Objectives: Longitudinal evidence on Locomotive Syndrome (LoS) progression in community-dwelling older adults remains limited. We examined 8-year transitions in LoS stages in a population-based Japanese cohort.

Methods: Between 2014 and 2017, 415 residents aged 50–89 years were randomly enrolled. LoS stage (0–3) was assessed at baseline and at follow-up using Japanese Orthopaedic Association criteria, based on the 25-question Geriatric Locomotive Function Scale and standard performance tests. Follow-up data were available for 169 participants (40.7%) after a mean interval of 8.46 years. Baseline characteristics were compared between participants and non-participants. Stage transitions were analyzed according to baseline age, sex, and LoS stage. To address attrition bias, a multivariable model for follow-up participation, inverse probability weighting (IPW), and scenario-based sensitivity analyses were applied.

Results: Advanced LoS (Stage 2 or 3) increased from 8.8% to 30.2%, indicating significant overall progression (P <0.001). Transitions were heterogeneous, with some improvement. The proportion of participants with worsening increased with age, ranging from 19.0% [95% confidence interval (CI) 10.2%–30.9%] among those aged 50–59 years to 66.7% (95% CI 34.9%–90.1%) among those aged 80–89 years. Among participants with baseline Stages 0–2, baseline Stage 0 (vs Stage 1) and older age were independently associated with worsening. Participants were younger and fitter than non-participants. Worsening was 37.3% in complete cases and 40.1% after IPW; advanced LoS at follow-up increased from 30.2% to 42.2% after IPW.

Conclusions: LoS stages progressed substantially over 8 years, with a marked increase in advanced LoS. Because follow-up participation was selective, these estimates likely underestimate the true burden in the original cohort.

Objectives : Life space (LS) is an important indicator of functional recovery after total hip arthroplasty (THA). In this study, we aimed to investigate the association between restoration of LS to preoperative levels 6 months after THA and perioperative improvements in walking performance, adjusting for demographic and clinical factors.

Methods : This retrospective cohort study included 104 patients with hip osteoarthritis undergoing primary unilateral THA between January 2019 and April 2023. Participants were classified into restoration and non-restoration groups based on whether their LS returned to preoperative levels at 6 months postoperatively. Logistic regression analysis was conducted with LS restoration as the dependent variable, perioperative changes in gait speed as the main explanatory variable, and preoperative gait speed and preoperative LS score as covariates. Model performance was assessed using the area under the receiver operating characteristic (ROC) curve.

Results : LS repair was associated with improved gait speed during the perioperative period [odds ratio (OR) 18.3, 95% confidence interval (CI) 1.44–233.0], high preoperative gait speed (OR 9.4, 95% CI 2.28–69.0), and low preoperative LS score (OR 0.967, 95% CI 0.94–0.99). The predictive model demonstrated good discriminatory ability (area under the ROC curve 0.791; 95% CI 0.699–0.883).

Conclusions : Perioperative gait speed improvement and high preoperative walking ability are major factors associated with LS restoration after THA. Conversely, patients with low preoperative LS may have a higher potential for restoration. These findings emphasize the importance of targeted interventions aimed at improving ability to promote community mobility and independence after THA.

Objectives: This study aimed to investigate the effects of restricted shoulder girdle motion on knee joint kinematics and kinetics during walking, as a preliminary step toward clarifying the role of trunk function in individuals with knee osteoarthritis.

Methods: Twenty healthy male participants walked along a 7.0-m straight pathway under three conditions—neutral, flexed, and extended shoulder girdle positions—while wearing a clavicle band to restrict shoulder girdle motion. Kinematic and kinetic data for the knee joint and trunk were collected using a three-dimensional motion analysis system and a force plate.

Results: In both the flexed and extended shoulder girdle positions, the ranges of motion of shoulder flexion–extension and pelvic rotation decreased. In the flexed shoulder girdle position, increased knee flexion angle was associated with a statistically significant reduction in the first peak of the external knee adduction moment (KAM), although the effect sizes were small.

Conclusions: These findings suggest that experimentally manipulated restricted shoulder girdle motion is associated with significant changes in KAM. They may also provide preliminary evidence of a relationship between upper-body and lower-limb kinematics and kinetics. However, given the small effect sizes observed, these findings should be interpreted with caution.

Objectives : Gait function is associated with prognosis in patients with acute myocardial infarction (AMI). This study aimed to examine whether achieving ambulation of 50 m within 14 days after weaning from mechanical circulatory support (MCS) is associated with clinical outcomes in AMI patients treated with percutaneous coronary intervention (PCI) and MCS.

Methods : In this retrospective single-center cohort study, we included 91 patients with AMI who underwent primary PCI and required MCS between April 2015 and June 2023 and survived at least 14 days after MCS weaning. Gait ability at 14 days after MCS weaning was classified as gait recovery (walking ≥50 m), gait initiation (walking <50 m), or non-gait. The primary outcome was a composite of all-cause mortality or cardiovascular/cerebrovascular hospitalization within 1 year. Clinical outcomes were compared among groups using Kaplan–Meier analysis and the log-rank test.

Results : Of the 91 patients who survived 14 days after MCS weaning, 50 (55%) achieved gait recovery. These patients had more favorable clinical and functional profiles both at ICU admission and at the time of MCS weaning. Patients who achieved gait recovery had a lower incidence of 1-year clinical events than those in the gait initiation and non-gait groups, whereas outcomes in the gait initiation group were comparable to those in the non-gait group. No significant temporal differences were observed in gait recovery rates or clinical outcomes.

