Objectives: This study aimed to clarify the relationship between depressive symptoms on admission and improvement in activities of daily living (ADLs) among patients with fractures admitted to a recovery rehabilitation unit.

Methods: This retrospective observational study enrolled patients with fractures who were admitted to a rehabilitation hospital between August 2018 and October 2020 in Okinawa City, Japan. Based on Geriatric Depression Scale scores, patients were divided into two groups: one group with depressive symptoms and another group without depressive symptoms. Associations between depressive symptoms and the motor Functional Independence Measure (FIM) gain were identified using multivariate linear regression analyses.

Results: Out of 127 patients (range, 40.0–83.0 years; male: 27.6%), 71 had depressive symptoms on admission. Multiple linear regression analysis revealed that depressive symptoms on admission were significantly associated with motor FIM gain (β coefficient: −5.022, 95% confidence interval −9.551 to −0.494, P = 0.030). Body Mass Index on admission, motor FIM on admission, Mini-Mental State Examination on admission, and use of antidepressants were also associated with motor FIM gain.

Conclusions: Among patients with fractures admitted to a recovery rehabilitation unit, depressive symptoms on admission were associated with less improvement in ADLs. The use of antidepressants was also an independent factor affecting the improvement of ADLs in these patients.

Objectives: This study aimed to establish standardized categories of rehabilitation approaches in long-term care and evaluate their appropriateness through a Delphi survey with an expert panel.

Methods: We adopted the Delphi method using the RAND/UCLA Appropriateness Method. A panel of 15 multidisciplinary rehabilitation experts comprising physicians, physical therapists, occupational therapists, and speech-language-hearing therapists was established. We developed a questionnaire comprising 10 main categories and 58 subcategories based on the glossary review and cross-sectional survey. Panelists rated the categories on a Likert scale from 1 (extremely inappropriate) to 9 (extremely appropriate). The survey was repeated until all categories reached a consensus on “appropriate” and “agreement.”

Results: All 15 panelists participated in three rounds of the Delphi survey. In the first round, although all categories were deemed “appropriate,” one main category and six subcategories did not achieve “agreement.” In the second round, all categories reached the status of “appropriate” and “agreement.” However, some of the comments needed further consideration. After making minor revisions, all items ultimately reached the status of “appropriate” and “agreement.”

Conclusions: This study achieved consensus on the terminology for standardized categories of rehabilitation approaches in long-term care. Future research should assess their reliability and validity using real-world clinical data.

Objectives: Reactive stepping is necessary to prevent falls when a person slips or trips while walking, particularly in outdoor activities. Individuals with stroke usually exhibit reactive balance impairment. Trunk training is effective for improving balance and mobility after stroke; however, its effect on reactive stepping remains unknown. This study aimed to examine the effects of trunk training on reactive stepping in community-dwelling individuals after stroke.

Methods: This study was conducted using an A-B-A single-subject design. Two community-dwelling women with chronic stroke (79 years old, 9 years post-stroke and 83 years old, 17 years post-stroke) participated in this study. The baseline (A) and intervention (B) phases lasted for 6 weeks. Specifically, the participants did not receive any intervention in phase A, whereas they performed home-based trunk training in phase B. Outcome measures included the foot-off time, maximum trunk rotation angular velocity, number of steps during forward reactive stepping following perturbation, and Trunk Impairment Scale (TIS) score.

Results: Decreased trunk rotation and step count corresponding to improved TIS score were observed in one case after the intervention. However, trunk control did not improve in the other case after the intervention, and reactive stepping kinematics remained unchanged.

Conclusions: Enhancing trunk control may improve reactive stepping in individuals with chronic stroke; nevertheless, further evidence is required.

Objectives: This study aimed to investigate the sedentary time of patients with hip fractures, including those with cognitive decline, in the early postoperative period.

Methods: Participants were patients with hip fractures treated at our hospital. A triaxial accelerometer was attached to the contralateral hip, and activity was recorded for three postoperative days (4320 min).

Results: Thirty patients (mean age: 86.5 years; female, n=23) were included in the analysis. The mean activity times were: sedentary time, 1364.0 ± 59.9 min/day (mean ± standard deviation); light-intensity physical activity time, 71.9 ± 57.8 min/day; and moderate-to-vigorous-intensity physical activity time, 4.1 ± 3.2 min/day. Sedentary time was linked to the scores on the Mini-Mental State Examination-Japan.

Conclusions : Early postoperative patients with hip fractures have long sedentary times and less time for moderate-to-vigorous-intensity physical activity. Patients with hip fractures with cognitive decline have significantly longer sedentary time than those without cognitive decline.

