Purpose: Postoperative acute pain and pain-related anxiety and catastrophizing cause the exacerbation of pain and disability. In this study, we created an illusion of motion through tendon vibration and investigated its effects on sensory and emotional pain and on the range of motion. Method: As part of a quasi-randomized controlled trial, 14 patients were enrolled. They were assigned to an illusory movement group (7 patients, with vibration of the tendon), or a control group (7 patients, with no vibration). For both the groups, pain (measured by Visual Analog Scale; VAS), pain catastrophizing scale (PCS) score, hospital anxiety and depression scale (HADS) score, and range of motion were assessed before and after the task. Intervention period was 7 days starting from postoperative day 1. Evaluation periods were 7 days, 1 month, and 2 months from the day after surgery. Result: In all the outcomes, we showed main effects and interaction for both the groups (All; p<0.05). In period factor, both illusory movement and control group was significantly improvement in the 7 day, 1 month and 2 month from postoperative day compared to the 1 day from postoperative day (p<0.05). Discussion: We demonstrated that postoperative pain, range of motion, and emotional pain can be improved by creating an illusion of motion through tendon vibration starting from postoperative day 1. This clinical study reports an effective measure to prevent the occurrence of chronic pain.

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Purpose: A key element in enhanced postoperative recovery is early mobilization. However, this may be hindered by orthostatic hypotension (OH). The purpose of the present study was to assess the impact of OH the day after gastric cancer surgery to the postoperative course. Methods: A total of 211 patients who underwent elective gastrectomy for gastric cancer with perioperative physiotherapy were examined between 2004 and 2011. The subjects were compared in terms of their hospital course based on presence and absence of OH the day after surgery. Results: The time to achieve a sitting position, standing up and walking in the OH-positive group was significantly delayed compared to the OH-negative group. There were no significant differences in the postoperative complications and length of hospital stay between the patients with and without postoperative OH. Conclusion: OH on the first day after gastric cancer surgery leads to a delay in mobilization, but the incidence of postoperative complications and length of hospital stay were not significantly different between patients with and without postoperative OH.

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Objective: We aimed to evaluate age-related changes of motor nerve function. Methods: Motor function was investigated by grip strength, timed up and go test (TUG), normal walk, and fastest walk. Motor nerve conduction velocity (CV1) was calculated by measuring latency differences of evoked electromyograms in 25 elderly and 26 young subjects as a conventional method. In addition, motor nerve conduction velocity (CV2) from the time at point 0 to the maximum value of the correlation coefficient (R_τMAX), and the differences between CV1 and CV2 (DCV) were investigated as the motor nerve conduction velocity-related indexes. Moreover, motor nerve conduction velocity (CV3) was also calculated by measuring time differences between the evoked electromyograms. Results: The elderly persons were considered to have high levels in the motor function because no difference between the elderly and young subjects was observed in the TUG, and the normal walk test. CV1, CV2, and CV3 had no significant difference between the two age groups. However, CV2 was lower than CV1 in both the elderly and the young subjects. The possibility of conducting abnormal values of CV3 was shown in certain evoked electromyograms. A negative correlation was observed between R_τMAX and DCV in the elderly and a positive correlation was observed between R_τMAX and CV2 in the young. Conclusions: It was suggested that for the older individuals, including those that maintain a higher level of physical strength and motor nerve conduction velocity, an age-related change of motor nerve function could be estimated with the present methods.

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Purpose: To assess the relationship between initiation of early mobilization and walking ability at discharge in heart failure (HF) patients with clinical scenarios (CS) 1 and 2. Methods: Elderly HF patients (aged &ge; 65 years) who were hospitalized and received in-hospital phase physiotherapy between June 2011 and June 2013 were eligible to enter the study. Six hundred and seven HF patients with CS1 and 2 (339 males, 268 females, aged 80 ± 7 years) were enrolled in the present study. We divided these patients into 2 groups; independent walking group and assisted walking group, according to the walking ability at discharge. We evaluated the difference in progress of cardiac rehabilitation between two groups and the determinants of walking ability at discharge. Results: Age (odds ratio 1.13, p<0.01) and initiation of walking (odds ratio 1.10, p<0.05) were related to walking ability at discharge. Using the receiver-operating characteristics curve analysis to predict walking ability at discharge, initiation of walking 4 days after hospital admission was identified as the cut-off value for determining walking ability at discharge (sensitivity 0.689, specificity 0.520, area under the curve 0.643, positive predictive value 28%, negative predictive value 87%, p<0.01). Conclusion: Age and initiation of walking were independent determinants of walking ability at discharge in elderly HF patients. Initiation of walking 4 days after hospital admission was identified as the cut-off value for determining walking ability at discharge.