Conclusions : Achieving ambulation of at least 50 m within 14 days after MCS weaning was associated with better 1-year clinical outcomes in AMI patients requiring MCS.

Objectives: Upper-limb weakness significantly impairs activities of daily living in individuals with neurological disorders. Exercise at the anaerobic threshold or higher is recommended for efficient training and rehabilitation in such cases. Given a lack of standardized, non-invasive methods to assess the anaerobic threshold for small muscles in clinical practice, we used T₂-mapping magnetic resonance imaging (MRI) and cumulative frequency curves of Z values (CFZ) to detect a minimum exercise strength target for physical rehabilitation of forearm muscles above the anaerobic threshold.

Methods: T₂ values for ten forearm muscles in 13 healthy adult volunteers were obtained in the resting state and after isotonic flexion and extension of the wrist. T₂ was normalized by Z = (T_2e– T_2r)/SD_r, where T_2e is T₂ after exercise, and T_2r and SD_r are the mean and standard deviation of T₂ at rest.

Results: In the horizontal direction exercise, the sensitivity values and CFZ of four out of five agonist muscles did not increase, nor shift, showing that these muscles were contracted by the aerobic metabolism. In the vertical direction exercise, in four of five agonist muscles and in two synergist muscles, the sensitivity values increased to about 50% and the CFZ was shifted to the right, indicating that these muscles were contracted by the anaerobic metabolism.

Conclusions: Vertical direction exercise without extra weight can provide a minimum exercise strength that is higher than the anaerobic threshold. T₂-mapping MRI is useful for setting exercise strength targets in the physical rehabilitation of small muscles.

Objectives: Examiner reliability of dynamic quantitative sensory testing (QST) of the knee varies across studies, and the optimal assessment site remains unclear. This study aimed to examine the intra- and inter-examiner reliability of QST performed at the medial joint space of the knee.

Methods: A cross-sectional study was conducted in 30 healthy adults. QST was assessed at the medial knee joint space using the following measures: pressure pain threshold (PPT) for static QST and temporal summation (TS) and conditioned pain modulation (CPM) for dynamic QST. Two examiners performed each measurement twice on the same day. Intra-examiner reliability was evaluated using intraclass correlation coefficients [ICC (1, k)], and inter-examiner reliability was evaluated using ICC (2, k) and ICC (3, k).

Results: The intra-examiner reliability ICCs for Examiners A/B were 0.98/0.99 for PPT, 0.81/0.88 for TS, 0.79/0.90 for CPM absolute change, and 0.84/0.95 for CPM percentage change. Inter-examiner reliability showed ICC (2, k)/ICC (3, k) values of 0.89/0.91 for PPT, 0.91/0.91 for TS, 0.66/0.66 for CPM absolute change, and 0.64/0.64 for CPM percentage change.

Conclusions: This exploratory study suggested that QST performed at the medial joint space of the knee exhibited good intra- and inter-examiner reliability, with low variability compared to previously reported assessment sites. These preliminary findings indicate a potential advantage of this location for assessing knee pain. Future studies are needed to verify the clinical validity and applicability of these findings in patients with knee disorders.

Objectives: The “too many toes” sign is a clinical indicator for evaluating flatfoot. However, standardized assessment conditions remain undefined. In rehabilitation settings, this sign is used to monitor alignment, functional progression, and response to interventions such as intrinsic foot muscle training and gait retraining. Despite its widespread use, the height at which images are obtained may affect diagnostic interpretation. This study aimed to clarify the influence of imaging height on the assessment of the “too many toes” sign in patients with flatfoot.

Methods: In this cross-sectional observational study, 11 patients with flatfoot were evaluated preoperatively. Standing photographs were captured at floor level and at 40-cm height behind the participants. The horizontal distance between the lateral malleolus and the fifth toe was measured using ImageJ. Two board-certified foot-and-ankle surgeons assessed the presence of the “too many toes” sign. Statistical comparisons were performed using t-tests and a McNemar test.

Results: The mean horizontal distance from the lateral malleolus to the fifth toe significantly increased from 0.47 ± 0.13 cm at floor level to 0.59 ± 0.15 cm at 40-cm height. From the floor-level images, two cases were classified as positive for the “too many toes” sign and nine as negative. Conversely, images obtained at 40-cm height identified ten positive and one negative case.

Conclusions: Imaging height significantly influences the visibility of the lateral toes and assessment of the “too many toes” sign in flatfoot, highlighting the need to standardize camera height for consistent clinical evaluations.

Objectives: This study investigated whether moderate-to-vigorous physical activity (MVPA) in patients after pulmonary resection is significantly associated with the 6-min walking distance recovery rate (6MWD-RR).

Methods: A single-center retrospective cohort study was conducted between October 2017 and March 2020. Of the 114 patients who underwent pulmonary resection for neoplastic lung disease, 60 were included in the final analysis. The 6-min walk test was performed preoperatively and before discharge. The 6MWD-RR was calculated as (postoperative 6MWD/preoperative 6MWD) × 100. Participants were classified into High (6MWD-RR ≥90%) and Low (6MWD-RR <90%) RR groups. Postoperative MVPA was measured using a triaxial accelerometer after chest tubes were removed. Multivariate logistic regression analysis was used to examine the association between %MVPA (MVPA [min/day]/wearing time [min/day] × 100) and 6MWD-RR.

