Objective: This study aimed to derive a clinical prediction rule (CPR) that can predict changes in health-related quality of life at 5 months for patients with knee osteoarthritis (KOA) undergoing conservative treatment. Methods: Patients with KOA receiving physical therapy and exercise therapy at an outpatient clinic were included in this study. The basic characteristics, medical information, and motor function test results were recorded at baseline. The primary outcome measure was the change in the Japan Knee Osteoarthritis Measure (JKOM) 5 months after the baseline measurement. A decision tree analysis was performed with the basic characteristics, medical information, and the motor function test results as the independent variables and the changes in the JKOM after 5 months (≥8 in the improved groups) as the dependent variable. Results: Analyzed data from 87 patients. The variables included the visual analog scale score, bilateral KOA, 5-m walk test, JKOM, and body mass index. Six CPRs were obtained from the terminal nodes. Accuracy validation of the model for the entire decision tree revealed an area under the receiver operating characteristic curve of 0.87 (validation data: 0.83), a positive likelihood ratio of 2.6, and a negative likelihood ratio of 0.1. Conclusion: This CPR is an inspection characteristic that can exclude the possibility of the occurrence of an event based on a negative result. However, since the results of this study represent the first process of utilizing the CPR in actual clinical practice, its application should be kept in mind.

Objective: To investigate the impact of multidisciplinary team (MDT) intervention for early mobilization (EM) of patients with aneurysmal subarachnoid hemorrhage (aSAH) in the intensive care unit (ICU). Methods: A retrospective uncontrolled before–after observational study was conducted to assess patient outcomes before and after introducing MDT in the stroke care unit (SCU). Participants admitted to the SCU from April 2017 to September 2023 were categorized into conventional (April 2017 to June 2020) and MDT (July 2020 to September 2023) groups. The measured primary outcome was the days until sitting, standing, and walking commenced. Results: A total of 131 patients were screened, with 115 included in the analysis. The MDT group comprised 56 individuals (48.7%), whereas the conventional group consisted of 59 patients (51.3%). The MDT group exhibited a significantly shorter duration until sitting (4 [3–7] vs. 7 [5–17], p <0.001), standing (5 [3–7] vs. 10 [5–17], p <0.001), and walking (7 [5–10] vs. 16 [7–23], p <0.001) commenced. Furthermore, the MDT group showed a significantly higher ICU mobility scale (IMS) (8 [5–8] vs. 5 [3–8], p <0.001) at SCU discharge, shorter length of SCU stay (16 [15–17] vs. 17 [15–24], p = 0.048), and hospital stay (34 [25–48] vs. 48 [33–80], p = 0.006). Conclusion: This study suggests that MDT played a facilitative role in promoting the EM of patients with aSAH. Their involvement streamlined the mobilization process, shortening the days until the initiation of mobilization.

Objective: This study investigated the factors that influence Ikigai among people aged 75 years and older using home medical and nursing care with home-visit rehabilitation. Methods: This cross-sectional study involved 66 home-visit rehabilitation users aged 75 years or older who received home medical and nursing care at 2 home-care nursing stations. The following attributes were evaluated: Ikigai-9, life-space assessment (LSA), home-based LSA (Hb-LSA), Frenchay activities index (FAI), functional independence measure (FIM), self-efficacy for activities of daily living (SEADL), self-efficacy scale for going out among community-dwelling elderly (SEGE), and physical function. The correlation between Ikigai-9 scores and each assessment was examined. Multiple regression analysis was performed using the Ikigai-9 as the dependent variable and the correlated items as independent variables. Results: The Hb-LSA, FAI, FIM, SEADL, and SEGE were correlated with Ikigai-9. Among the correlated items, the FAI was selected for multiple regression analysis. Conclusion: Home-visit rehabilitation users aged 75 and over may be more likely to feel Ikigai if they have higher instrumental ADLs.

