2013
    Released on J-STAGE: June 01, 2013
    JOURNAL FREE ACCESS
    Supplementary material
    Yoshikawa T, Shimada Y, Miyakoshi N, Matsunaga T, Hatakeyama K, Iwami T. Motion analysis of anterior inclination of the trunk while standing using a new three-dimensional musculoskeletal model combining the trunk and lower limbs. Jpn J Compr Rehabil Sci 2013; 4: 17-21.
    Purpose: We developed a three-dimensional musculoskeletal model and used this model for motion analysis of the change in posture from standing upright to maximum anterior inclination of the trunk.
    Methods: A new three-dimensional musculoskeletal model combining the trunk and lower limbs was constructed from a healthy volunteer. For motion analysis using this model, five healthy volunteers participated in this study. A three-dimensional motion analysis system was used to analyze the flexion phase from standing upright to maximum anterior inclination of the trunk, and the return phase from maximum anterior inclination of the trunk to standing upright. The muscle activities of the erector spinae, the rectus abdominis and the gluteus maximus were calculated from the motion analysis. The ratio of muscle activity at standing upright phase to the peak muscle activity was analyzed statistically for each muscle.
    Result: The mean ratios of muscle activity at standing upright phase to peak muscle activity were 1: 3.94 ± 0.65 (mean ± SD) for the erector spinae, 1:1.75 ± 0.22 for the erector spinae, and 1: 4.07 ± 0.68 for the gluteus maximus. The muscle activity at standing upright phase and the peak muscle activity were significantly different in all muscles (paired t-test ; p < 0.0001).
    Conclusion: A new three-dimensional musculoskeletal model combining the trunk and lower limbs is useful for simultaneous analysis of muscle activities of the trunk and lower extremities.
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  • Toyoko Asami, Naoya Yamanouchi, Akihiko Asami, Hisato Tanaka, Norihiko ...
    Article type: Original Ariticle
    2013 Volume 4 Pages 22-29
    Published: 2013
    Released on J-STAGE: June 01, 2013
    JOURNAL FREE ACCESS
    Supplementary material
    Asami T, Yamanouchi N, Asami A, Tanaka H, Nogami N. The effectiveness of patches containing Loxoprofen Sodium Hydrate (LX-P) in the conservative therapy of muscular back pain - Clinical results using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ). Jpn J Compr Rehabil Sci 2013; 4: 22-29.
    Objectives: We investigated the analgesic effect, degree of patient satisfaction, and QOL improvement provided by patches containing loxoprofen sodium hydrate (LX-P) using a questionnaire based on the evaluation criteria of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ).
    Methods: In this study of 53 patients (18 men, 35 women) with muscular back pain, LX-P 100mg was applied once per day for four weeks. Patients provided subjective feedback by answering a questionnaire.
    Results: After one week of LX-P application, Visual Analogue Scale (VAS) scores were significantly lower and in the fourth week over 50% of the patients who had switched from other NSAIDs reported improved satisfaction over the drug previously used. The JOABPEQ Severity of Illness Index (for all patients) was significantly higher after one week for pain- related disability and lower back functional disorder, and was significantly higher after two weeks for daily life disability. The rate of effectiveness of LX-P against pain-related disabilities in the fourth week was 62.2%.
    Conclusion: LX-P showed satisfactory analgesic effect and QOL improvement. We believe it is effective for clinical practice.
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  • Naglaa A. Gadallah, Mohamed R. Awad, Klaus R. von Wild, Hanan E. El-He ...
    Article type: Original Ariticle
    2013 Volume 4 Pages 30-38
    Published: 2013
    Released on J-STAGE: June 01, 2013
    JOURNAL FREE ACCESS
    Gadallah NA, Awad MR, von Wild KR, El-Hefnawy HE, El-Arousy NH, El-Hefnawy NG, Abdou TA, El Shafie EA, El Zohiery AK. Neural and muscular dysfunction in fibromyalgia. Jpn J Compr Rehabil Sci 2013; 4: 30-38.
    Objectives: Our aim was to assess peripheral neural and muscular dysfunction in patients with fibromyalgia syndrome (FMS) by interrelating different electrophysiologic and histopathologic studies, in a trial to further elucidate the pathophysiology of fatigue in FMS.
