This narrative review introduces case complexity and medical rehabilitation needs in a stroke rehabilitation setting, and proposes methods to more efficiently enhance functional recovery in the acute stage after stroke onset. Therapists may measure a construct of individual need complexity around and beyond the basic and common needs for medical necessity, and thereby screen acute patients who could benefit more from additional rehabilitation inputs. This review also describes the clinical significance of medical rehabilitation needs and challenges for efficient stroke rehabilitation. Overall, we propose that challenging research trials should be conducted to compare the effectiveness of the arrangement of rehabilitation service allocation based on needs assessment after stroke with the usual care pathway.

Objective: We evaluated the accuracy of a neural network to classify and predict the possibility of home oxygen therapy at the time of discharge from hospital based on patient information post-coronavirus disease (COVID-19) at admission. Methods: Patients who survived acute treatment with COVID-19 and were admitted to the Amagasaki Medical Co-operative Hospital during August 2020–December 2021 were included. However, only rehabilitation patients (n = 88) who were discharged after a rehabilitation period of at least 2 weeks and not via home or institution were included. The neural network model implemented in R for Windows (4.1.2) was trained using data on patient age, gender, and number of days between a positive polymerase chain reaction test and hospitalization, length of hospital stay, oxygen flow rate required at hospitalization, and ability to perform activities of daily living. The number of training trials was 100. We used the area under the curve (AUC), accuracy, sensitivity, and specificity as evaluation indicators for the classification model. Results: The model of states at rest had as AUC of 0.82, sensitivity of 75.0%, specificity of 88.9%, and model accuracy of 86.4%. The model of states on exertion had an ACU of 0.82, sensitivity of 83.3%, specificity of 81.3%, and model accuracy of 81.8%. Conclusion: The accuracy of this study’s neural network model is comparable to that of previous studies recommended by Japanese Guidelines for the Physical Therapy and is expected to be used in clinical practice. In future, it could be used as a more accurate clinical support tool by increasing the sample size and applying cross-validation.

Objective: This study aimed to investigate whether longitudinal changes in exercise capacity in patients with acute myocardial infarction (AMI) differ by sex and clarified what contributed to these differences. Methods: We retrospectively examined the differences in each variable between men and women in 156 patients with AMI (mean age: 65 ± 12 years; 82.0% male) who participated in a 3-month cardiac rehabilitation (CR) program and could be followed-up for exercise capacity 12-months after AMI onset. Sex-related differences in the change in peak oxygen uptake (peak VO₂) at baseline, 3-months, and 12-months after AMI were analyzed. Results: Male patients with AMI were younger and had higher body mass index and employment rate than women. The attendance of the CR program was higher in women (men vs. women; 10 [3–15] vs. 14 [11–24] sessions, p = 0.0002). Women showed a significant lower %change in peak VO₂ after 12 months (men vs. women; 7.8% [–0.49% to 14.6%] vs. 1.3% [–5.7% to 7.5%], p = 0.013). In multiple linear regression analysis, age (β = –0.76, 95% confidence interval [CI] = –1.0 to –0.50, p <0.0001) and female sex (β = –6.3, 95% CI = –9.1 to –3.5, p <0.0001) were negative independent predictors of change in peak VO₂ over 12 months, while CR attendance (β = 0.21, 95% CI = 0.0032–0.42, p = 0.047) and recommended exercise habit after the CR program (β = 2.1, 95% CI = 0.095–4.1, p = 0.040) were positive independent predictors of change in peak VO₂ over 12 months. Conclusion: In female patients, exercise capacity improved during the CR program but decreased to AMI onset levels after 12 months.

Objective: This study aimed to determine the association between echo intensity (EI) of vastus lateralis and knee extension strength (KES) in patients with type 2 diabetes mellitus (T2DM). Methods: This retrospective study included a total of 304 patients (189 males and 115 females) with T2DM who were hospitalized for treatment or care. EI and muscle thickness (MT) of the right vastus lateralis were assessed from transverse ultrasound images. Maximal isometric KES was evaluated using a dynamometer and normalized for body weight (%KES). Results: %KES was significantly positively correlated with MT and stages of change for exercise behavior, and significantly negatively correlated with age, T2DM duration, and EI. %KES was significantly higher in male than in female. %KES was significantly higher in non-diabetic peripheral neuropathy (DPN) than in DPN. Stepwise multiple regression analysis showed that sex, age, T2DM duration, EI, and stages of change for exercise behavior were significant determinants of %KES. Conclusion: The study results suggest that EI is associated with %KES in patients with T2DM.