Objective: The purpose of this study was to identify the risk factors for the development of chronic lower back pain in older workers. Methods: This was a prospective cohort study using an Internet survey of workers aged 60–75 years, with a baseline survey conducted in September 2022 and a follow-up survey in October 2023. A total of 2257 participants who did not have chronic lower back pain in the baseline survey were included in the analysis, and the risk factors for chronic lower back pain were examined by logistic regression analysis. Results: The median age of the analyzed participants was 63.0 years, and the incidence of chronic lower back pain was 9.0%. Logistic regression analysis revealed that poor sleep habits (adjusted odds ratio [aOR]: 1.66, 95% confidence interval [CI]: 1.21–2.26), poor eating habits (aOR: 1.44, 95% CI: 1.03–2.01), no physical activity (aOR: 1.45, 95% CI: 1.00–2.09), and high stress (aOR: 1.62, 95% CI: 1.13–2.32) were significantly associated with the occurrence of chronic lower back pain. Conclusion: A comprehensive multidisciplinary collaboration program incorporating the assessment and management of lifestyle habits and mental health issues should be developed and implemented to prevent chronic lower back pain in older workers.

Chronic kidney disease (CKD) is a recognized risk factor for cognitive impairment and dementia. Unfortunately, the number of patients with both CKD and dementia has been steadily increasing with the aging patient population. Therapeutic management and clinical decision-making become more challenging in patients with dementia who often experience worsening prognoses, highlighting the urgency of developing effective countermeasures. This review explores available research on the epidemiology, contributing factors, mechanisms, and outcomes of cognitive impairment and dementia in patients with CKD while outlining the impact of exercise therapy on cognitive function.

Objective: In this study, we aimed to determine the effects of 2-week neuromuscular electrical stimulation (NMES) on quadriceps muscle atrophy and lower extremity motor score in individuals with subacute incomplete cervical spinal cord injury (SCI). Methods: This stratified randomized controlled trial, conducted in the advanced critical care center of a university hospital, comprised 49 individuals with American Spinal Injury Association (ASIA) impairment scale grade C and D incomplete cervical SCI. The participants were stratified based on the ASIA impairment scale grade and randomly assigned to the control (n = 25) or NMES (n = 24) group. The control group participants received only conventional rehabilitation; the NMES group participants received conventional rehabilitation plus NMES in the quadriceps muscles of both lower limbs. The primary endpoints were quadriceps muscle thickness and L3 ASIA lower extremity motor score (L3 motor score), measured at the study’s initiation and after 2 weeks. Results: The quadriceps muscle thickness changes on the stronger and weaker sides were –14.2% ± 11.3% and –15.1% ± 13.8%, respectively, in the NMES group and –25.7% ± 16.8% and –26.0% ± 13.3%, respectively, in the control group, indicating significantly lesser reduction on both sides in the NMES group (p <0.05). The L3 motor scores on the stronger and weaker sides were 0.8 ± 1.2 and 1.3 ± 1.4 (NMES group) and 0.4 ± 0.8 and 0.4 ± 0.8 (control group), respectively, indicating significant improvement only on the weaker side (p <0.05). Conclusions: For subacute incomplete cervical SCI, 2 weeks of NMES reduces quadriceps muscle atrophy and improves the L3 motor score values on the weaker side compared with standard treatment.

Objective: This study examined the impact of sports participation on the health status of individuals with spinal cord injuries (SCI), with emphasis on the role of health-related social capital (HRSC). Methods: This study included 65 individuals with SCI (42 who participated in sports and 23 who did not). The following information was obtained from the participants through an online questionnaire: their basic information, information regarding activities of daily life independence, physical activity, mental health, lifestyle, insomnia, and social capital. We compared the outcomes between participants with and without sports participation and examined their correlations. Multiple regression analysis with forced entry was performed to determine the association between HRSC and health outcomes. Results: Physical activity, mental health, and HRSC were significantly higher in individuals with SCI who participated in sports (p <0.01 or p <0.05) than in individuals with SCI who did not participate in sports. The HRSC of individuals with SCI with sports participation showed a significant positive correlation with lifestyle and a significant negative correlation with insomnia score (p <0.05). Multiple regression analysis revealed that higher HRSC was associated with lifestyle in individuals with SCI who participated in sports (p <0.05) compared with individuals with SCI who did not participate in sports. Conclusion: The study findings underscore the potential benefits of sports participation in individuals with SCI, including increased physical activity and development of HRSC. However, it is essential to consider the implications of sports involvement on the psychological well-being of individuals with disabilities and provide appropriate support.

