Objectives: In stroke rehabilitation, the Fugl-Meyer Assessment Lower Extremity (FMA-LE) motor scale is widely used to assess consecutive recovery steps from motor paralysis and predict prognosis after stroke. However, there has been limited opportunity to refer to the useful yet few studies that evaluated the minimal important change (MIC) and the minimal detectable change (MDC) of the FMA-LE motor scale. The aims of this review were to: (1) identify studies that have estimated the MIC and MDC, (2) identify the calculated MIC and MDC values and disease phases in previous studies, and (3) assess the methodological quality of the MIC and MDC studies of the FMA-LE motor scale. Methods: A scoping review was undertaken following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) recommendations. 3 databases (PubMed, CINAHL, and Web of Science) were used for the literature search. Reports of the MIC and MDC of the FMA-LE motor scale in patients with stroke were selected. Results: 6 studies were included after confirming their eligibility. In the acute phase, inter-rater MDC was 3.23 points. In the early subacute phase, intra-rater MDC was 1.24 points. In the chronic phase, intra-rater MDC was 3.80, 4.87, and 7.98 points, inter-rater MDC was 3.57 and 5.96 points, and MIC was 6.00 points. Conclusion: No late subacute threshold was identified for the MDC, and no acute or subacute threshold was identified for the MIC. Compared with the quality of the MIC study, there is room for improvement in the quality of the MDC studies with respect to study design.

Objectives: The need for early postoperative rehabilitation in patients with congenital heart disease (CHD) is increasing. However, rehabilitation settings in the pediatric intensive care unit (PICU) are usually determined subjectively by therapists. To address the lack of objective measurements, we sought to determine the effectiveness of near-infrared spectroscopy (NIRS) in evaluating skeletal muscles during rehabilitation of patients in the PICU. This case series aimed to clarify the characteristics of skeletal muscle oxygenation during exercise in 2 postoperative patients with CHD. Methods: The participants were two 6-month-female infant: one had undergone the Yasui operation (Case 1), and the other had undergone a bidirectional Glenn anastomosis (Case 2). Vital signs and tissue oxygen saturation (StO₂) were measured during each exercise task, and the muscle oxygen extraction ratio (MOER), an index of the intramuscular oxygen extraction rate, was calculated. The results were compared between the two cases. Results: Case 1 showed no significant changes in vital signs, StO₂, or MOER, whereas Case 2 had low oxygen saturation at rest and low StO₂ during the exercise tasks. MOER increased during the exercise tasks. Conclusions: The results showed that sitting did not impose a strong cardiopulmonary load on postoperative patients. However, in children with cyanotic cardiac disease, such as in Case 2, skeletal muscle oxygenation should be considered, and NIRS monitoring may be useful for safely performing rehabilitation.

Objectives: Recently, rehabilitation professionals in Japan have become increasingly involved in Kayoi-no-ba for long-term care prevention. However, there are significant differences in the quality and content of professional rehabilitation support. This study aimed to develop a competency scale for rehabilitation professionals who support Kayoi-no-ba. Methods: A survey was mailed to rehabilitation supervisors at 440 facilities selected from a nationwide Internet search of facilities that implement the “community-based rehabilitation activity support project,” and rehabilitation professionals involved in supporting Kayoi-no-ba were asked to respond to the survey. The questionnaire was self-administered, and responses were sought via a 6-point scale for the 50 proposed competency items. For statistical analysis, exploratory factor analysis was conducted to examine the factor structure of the scale. Covariance structure analysis was used to assess model fit and to evaluate the reliability and internal consistency of the scale. Results: Among the 260 facilities that responded (59.1%), 607 participants provided valid responses. The final competency scale had a 3-factor structure (knowledge and attitude, ability to coordinate groups, and clinical practice skills) comprising 20 items. Model fit and internal consistency were good. Conclusions: Our findings indicate that rehabilitation professionals who support Kayoi-no-ba should have the attitude and knowledge of supporters, the ability to coordinate groups, and the clinical practice skills of rehabilitation therapists. This competency scale could be used as a guideline to improve the quality of support.

