Objective: The relationship between pre-stroke frailty and clinical outcomes remains unclear. This systematic review aimed to examine the association of pre-stroke frailty with mortality, length of stay (LOS), and functional outcomes in people with stroke. Methods: We used several databases, including PubMed, EMBASE, and CENTRAL. We searched for studies investigating the association between pre-stroke frailty and clinical outcomes. The Quality in Prognosis Studies tool was used to assess the risk of bias in the included studies. Meta-analyses were performed using the random effects model. The certainty of evidence was assessed with the Grading of Recommendations, Assessment, Development, and Evaluation. Results: Fourteen studies (participants: 11583) were included in this review. Pre-stroke frailty is associated with higher mortality (odds ratio: 1.11; 95% confidence intervals [CI]: 1.0–1.23), longer LOS (mean difference: 0.75; 95% CI: −0.29 to 1.78), and poorer functional outcomes (standardized mean difference: 0.79; 95% CI: 0.48–1.1). The certainty of evidence is low due to risk of bias, inconsistency, and imprecision. Conclusions: These results suggest that frailty before stroke onset may be associated with higher mortality, increased LOS, and poorer functional outcomes.

Objectives: The reliability of observational gait analyses is generally considered poor or moderate. This is considered due to the drawbacks in the experimental designs and measurement methods used in related studies. This study examined the reliability and validity of physical therapists’ (PTs) visual joint angle estimation in gait analysis with a rigorous design. Methods: Twenty PTs were divided into 2 groups of 10 each based on their experience: <10 years and >10 years. They observed videos and still images of patients with gait disorders and visually estimated the joint angles at specific points during the gait cycle. Reliability was assessed using the intraclass correlation coefficient, and validity was assessed by a correlation analysis, which compared their estimates with reference values obtained from the digital video analysis. Results: Intra-rater reliability for visual estimation using video tended to exceed 0.6 for most indicators, whereas inter-rater reliability ranged from 0.04 to 0.59. For validity, correlation coefficients indicated an accuracy of 0.06–0.62 for video and 0.08–0.68 for still images. Conclusions: Although intra-rater reliability tended to be higher than inter-rater reliability, neither reached levels considered sufficiently reliable, and validity showed only limited agreement with reference values. These results highlight the limitations of visual estimation in joint angle assessment. Future efforts should focus not only on improving observational consistency but also on improving agreement with reference values through corrective training using still images.

Objectives: Chronic fracture pain (CFP) is a significant issue in patients with osteoporotic fractures (OFs) in convalescent rehabilitation wards (CRWs). This study aimed to examine the association between CFP and the Japanese short-form Central Sensitization Inventory (CSI-9) and verify the predictive validity of CSI-9 in patients with OF admitted to a CRW. Methods: This single-center retrospective study included 71 patients with OF (median age: 85.3 years, 54 females). CFP was defined as pain of Numerical Rating Scale (NRS) score ≥4 persisting at discharge, despite >3 months post-fracture. Multiple logistic regression and receiver operating characteristic curve analyses were performed to assess the association and predictive validity of the CSI-9 for CFP. Results: The incidence of CFP was 38.0%. CSI-9 was independently associated with CFP at admission (odds ratio = 1.12, 95% confidence interval [CI]: 1.01–1.24) and discharge (odds ratio = 1.15, 95% CI: 1.03–1.29). The area under the curve for the CSI-9 was 0.727 (95% CI: 0.605–0.850) at admission and 0.752 (95% CI: 0.637–0.867) at discharge, indicating fair predictive accuracy. The optimal cutoff values for the CSI-9 were 8 points at admission and 6 points at discharge. Conclusions: CSI-9 was independently associated with CFP and demonstrated moderate predictive accuracy in patients with OF in CRWs. Assessing central sensitization-related symptoms using the CSI-9 may be useful for evaluating and preventing CFP in this population. Further validation using large-scale prospective studies is required.