Results: The High- and Low-RR groups comprised 39 (26 men, 67%) and 21 (9 men, 43%) patients, respectively. In the multivariate logistic regression analysis adjusted for age, sex, and preoperative factors (forced vital capacity %predicted, 6MWD, quadriceps strength), a higher %MVPA was significantly associated with a higher 6MWD-RR (odds ratio 1.38, 95% confidence interval 1.08–1.87).

Conclusions: Higher postoperative %MVPA was associated with better functional recovery at discharge after lung resection. Further studies are required to clarify the causal relationships and to establish effective postoperative rehabilitation strategies.

Objectives: This study characterized the joint-specific time course of upper-limb spasticity to identify predictors of subsequent spasticity progression in post-stroke patients undergoing inpatient rehabilitation in a convalescent (Kaifukuki) rehabilitation ward (KRW).

Methods: This single-center retrospective cohort study included 76 post-stroke patients with upper-limb paresis admitted to a KRW between January and December 2020. Spasticity of the elbow, wrist, and finger flexors was assessed monthly using the Modified Ashworth Scale (MAS) at 1–4 months after admission. Upper-limb motor function and neurological findings, including tendon reflexes, were evaluated at admission. Motor recovery was classified using the Brunnstrom recovery stage (BRS). Multivariate logistic regression analysis was used to identify factors associated with increased finger flexor spasticity (MAS ≥1+) at discharge.

Results: Upper-limb spasticity increased 2 months after admission, with earlier increases observed in distal joints when compared with proximal joints. By discharge, approximately one-third of patients demonstrated increased spasticity. At 3 months after admission, increased spasticity was most frequent in patients with BRS3 (upper limb, 59%; hand/fingers, 84%). Multivariate analysis revealed that lower Fugl-Meyer Assessment scores of the upper extremity and greater tendon reflex hyperreflexia at admission were independently associated with increased finger flexor spasticity at discharge.

Conclusions: Upper-limb spasticity tended to increase earlier in distal joints, particularly in the wrist and finger flexors, than in the proximal joint during subacute inpatient rehabilitation. Severe upper-limb paresis and tendon reflex hyperreflexia at admission may be risk factors for worsening finger spasticity.

Objectives: Body lateropulsion (BL) is a postural orientation disorder after stroke, characterized by an involuntary tilt of the body to one side. We aimed to evaluate the validity of the Grading of Lateropulsion (GoL)—a measure of BL severity—by examining its associations with balance, ataxia, and walking ability in patients with infratentorial stroke. We also assessed the distribution characteristics of GoL scores.

Methods: We evaluated 21 patients with infratentorial stroke who presented with BL using the Berg Balance Scale (BBS), subjective visual vertical, Scale for the Assessment and Rating of Ataxia (SARA), and Functional Ambulation Category (FAC). We then analyzed the correlations between these measures and GoL. We also calculated the proportions of patients with the lowest and highest GoL scores. In patients who completed the 1-month follow-up, FAC scores were compared between baseline and follow-up.

Results: Significant correlations with GoL were observed for BBS, SARA, and FAC. GoL Grade 1 was observed in 57.1% of the patients and Grade 4 in 28.6%, suggesting the presence of both floor and ceiling effects. The median FAC score increased from 4 at baseline to 5 at follow-up, demonstrating a significant improvement.

Conclusions: GoL severity was strongly associated with ataxia, balance function, and walking independence, indicating a complex and multifactorial pathophysiology of BL. However, notable floor and ceiling effects as well as the negatively skewed distribution of GoL scores indicated limited sensitivity for detecting subtle changes in BL severity.

Objectives: This study aimed to examine the associations between motoric cognitive risk syndrome (MCR), its component subjective cognitive decline (SCD), and health-related indicators among community-dwelling older adults.

Methods: This cross-sectional study included community-dwelling older adults. MCR was defined as the presence of SCD and slow gait speed. Health-related indicators included the Questionnaire for Medical Checkup of the Old-Old (QMCOO), physical frailty, and social frailty. Participants were divided into three groups according to MCR components: a healthy group, a group with SCD, and an MCR group. Basic characteristics and health-related indicators of the groups were compared. Multivariate regression analyses were performed with QMCOO, physical frailty, and social frailty as dependent variables and MCR and SCD as independent variables.

Results: Among the 138 participants included in the analysis, 41 (29.7%) belonged to the healthy group, 82 (59.4%) to the SCD group, and 15 (10.9%) to the MCR group. In the multivariate regression analysis, QMCOO was significantly associated with MCR (β = 0.217, P = 0.011) and SCD (β = 0.190, P = 0.022). MCR was significantly associated with physical frailty (odds ratio =19.495, P <0.001) but showed no significant association with social frailty. In contrast, SCD was not significantly associated with either frailty type.

Conclusions: MCR and SCD were significantly associated with existing health-related indicators, suggesting their potential utility as markers for early detection of health deterioration in older adults.

Objectives: This study investigated whether sarcopenia at admission is independently associated with physical performance at discharge in older patients with stroke, after adjusting for stroke severity and other clinical variables.

Methods: This prospective cohort study included patients with stroke aged 65 years or older admitted to a rehabilitation hospital between November 2021 and August 2024. Sarcopenia was defined by Asian Working Group for Sarcopenia 2019 criteria (handgrip strength and skeletal muscle mass index). Physical performance was assessed using the Short Physical Performance Battery (SPPB) at admission and discharge. Multiple linear regression examined the association between sarcopenia and SPPB scores at discharge, adjusting for age, sex, body mass index, stroke type, premorbid modified Rankin Scale, Charlson Comorbidity Index, Brunnstrom recovery stage, National Institutes of Health Stroke Scale, and SPPB score at admission.