Objective: Social participation is an essential component of active aging. Physical dysfunction is restriction of social participation, but it is inconclusive that improvement of physical function contributes to promote social participation. Therefore, understanding the other factor that moderates the association between physical dysfunction and social participation is important, and social network (i.e., ties with family and friends) may be a key factor. The aims of this study were to investigate the association between physical function and frequency of social participation, with social network as a moderator, and to examine the gender differences on the relationships. Methods: We conducted a cross-sectional study among 287 community-dwelling older adults. We asked how often they participated in social groups in a week to measure frequency of social participation. Physical function and social network were measured by using the modified version of Short Physical Performance Battery for community-dwelling older adults and the abbreviated Lubben Social Network Scale, respectively. To investigate the association, we performed a linear regression analysis. Results: After adjustment, a linear regression analysis showed interactions between physical function and social network on frequent social participation (β: −0.20, 95% confidence interval [CI]: −0.40 to −0.01). Furthermore, the same association was observed only in women (adjusted β: −0.33, 95% CI: −0.65 to −0.02). Conclusion: Our results suggested that social network moderates the association between physical function and social participation, and observed gender differences on the relationships. The findings of this study indicated the importance of multidimensional assessment and measures for improving social participation, not only physical function but also social network.

Objective: While prolonged sedentary behaviors (SBs) increase cardiovascular disease (CVD) risk, interrupting prolonged sitting (PS) with frequent light exercise reduces arterial functional decline. Skeletal muscle electrical stimulation (EMS) enhances peripheral circulation through passive muscle contraction, suggesting that EMS reduces CVD risk by providing an alternative to active exercise for prolonged SBs. This study aimed to investigate the effects of EMS to skeletal muscles during PS on the endothelial function of the brachial artery (BA). Methods: Study participants included 12 healthy adult men who were subjected to 15 min of supine rest, followed by 1 h of PS only (control [CON] trial), or 20 min of EMS to the lower extremities at 50% of the maximum tolerance intensity during PS (EMS trial). Flow-mediated dilation (FMD) of the BA was measured before and 30 min after PS, and normalized FMD (nFMD) was calculated. Results: The nFMD of the CON trial significantly decreased 30 min after PS completion (6.21% ± 1.13%) compared with that before PS (7.26% ± 0.73%), and there was no significant change in the EMS trial before and after PS. The EMS trial showed a significant increase in the nFMD 30 min after PS completion (1.14 ± 0.77) compared with that before PS (0.84 ± 0.43). However, no significant difference was observed in the CON trials. Conclusion: Passive contraction of the lower extremity muscles by EMS increases BA nFMD, suggesting that prolonged sedentary lower extremity EMS use may reduce the risk of vascular endothelial dysfunction.

Objective: The study aim was to investigate the association between initiating mobilization within 7 days after onset and symptomatic cerebral vasospasm (SCV) in patients with aneurysmal subarachnoid hemorrhage (aSAH). Methods: This was a retrospective multicenter case-control study in Japan. Patients with a diagnosis of aSAH who underwent physical therapy with/without occupational therapy were included and categorized into 2 groups according to the presence or absence of SCV. Initiating mobilization was defined as sitting on the bed edge (at least once, with/without assist, regardless of duration) within 7 days after aSAH onset. Cox proportional hazards regression analysis was performed to evaluate the association between initiating mobilization within 7 days after onset and SCV. Results: The analysis included 510 patients. Among all included patients, 57 (11.2%) patients had SCV. In the univariate Cox proportional hazards regression analysis, initiating of mobilization was not associated with SCV (hazard ratio [HR] = 0.78; 95% confidence interval [CI] = 0.45–1.32). In the multivariate analysis, only the modified Fisher scale was significantly associated with SCV (HR = 26.23; 95% CI = 1.21–571.0). Conclusion: Initiating mobilization within 7 days after aSAH onset was not associated with SCV in patients with aSAH.

Objective: To develop an equation of the predicted amount of low-intensity physical activity (LPA) by analyzing clinical parameters in patients with chronic obstructive pulmonary disease (COPD). Methods: In this cross-sectional study, we analyzed the assessments of clinical parameters evaluated every 6 months from the start of pulmonary rehabilitation in 53 outpatients with stable COPD (age 77 ± 6 yrs; 46 men; body mass index 21.8 ± 4.1 kg/m²; forced expiratory volume in one second 63.0 ± 26.4% pred). An uniaxial accelerometer was used to measure the number of steps and the time spent in LPA of 1.8–2.3 metabolic equivalents during 14 consecutive days. We also evaluated body composition, respiratory function, skeletal muscle strength, inspiratory muscle strength, exercise capacity, and gait speed. Factors associated with the time spent in LPA were examined by multivariate regression analysis. Internal validity between the predicted amount of LPA obtained by the equation and the measured amount was examined by regression analysis. Results: Multivariate regression analysis revealed that gait speed (β = 0.369, p = 0.007) and maximum inspiratory mouth pressure (PI_max) (β = 0.329, p = 0.016) were significant influence factors on LPA (R² = 0.354, p <0.001). The stepwise regression analysis showed a moderate correlation between the measured amount and predicted amount of LPA calculated by the regression equation (r = 0.609, p <0.001; LPA = 31.909 × gait speed + 0.202 × PI_max − 20.553). Conclusion: Gait speed and PI_max were extracted as influence factors on LPA, suggesting that the regression equation could predict the amount of LPA.