Objectives: In recent years, the number of elderly heart failure patients with multiorgan failure has been increasing. Furthermore, the combination of heart failure and decreased hepatic reserve can cause severe skeletal muscle impairment and decreased survival rates. This study investigated whether the degree of improvement in the five repetitions of sit-to-stand (5STS) and walking speed (WS) differs depending on hepatic reserve in elderly heart failure patients. Methods: The patients were divided into the following two groups: good hepatic reserve (albumin–bilirubin score [ALBI score] ≤−2.25) and poor hepatic reserve (ALBI score >−2.25). Propensity score matching was performed using the brain natriuretic peptide level. A two-way analysis of variance (ANOVA) was performed to examine the main effects of the hepatic reserve and time points (admission or discharge). Results: After propensity score matching, 28 out of the 33 (84.8%) patients in the good hepatic reserve (age, 83.74 ± 9.25 years and ALBI score, −2.55 ± 0.19 points) and 27 out of 40 (67.5%)patients in the poor hepatic reserve (age, 85.85 ± 7.53 years and ALBI score, −1.93 ± 0.26 points) were analyzed. Two-way ANOVA showed that the 5STS (p = 0.04) and WS (p = 0.01) in poor hepatic reserve tended to be worse than in good hepatic reserve. Furthermore, the 5STS (p = 0.04) and WS tended to improve at discharge in both groups. However, the improvement in WS was not significant (p = 0.15). Conclusions: Our study suggests that the hepatic reserve in elderly heart failure patients may be an important factor in the assessment of physical functions.

Objectives: This study aimed to determine whether neuromuscular electrical stimulation (NMES) of the quadriceps muscle early after total knee arthroplasty (TKA) is effective in improving muscle strength. Methods: This was a single-center, non-blinded, randomized controlled trial involving 37 patients (60 knees) who underwent TKA. Patients were randomly assigned to either the intervention group (19 patients, 30 knees) or the control group (18 patients, 30 knees). Both groups received standard rehabilitation starting on postoperative day 1. Additionally, the intervention group received NMES therapy starting on postoperative day 2. NMES was administered at the highest tolerable intensity for 15 min per session (10-s stimulation and 10-s rest) twice daily for 4 weeks. Outcome measures included voluntary isometric quadriceps strength, knee joint range of motion (ROM), visual analog scale (VAS), and the Timed Up and Go (TUG) test, which were assessed preoperatively and at 4, 8, and 12 weeks postoperatively. The outcomes were compared between the two groups. Results: Both groups showed improvements in all outcomes over time. However, no significant differences were observed between the two groups (muscle strength: p = 0.412, flexion ROM: p = 0.668, extension ROM: p = 1.000, VAS score: p = 0.192, TUG test score: p = 0.296) (p-values are main effects of group factors in the split-plot analysis of variance). Conclusions: NMES in the early postoperative period after TKA did not provide significant additional functional recovery benefits compared with standard rehabilitation.

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.

Low back pain guidelines recommend patient education as a component of management. Multimedia education materials to provide patient education are increasingly being used not only due to the convenience of digital services but also because this is an efficient way to deliver educational information to under-resourced or rural/remote regions without optimal healthcare services. To maximize the knowledge transfer of research findings and low back pain guidelines, scientifically backed information must evolve beyond journal prints, bland government websites, and the basic web design of budget-constrained advocacy groups. Materials must instead be engaging for the public and compete with the various sources of low back pain misinformation, which can appear attractive and eye-catching while being conveniently accessed. We discuss a data subset from a larger musculoskeletal healthcare review to highlight the educational materials used in low back pain randomized controlled trials found in the literature. While there is no standard way to appraise the effectiveness of such educational materials, potential options are discussed. Future research is needed to determine whether knowledge is being transferred and whether this is the avenue to improving patient outcomes.

Introduction: Although the number of cancer survivors has increased, the role of physical therapy in return to work (RTW) for employed patients with cancer remains unclear. Case presentation: The patient is a 50-year-old man diagnosed with cholangiocarcinoma who worked as a liquefied petroleum gas station filler. He started perioperative rehabilitation and underwent pancreaticoduodenectomy for cholangiocarcinoma. He developed a postoperative pancreatic fistula, which improved with conservative treatment over 40 days. Although he achieved independence regarding day-to-day activities, his physical condition and workability worsened, as his skeletal muscle index decreased from 8.7 to 7.7, 6-min walk distance from 518 to 460 m, and work ability index (WAI) from 37 to 20 points. His physical therapist was concerned about his RTW and recommended that he receive RTW support from the Department of Occupational Medicine (DOM). The DOM employed a team approach for the RTW strategy, and the primary physician, occupational physician, and company collaborated to support the patient. After the outpatient treatment protocol and RTW support plans were formulated, the patient was discharged. The physical therapist reported declining physical performance and WAI at the DOM’s multidisciplinary conference. After consulting with multiple professionals, the team recommended work resumption in stages: part-time for three months and full-time for four months after surgery while undergoing oral adjuvant chemotherapy. The WAI improved to 35 points after RTW. Conclusion: This case report suggests that physical therapists are vital in providing continuous patient support, from perioperative rehabilitation to DOM intervention, to build physical strength for return to work.