Objective: The objective of this study was to confirm that early mobilization (EM) could reduce pneumonia in patients undergoing robot-assisted minimally invasive esophagectomy (RAMIE) for thoracic esophageal squamous cell carcinoma (TESCC). Methods: Postoperative pneumonia was defined as physician-diagnosed pneumonia using the Esophagectomy Complications Consensus Group definition of pneumonia with a Clavien–Dindo classification grade II–V on postoperative day (POD) 3–5. EM was defined as achieving an ICU Mobility Scale (IMS) ≥7 by POD 2. Patients were divided into EM (n = 36) and non-EM (n = 35) groups. Barriers to EM included pain, orthostatic intolerance (OI), and orthostatic hypotension. Results: The overall incidence of postoperative pneumonia was 12.7%, with a significant difference between the EM (2.8%) and non-EM (22.9%) groups (P = 0.014). The odds ratio was 0.098 in the EM group compared to the non-EM group. A significant difference was found between the two groups in terms of the barriers to EM at POD 2 only for OI, with a higher incidence in the non-EM group. Multivariate logistic regression analysis showed that patients with OI were more likely to be unable to achieve EM than those without OI (odds ratio, 7.030; P = 0.006). Conclusion: EM within POD 2 may reduce the incidence of postoperative pneumonia in patients undergoing RAMIE for TESCC. Furthermore, it was suggested that OI can have a negative impact on the EM after RAMIE.

Objective: To verify the efficacy of smile training in improving gait disturbances in patients with Parkinson’s disease (PD) exhibiting neuropsychiatric symptoms. Methods: A single-case BAB design with three intervention periods (B1, A1, and B2) was used. During periods B1 and B2, 10 min of smile training (facial muscles training and positive thinking training) was performed before the usual exercise therapy. During the A1 period, the participant received only the usual exercise therapy. During the intervention period, the Timed Up and Go test (TUG) was performed daily in both directions. Tau-U was calculated to determine the effect size of the TUG test time and the number of steps taken during each period. Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) Part III, Hospital Anxiety and Depression Scale (HADS), 10-meter walk at maximum speed, Berg Balance Scale, and Characterizing Freezing of Gait Questionnaire (C-FOGQ) were administered on the day before the start of the intervention and the last day of each period. Results: Comparisons of A1 to B2, TUG time, and the number of steps taken on both turns revealed large reductions (Tau-U ≥0.74, p <0.01). The 10-meter walk speed and MDS-UPDRS Part III bradykinesia scores improved, whereas the frequency of gait freezing on the C-FOGQ remained unchanged. The HADS scores did not show significant changes; however, the participant made more positive statements in his reflections. Conclusion: Smile training may be an effective intervention for improving gait and other motor symptoms in patients with PD.

Patient Background: A 75-year-old man had difficulty moving around at home because of loss of appetite and neglect of medication for several days. He was brought to the emergency room and admitted on the same day with a diagnosis of dehydration and diabetic ketoacidosis. He started physical therapy (PT), had frequent fainting and presyncope due to hypotension, and had difficulty leaving bed. The patient was transferred to our hospital to continue PT. Test results on admission were as follows: short physical performance battery (SPPB) [points], 1/12 points; chair stand 5 times (CS5) [sec], not possible; functional independent measure (FIM) [points], 66/126; standing test: blood pressure (BP) [mmHg], 130/60/HR [beats per minute], 76 in supine, 90/56/79 in sitting, 70/–/79 in standing. Process: After transfer, BP continued to fall markedly and he frequently fainted and required assistance with nearly all activities of daily living (ADL). Neuromuscular electrical stimulation (NMES) of the thigh and lower leg was performed five times a week for 30 min. After approximately 3 days of NMES, BP decreased slowly, presyncopic symptoms disappeared, and he could leave bed more frequently and for longer periods. The patient became independent in ADL and was discharged on Day 142. Results at discharge were as follows: SPPB, 11/12; CS5, 13.5; FIM, 114/126. Discussion: Although NMES is not effective for orthostatic hypotension (OH) associated with diabetic autonomic neuropathy (DAN), stabilization of BP early after the introduction of NMES may have been due to its peripheral sympathetic nerve-stimulating effect. Conclusion: The combination of exercise therapy and NMES for OH caused by DAN can alleviate hypotension.