Classification and regression trees (CART), was applied to develop decision rules to investigate about the conditions for determining a discharge destination in aged stroke patients. Descriptive and functional status data for the 374 patients were collected at the time of discharge. 82.6% of the patients were discharged to home. In the analysis of single variable, the significant differences concerning the discharge destination were observed in the numbers of family, the existence of a spouse living with a patient, and each functional independence measure (FIM) score (18 items) at the time of discharge. The decision tree, which consists of a FIM toilet transfer and the family number, was obtained as a result of the analysis by CART. When the patient was needed a care for toilet transfer, and when the numbers of family was two or less, it was difficult for the patient to discharge to home (rate of discharge to home was 21.7%). CART is considered to be an effective tool in research for classification, prediction, etc, because it is able to handle both a continuous variable and a category variable, and to be understood a result intuitively.

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Ninety-three new outpatients with muscular low back pain were treated with traditional lumbosacral corset (traditional corset) or one with a front to back tensile band (extensile corset) or without any corset (control participants) for two weeks. Randomization was performed according to birth date. Among the patients abdominal obesity subgroups were defined as males with the waist-hip ratio (W/H)≥90% and females with W/H≥80%. Quebec Back Pain Disability Scale scores were measured at baseline and two weeks. Participants without abdominal obesity (n=49), treated with the extensile corset, demonstrated significant improvement compared with control participants (p=0.001). In the abdominal obesity subgroup (n=44), treated with the traditional corset, demonstrated significant improvement compared with control participants (p=0.015). In the conclusion, abdominal obesity should be considered when recommending corsets for patients with acute muscular low back pain.

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Objectives: To establish reliability of the modified Ashworth scale for measuring muscle tone in a range of muscle groups (elbow extensors, wrist extensors, knee flexors and ankle dorsiflexors) in subacute and chronic stroke patients. Design: A crosssectional study involving randomized measurements by two raters. We estimated reliability using the x statistic with quadratic weighs (x_w). Setting: A stroke rehabilitation unit. Subjects: People admitted to hospital with a subacute or chronic stroke (median age, 68 yrs, 16 men and 8 women). Results: Inter-rater agreement for the modified Ashworth scale was fair to excellent for all tested muscle groups (x_w=0.66-0.76) and excellent for the total score (x_w=0.91). Conclusions: The modified Ashworth scale was reliable in all tested muscle groups. The total score also demonstrated reliability. The rater's manual to examine the modified Ashworth scale was useful for improvement of reliability.

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Utilization of stroke unit and acute thrombolytic therapy within 3 hours of onset introduced the new era of acute stroke therapy. Acute ischemic stroke is no longer “Cinderella disease, ” but a “brain attack” because its neurological deficit can be reversed or diminished by a dedicated management. An acute stroke center should be organized to provide the best stroke therapy at any time. Rehabilitation in the recovery stage could be done in the specialized rehabilitation hospitals within Kumamoto due to inter-hospital cooperation. Our acute stroke team can concentrate on the treatment of stroke in the acute stage (within 2-3 week from the onset). We have been developing this stroke management system based on an acute stroke unit with referral to a rehabilitation unit in other hospital (regional inter-hospital referral model) in contrast to the conventional system with a combined acute and rehabilitation stroke unit in a single hospital (intra-hospital referral model). Eight-hundred and six patients (459 male, 347 female, 71.0±12.2 years old) with acute ischemic stroke were admitted to three hospitals between May 1999 and April 2000. The average NIHSS was 8.2 (median 5). 41.3% of the patients admitted within 3 hours of stroke onset. The length of hospital stay was 17.3±17.4 (median 14) days. Two-fifth of all patients discharged to their home, and 76.6% of them discharged within 14 days. Another 2/5 patients were transferred to rehabilitation hospitals, and 62.1% of them discharged within 21 days. The reduction of length of hospital stay was achieved by the use of clinical pathway and the inter-hospital cooperation.

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