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Purpose: This study aimed to clarify the preoperative factors that influence the severity of dynamic equinus during walking after selective hip muscle release surgery in ambulant cerebral palsy patients and to determine guidances for physical therapy. Methods: Seventeen patients (17 limbs) with cerebral palsy of Gross Motor function Classification System (GMFCS) level I or II who underwent selective hip muscle release surgery were selected. We assigned these patients to the reduction, and non-reduction groups on the basis of the change in severity of dynamic equinus during walking at 8 weeks postoperatively. We examined the range of motion, modified Ashworth scale score, and joint torque for the lower extremity. Results: Compared with the non-reduction group, the reduction group, showed a significantly greater value when Dorsiflexion with Knee Joint Extention was subtracted from Dorsiflexion with Knee Joint Flexion and a significantly lesser value for the popliteal angle at 8 weeks after surgery. The modified Ashworth scale, and joint torques of the lower extremity showed non-significant differences between groups. Conclusions: The preoperative factors that influenced the change in severity of dynamic equinus during walking after selective hip muscle release surgery in ambulant cerebral palsy patients were extensibility of the soleus and hamstring muscles. These findings suggest that when providing physical therapy for patients with cerebral palsy, the severity change of dynamic equinus during walking can be alleviated after hip surgery by maintaining the extensibility of each muscle.

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Purpose: This study aimed to utilize path analysis to investigate and model the associations between factors associated with depressive symptom in workers. Methods: Three hundred and forty-six workers (mean age=41.9 years) participated in this study. Depressive symptoms were assessed using the Self-Rating Depression Scale (SDS). The factors measured were psychosocial conditions in the workplace, sleep status, physical activity levels during occupational, transport and leisure time, and musculoskeletal pain. The hypothesized relationships between the factors were modeled. The model was then revised and modified utilizing path analysis. Results: The fit of the path analysis model was good (x^2=21.0, p=0.14, GFI=0.99, RMSEA=0.03). The association between SDS and musculoskeletal pain was mediated by job satisfaction and stress. The association between SDS and physical activity during leisure time was mediated by musculoskeletal pain. Conclusions: Musculoskeletal pain and leisure time physical activity have both a direct and an indirect influence on depressive symptom among workers. These influences are separate from the influence of psychosocial conditions in the workplace.

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Purpose: The purpose of this study was to investigate the characteristics and factors associated with pelvic alignment on the triplane in patients with chronic hemiplegia in the sitting position by determining the standard values of inclination (pelvic inclination of the sagittal plane). Methods: This study examined 47 patients with hemiplegia. The relationship between the inclination of the loading rate of the buttocks on the paralyzed side, the Brunnstrom recovery stage in the lower limbs, the loading sensation in the buttocks, Pusher syndrome, and the respective basic ability to move, were investigated by measuring the pelvic alignment on the triplane in the rest sitting position. Results: There was no association between hemiplegia and pelvic alignment on the triplane. The mean inclination of sagittal plane on the paralyzed and nonparalyzed sides were both about 10 degrees. There were no significant differences in the mean values. The anterior pelvic inclination group exhibited a better loading rate in the buttocks on the paralyzed side, more loading sensation in the buttocks, and superior standing-up and walking abilities than the posterior pelvic inclination group. Conclusion: This study suggested that the pelvic inclination angle of patients with hemiplegia in the sitting position is valuable for screening their basic moving ability, buttocks loads and sensory functions.

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[in Japanese]

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