In recent years, the number of cancer survivors has been increasing each year due to advances in the early diagnosis and treatment of cancer. Cancer survivors present a variety of physical and psychological complications due to cancer and its treatment. Physical exercise is an effective nonpharmacological treatment for complications in cancer survivors. Furthermore, recent evidence has shown that physical exercise improves the prognosis of cancer survivors. The benefits of physical exercise have been widely reported, and guidelines for physical exercise for cancer survivors have been published. These guidelines recommend that cancer survivors engage in moderate- or vigorous-intensity aerobic exercises and/or resistance training. However, many cancer survivors have a poor commitment to physical exercise. In the future, it is necessary to promote physical exercise among cancer survivors through outpatient rehabilitation and community support.

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.

Objective: The purpose of this study was to investigate the outcomes of physiotherapy on patients in psychiatric long-term care wards in Japan and to identify the characteristics of patients who have been discharged to the community. Methods: The subjects comprised 50 patients who were admitted to the psychiatric long-term care wards at four different hospitals in Japan and prescribed physiotherapy. General physiotherapy for the patients’ diseases was provided. The main outcome was whether a patient was discharged to the community (discharged group) or remained hospitalized (hospitalized group) at the end of physiotherapy. Basic subject characteristics, including age, sex, F-code, classification of the diagnosis that led to physiotherapy, length of hospital stay, and length of physiotherapy, were collected from medical records. The Functional Independence Measure (FIM) tool was administered at the initial and final evaluations. Results: At the end of physiotherapy, there were 14 subjects in the discharged group and 36 subjects in the hospitalized group. There were significant differences in the classification of diagnosis, length of stay (LOS), and classification of LOS between the two groups. Two-way analysis of variance showed interactions between the FIM subitems of self-care, transfer, and locomotion. Conclusion: The discharged group had higher FIM scores at the start of physiotherapy and a greater FIM gain.

Cancer rehabilitation in the United States has gone from a small obscure rehabilitation subspecialty to an area of intense interest. American cancer rehab's recent growth can be attributed to the ever increasing number of cancer survivors. The future of cancer rehabilitation may be accelerated by the concept of exercise as cancer medicine.

Objective: The study aimed to demonstrate the significance of early postoperative physical therapy interventions on clinical outcomes by determining the influence of the distance walked under the supervision of a physical therapist in the early postoperative period after liver cancer. Methods: All consecutive patients who underwent surgery for liver cancer between April 2018 and March 2020 were eligible for enrollment in the study. The total walking distance during physical therapy till the third postoperative day was examined. The clinical outcomes comprised duration of postoperative hospital stay, time to independent walking, and occurrence of postoperative complications. For data analysis, the patients were divided into two groups: those who walked more than the median total distance (the long-distance group) and those who walked less than the median distance (the short-distance group). We used propensity score matching to match the background characteristics between the groups. Results: Of the 65 patients who were eligible, 14 patients were included in the two groups each, after matching. The long-distance walking group had a significantly shorter hospital stay (9.0 days vs. 11.0 days, p=0.008) and a shorter time to independent walking (3.5 days vs. 7.5 days, p=0.019) than the short-distance walking group. There were no significant differences in postoperative complications between the two groups (7.1% vs. 42.8%, p=0.08). Conclusion: In the early postoperative period after liver cancer surgery, increasing the walking distance under the supervision of a physical therapist is important for improving clinical outcomes. Further prospective studies are needed to confirm the findings of this study.