Results: Of 198 patients screened, 145 were included in the final analysis (mean age, 76.9 ± 7.1 years; 74 were male), and 85 participants (58.6%) presented with sarcopenia. After adjustment, sarcopenia at admission was independently associated with lower SPPB scores at discharge (β = −0.123; 95% confidence interval: −1.874 to −0.066; P = 0.036). Age, premorbid modified Rankin Scale score, stroke severity, and admission SPPB score were also significant predictors of physical performance at discharge.

Conclusions: Sarcopenia is independently associated with poorer physical performance at discharge among older patients with stroke, even after accounting for stroke-related factors. Early identification and management of sarcopenia may allow optimization of rehabilitation outcomes in this demographic, although the clinical significance of this association warrants further investigation.

Objectives: Although the appearance of virtual reality avatars influences physical and psychological states, the specific impact of the appearance of the avatar’s legs on postural stability is unknown. This study investigated the association between the visual design of an avatar’s lower limbs and postural stability in healthy adults.

Methods: This preliminary study enrolled healthy adults aged 20–50 years, who were randomly assigned to use either a large-legged avatar or a slender-legged avatar. Their postural stability and virtual avatar embodiments were subsequently evaluated.

Results: Ten healthy adults (mean age: 35.3 ± 9.6 years; 50% male) participated in the study. The convex hull area, rectangular area, and total path length were significantly larger when using the slender-legged avatar, with the convex hull area ratio (slender-legged/large-legged avatar) averaging 2.3 ± 1.5. The extent of change was significantly correlated with avatar embodiment (r=0.69).

Conclusions: In this pilot study, the slender-legged avatar was associated with approximately twice the postural sway observed for the large-legged avatar. A higher avatar embodiment had a greater impact on postural stability. These preliminary findings suggest potential applications for avatar design in virtual reality rehabilitation, pending confirmation in larger studies.

Objectives: In the current study, a convolutional neural network (CNN) model for estimating the skeletal muscle index (SMI) from lower leg digital images was developed, and its predictive performance was evaluated.

Methods: One hundred healthy adults participated in the study; 50 men and 50 women (median age 37.5 years, interquartile range 28–44 years). Digital images of the non-dominant lower leg were obtained from lateral and posterior views. A CNN model was trained to estimate SMI after applying data augmentation and Canny edge detection. Predictive accuracy was evaluated using fivefold cross-validation (80% training, 20% testing).

Results: The mean SMI was 7.0 ± 1.1 kg/m². The mean absolute percentage error ranged from 3.70% to 4.15% for lateral images and from 4.23% to 4.85% for posterior images. The respective concordance correlation coefficients ranged from 0.93 to 0.94 and from 0.90 to 0.91, indicating strong agreement with the reference values.

Conclusions: The CNN model accurately estimated SMI from lower leg digital images, with prediction errors below 5%. This simple, noninvasive method could serve as a practical tool for screening skeletal muscle mass.

Objectives: This study aimed to investigate the impact of preoperative frailty risk, assessed using the Hospital Frailty Risk Score (HFRS), on hospitalization-associated disability (HAD) and in-hospital complications in patients aged 65 years or older who underwent open heart valve surgery.

Methods: This retrospective cohort study included patients in the JMDC database aged 65 years or older with valvular heart disease who underwent open heart valve surgery between April 2017 and December 2022. Patients were categorized into low (HFRS <5) and high frailty risk (HFRS ≥5) groups. The primary outcome was the proportion of patients with HAD. The secondary outcomes included the proportion of patients who developed pneumonia, respiratory failure, and delirium during hospitalization. Mediation analysis was performed to examine whether preoperative frailty risk influenced the risk of HAD through postoperative complications.

Results: Among 4658 patients (mean age 75.0 ± 5.5 years), 328 (7.0%) were classified as high frailty risk. The high risk group had a significantly higher proportion of HAD than the low risk group [odds ratio (OR), 3.49; 95% confidence interval (CI), 2.60–4.67; P <0.001]. Mediation analysis showed that high frailty risk was independently associated with HAD (direct effect: OR, 2.75; 95% CI, 2.01–3.76; P <0.001). The indirect effect mediated by postoperative complications was significant (OR, 1.26; 95% CI, 1.11–1.43; P <0.05), accounting for 19% of the total effect.

Conclusions: The preoperative frailty risk assessed by the HFRS may serve as a useful predictor of HAD and in-hospital complications in older patients undergoing open heart valve surgery.

Objectives: This study aimed to prospectively investigate the factors affecting the diminished ability of patients to stand up following hematopoietic stem cell transplantation (HSCT).

Methods: Fifty patients were enrolled in the study. Pre- and post-HSCT physical performance was assessed using the Short Physical Performance Battery (SPPB). Post-HSCT physical performance decline was defined as a decrease of at least 1 point in the SPPB chair rise score at hospital discharge compared with the pre-HSCT score. Factors associated with this decline were analyzed using multiple logistic regression.

Results: A functional decline in the ability to stand up post-HSCT was noted. The total corticosteroid dose (odds ratio, 1.03, 95% confidence interval 1.00–1.05) showed an independent association with physical performance decline post-HSCT.