Objectives: Predicting postoperative clinical outcomes from preoperative physical factors of patients undergoing total knee arthroplasty (TKA) would be useful. This study aimed to investigate the association between preoperative physical factors and postoperative outcomes.

Methods: This study included 119 patients. The preoperative physical factors and 1-year postoperative clinical outcomes were collected and assessed. Physical factors included age, sex, body mass index, skeletal mass index, knee range of motion, 5-m walk time, and Timed Up-and-Go (TUG) test result. Postoperative outcomes were evaluated using a sum of symptoms, pain, activities of daily living, and quality of life subscales of the Knee injury Osteoarthritis Outcome Score (KOOS-4), and the Oxford Knee Score (OKS). Correlation between physical factors and postoperative outcomes was analyzed by Spearman’s rank correlation coefficient, and the association between physical factors and KOOS-4 or OKS was analyzed using multiple regression analysis. Receiver operating characteristic analysis was performed to calculate the cut-off value for the TUG test time associated with minimum postoperative OKS of 40.

Results: Among the preoperative physical factors, TUG test time showed significant correlation with OKS (ρ=−0.267), but none correlated with KOOS-4. Multiple regression analysis showed a significant association between TUG test time and OKS (95% confidence interval: −0.590 to −0.163) but not with KOOS-4. The cut-off value of preoperative TUG test time associated with minimum postoperative OKS of 40 was 12.96 s.

Conclusions: Among the preoperative physical factors of patients undergoing TKA, the TUG test time was associated with clinical outcomes at 1 year after surgery.

Objectives: This study aimed to investigate tongue pressure in patients undergoing maintenance hemodialysis (MHD) and identify factors associated with tongue pressure, such as nutritional status and sarcopenia components.

Methods: This cross-sectional study included 80 outpatients undergoing MHD at our hospital between February and August 2024. Tongue pressure was measured using a tongue pressure measuring device. Patients were divided into groups of low tongue pressure (<30 kPa) and high tongue pressure (≥30 kPa). The geriatric nutritional risk index (GNRI) and the nutritional risk index for Japanese hemodialysis patients (NRI-JH) were used as nutritional indicators. To identify factors strongly associated with tongue pressure in MHD, a multiple regression analysis was performed, with tongue pressure as the dependent variable.

Results: The median age of the participants was 81.0 years. The mean tongue pressure was 29.0 kPa, and 58.8% of the patients had tongue pressure less than 30 kPa. Tongue pressure was significantly lower in the oldest age group (≥85 years) than in the younger groups (≤64 years and 65–74 years). Significant correlations were noted between tongue pressure and age, serum albumin, skeletal muscle mass index, phase angle, and handgrip strength. In the multivariate analysis, age, GNRI, and handgrip strength were independent predictors of tongue pressure.

Conclusions: This study revealed that age, handgrip strength, and GNRI were independently associated with tongue pressure in patients undergoing MHD. These factors may be used as indicators of tongue pressure in patients undergoing MHD.

Background: Vacuum swallowing improves pharyngeal bolus passage by creating negative pressure in the esophagus. In this study, we aimed to (1) assess whether patients with dysphagia and lateral medullary syndrome (LMS) could reproduce vacuum swallowing and (2) evaluate its safety using a swallowing and breathing monitoring system (SBMS).

Cases: Two patients with dysphagia and LMS were instructed to perform vacuum swallowing. Videofluoroscopic examination of swallowing (VF) was performed. High-resolution manometry parameters, including the esophageal minimum pressure (Pmin) and maximum pressure (Pmax) in the lower esophageal sphincter, were compared to the values obtained during non-vacuum swallowing. The coordination between vacuum swallowing and breathing was evaluated using an SBMS. VF showed that pharyngeal residues in the pyriform sinus were sucked into the esophagus during vacuum swallowing. No aspiration was observed. During vacuum swallowing, Pmin was significantly lower, and Pmax was significantly higher than the respective measurements during non-vacuum swallowing. In the SBMS study, vacuum swallowing followed an expiratory swallowing pattern; this pattern was observed in three out of five swallowing episodes in Patient 1 and in all swallowing episodes in Patient 2. Deglutition apnea was observed during vacuum swallowing.

Discussion: Vacuum swallowing may be a feasible method for improving pharyngeal bolus passage. Patients could safely master vacuum swallowing. Instructions to exhale before and after vacuum swallowing are recommended to prevent aspiration.

Objectives: The purpose of this study was to determine which components of screening tests are important for assessing locomotive dysfunction during locomotive health checkups and best predict falls in a prospective cohort study.