Objectives: This study aimed to investigate the effect of the number of days from surgery to ambulation on activities of daily living (ADL) at discharge in postoperative patients with type A aortic dissection (TAAD). Methods: It included patients with a diagnosis of TAAD who were independent in ADL before the onset of symptoms. ADL was assessed using the Katz Index (KI), with a KI score of 6 points at discharge defining independence and less than 6 points classified as dependence. Patients were divided into 2 groups based on independence in ADL at discharge. Logistic regression analysis was performed with independence in ADL at discharge as the object variable and the number of days from surgery to ambulation as the explanatory variable. A receiver operating characteristic curve was constructed to calculate the cutoff value. Results: A total of 100 patients were included in the analysis. There was a significant difference in the number of days to ambulation between the 2 groups. Multiple logistic regression analysis revealed that the probability of being independent in ADL at discharge was significantly lower with more days to ambulation (odds ratio: 0.93, 95% confidence interval: 0.86–0.99, P < 0.035). The cutoff value for the number of days from surgery to ambulation for independence in ADL at discharge was 8 days (area under the curve: 0.64). Conclusions: In postoperative patients with TAAD, the longer the postoperative days to start ambulation, the more difficult ADL recovery may be, but the cutoff values need further validation.

Objectives: Inpatient cardiac rehabilitation (CR) and pharmacotherapy are important for better in-hospital outcomes in elderly heart failure (HF) patients. We aimed to examine whether conventional CR combined with Waon therapy (Waon-CR) improves exercise capacity compared to CR alone in elderly HF patients. Methods: Decompensated and hospitalized HF patients who could not walk independently over 200 m were recruited. Patients admitted from May 2020 to March 2021 and from April 2021 to March 2024 were included in the CR and Waon-CR groups, respectively. Participants underwent a 5-session program during hospitalization. The main outcome measure was a 6-minute walk distance (6MWD) at the completion of the program. We also investigated exercise-related adverse events. Results: A total of 34 patients (mean age 79.5 years, 13 males) were enrolled, including 18 patients in the CR group and 16 patients in the Waon-CR group. The 6MWD after the 5-session program was longer in the Waon-CR group than in the CR group (362.2 ± 103.7 vs. 286.3 ± 100.6 m, p = 0.038). Significant improvement of the 6MWD was demonstrated in the Waon-CR group after adjusting for confounding factors (adjusted B, 147.0 m; 95% confidence interval, 41.3–252.8 m, p = 0.012). There were no adverse events during the hospital stay. Conclusions: Inpatient Waon-CR was feasible and led to improved 6MWD in elderly HF patients at the completion of the 5-session program.

Objectives: The effect of the co-occurrence of whole-body muscle wasting and respiratory muscle weakness on the clinical characteristics of patients with chronic obstructive pulmonary disease (COPD) is unclear. We investigated this association in patients with chronic respiratory diseases. Methods: 47 outpatients with mild to very severe COPD were classified into four groups according to their fat-free mass index and respiratory muscle strength: 19 without muscle wasting and respiratory muscle weakness (normal), 6 with muscle wasting only (MW), 11 with respiratory weakness only (RW), and 11 with muscle wasting and respiratory weakness (MW + RW). We measured their body composition, pulmonary function, lower muscle strength, submaximal exercise capacity, physical activity in daily life, nutritional status, frailty status, and health-related quality of life (QOL). Multiple linear regression analyses examined the association of muscle wasting and/or respiratory muscle weakness with participant characteristics, using each participant’s characteristics as an explained variable adjusted for confounding variables (Normal as the reference). Results: The regression analysis revealed that the percentage of vital capacity, lower muscle strength, submaximal exercise capacity, nutritional status, and frailty status were worse in the MW + RW group than in the Normal group. The MR + RW group had the largest number of variables with significant differences compared to the Normal group. Conclusions: These data suggest that the co-occurrence of whole-body muscle wasting and respiratory muscle weakness was significantly associated with deteriorating clinical characteristics in patients with COPD.

Objectives: Physical activity is a relevant factor for the locomotive syndrome (LS); however, the association between intensity of physical activity and LS is unclear. This study aimed to investigate the associations among different intensities of physical activity (vigorous, moderate, and light), sedentary time, and LS. Methods: A cross-sectional analysis of records from 2890 Japanese community residents (mean age: 57.5 years) was conducted. LS was assessed using the stand-up test, two-step test, and 25-question Geriatric Locomotive Function Scale. Physical activity and sedentary time were assessed by self-administered questionnaires. The associations among physical activity, sedentary time, and LS were examined by logistic regression analysis stratified by age (<65 years and ≥65 years) and sex. Results: Vigorous physical activity in men aged ≥65 years, and moderate and vigorous physical activities in women aged <65 years were significantly associated with lower odds of LS. By contrast, no significant association was found between physical activity and LS in men <65 years and women ≥65 years of age. No association between light physical activity and the LS was found in either group. The association between sedentary time and LS was observed in women aged <65 years. Conclusions: Physical activity and sedentary time were associated with the LS but in an age- and sex-dependent manner. This study highlights the importance of engaging individuals in high-intensity physical activity to prevent or address LS.