Conclusions: The total corticosteroid dose is a valuable predictor of physical performance decline post-HSCT. Therefore, standing up movements should be evaluated cautiously in patients who are expected to receive high corticosteroid doses for the treatment of acute graft-versus-host disease or HSCT regimens.

Objectives: This study examined the feasibility, short-term safety, and changes in objective mobility measures associated with initiating gait training between postoperative day (POD) 2 and POD 4 and completing it by POD 14 following surgery for thoracic myelopathy.

Methods: This retrospective, single-arm cohort study included 11 patients with thoracic myelopathy and preoperative gait impairments. Individualized gait training combined recumbent cycling and treadmill walking (~40 min/session, 3–5 times/week) at a “somewhat hard” intensity on the modified Borg scale (rating: 6). Primary outcomes were walking speed and step length on the 10-m Walk Test. Secondary outcomes included time and step count from the Timed Up-and-Go Test (TUG), the Japan Orthopaedic Association lower-extremity motor function score (JOA-LE), static balance, muscle strength, and sensory function. Assessments were performed preoperatively and on POD 14.

Results: Walking speed (median change 0.25 m/s, P = 0.029) and step length (median change 0.05 m, P = 0.009) improved significantly. TUG results also improved for completion time (median change −3.03 s, P = 0.007) and step count (median change −3 steps, P = 0.046). Standing balance improved, with nine patients achieving independence in the Romberg position with eyes closed (P = 0.029). No notable changes were observed in JOA-LE, muscle strength, or sensory function. No adverse events occurred.

Conclusions: Early, device-assisted gait training initiated within POD 4 was feasible and safe, and it was associated with short-term improvements in objective mobility measures. Controlled trials are warranted to confirm these findings.

The acute phase of stroke is characterized by heightened neuroplasticity; however, rehabilitation interventions are often limited because of impaired voluntary motor control and systemic instability. Severe cases may miss the opportunity for recovery before adequate physiological readiness is achieved. Cyclic neuromuscular electrical stimulation (NMES) is a noninvasive modality that induces muscle activity and sensory input independently of volitional effort. Besides suppressing muscle atrophy, NMES can potentially activate the central nervous system. This narrative review aimed to investigate the neurophysiological mechanisms and clinical applicability of cyclic NMES in patients with acute stroke, focusing on its strategic value and current challenges. NMES in the acute phase showed modest improvements in muscle strength, spasticity, and walking ability. However, inconsistencies in patient selection, stimulation parameters, and outcome measures remain major barriers to its application. Successful clinical integration requires redefining NMES as a “priming stimulus,” with an emphasis on comfort, responsiveness, and continuity. Developing semi-standardized, strategically guided protocols is necessary. Cyclic NMES can be a preparatory intervention during the critical “window of neuroplasticity” in acute stroke rehabilitation, offering potential benefits that extend beyond conventional adjunctive therapies. Further studies focusing on stratified patient selection and neurophysiologically informed outcome measures are needed to enhance evidence-based application.

Objectives: Fully immersive virtual reality (FIVR) systems are emerging as innovative tools for upper limb stroke rehabilitation. These systems provide immersive, interactive environments that foster motivation, engagement, and functional recovery. This scoping review examines the usability of FIVR systems for upper limb rehabilitation among stroke survivors, focusing on evaluation methods, patient and therapist experiences, and barriers to adoption.

Methods: The review followed PRISMA-ScR guidelines. A systematic search of PubMed, IEEE Xplore, and Scopus identified 20 eligible studies. Data were extracted on study design, participant demographics, VR system characteristics, software, task type, game/task elements, usability evaluation methods, and key findings.

Results: The findings demonstrate generally positive benefits in terms of usability and engagement, with participants indicating both motivation and enjoyment during FIVR interventions. However, there was considerable variability in assessment methods, including both quantitative and qualitative approaches, as well as in hardware, software, interaction methods and no standardized framework. Common challenges included mild side effects (e.g., dizziness), technical complexity, and the need to adapt to patients’ varying abilities. Such limitations highlight gaps in the standardization and replicability of usability assessment across studies.

Conclusions: FIVR systems offer potential as supplements to conventional therapy, providing engaging and personalized rehabilitation experiences. Improving usability assessment through standardized frameworks, addressing technical and accessibility barriers, and ensuring the adaptability of interventions to individual patient needs are critical to optimizing effectiveness and supporting broader clinical adoption.

Objectives: Several tools are available for the assessment and classification of lesion level in spina bifida (SB) patients. This study aimed to quantitatively investigate potential relationships that lesion level and mobility style may have with bone mineral density (BMD) and body composition in both lower and upper limbs using dual-energy X-ray absorptiometry (DXA) scans in patients with SB.

Methods: We investigated 74 patients (34 boys, 40 girls) with SB (mean age 12.8 years, range 10–18 years) using DXA scans to analyze BMD and body composition. Participants were classified by lesion level (upper lumbar or above, mid lumbar, lower lumbar, and sacral) for analysis of lower and upper limbs. Patients were reclassified by functional mobility scale (FMS) 50-m rating (wheelchair users, assisted ambulators, and independent ambulators) for further analysis of upper limbs.

Results: The abovementioned lesion level groups contained 18, 17, 20, and 19 patients, respectively. A one-way analysis of variance (ANOVA) of lower limb outcomes showed significant intragroup homogeneity for BMD and body composition and also revealed a stepwise pattern that was consistent across multiple analyses. The FMS-based upper limb groups contained 19, 15, and 40 patients, respectively. Our analysis of BMD and percent bone mineral content did not reveal statistically significant trends in the upper limbs.