Objective: Preoperative performance status is an important factor in thoracic surgery, but little is known about the effect of preoperative physical activity (PA) on the postoperative course. This study investigated the associations between preoperative PA and postoperative complications and clinical outcomes of lung cancer surgery. Methods: This prospective observational study included patients who underwent surgery for lung cancer at a single institution. PA was measured before hospitalization for 5 consecutive days and then after surgery until hospital discharge. The daily step count and time spent performing moderate intensity activity (> 3 metabolic equivalents) were measured with an accelerometer. We examined the correlations between PA and preoperative pulmonary function and physical fitness, and examined the relationship between postoperative complication and PA. Finally, a multivariate analysis was performed with pre-hospital PA as the dependent variable. Results: Forty-two patients were analyzed. Univariate analysis found no correlation between pre-hospital PA and preoperative pulmonary function, but found significant positive correlations between pre-hospital PA and time spent performing moderate intensity activity, in-hospital PA, preoperative 6-minute walk distance, and maximum gait speed (r > 0.5, p < 0.01). The nine patients who developed postoperative complications had significantly lower pre-hospital and postoperative step count than the patients with no complication (p = 0.04). Multiple regression analysis showed that pre-hospital PA was significantly associated with time spent performing moderate intensity activity, maximum gait speed, and postoperative complication. Conclusions: Evaluation of pre-hospital PA is useful in predicting the postoperative course after lung cancer surgery.

Background: Early mobilization and rehabilitation interventions should be provided to patients who survived severe COVID-19 to improve their physical function and activities of daily living (ADL). However, their physical and mental status at discharge has not been well described in Japan. We report the intervention provided for a survivor of severe COVID-19 and his physical and mental status at discharge from an acute care hospital. Case Report: A 62-year-old man was admitted to our emergency department with a diagnosis of COVID-19 with severe acute respiratory dysfunction. He had complicated intensive care unit-acquired weakness (ICU-AW) and delirium during mechanical ventilation therapy. Rehabilitation intervention was initiated on the seventh day post-admission and was gradually performed according to his respiratory and hemodynamic status. As a result of the rehabilitation intervention, ICU-AW and cognitive function gradually improved. On hospital day 37, he independently performed basic ADL and was discharged. However, he lost approximately 9% of his body weight at discharge. In addition, his hand grip strength and six-minute walking distance were lower and shorter than the reference values, respectively. His mental component summary of the Short Form-8™ was lower than the national standard deviation for the Japanese population. Conclusion: Although survivors of severe COVID-19 who undergo early rehabilitation can be discharged from an acute care hospital, they may have several impairments in their physical and mental status, including muscle function, diffusion capacity, exercise tolerance, and health-related quality of life.

Objectives: Patients with cancer cachexia have poor adherence to treatment, which affects their prognosis. Currently, there are many studies on the effects of rehabilitation on cancer cachexia, but there is a lack of evidence on the effects of nutrition therapy alone or in combination with rehabilitation and nutrition therapy. This article describes a case in which rehabilitation nutrition care process was effective in a patient with lung cancer who developed cancer cachexia. Methods: A 68-year-old woman was hospitalized for treatment of lung adenocarcinoma. The patient had moderate malnutrition, sarcopenia, and cachexia at the time of admission, so the authors intervened according to rehabilitation nutrition care process. The physiotherapist mainly prescribed resistance training and aerobic exercise, 40-60 minutes a day, 5-6 days a week. And the dietitian provided oral nutritional supplements (100 kcal, branched-chain amino acid: 3.0 g) in addition to hospital food and adjusted the patient's energy intake to 26.96-33.05 kcal/kg/day and protein intake to 1.07-1.14 g/kg/day. Outcomes: Comparing the initial evaluation with the discharge, nutritional status, such as body mass index and skeletal muscle mass, and physical functions, such as maximum grip strength, gait speed, and functional independence measure (motor items), were improved. Conclusions: Rehabilitation nutrition care process-based interventions may improve nutritional status and physical functions more than exercise therapy alone in patients with lung cancer cachexia.

Post-polio syndrome refers to the physical and psychological sequelae caused by poliovirus infection. For this reason, according to which the emotional and sensorimotor sphere is affected, we consider a biobehavioural approach based on education and therapeutic exercise to be necessary. The aim of this case report is to evaluate the effect of a biobehavioural approach in a patient with post-polio syndrome and low back pain. We describe a 57-year-old man with post-polio syndrome and low back pain following a fall at the end of February 2020. The pain, disability and lack of functionality caused by both processes led him to contact a physiotherapy service. A therapeutic planning was carried out for 3 months, where a biobehavioural approach based on therapeutic exercise and education, with an assessment and three face-to-face sessions which were complemented by online follow-up and finalised due to the Sars-Cov-2 pandemic in a telerehabilitation approach. It was organised in two phases; the initial phase lasted 2 weeks with the aim of reducing the symptoms of the lumbar region, and the advanced phase in which the aim was to improve his physical condition. During the three-month intervention, four assessments were conducted (Pre, at 4 weeks, at 8 weeks and at 12 weeks). At follow-up, improvements in functional and psychological variables were obtained. This case suggests that a biobehavioural approach through telerehabilitation was a useful option in this reported case and could be an option of treatment to improve psychological, physical and functional variables in this patient.