    Methods: Thirty FMS patients and ten controls were enrolled in the study. To test for muscle fatigue, muscle fiber conduction velocity (MFCV) and quantitative surface EMG analysis were performed before and after sustained contraction. Muscle biopsies were examined by light and electron microscopy.
    Results: Electrodiagnostic studies revealed pathological fatigue response in patients compared to controls. Patients showed statistically significant lower MFCV (P < 0.0001) and higher percent drop in MFCV following sustained contraction (P < 0.001).
     Light microscopy examination of patients’ muscle biopsies revealed a significantly higher percentage of fiber size variability, increased central nucleation, increased glycogen and higher percent increase in fiber type I.
     Electron microscopy revealed different abnormalities. The aggregation of bizarrely-shaped mitochondria was the most remarkable finding in all patients, but in none of the controls.
    Conclusion: There is definite evidence of neural and muscular interconnected dysfunction. The development of fatigue in FMS is significantly influenced by fiber type composition of the skeletal muscle and disrupted muscle mitochondria.
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  • Takako Itsukaichi, Yoshimi Suzukamo, Shin-Ichi Izumi
    Article type: Original Ariticle
    2013 Volume 4 Pages 39-46
    Published: 2013
    Released on J-STAGE: June 01, 2013
    JOURNAL FREE ACCESS
    Supplementary material
    Itsukaichi T, Suzukamo Y, Izumi S. Factors influencing the planning of home-based rehabilitation services by care managers. Jpn J Compr Rehabil Sci 2013; 4: 39-46.
    Purpose: To describe the planning of home-based rehabilitation (HBR) by care managers and to show the relationship between the knowledge/understanding of the care managers regarding HBR and their planning experience regarding these services.
    Methods: Five hundred certified care managers in the Miyagi Care Manager Association completed a questionnaire that included queries on the participants’ knowledge/understanding of HBR and on their experiences in selecting HBR in their care plans. Factors affecting selection of HBR were explored with the chi-square test, followed by logistic regression analysis.
    Results: Among 113 care managers who are currently engaged in home-based care, 78 (69%) have experience with HBR. The planning of HBR was affected by the availability of facilities that offer HBR and the knowledge/understanding of care managers.
    Conclusion: The knowledge/understanding of HBR by the care manager is important to provide the HBR service.
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  • Keiko Kanetaka, Yoshimi Suzukamo, Toshiyuki Kakui, Akira Michimata, Sh ...
    Article type: Original Ariticle
    2013 Volume 4 Pages 47-54
    Published: 2013
    Released on J-STAGE: May 09, 2014
    JOURNAL FREE ACCESS
    Supplementary material
    Kanetaka K, Suzukamo Y, Kakui T, Michimata A, Izumi S. Impact of a communication skills training course for students of therapist training schools. Jpn J Compr Rehabil Sci 2013; 4:47-54.
    Purpose: Communication skills are necessary when students of therapist training schools undergo clinical practice. We verified the effects of introducing a course on communication skills training based on coaching theory.
    Methods: Second-year students of a vocational college participated in the study. Fourteen students in the occupational therapy department attended a course on communication skills training (CS group) and 21 students in the physiotherapy department did not attend the course (control group). The CS group received 6 classes on communication skills. Assessments by self and others (CS group only) on communication skills, anxiety assessment, and self-efficacy assessment were conducted before the course (T1), two months after T1 (T2), and 3 months after T1 before clinical practice (T3). In the CS group, course evaluation was also conducted at T2.
    Results: For course evaluation, all participants selected the top two grades on a five-grade scale for necessity, satisfaction, contents, interest and understanding. For communication skills self-assessment, the scores at T2 and T3 were higher than that at T1 in both groups. For communication skills assessment by others, the score at T3 was higher compared to those at T1 and T2. For anxiety assessment, state anxiety did not change in the CS group, but increased at T3 in the control group.
    Conclusion: The findings of this study indicate that the communication skills training course improves the communication skills of students and eases their state anxiety before clinical practice.
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  • Yasunori Kawasaki, Yoshimi Tsuchida, Makio Yamaga, Hiroaki Koga, Tsuyo ...