Conclusions: Lower limb body composition among children with SB was significantly classified by lesion level using ANOVA. In the upper limbs, our results showed no significant correlation between lesion level and BMD or body composition.

Objectives: This study aimed to determine the association between preoperative functional mobility and exceeding the planned length of hospital stay (LOS) after lumbar fusion surgery for lumbar spinal stenosis (LSS) and to identify factors associated with preoperative functional mobility.

Methods: A total of 122 patients who underwent lumbar fusion for LSS were included. Preoperative functional mobility was assessed using the Timed Up-and-Go (TUG) test. LOS was categorized as standard (≤14 days) or exceeded (>14 days). Risk ratios (RRs) with 95% confidence intervals (CIs) were estimated using modified Poisson regression to analyze the association between preoperative TUG performance and LOS. Additionally, linear regression was used to identify factors associated with preoperative TUG performance.

Results: In the univariate modified Poisson regression model, exceeding the planned LOS was associated with preoperative TUG performance (RR, 1.10; 95% CI, 1.06 to 1.14; P <0.001). In the adjusted model, this association remained significant (RR, 1.10; 95% CI, 1.06 to 1.14; P <0.001). Poorer preoperative TUG performance was also associated with female sex (mean difference, −2.02 s; 95% CI, −3.60 to −0.43; P = 0.014) and psychiatric comorbidities (mean difference, 7.91 s; 95% CI, 1.95 to 13.87; P = 0.010).

Conclusions: Poorer preoperative functional mobility is an independent predictor of exceeding the planned LOS after lumbar fusion surgery for LSS. Routine preoperative assessment with the TUG test may help identify high-risk patients, and targeted strategies such as enhanced preoperative and postoperative rehabilitation could reduce the likelihood of prolonged hospitalization.

Objectives: This study examined associations of toe grip strength (TGS) with fall occurrence and the number of falls in community-dwelling older adults and evaluated knee extension strength (KES) and hand grip strength (HGS) as established indicators.

Methods: Adults aged 65–94 years (n=208) at 2018 municipal health checkups were enrolled. TGS, KES, and HGS were measured with quantitative devices and normalized to body weight (%BW). Prior-year falls were recorded at baseline, and fall occurrence and the number of falls over the subsequent year were collected at the next annual checkup. Associations were estimated with multivariable logistic regression for fall occurrence and negative binomial regression for the number of falls, adjusted for age, sex, prior-year fall history, cardiovascular disease or stroke, physical activity, and serum albumin. Nonlinearity was assessed with restricted cubic splines.

Results: Higher TGS was associated with lower odds of fall occurrence [odds ratio (OR) 0.94, 95% confidence interval (CI) 0.89–0.99, P = 0.015] and fewer falls [risk ratio (RR) 0.95, 95% CI 0.91–0.99, P = 0.015]. KES was weakly associated with falls (OR 0.99, 95% CI 0.98–1.00, P = 0.041; RR 0.99, 95% CI 0.98–1.00, P = 0.042), whereas HGS showed no association. Splines indicated nonlinearity: TGS odds were flat around 17–27 %BW and rose below ~17 %BW; KES odds increased below ~75 %BW; HGS was flat around 45–55 %BW.

Conclusions: TGS was associated with fall occurrence and the number of falls, whereas KES showed weak associations and HGS showed no association, indicating that the TGS measurement may be useful for risk assessment.

Objectives: Of various frailty indicators, none are suitable for cardiovascular disease (CVD). We aimed to verify the association between the Kihon checklist (KCL) score and prognosis of older adults with CVD.

Methods: Participants (n = 336) were adults with CVD (aged ≥ 65 years, mean age 81 years) who required hospitalization. They were assessed with the KCL, and data were obtained for left ventricular ejection fraction (LVEF) and brain natriuretic peptide (BNP) at discharge, and the occurrence of all-cause death, CVD composite endpoint, CVD death, and CVD hospitalization after discharge. The cutoff value of the KCL score for all-cause death was calculated using receiver operating characteristic analysis, and participants were divided into two groups. The relationship between KCL score and prognosis was examined using survival time (Kaplan–Meier method) and Cox proportional hazards analyses.

Results: The KCL cutoff value was 8 (KCL < 8, n=155). Survival time analysis showed significant differences in all-cause death, CVD composite endpoint, and CVD death (log-rank test: P < 0.001, each). Cox proportional hazards analysis showed that KCL score of 8 or higher was significantly associated with all-cause death [hazard ratio (HR), 2.731; 95% confidence interval (CI), 1.202–6.205] and CVD death (HR, 2.875; 95% CI, 1.124–7.353). In the HF only group, KCL score of 8 or higher was not significantly associated with all-cause death, CVD death, or CVD composite endpoint.

Conclusions: Total KCL score was associated with mortality in the overall cohort of older adults with CVD, although the association in the HF subgroup alone showed a borderline trend.

Objectives: Approximately 40% of stroke patients discharged from rehabilitation hospitals achieve restored gait using an ankle–foot orthosis. However, whether the use of lower-limb orthoses (LLO) at discharge is required is unknown in the acute phase. Therefore, it is difficult to explain the use of LLO to patients and their families. The aim of this study was to investigate the factors associated with the use of LLO at discharge based on acute functional impairment.

