Purpose: The aim of this study was to investigate the long-term effect of improving the assessment ability of visiting rehabilitation workers relative to their awareness of changes in the medical condition of elderly patients requiring care.
Method: We conducted a one-time intervention comprising lectures, practical skills, and group work on “whole-body management of internal disabilities” and “assessment of findings related to daily activities of living” for 33 visiting rehabilitation workers. Long-term intervention effects were evaluated based on such factors as clinical assessment knowledge and degree of improvement, awareness of change of disease state, and subjective assessment evaluation. These evaluations were made before the intervention and 6 months and 1 year after the intervention.
Result: The degree of knowledge and frequency of implementation of the “assessment of findings related to daily activities of living” at the 6-month and one-year time points after the intervention improved. In addition, the number of experiences of awareness of changes in the condition of the patient increased, and subjective assessment ability also improved.
Conclusion: This one-time intervention improved the knowledge of the visiting rehabilitation workers regarding their ability to assess and subjectively evaluate their elderly patients.
Background: The aim of this study was to evaluate the impact of moderate postoperative anemia on functional decline after cardiac surgery.
Methods: A total of 135 adult patients (female 17%, age 70 ± 7 years) who underwent off-pump coronary artery bypass grafting (OPCAB) without blood transfusion between April 2013 and April 2017 were retrospectively studied. Moderate postoperative anemia was defined as hemoglobin concentration lower than 10 g/dl for three consecutive postoperative days. Variables were compared between the moderate postoperative anemia group and controls. Postoperative functional decline was determined by a decrease in short physical performance battery (SPPB) summary score at discharge compared with the preoperative SPPB summary score.
Results: The prevalence of moderate postoperative anemia was 33% after OPCAB without blood transfusion. The prevalence of functional decline in patients with moderate postoperative anemia was significantly higher than in controls (32 vs. 14%, p = 0.017). In multivariate logistic analysis, postoperative moderate anemia was independently associated with functional decline after adjusting for confounding variables (OR: 2.80, 95% CI: 1.18 to 6.65, p = 0.020).
Conclusion: Moderate postoperative anemia is a risk factor of functional decline after OPCAB without blood transfusion.
Purpose: The purpose of this study was to measure the physical activity (PA) of stroke inpatients in a convalescent rehabilitation ward using the Activity Monitoring and Evaluation System (A-MES) and clarify the change in PA during their hospitalization and difference in PA between patients who could and could not walk independently.
Methods: One hundred and sixty-nine stroke inpatients in our convalescent rehabilitation ward were included in this study. We attached the A-MES to patients for a whole day and measured PA (times spent walking, standing, operating wheelchairs, sitting, lying down) over 24 hours (24H), in the daytime (8 a.m.–5 p.m.), and during physical and occupational therapies both at their admission and discharge. We compared the PA at their admission and discharge and PA in patients who could and could not walk independently.
Results: At their discharge, the time spent walking and standing increased from 7% to 15% (24H) and from 12% to 26% (daytime). The time spent lying down decreased from 55% to 48% (24H) and from 25% to 15% (daytime). The time spent walking and standing tended to be shorter in patients who could not walk independently.
Conclusion: The PA of inpatients in the convalescent rehabilitation ward increased at their discharge compared to their admission. The time spent walking and standing was short in patients who could not walk independently. We must consider methods to improve their PA.
Objective: Stroke patients’ knee extension strength of the affected side is reportedly associated with walking ability, making it an evaluation criterion of great importance in health care. While reference strengths for determining walking independence have been published, they do not explicitly apply during the acute stage of a stroke. This study’s objective was to investigate whether knee extension strength on the affected side in acute stroke could serve as a metric for estimating walking independence and, if so, provide reference values to this end.
Method: Data was analyzed for 177 stroke inpatients at our hospital. Logistic regression analysis was performed using isometric knee extension strength on the affected and non-affected sides measured within 30 days of stroke onset as independent variables, and the ability to walk independently (yes/no) as the dependent variable. Receiver operating characteristic curve analysis was used to calculate the optimal cut-off for determining walking independence.
Results: Knee extension strength on the affected side was identified as a significant predictor of walking independence. Receiver operating characteristic curve analysis calculated its optimal cut-off value as 0.98 Nm/kg (sensitivity 76.1%, specificity 76.5%).
Conclusion: Knee extension strength on the affected side following a stroke can serve as a useful criterion for evaluating independent walking ability, even in the acute stage.
Purpose: The purpose of this study was to investigate the influence of knee joint angle and extension force on the posterior patellar tilt using ultrasound sonography.
Method: The posterior patellar tilts were measured with knee joint flexion angles at 30°, 60°, and 90° in combination with 0%, 30%, 50%, and 100% of the knee joint extension forces. A series of five sonographic images were joined to cover the area necessary for the angle measurement. An optical motion capture system was used to monitor the orientation and location of the probe to minimize the misalignment among the images.
Result: The posterior patellar tilt decreased at a knee joint flexion angle of 30° with increasing knee extension muscle force. However, the posterior patellar tilt exhibited the opposite trend with the increase of extension force when the knee flexion angles were at 60° and 90°. The highest posterior tilt was observed at a knee flexion angle of 60° with 100% of the knee joint extension force. These results were consistent with those of previous studies using Open MRI.