    Article type: Original Ariticle
    2013 Volume 4 Pages 55-60
    Published: 2013
    Released on J-STAGE: May 09, 2014
    JOURNAL FREE ACCESS
    Supplementary material
    Kawasaki Y, Tsuchida Y, Yamaga M, Koga H, Nakamura T, Nose Y, Iiyama J. Relationship between therapists’ years of experience and Functional Independence Measure gain and efficiency in stroke rehabilitation. Jpn J Compr Rehabil Sci 2013; 4:55-60.
    Objective: This study aimed to clarify whether or not the years of experience of physical therapists (PTs) and occupational therapists (OTs) influences rehabilitation treatment results as quantified using the Functional Independence Measure (FIM).
    Methods: The subjects were PTs and OTs who took care of 354 cerebrovascular accident (CVA) patients. With motor FIM gain and motor FIM efficiency as the evaluation scales, the following three combinations were evaluated: 1) FIM gain and efficiency on transfers, locomotion, and stairs, and PTs’ years of experience; 2) FIM gain and efficiency in eating, grooming, bed bath, dressing, toilet behavior, urination management, and defecation management, and OTs’ years of experience; and 3) motor FIM gain and motor FIM efficiency on all items and years of experience (PTs’ + OTs’). Results were analyzed using simple regression, multiple regression, and stratified simple regression.
    Results: A weakly positive relationship was observed between a PT’s years of experience and motor FIM gain in moderately impaired patients. No relationship was observed between an OT’s years of experience and motor FIM gain. There was no relationship between years of experience and motor FIM efficiency.
    Conclusion: These results suggest that activities of daily living involving the lower limbs are influenced by a PT’s years of experience.
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  • Makoto Tokunaga, Kimiko Fukunaga, Katsuhiko Sannomiya, Yoshihiko Imada ...
    Article type: Original Ariticle
    2013 Volume 4 Pages 61-66
    Published: 2013
    Released on J-STAGE: May 09, 2014
    JOURNAL FREE ACCESS
    Supplementary material
    Tokunaga M, Fukunaga K, Sannomiya K, Imada Y, Inoue R, Hamasaki H, Noguchi D, Nakashima Y, Watanabe S, Nakanishi R, Yamanaga H. The difference between measured Nichijo-seikatsu-kino-hyokahyo (NSKH) score and predicted NSKH score derived from ADL is related to FIM gain. Jpn J Compr Rehabil Sci 2013; 4: 61-66.
    Purpose: To determine if the difference between measured Nichijo-seikatsu-kino-hyokahyo score (NSKH) and predicted NSKH score (measured NSKH-predicted NSKH) derived from the Functional Independence Measure (FIM) score is related to FIM gain, and whether it increases the predictive accuracy of FIM gain.
    Methods: We studied 102 stroke patients in the Kaifukuki rehabilitation ward with FIM scores at admission between 18 and 58. We analyzed whether a correlation exists between “measured NSKH- predicted NSKH” and “FIM gain”, and performed a multiple regression analysis to predict FIM gain.
    Results: A significant negative correlation (correlation constant -0.275, p<0.01) was detected between measured NSKH-predicted NSKH and FIM gain. The adjusted R-square value increased by 0.101 after incorporating measured NSKH-predicted NSKH into the predictive equation for FIM gain, which included age and FIM score at admission.
    Conclusion: This study demonstrates that measured NSKH-predicted NSKH correlates with FIM gain, and that measured NSKH-predicted NSKH is an index that increases the predictive accuracy of FIM gain.
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Case Report
  • Keiichiro Shindo, Ken Sugiyama, Kazunori Nishijima, Yoshihito Furusawa ...
    Article type: Case Report
    2013 Volume 4 Pages 67-72
    Published: 2013
    Released on J-STAGE: May 09, 2014
    JOURNAL FREE ACCESS
    Supplementary material
    Shindo K, Sugiyama K, Nishijima K, Furusawa Y, Kondo T, Izumi S. Rehabilitation of four patients with critical illness polyneuropathy following living-donor liver transplantation. Jpn J Compr Rehabil Sci 2013; 4: 67-72.
