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.

Objective: The movement of the diaphragm plays an important role in respiration. In this study, we proposed and validated a new method for estimating the volume of a single ventilation (representing the tidal volume [VT]) from the vertical distance of diaphragmatic movement and thoracic circumference. Method: Diaphragm excursion (DE) was measured in healthy adult subjects via ultrasound, and the thoracic cavity volume change was estimated based on DE and thoracic circumference. Moreover, we measured the VT obtained by an expiratory gas analyzer and examined the relationships between DE and thoracic volume change (TVC) and between DE and VT. Results: The results showed that a correlation (ρ = 0.609) existed between DE and VT, and an even higher correlation existed between TVC and VT. TVC correlated better with the product of thoracic circumference squared and DE (ρ = 0.839) than with the product of thoracic circumference and DE as an alternative index (ρ = 0.746). Conclusion: Our findings demonstrate that, taking into account body size in addition to DE, changes in thoracic cavity volume are useful predictors of VT and provide an alternative measure for assessing the respiratory function, which will improve clinical and research practice in respiratory care.

Objectives: Accurately predicting the likelihood of inpatients’ home discharge in a convalescent ward is crucial for assisting patients and families in decision-making. While logistic regression analysis has been commonly used, its complexity limits practicality in clinical settings. We focused on decision tree analysis, which is visually straightforward. This study aimed to develop and validate the accuracy of a prediction model for home discharge for inpatients in a convalescent ward using a decision tree analysis. Methods: The cohort consisted of 651 patients admitted to our convalescent ward from 2018 to 2020. We collected data from medical records, including disease classification, sex, age, duration of acute hospitalization, discharge destination (home or nonhome), and Functional Independence Measure (FIM) subitems at admission. We divided the cohort data into training and validation sets and developed a prediction model using decision tree analysis with discharge destination as the target and other variables as predictors. The model’s accuracy was validated using the validation data set. Results: The decision tree model identified FIM grooming as the first single discriminator of home discharge, diverging at four points and identifying subsequent branching for the duration of acute hospitalization. The model’s accuracy was 86.7%, with a sensitivity of 0.96, specificity of 0.52, positive predictive accuracy of 0.88, and negative predictive accuracy of 0.80. The area under the receiver operating characteristic curve was 0.75. Conclusion: The predictive model demonstrated more than moderate predictive accuracy, suggesting its utility in clinical practice. Grooming emerged as a variable with the highest explanatory power for determining home discharge.

Clinical research based on epidemiological study designs requires a good understanding of statistical analysis. This paper discusses the common misconceptions of p-values so that researchers and readers of research papers will be able to properly present and understand the results of null hypothesis significance testing (NHST). The p-values calculated by NHST are categorized as three different types: “significant at p <0.05,” “significant at p <0.01,” or “not significant.” If specified, they may be written as p = 0.124. The 95% confidence interval (CI) of the supplementary statistics is presented regardless of the p-value, and the range of the CI is observed and discussed to determine whether the results are clinically valid. The effect size (ES), which is a measure of the magnitude of the effect, is also referenced and discussed. However, the ES should not be overestimated. It is important to examine the actual descriptive statistics and consider them comprehensively as much as possible. A high detection power of 80% or more indicates that NHST with high accuracy was applied. However, even when it falls below 80%, it is important to consider the limitations of the study, because the results are not completely useless.

Objective: The study aimed to examine the effect of dedicated physical therapy (PT) staffing on the outcomes of patients admitted to a general medical ward with acute cholangitis. Methods: This retrospective observational study was conducted in an 865-bed tertiary-care hospital in Japan. Patients with acute cholangitis between September 2015 and August 2017 were enrolled. Patients admitted to a ward with dedicated PT staffing were included in the dedicated group, while those admitted to a ward without dedicated PT staffing were included in the non-dedicated group. Each group was further divided into pre-dedicated and post-dedicated period based on September 1, 2016, at which PT staffing was implemented. The primary outcome was absolute functional gain (AFG), which was defined as the difference between Barthel index at discharge and that at admission. A difference-in-difference analysis was conducted to examine the changes in AFG associated with ward-dedicated PT staffing. Results: We identified 456 patients with acute cholangitis. Complete case analysis was applied, resulting in 252 patients in the final analysis. Patients were assigned to the dedicated group in the pre-dedicated period (n = 66) and post-dedicated period (n = 52), and to the non-dedicated group in the pre-dedicated period (n = 60) and post-dedicated period (n = 74). The adjusted difference-in-difference estimator was 17.1 (95% confidence interval: 5.6 to 28.5, p = 0.003) for AFG. Conclusion: Ward-dedicated PT staffing may improve the AFG of general medical patients in an acute hospital. Ward-dedicated PT staffing should be among the strategies utilized in the acute care process.

Objective. Increase in population's longevity has led to considerable efforts worldwide on physical therapy aging research. The aim of this study is to identify which are the main scientific journals, as well as the most productive authors, institutions and keywords related to the journals, that have published about physical therapy and aging. Methods. Original articles published from 1990 to 2014 were retrieved from the bibliographic database Science Citation Index Expanded of Web of Science Core Collection. After standardization of the bibliographic information, a series of bibliometric indicators was obtained regarding authors, institutions, citation and keywords of the core journals using bibliometric software. The PAJEK network analysis program was used for graphic representation. Results. A total of 2,237 original articles are included in this analysis. The number of identified journals is 573, with an average growth of publishing journals throughout the studied period of 9.41%. Bradford's distribution shows 12 core journals, out of which 41.67% have published constantly all throughout the 25-year period, being the most productive one Physical Therapy. Fritz, Julie M is the most productive author, and University of Sydney the most productive institution. The keyword exercise is used in an outstanding way. Conclusions. The productivity trends provided an indication of the greater scientific interest of physical therapy in aging as a line of research. Collectively, the data indicated that physical therapy-specific journals are being consolidated but non-specific are still a significant research source, and that a fundamental element of their research includes exercise and movement.