Conclusion: By monitoring the orientation and location of the probe of ultrasound sonography, it became possible to capture the patellar motion in the sagittal plane in clinical settings. Posterior patellar tilt has been reported to be associated with jumper’s knee. It is suggested that strong knee extension force at 60° of knee flexion is involved in the jumper’s knee.
Purpose: The purpose of this study was to identify the relationship between the movements of the pelvis, trunk, and thigh during unilateral hip flexion in the standing position and the aged-related effects of this relationship.
Method: The study contained two groups with 10 male subjects in each: a young group (mean age 24.3 years, SD 4.5 years), and an elderly group (mean age 72.2 years, SD 4.1 years). Three-dimensional motion analysis of the trunk, pelvic and lower extremities and ground reaction force measurements were performed during hip flexion in the standing position: the segmental positions, joint angles, and center of pressure were calculated. The relationship among each parameter was analyzed.
Result: Pelvic posterior tilt, lateral tilt and trunk flexion movements increased linearly with hip flexion, irrespective of age. Aging effects were found in pelvic posterior tilt and trunk flexion movements, indicating smaller movements in the elderly group than in the young group. Standing posture did not show any age-related effects.
Conclusion: These results suggest the significance of the relationship between age and the movements of the pelvis, trunk and hip flexion during hip flexion tasks in the standing position and the necessity to analyze trunk and pelvic movements while evaluating motor tasks with hip flexion.
Purpose: The present study aimed to clarify the factors influencing the life space of community dwelling elderly patients with Parkinson’s disease (PD).
Methods: The study included 45 community dwelling elderly patients with mild-to-moderate idiopathic PD. The following assessments were performed: life-space assessment (LSA), Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) motor scores, fall prevention self-efficacy (FPSE) score, 10-m walking time, and Timed Up & Go test. MDS-UPDRS motor scores involve sub-scores for rigidity (MDS-UPDRS part III item 3), tremor (items 15–18), bradykinesia (items 2, 4–8, and 14), and axial symptoms (items 1 and 9–13). Spearman rank correlations were calculated between LSA and the other variables described above. After adjusting for age, sex, and disease duration, hierarchical multiple regression analysis was performed to clarify the independent relationship of LSA with the other variables.
Results: FPSE score (β = 0.39, p < 0.01) and axial symptoms (β = –0.54, p < 0.01) were significantly associated with LSA (adjusted R2 = 0.66).
Conclusions: The results of this study suggest that FPSE and axial symptoms influence LSA in community dwelling elderly patients with mild-to-moderate idiopathic PD. Therefore, physical therapy for axial symptoms is necessary to support physical activity in patients with PD. Additionally, psychological support can maintain self-efficacy that corresponds to motor capacity.
Purpose: This study aimed to analyze nutritional conditions and factors affecting the same at admission to rehabilitation hospital.
Methods: The number of hospitalized patients from June 2017 to July 2018 was 417, of which 167 patients (over 65 years old) who did not fall under the exclusion criteria were included in this study. Factors related to nutritional condition such as basic attributes, cause disease, condition before hospitalization (With or without surgery, gait independence and meal form at acute hospital discharge, hospital term of acute hospital), swallowing function (Repetitive saliva swallowing test, tongue pressure, strength of suprahyoid muscles, trunk function, and grip strength were measured. The nutritional status was assessed using the mini-nutritional assessment-short form. Patients with 7 points or less were included in the malnutrition group, and patients in the non-malnutrition group had 8 points or more. We analyzed the differences between the malnutrition group and non-malnutrition group of subjects using univariate analysis. Following which, multivariate analysis (logistic regression analysis) was performed. Explanatory variables were those with significant differences in univariate analysis. The dependent variable was the presence or absence of nutritional disorder.
Results: There were 68 patients in the malnutrition group (40.7%) and 99 patients in the non-malnutrition group (59.3%). Gait independence at acute hospital discharge and tongue pressure were found to be significant predictors of nutrition disorders in the multivariate analysis.
Conclusions: This report seems to be useful for future research. We plan to carry out a longitudinal study in the future．
Purpose: This study aimed to investigate the factors influencing functional independence measure (FIM) motor score at the end of physical therapy (PT) in proximal femoral fracture patients with psychiatric disorders.
Methods: The subjects were 193 proximal femoral fracture patients (57 men and 136 women, mean age=72.7 years [standard deviation=12.0 years]) with psychiatric disorders. A multiple regression analysis was performed to determine whether any of those factors could affect FIM motor score at the end of PT.
Results: The multiple regression analysis demonstrated that age (β = –0.13), gait independence before injury (β = 0.21), place of residence before injury (β = 0.10), FIM motor score at the start of PT (β = 0.46), and FIM cognitive score at the start of PT (β = 0.27) were significant contributors to FIM motor score at the end of PT.
Conclusions: Age, gait independence before injury, place of residence before injury, and FIM score at the start of PT affected FIM motor score at the end of PT in proximal femoral fracture patients with psychiatric disorders.