    Reports of critical illness polyneuropathy (CIP) following liver transplantation (LT) are rare, and rehabilitative approaches for CIP after LT have yet to be described in detail. Four patients who underwent living-donor LT developed extremity and/or respiratory muscle weakness after LT, suggesting of CIP. Rehabilitation was initiated at the bedside to prevent joint contracture, disuse muscle weakness, and pulmonary complications. Exercise intensity was increased gradually according to a set of safety indices. Electrophysiologic studies demonstrated motor-dominant axonal degenerations in extremities of all patients. Although no patient recovered fully by rehabilitation, all patients achieved gradual improvement in muscle strength, ability to walk with or without aid, and a final Barthel index score of 90. CIP is an important complication following LT, and should be suspected in patients who develop post-transplant muscle weakness in the extremities or respiratory muscles. The present results suggest that early rehabilitation after LT prevents secondary disuse syndrome and contributes to achieve favorable functional outcome.
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Original Article
  • Saori Miura, Masahiro Satake, You Tamura, Mitsunori Ikeda, Atsuyoshi K ...
    Article type: Original Ariticle
    2013 Volume 4 Pages 73-79
    Published: 2013
    Released on J-STAGE: May 09, 2014
    JOURNAL FREE ACCESS
    Supplementary material
    Miura S, Satake M, Tamura Y, Ikeda M, Kawagoshi A, Sugawara K, Takahashi H, Homma M, Sakata S, Shioya T. Evaluation of walking time according to walking speed using a triaxial accelerometer system. Jpn J Compr Rehabil Sci 2013; 4: 73-79.
    Purpose: The primary purpose of this study was to quantify the walking time in daily life as slow and fast walking times using a newly improved triaxial accelerometer system. The secondary purpose was to study the slow and fast walking times of healthy young and elderly adults and stable patients with chronic obstructive pulmonary disease (COPD) using this system.
    Methods: Twenty-six healthy young subjects, 15 healthy elderly adults, and 11 stable COPD patients participated in this study. The subjects’ time spent walking, standing, sitting, and lying down were assessed using an activity monitoring and evaluation system (A-MESTM). We evaluated the slow and fast walking times according to changes in the detection threshold in the system’s software.
    Results: The distinguishing speed was found to be 2 km/h, and thus we divided the subjects’ walking time into slow (<2 km/h) and fast (≥2 km/h) walking using 2 km/h to distinguish the speed. Ninety-five percent of the walking measured by the A-MESTM was slow walking. The fast walking time of the stable COPD patients was significantly shorter than that of the healthy young and elderly adults (p<0.01).
    Conclusion: These results suggest that walking time in daily life can be differentiated as slow (<2 km/h) and fast (≥2 km/h) walking using a new triaxial accelerometer system.
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Brief Reports
  • Shinya Ito, Yutaka Tomita, Shigeo Tanabe
    Article type: Brief Reports
    2013 Volume 4 Pages 80-83
    Published: 2013
    Released on J-STAGE: September 10, 2015
    JOURNAL FREE ACCESS
    Supplementary material
    Ito S, Tomita Y, Tanabe S. Development of a method to assess alignment of the foot and lower leg. Jpn J Compr Rehabil Sci 2013; 4: 80-83.
    Purpose: Three-dimensional analyses of the foot and lower leg have been restricted to large-scale research facilities, since such analyses require a large experimental area and expensive measurement systems. Therefore, we developed a new three-dimensional method of analyzing still pictures using commercially available digital cameras, and applied it to clinical use.
    Methods: We used three digital cameras. One was set 6 m behind the subject, while the other two were placed at 45 degrees to the right and left sides of the first camera, each the same distance from the subject. We used a plaster model of a lower leg and foot, on which several markers were mounted. The positions of the three-dimensional coordinates of the markers were computed by triangulation from the pictures taken with the three cameras, and the accuracy was verified.
    Results: The average reading error was 0.6 mm, and the average and maximum repetition errors were 1.3 mm and 1.6 mm, respectively. Comparison with direct evaluation was found to be 2.3% at maximum. These results showed that the method is highly reliable.