Methods: This study retrospectively investigated 152 patients who were transferred to a convalescent rehabilitation ward (CRW) after undergoing acute rehabilitation between 1 May 2009 and 31 March 2018 and regained gait ability. The user (U) group included patients who used LLO. Multivariate analysis was performed for factors related to acute functional impairment 1 week after starting physical therapy and the use of LLO at discharge from the CRW. The predictive performance of each factor was analyzed. Acute functional impairment was measured in terms of paralyzed lower-limb motor function, trunk function, non-paralyzed side function, and higher brain function.

Results: Seventy-four patients (49%) were in the U group, and acute functional impairment was more severe than that in the non-user group, except for the non-paralyzed side function. Multivariate analysis showed that a paralyzed ankle dorsiflexor muscle, as assessed by the foot pat test, was associated with LLO use at discharge (P=0.003).

Conclusions: A paralyzed dorsiflexor muscle during the acute phase is a factor that helps determine whether to use LLO at discharge from the CRW.

Objectives: Cachexia is a condition marked by weight loss and reduced skeletal muscle mass, with or without the loss of fat mass, commonly occurring in patients with chronic diseases such as cancer and heart failure, on a background of inflammation. Interventions that combine nutrition and exercise may offer greater benefits than either approach alone in mitigating cachexia-related impairments. Nevertheless, their overall impact remains unclear. The aim of this review was to evaluate the effectiveness of combined nutritional and exercise interventions for cachexia in patients with chronic diseases.

Methods: We conducted searches via PubMed, the Cochrane Library, Embase, CINAHL, PEDro, ICTRP, and ClinicalTrials.gov through to 3 December 2024. Eligible studies were intervention studies or observational studies comparing combined nutritional and exercise interventions with control conditions, which included usual care or unimodal interventions (nutrition or exercise alone), in patients diagnosed with cachexia according to the Evans or Fearon criteria. The assessed outcomes included body weight, body composition, mortality, activities of daily living, physical function, exercise tolerance, and quality of life.

Results: Of 1926 identified records, five studies involving only patients with cancer met the inclusion criteria. There is significant uncertainty regarding how combined interventions impact mortality rates compared to control groups (two studies, 66 participants: odds ratio 1.15, 95% confidence interval 0.13–9.97; I² = 0%; evidence of very low certainty). Meta-analyses for other outcomes could not be performed because of sparse and heterogeneous data. We also identified 22 ongoing trials involving patients with cancer, chronic kidney disease, and AIDS, with results pending.

Conclusions: Current evidence regarding combined nutritional and exercise interventions for cachexia is of very low certainty, and no high-quality evidence currently exists to support their effectiveness. Findings across studies are inconsistent, and further rigorous, well-designed trials are urgently needed. The development and adoption of core outcome sets will be essential to enable future meta-analyses. Results from ongoing trials are awaited.

Objectives: Locomotive syndrome (LS) is prevalent among older adults, particularly women, and is a major contributor to the need for long-term care. In rapidly aging Japan, addressing LS has become a public health priority. Although skeletal muscle mass, percent body fat (PBF), balance, and walking speed have each been linked to LS, their interrelationships remain unclear. This study examined how muscle mass and PBF are associated with LS risk in relation to balance and walking speed.

Methods: This cross-sectional study analyzed community-dwelling older women aged 65 years or older, recruited from a larger cohort of adults aged 18 years or older who were able to ambulate independently. Assessments included skeletal muscle index (SMI), PBF, balance (single-leg standing time), walking speed, and LS status (two-step test, stand-up test, and the 25-question Geriatric Locomotive Function Scale). Path analysis was performed to examine the associations among variables.

Results: A total of 285 participants were included. The path model demonstrated acceptable fit (goodness-of-fit index = 0.986; adjusted goodness-of-fit index = 0.945; root mean square error of approximation = 0.056). PBF was associated with balance function (β = −0.24), which was statistically related to both walking speed (β = 0.33) and LS risk (β = −0.37). SMI showed no association with balance.

Conclusions: In predominantly non-sarcopenic older women, higher PBF was associated with increased LS risk, with these associations statistically related to balance and gait functions. Prospective studies are warranted to confirm these pathways and clarify causal relationships.

Objectives: Functional exercise capacity is impaired in patients with chronic diseases or malignancies. This study aimed to investigate the association between exercise tolerance and the prognosis of patients with hepatocellular carcinoma receiving locoregional therapy.

Methods: This single-center prospective study enrolled 41 consecutive patients with hepatocellular carcinoma who had a Barthel index of 100 and received locoregional therapy. Baseline exercise tolerance, physical function, and body composition were measured. Factors associated with mortality were assessed using a Cox proportional hazards model. Recurrence-free and overall survival rates were evaluated using the Kaplan–Meier analysis and log-rank test.

Results: Of the 41 patients, 16 were shown to have exercise intolerance through the 6-min walk test. None of the baseline laboratory data, physical function, body composition, or sarcopenia comorbidity showed significant differences between exercise-tolerant and exercise-intolerant patients. During a median follow-up period of 31 months, 8 patients died. The multivariate Cox proportional hazards model identified the baseline albumin-bilirubin score and exercise intolerance as independent predictors of mortality. Kaplan–Meier analyses showed that the overall, but not recurrence-free, survival rate was significantly lower in patients with exercise intolerance than in those with exercise tolerance.

Conclusions: Exercise intolerance is associated with lower survival in patients with hepatocellular carcinoma receiving locoregional therapy. In particular, patients with albumin-bilirubin grade 2 and exercise intolerance may be at high risk of poor prognosis after locoregional therapy.