Methods: Four hundred and sixty-eight residents were assessed for locomotive syndrome, frailty, knee and back pain, bone mass, muscle mass, grip strength, gait speed, gait variability, and kyphosis at a baseline locomotive health checkup. Residents were followed up after 1 year and surveyed about their incidence of falls.

Results: A total of 379 residents were analyzed in the study. Principal component analysis was used to divide components using all screening tests for locomotive dysfunction. The primary variable making up the first principal component was “mobility function,” the second was “muscle function,” and the third was related to “spinal alignment.” The tests that showed the highest principal component loadings in each component were the five-question Geriatric Locomotive Function Scale, muscle mass index, and kyphosis index. Binary regression analyses, adjusted for age and past fall history, showed that the five-question Geriatric Locomotive Function Scale was independently related with the incidence of falling (odds ratio=2.04; 95% confidence interval: 1.04–3.99).

Conclusions: We propose that during a locomotive health checkup, mobility function, muscle function, and spinal alignment are important components for the assessment of locomotive dysfunction. Notably, the five-question Geriatric Locomotive Function Scale is a simple and convenient screening test that can predict the future incidence falls.

Objectives: This study investigated the relationship between the three phases of hyoid bone movement and pharyngeal residue using the videofluoroscopic swallowing study (VFSS).

Methods: We retrospectively analyzed the data from 66 patients who underwent VFSS between April 2019 and December 2019. Hyoid bone movement was classified into three phases: upward, forward, and downward. We measured the velocity and distance of hyoid bone movement in each phase, as well as the pharyngeal residue after swallowing. The correlation between hyoid bone movement and the amount of pharyngeal residue was analyzed using Spearman’s rank correlation coefficient. A receiver operating characteristic (ROC) analysis was performed to evaluate the presence of pyriform sinus residue.

Results: Hyoid bone velocity and distance during the forward phase correlated with the amount of pyriform sinus residue (velocity: r=0.311, P=0.011; distance: r=0.255, P=0.0389). ROC analysis revealed that the cutoff value for hyoid bone velocity during the forward phase was 26.1 mm/s (0.846 sensitivity, 0.604 specificity) with an area under the curve of 0.717.

Conclusions: The velocity and distance of the hyoid bone during the forward phase were significantly related to the amount of pyriform sinus residue. In VFSS assessment, it is important to classify hyoid bone movement into three phases—upward, forward, and downward—and to calculate its velocity and distance.

Objectives : This study aimed to investigate whether lower limb phase angle (LL-PA) at admission predicts functional outcomes in patients undergoing rehabilitation.

Methods : In this retrospective study, we measured the LL-PA of 256 patients (mean age 74.09±12.86 years) admitted to a convalescent rehabilitation ward upon arrival. The primary outcomes at discharge were motor Functional Independence Measure (FIM) scores and walking independence. The secondary outcomes included a 10-m walking speed and Timed Up-and-Go test result.

Results : The LL-PA independently predicted discharge motor FIM scores (β=0.323, P <0.001) and walking independence (odds ratio=3.302, 95% confidence interval: 1.714–6.360). The sex-specific cut-off value for predicting walking independence was 3.050° for men (sensitivity, 0.804; specificity, 0.853) and 2.650° for women (sensitivity, 0.769; specificity, 0.812).

Conclusions : LL-PA at admission is a significant predictor of functional outcomes in patients undergoing rehabilitation, with potential utility in early prognostic assessments.

Objectives: This study aimed to determine the relationship between preoperative fatty infiltration of the lower extremity muscles and walking speed at 2 weeks after total hip arthroplasty (THA).

Methods: This was a single-institution retrospective cohort study. Participants in this study were patients undergoing primary THA. Fatty infiltration in each muscle (bilateral psoas major, gluteus maximus, gluteus medius, gluteus minimus, quadriceps, and triceps surae) was assessed using non-contrast X-ray computed tomography images obtained during a detailed preoperative examination. The outcome of this study was the normal comfortable walking speed at 2 weeks after THA. Decreased walking speed was defined as less than 0.8 m/s (non-decreased group, coded 0; decreased group, coded 1). Multivariate logistic regression analysis was used to analyze the relationship between fatty infiltration of each skeletal muscle and walking speed.

Results: A total of 168 participants were included in the analysis. On the operative side, the analysis identified fatty infiltration of the gluteus medius (odds ratio, 0.95; 95% confidence interval, 0.91–0.99) as a determinant of decreased walking speed after THA. On the nonoperative side, the analysis identified fatty infiltration of the quadriceps (odds ratio, 0.91; 95% confidence interval, 0.83–0.99) as a determinant of decreased walking speed after THA.