    Conclusion: Although a three-dimensional analysis using this method has the limitation of still picture analysis, it may be useful in many clinical applications because it requires only inexpensive apparatus and a small experimental area.
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Original Article
  • Hideto Okazaki, Hidehik Beppu, Kenmei Mizutani, Shigeru Sonoda
    Article type: Original Ariticle
    2013 Volume 4 Pages 84-87
    Published: 2013
    Released on J-STAGE: September 10, 2015
    JOURNAL FREE ACCESS
    Supplementary material
    Okazaki H, Beppu H, Mizutani K, Sonoda S. Changes muscle and plasma hepatocyte growth factor levels under casting immobilization. Jpn J Compr Rehabil Sci 2013; 4: 84-87.
    Purpose: Hepatocyte growth factor (HGF) contributes to the proliferation of muscle cells, however, the relationship between the level of HGF in muscle and that in the blood is unknown. In this study, we examined the influence of exercise on HGF levels in muscle and blood using a rat model of hindlimb muscle atrophy.
    Methods: Thirty female Sprague-Dawley rats were used. Fifteen of the rats were cast-immobilized for 14 days (CAS); the remaining fifteen rats were allowed normal activity as the control group (CNT). After removal of the cast, rats were divided into three groups (n=5 per group) as follows: a pre-exercise group (PE), a normal activity group (normal activity for seven days) (NA) and a treadmill training group (20° slope, 15 m per min, 20 min per day for seven days; TR). The CNT group was also divided into the same three groups. At the end of the study period, the wet weight of the left soleus muscle per body weight, plasma HGF level and left soleus muscle HGF level were measured and multiple comparisons were performed.
    Results: Muscle weight was significantly lower in CAS-PE than in all CNT groups. Muscle HGF level was significantly higher in CAS-TR than in either CAS-PE or CAS-NA. There were no statistically significant differences between any of the other groups.
    Conclusion: Muscle HGF is expressed in response to relatively high intensity exercise but the dynamics of HGF are limited to intramuscular distribution.
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  • Makoto Tokunaga, Susumu Watanabe, Tadashi Terasaki, Tomohiro Takita, T ...
    Article type: Original Ariticle
    2013 Volume 4 Pages 88-96
    Published: 2013
    Released on J-STAGE: September 10, 2015
    JOURNAL FREE ACCESS
    Supplementary material
    Tokunaga T, Watanabe S, Terasaki T, Takita T, Yonehara T, Nishi T, Kanazawa C, Kawano S, Yamakuma K, Yamaga M, Hashimoto Y. A study of standard criteria for hospital admission fees using the Nichijo-seikatsu-kino-hyokahyo in Kaifukuki rehabilitation wards. Jpn J Compr Rehabil Sci 2013; 4: 88-96.
    Purpose: To consider methods, based on study results, which would allow the differences in severity distribution between hospitals to be reflected in the hospital admission fee standards, using the Nichijo-seikatsu-kino-hyokahyo (NSKH).
    Methods: A sample of 3,389 patients with stroke was analyzed. Scores obtained from NSKH were divided into four categories: scores 0 to 4, 5 to 9, 10 to 14, and 15 to 19. The numbers of patients in the four categories, changes in NSKH score (NSKH gain), and the return home rates were computed for all the participating hospitals and for each of six and other hospitals. We calculated the adjusted NSKH gain and adjusted return home rate at each hospital, using a correction method based on the distribution of NSKH scores for patients in all the participating hospitals (the standard severity distribution).
    Results: The following differences were found between the hospitals. The percentage of patients identified as “critically ill” (with NSKH scores of 10 to 19) ranged from 29.4 to 44.8%. Patients with NSKH scores of 15 to 19 (severely critically ill patients) occupied 33.6 to 50.2% of the patients with NSKH scores of 10 to 19 (critically ill patients). The mean NSKH scores on admission ranged from 6.52 to 8.60, while the adjusted NSKH gain ranged from 2.23 to 3.50 points and the adjusted return home rates ranged from 58.3 to 74.3%.
    Conclusion: There may be a need to give higher evaluation to hospitals that show high mean NSKH scores at admission. In addition, adjustment by the standard severity distribution may have to be used in determining NSKH gain and the return home rate.
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