Objective: This study aimed to adapt a pre-existing cross-country comparison (CCC) model to Occupational Health Physiotherapy (OHP) practice as a basis for locating and examining contextual factors that may influence OHP practice in Japan and Australia. Method: A secondary analysis was conducted of existing publicly-available data on OHP and related influential factors, following the five components of the CCC model: work-related legislation; labor market characteristics; culture; physiotherapy practice norms; and organization of OHP practice. Results: Legislation in both countries promotes safe work and rehabilitation of work injured/ill workers. 2019 unemployment was lower in Japan with higher employment protection than Australia. Both countries have an ageing workforce and rising retirement age. Cultural differences relate to higher long-term orientation and uncertainty avoidance in Japan. Australia has higher individualism and physiotherapists are autonomous practitioners with direct access, which differs from Japan. Both countries have a national OHP subgroup, to date only Australia has OHP professional practice standards. Discussion: This study is the first to compare OHP practice in Japan and Australia. Contextual similarities and differences observed may underpin OHP practitioner role and its enhancement in work-related musculoskeletal disorder prevention and management strategies, the return-to-work process, and development of this physiotherapy discipline nationally. Conclusion: Adapting the CCC model to OHP practice enabled a structured exploration of resources and data, from which to extract and compare contextual factors that may shape OHP practice in Japan and Australia. This in turn may provide a useful springboard for further discussion about OHP practice internationally.

Objectives: This study was to clarify changes in physical function and quality of life (QOL) for postoperative, and to examine the influence of the amount of physical activity on these variables. Methods: This study included 29 patients who underwent gastrointestinal cancer surgery. The QOL measurement was used to the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire for preoperative and 2nd and 4th postoperative weeks. Physical function measured knee extension strength, 4 m walk time, 5 times sit-to-stand test, and 6-minute walk for preoperative and 1st and 2nd postoperative weeks. The amount of physical activity score was based on METs-hours, which is estimated from cumulative physical activity. As basic characteristics were investigated cancer stage, comorbidities and complications, and operative. Statistical analysis was repeated measures analysis of variance was performed to observe postoperative changes in physical function and QOL. Furthermore, stepwise multiple regression analysis was used to the parameters of physical function and QOL affected by the physical activity score were investigated. Results: Physical function decreased postoperatively and generally improved 2nd postoperative week. Though scores on the QOL functional scales improved, some items did not improve sufficiently. Multiple regression analysis showed that physical activity score had an effect on constipation and emotion functioning. Conclusions: Improvement in symptom scales is not sufficient in a short period of time, and they need to be followed up by increasing the amount of physical activity and promoting instantaneous exercise.

Objective: Muscle atrophy is associated with autologous stem cell transplantation (ASCT) -related outcomes in patients with malignant lymphoma (ML). However, the impact of ASCT on muscle mass remains unclear in patients with ML. The aims of this study were to investigate changes in muscle mass and risk profiles for muscle atrophy after ASCT. Method: We enrolled 40 patients with refractory ML (age 58 [20-74] years, female/male 16/24, body mass index (BMI) 21.1 kg/m² [17.1-29.6]). Psoas muscle mass was assessed using the psoas muscle index (PMI) before and after ASCT. Statistical analysis used: Independent factors associated with a severe decrease rate of change in PMI were evaluated by decision-tree analysis, respectively. Results: PMI was significantly decreased after ASCT (4.61 vs. 4.55 cm²/m²; P=0.0425). According to the decision-tree analysis, the regimen was selected as the initial split. The rates of change in PMI were −5.57% and −3.97% for patients administered MCEC and LEED, respectively. In patients who were administered LEED, the second branching factor was BMI. In patients with BMI < 20.3 kg/m², the rate of change in PMI was −7.16%. On the other hand, the rate of change in PMI was 4.05% for patients with BMI ≥ 20.3 kg/m². Conclusion: We demonstrated that muscle mass decreased after ASCT in patients with ML. Patients who received MCEC and patients with low BMI were at risk for a decrease in muscle mass.