Conclusions: In patients undergoing THA, increased fatty infiltration of the gluteus medius on the operative side and the quadriceps on the nonoperative side were associated with decreased walking speed at 2 weeks postoperatively.

Objectives: Delayed initiation of postoperative rehabilitation may be detrimental for improving everyday activities in postoperative patients with valvular heart disease. Rehabilitation is essential for postoperative valvular heart disease; however, the effective starting time of rehabilitation is unknown. This study aimed to investigate whether a delay in postoperative rehabilitation affects outcomes in patients after waiting for surgery for valvular heart disease.

Methods: Data from the JMDC database were extracted for 4330 patients diagnosed with valvular heart disease and who underwent surgery within 5 days of admission. Patient characteristics were compared between the usual rehabilitation group (started rehabilitation within 2 days postoperatively) and the delayed rehabilitation group (started rehabilitation at 3–5 days postoperatively). The primary outcome was hospitalization-associated disability (HAD); that is, the proportion of patients who showed a decline in the Barthel Index during hospitalization. Barthel Index at discharge, pulmonary complications following hospitalization, and postoperative complications were the secondary outcomes. Outcomes were compared in the usual and delayed rehabilitation groups after propensity score matching.

Results: Of the 4330 patients, 3845 patients were assigned to the usual rehabilitation group, and 485 patients were assigned to the delayed rehabilitation group. After propensity score matching, statistical analysis was performed on the usual and delayed rehabilitation groups, which each contained 418 patients. The delayed rehabilitation group had significantly higher rates of HAD (10.5% vs 8.1%) and respiratory complications (14.8% vs 11.2%) than the usual rehabilitation group.

Conclusions: Delayed postoperative rehabilitation may be associated with poor prognosis in patients with valvular heart disease.

Objectives: In an ultra-aged society, the increasing number of elderly individuals requiring nursing care because of complications and disabilities poses a significant challenge for healthcare providers, along with a decline in the quality of life (QoL). Therefore, investigating the underlying causes and establishing effective preventive measures is imperative. Sarcopenia, characterized by a reduction in muscle strength throughout the body, can negatively impact QoL because of declining physical function. This study aimed to elucidate the interrelationship between physical function and health-related quality of life (HRQoL) in elderly individuals requiring long-term care.

Methods: The participants (n=67) were elderly individuals (32 men, 35 women) requiring light nursing care. HRQoL was assessed using the EuroQol Group 5-Dimensions 5-Level (EQ-5D-5L) scale. Relationships between the EQ-5D-5L score and age, body mass index, SARC-CalF, and sex were examined. The relationships between the EQ-5D-5L score and the 10-s chair stand test, functional reach test (FRT), grip strength, 10-m walking test, and Timed Up-and-Go (TUG) test were investigated separately for men and women.

Results: A correlation was identified between EQ-5D-5L score and sex. In men, a correlation was identified between EQ-5D-5L and TUG test results. In women, a comparable correlation was observed between EQ-5D-5L score and the 10-m walking test, FRT, and TUG test.

Conclusions: The findings revealed a correlation between physical functions, including standing and walking, and QoL in elderly individuals requiring light nursing care. Maintaining and enhancing standing and walking abilities among this demographic group should be a high priority.

Objectives: This study examined the relationships between preoperative posterior pelvic tilt with muscle strength, gait speed, hip function, and quality of life in older patients with hip osteoarthritis.

Methods: This cross-sectional study included 65 patients with hip osteoarthritis (75.0 ± 10.4 years; 83.1% female). Pelvic tilt angle was calculated from the frontal view of the hip joint in the standing position using radiographic images. The patients were divided into anterior (n=13) and posterior (n=52) groups based on a standard pelvic tilt angle of 27.9°. Clinical outcomes included preoperative isometric hip flexion and knee extension muscle strength, a five-time sit-to-stand test, gait speed, the Harris Hip Score (HHS), and the Japanese Orthopedic Association Hip-Disease Evaluation Questionnaire score. Multiple regression analysis was performed to clarify the relationships between the posterior pelvic tilt and clinical outcomes.

Results: The posterior pelvic tilt group had significantly lower isometric knee extension muscle strength (P=0.032), HHS (P=0.020), and gait speed (P=0.006) than the anterior pelvic tilt group. Multiple regression analysis showed that the posterior pelvic tilt was significantly associated with lower gait speed (β=−0.271, P=0.046) and HHS (β=−0.272, P=0.045).