Objective: This study aimed to reveal the chronic pain prevalence in spinal muscular atrophy (SMA) patients and identify the clinical characteristics of these patients with chronic pain. The pain status was also investigated in SMA patients with chronic pain. Methods: This cross-sectional study was conducted between July 2018 and December 2018. SMA type II and type III patients in Japan were mailed a survey questionnaire. The survey items were chronic pain prevalence, clinical characteristics, and motor function. Patients with chronic pain also answered questions on various pain status parameters: pain intensity, frequency, duration, location using body map, and factors that exacerbated and relieved pain. Results: The questionnaire recovery rate was 61.1%. Sixty-four type II (mean age 17.3 ± 11.7 years) and 22 type III (mean age 44.9 ± 21.6 years) patients were eligible for inclusion. The prevalence of chronic pain in type II and III patients was 40.6% and 40.9%, respectively. Type II patients with chronic pain were more likely to report the inability to sit without manual support than those without pain (p = 0.03). Pain intensity in SMA patients was mild, but pain usually occurred daily, for prolonged durations, most often in the neck, back, and lower extremities. Sitting and high physical activity exacerbated pain the most. Conclusion: The percentage of patients with SMA with chronic pain was high, at above 40%. Moreover, the pain experienced by patients with SMA was low in intensity but frequent and most common in the lower extremities.

Introduction: Early implementation of neuromuscular electrical stimulation (NMES) has been reported to prevent muscle atrophy and physical functional decline in patients requiring mechanical ventilation. However, its effect in patients with acute exacerbation of interstitial lung disease (ILD) remains unclear. We herein report our experience using the NMES combined with mobilization in a patient with an acute exacerbation of rheumatoid arthritis-associated ILD (RA-ILD) requiring mechanical ventilation. Case Presentation: A 74-year-old man was admitted to the intensive care unit (ICU) and put on mechanical ventilation due to severe acute exacerbation of RA-ILD. Early mobilization and the NMES using a belt electrode skeletal muscle electrical stimulation system were started on day 7 of hospitalization (day 2 of ICU admission). The NMES duration was 20 min, performed once daily. The patient could perform mobility exercises on day 8 and could walk on day 16. We assessed his rectus femoris and quadriceps muscle thicknesses using ultrasound imaging, and found decreases of 4.5% and 8.4%, respectively, by day 14. On day 27, he could independently visit the lavatory, and the NMES was discontinued. He was instructed to start long-term oxygen therapy on day 49 and was discharged on day 63. His 6-minute walk distance was 308 m and his muscle thickness recovered to levels comparable to those at the initial evaluation at the time of discharge. Conclusion: Combining the NMES and mobilization started in the early phase and continued after ICU discharge was safe and effective in a patient with a severe acute exacerbation of RA-ILD.

Purpose: Physical activity (PA) interventions positively affect the physical function (PF) in patients with advanced cancer. However, patients must remain motivated during the intervention. We report a case wherein a smartphone application for PA intervention was useful in motivating the patient to improve adherence. Methods: A 40-year-old woman underwent an allogeneic hematopoietic cell transplantation (allo-HCT) for an advanced extranodal natural killer/T-cell lymphoma. On day 6, she developed the posterior reversible encephalopathy syndrome. She was managed in the intensive care unit for 3 days, and her PF declined markedly. We initiated a smartphone-based PA intervention from day 35. She was instructed to maintain a PA diary for self-monitoring of the daily steps and to set a new step-count goal every week. Results: The PA and PF improved within a short period thereafter. However, she developed severe acute graft-versus-host disease and was administered with high-dose systemic corticosteroids from day 49. The PA, PF, and quality of life (QOL) decreased again. The intervention was continued for 5 months with a high adherence. The PA, PF, and QOL improved gradually. She resumed independent activities of daily living and was discharged on day 202. Conclusion: Smartphone-based PA intervention may be effective against post-allo-HCT physical dysfunction.