Objectives: This study aimed to clarify the differences in goal setting and achievement trends in home-visit rehabilitation at different levels of independence in mobility.

Methods: Goals set at the beginning of home-visit rehabilitation were retrospectively examined using the Canadian Occupational Performance Measure (COPM). All goals were classified into nine categories in three domains based on the principles of the COPM. The participants were divided into three groups according to their level of independence in mobility. The proportion of participants with goals in each category was compared. Additionally, the COPM performance and satisfaction scores at the beginning of rehabilitation and 3 months later were compared.

Results: In total, 245 participants were categorized into the assisted (n=48), supervised (n=65), and independent groups (n=132). Functional mobility (36.3%) was the most common goal, accounting for the largest number of patients within each group. The percentages of those with goals in the categories of personal care (P = 0.013), community management (P < 0.001), household management (P < 0.001), quiet recreation (P < 0.001), and active recreation (P = 0.024) were significantly different among the three groups. All three groups showed significant improvements in performance scores (assisted group, P = 0.014; supervised group, P < 0.001; independent group, P < 0.001) and satisfaction scores (P < 0.001 in all three groups) in the self-care domain.

Conclusions: Goal categories for home-visit rehabilitation varied according to the level of independence in mobility. Nevertheless, goals in the self-care domain are likely to be achieved, regardless of mobility independence, after home-visit rehabilitation.

Background: Peripheral magnetic stimulation is increasingly used to treat dysfunctions associated with various disorders. However, there is currently no consensus regarding its efficacy across specific populations, disease conditions, intervention settings, treatment durations, or outcomes. This scoping review aimed to identify, summarize, and map relevant literature on peripheral magnetic stimulation, clarifying its application by disease type, treatment site, functional impairments, outcomes, and intervention setting.

Methods: A systematic search was conducted across several databases, including PubMed/MEDLINE, CINAHL Complete, Cochrane Library, Web of Science, and PEDro. Studies that examined the impact of peripheral magnetic stimulation on dysfunction across all disease types and populations were included.

Results: Of 804 screened articles, 97 met the inclusion criteria. Peripheral magnetic stimulation was primarily used for musculoskeletal, neurological, and incontinence-related diseases, focusing on disease-specific outcomes related to muscle and physical function in the affected areas. Conversely, its use in internal diseases was predominantly limited to chronic obstructive pulmonary disease, with few studies addressing its efficacy in cardiovascular diseases, cancer, and diabetes mellitus. Furthermore, peripheral magnetic stimulation settings varied widely, even when applied to similar diseases or dysfunctions.

Conclusions: Peripheral magnetic stimulation is primarily used to treat musculoskeletal, neurological, and incontinence-related diseases, with outcomes centered on disease-specific assessments of muscle and physical function. However, its application in internal diseases remains limited, especially in cardiovascular disease, cancer, and diabetes mellitus. In addition, standardized peripheral magnetic stimulation prescriptions have not yet been established. Future studies should emphasize its implementation in underserved diseases and dysfunctions and establish standardized treatment protocols.

Objectives : This study aimed to clarify the relationship between early postoperative regional phase angle (PhA) and walking ability at discharge in older patients with hip fractures.

Methods : The study included patients aged 75 years or older who underwent treatment for hip fractures at our hospital. We calculated the regional PhA from bioelectrical impedance analysis conducted between 3 and 7 days after surgery and investigated the association of PhA with walking ability at discharge.

Results : Overall, 255 cases were included in the analysis (61 men, average age 86.3 years; 194 women, average age 88.1 years). The results of intergroup comparisons based on walking ability demonstrated that the effect size (r) was large for lower limb PhA in men and upper limb PhA in women, whereas the effect size was small for trunk PhA in both men and women. Multiple logistic regression analysis with walking ability as the dependent variable revealed that cognitive function and sound-side lower limb PhA were associated with walking ability in men, whereas age, fracture type, cognitive function, and sound-side upper limb PhA were associated factors in women.

Conclusions : The prediction of walking ability in older patients with hip fractures may be possible using PhA data. The results of this study suggest that lower limb PhA for men and upper limb PhA for women are optimal indicators of walking ability at discharge.

Objectives: Non-older adults are at risk of developing sarcopenia, and exercise and increased physical activity are effective preventive interventions. Digital interventions, including gamification, may enhance the effects of exercise interventions. This systematic review and meta-analysis examined the effects of digital health interventions on muscle strength, muscle mass, and physical function in non-older adults at risk of sarcopenia.

Methods: We conducted a systematic review of randomized controlled trials that evaluated the effects of digital health interventions on outcomes related to sarcopenia. Literature searches were performed in MEDLINE (Ovid), Web of Science Core Collection, and CENTRAL databases. Risk of bias was assessed according to established guidelines, and meta-analyses were conducted. The certainty of evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework.

Results: In total, 28 studies were analyzed. The pooled results indicated that digital health interventions led to improvements in grip strength, performance in the chair-stand test, walking speed, Dynamic Gait Index, and Timed Up-and-Go test. In contrast, lower limb muscle strength and lean body mass did not show meaningful improvements. Although no major risks of bias were identified, the strength of the evidence remained limited because of the small number of studies and participants included.

Conclusions: This systematic review suggests that digital health interventions may lead to modest improvements in muscle strength, muscle mass, and physical function in non-older adults at risk of sarcopenia, although the current evidence remains inconclusive. Further studies are needed to establish their effect.