Conclusions: Preoperative posterior pelvic tilt is associated with decreased gait speed and hip function in patients with hip osteoarthritis. Given that a posterior pelvic tilt may compromise stability during gait, restrict daily activities, and increase the risk of falls, physical therapy interventions targeting these factors are essential, even before total hip arthroplasty.

Background: Immune-mediated necrotizing myopathy (IMNM) is a type of autoimmune myositis. Anti-signal recognition particle (SRP) antibodies are highly specific to this disease.

Case: A 76-year-old woman presented with a 4-month history of acute progressive limb muscle weakness and dysphagia. Blood examination revealed significantly elevated creatine kinase (CK) (3472 U/L) and SRP antibody positivity. The patient was near-bedridden and required alternative nutrition. She was treated with oral prednisolone and intravenous immunoglobulin. Rehabilitation therapy was initiated after confirming the decline in CK levels. She started with exercises on the bed and exercise load was gradually increased. Videofluoroscopic swallowing study showed severely weakened pharyngeal contractions and aspiration. Her symptoms improved slowly. She started transferring to a wheelchair after 2 months, gait training using parallel bars after 4 months, and was administered a paste diet once a day after 5 months. Rituximab was administered as additional treatment. Thereafter, the patient started gait training with a walker. The oral paste diet was increased to three times per day after 7 months, and a regular diet was adopted after 9 months. After 11 months, she was discharged home after achieving modified near independence in all activities of daily living.

Discussion : Low-intensity rehabilitation therapies were initiated under the supervision of therapists with regular follow-up and progression of exercise intensity based on multidisciplinary team discussions. If CK levels indicate that the disease has stabilized, early intervention in rehabilitation is important to prevent declining physical function.

Objectives: Trunk control involves multiple brain regions related to motor control systems. Therefore, patients with central nervous system (CNS) disorders frequently exhibit impaired trunk control, decreasing their activities of daily living (ADL). Although some therapeutic interventions for trunk impairments have been effective, their general effects on CNS disorders remain unclear. This review aimed to clarify this issue in patients with stroke, cerebellar ataxia, and Parkinson’s disease (PD), representing trunk control impairment by lesions in the cortical and corticospinal systems, cerebellum, and basal ganglia, respectively.

Methods: Using online databases, we searched for randomized controlled trials that investigated the effects of therapeutic interventions for trunk impairments in patients with stroke, cerebellar ataxia, and PD, reported in English from 2013 to 2023.

Results: Overall, 50 articles were reviewed. Core-stability exercise (CSE), which activates the trunk muscles, specifically in the lumbar and pelvic areas, through postural adjustment tasks, is effective in patients with stroke, cerebellar ataxia, and PD. Weight-shifting exercise, unstable surface training, training with transcutaneous electrical stimulation, and noninvasive brain stimulation have been effective in patients following stroke. The combination of CSE with task-oriented training based on daily activities has been effective in patients with cerebellar ataxia. Perceptual training, repetitive trans-spinal magnetic stimulation, and aquatic training effectively improved alignment and balance function in patients with PD.

Conclusions: This review provides evidence-based strategies to improve trunk control, ADL, and quality of life for patients with trunk control impairments caused by CNS disorders.

Objectives: Physical function assessments in patients with spinal muscular atrophy (SMA) are important indicators for assessing the effectiveness of treatment and changes over time in rehabilitation therapy. However, few reports exist on this indicator. This study calculated the minimal clinically important difference (MCID) for assessing motor function in the upper and lower limbs of individuals with SMA to estimate the degree of change within a functional score that is considered clinically meaningful.

Methods: This cohort study relied on individual participant measurements. A distribution-based approach was used to calculate the MCID values, incorporating data from 26 patients with SMA for the 6-Minute Walk Test (6MWT), Hammersmith Functional Motor Scale Expanded (HFMSE), Revised Upper Limb Module (RULM), and grip and pinch strength.

Results: The standard errors of measurement for all patients were: 58.38 m for 6MWT; 4.71 points for HFMSE; 3.25 points for RULM; 10.93 N and 9.86 N for right and left grip strength, respectively; 5.42 N and 4.73 N for right and left Palmar pinch; and 11.96 N and 8.66 N for right and left Key pinch. Significant correlations were observed between the physical function assessments.

Conclusions: We calculated MCID values for physical function evaluations of SMA and, as a sub-analysis, determined the SMA type and ambulatory status. These findings are expected to contribute to future SMA treatment and rehabilitation and promote the selection of appropriate physical function assessments.