In recent years, the importance of early physiotherapy for rapid mental and physical functional recovery is increasing with the increasing number of older patients and high-risk patients with duplicate disorders. Increasing the effectiveness of acute physiotherapy within a shorter hospital stay is a great challenge. We published the first expert consensus of early rehabilitation in Asia in 2017. Our expert consensus will contribute to the establishment of physiotherapy in intensive care for Asian populations. The minimum standard of clinical practice for physiotherapists working in critical care settings is important to showcase physiotherapists' knowledge and abilities as medical professionals working in the intensive care unit. We are planning to release the minimum standard of clinical practice for Japanese physiotherapists working in critical care settings in 2020. Being in the forefront among nations of aging populations, Japan has a rapidly increasing number of older frail patients with heart failure. Further studies are necessary to confirm the effectiveness of task-specific exercise training considering the characteristics of frailty.

Objective: Individuals maintain a spatial margin or 'personal space' between themselves and others. The form of this space and strategies for avoiding obstacles can be influenced by participant characteristics such as age. In this study, we investigated the characteristics of personal space and obstacle avoidance strategies in young and older adults. We also examined differences in perceptual personal space and walking trajectory during obstacle avoidance using a three-dimensional motion capture system. Methods Ten young adults and ten older adults participated in this study. We calculated actual obstacle avoidance trajectory and obstacle avoidance data such as the lateral spatial margin and body rotation angle during walking in a task that included obstacle avoidance. We also measured the perceptual personal space created by approaching a confederate. In order to calculate each personal space and obstacle avoidance data, we used a three-dimensional motion capture system. Two factors (two groups and personal space) of repeated analysis of variance were used in statistical analysis. Results We found no age-related differences in personal space or obstacle avoidance strategy in this study (F = 0.52, p = 0.48). However, we found significant differences in the form of perceptual personal space and personal space formed during obstacle avoidance (F = 11.86, p = 0.0030). Conclusion This study indicates that perceptual personal space did not reflect the walking trajectory created by actual obstacle avoidance. In addition, age did not influence the obstacle avoidance strategy. These results suggest that the perceptual personal space and aging have little effect in the situation of avoiding a single standing pedestrian.

Objectives: Although the Mini-Balance Evaluation Systems Test (Mini-BESTest) is known to be a reliable and valid measure of balance in individuals with stroke, the utility of this tool in relation to subacute stroke walking speed and the recovery of gait ability has not been explored. Here, we compared the measurement properties and their relationship to gait speed on the Mini-BESTest and the Berg Balance Scale (BBS) in middle and older ambulatory individuals with subacute stroke, and we investigated which balance assessment tool is more likely to capture the status of the recovery of gait speed.

Methods: We retrospectively analyzed the cases of 88 individuals 50 years or older with stroke who had been evaluated using the Mini-BESTest by using the BBS and by assessing their comfortable walking speed (CWS). The proportion of subjects who showed improvement was calculated for 34 stroke survivors from data obtained at admission to and discharge from the hospital.

Results: Compared with the BBS, the Mini-BESTest showed a better distribution of total scores without a ceiling effect. The two scales showed correlations with gait speed (Mini-BESTest: r=0.702; BBS: r=0.592) and discrimination between fast and slow walkers. The responsiveness of the Mini-BESTest was excellent, with an area under the curve of 0.894, thus discriminating between gait speed improvement versus non-improvement.

Conclusions: These results indicate that the Mini-BESTest is more useful than the BBS in terms of its measurement properties and ability to measure gait recovery in middle and older ambulatory individuals with subacute stroke.

Background: The Physiotherapy Evidence Database (PEDro) may help users to overcome some obstacles to evidence-based physiotherapy. Understanding the extent to which Japanese physiotherapists access research evidence via the PEDro website may suggest strategies to enhance evidence-based physiotherapy in Japan. Objectives: To quantify usage of PEDro in Japan, to compare this to usage in other countries, and to examine variations in PEDro usage within Japan. Design: An observational study of PEDro usage with geographic analysis. Methods: Data about visits to the home-page and searches of the database were recorded for 4 years. These data were analysed by each region of the World Confederation for Physical Therapy, each country in the Asia Western Pacific region, and each prefecture in Japan. Results: From 2010 to 2013, users of PEDro made 2.27 million visits to the home-page and ran 6.28 million searches. Usage (ie, number of searches normalised by population) was highest in Europe, followed by North America Carribean, South America, Asia Western Pacific, and Africa. Within the Asia Western Pacific region, population-normalised usage was highest in Australia, then New Zealand and Singapore. Japan ranked 10 among the 26 countries in the region. Within Japan, the highest population-normalised usage was in the Nagano, Kumamoto and Aomori prefectures, which was ten-fold higher usage than in some other prefectures. Conclusions: Although Japan has higher PEDro usage than many other countries in the Asia Western Pacific region, some prefectures had very low usage, suggesting that evidence-based practice may not be being adopted uniformly across Japan.