[Purpose] To clarify the necessity of leg length adjustment when measuring the knee extensor strength using hand-held dynamometers. [Subjects and Methods] The following items were measured in 108 (male: 21 and female: 87) elderly and middle-aged community residents of the general public: the knee extensor strength, maximum walking speed, and StandUp Test and 2-step Test scores. The knee extensor strength was evaluated by calculating the muscle strength- (N/kg) and torque- (Nm/kg) body weight ratios and examining their reproducibility, correlations, and associations with performance based on the sex. [Results] Both the muscle strength- and torque-body weight ratios showed high reproducibility and strong correlations, and these measurement values were consistent with the results of each performance test, regardless of the sex. [Conclusion] The influence of lower-leg length on the knee extensor strength of the elderly and middle-aged residents measured using hand-held dynamometers was not marked. Therefore, it may be possible to evaluate such strength based on non-adjusted values while carefully considering the purpose of their use.

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[Purpose] The purpose of this study was to investigate the relationship between standing sagittal alignment and balance ability in elderly females. [Subjects and Methods] The subjects were 26 elderly females. Standing sagittal alignment (trunk inclination angle, thoracic kyphosis angle, lumbar kyphosis angle, lumbosacral angle, hip flexion angle, knee flexion angle, and ankle extension angle) and balance ability (Timed up and go test, tandem posture with eyes open) were measured. [Results] Trunk inclination angle, lumbar kyphosis angle, hip flexion angle, and knee flexion angle were significantly related to the Timed up and go test result. Lumbar kyphosis angle, hip flexion angle, and knee flexion angle were significantly related to tandem posture with eyes open. [Conclusion] As lumbar kyphosis angle, trunk inclination angle, hip flexion angle, and knee flexion angle increased, balance ability declined.

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[Purpose] The objective of this study was to investigate the validity of evaluation of posture and movement by a new tri-axial accelerometer (DynaPort MoveMonitor: DMM). [Subjects and Methods] Twenty-six healthy young university students cycled and the accuracy of the judgement of cycling by DMM was evaluated. The students also performed sitting, standing, walking, and stair walking, and these activities were recorded by DMM and a video camera. We compared the times measured by DMM and the times measured on video, and examined the sensitivities and systematic errors using Bland-Altman analysis. [Results] Cycling was judged correctly at about 30% of the time. The sensitivities of walking and stair walking were over 80%. The sensitivity increased to 88.5% for the static actions of sitting and standing together. [Conclusion] Cycling was judged by DMM correctly about 30% of the total cycling time, and the times of sitting and standing were correctly judged as static actions.

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[Purpose] The purpose of this study was to examine changes in trunk-pelvis kinematics over the course of four weeks from pre- to post-operative total hip arthroplasty (THA). Minimally invasive surgery (MIS) was compared with the Dall method. [Subjects and Methods] The subjects were 21 hip osteoarthritis (hip OA) patients (MIS: 7 patients with 9 hip OA; Dall: 14 patients with 14 hip OA) and 10 healthy controls. Participants were measured for range of motion and leg muscle strength. The gait pattern of the trunk and pelvis angles between pre- and post-operative (1, 2, and 4 weeks) THA were also measured. [Results] The MIS group showed greater hip extensor and abductor strengths and decreased trunk and pelvis angles. The Dall group showed decreased hip abductor strength and trunk angle. There was no change in pelvis angle. The MIS and Dall groups had significantly lower ROM, muscle strength, and trunk angle than the healthy controls. [Conclusion] The results of this study suggest that it appears to be important to consider these elements in rehabilitation treatment after total hip arthroplasty.

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[Purpose] The purpose of this study was to clarify whether the anaerobic threshold (AT) obtained by an exercise test and the rate of perceived exertion (RPE) differed depending on the type of pole used for Nordic walking (NW). [Subjects and Methods] Using a ramp loading protocol, 10 males and females walked normally, and performed NW with Pole 1 (without strap, rubber tip circle), and Pole 2 (with straps, diagonally rubbed chips) on a treadmill. [Results] The AT of NW with Pole 1 was significantly higher than that of walking normally. The RPE of NW with Pole 2 was not significantly different from that of walking normally, but that of Pole 1 was significantly higher than that of walking normally. [Conclusion] These results suggest that the difference in the shape of the pole influences AT; therefore, using a pole such as pole 2 could be more effective for exercise therapy.

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[Purpose] The purpose of this study was to clarify the minimum detectable change (MDC) in the time constant of oxygen uptake (τVO₂), which is the intervention effect, in a constant load exercise test performed at different walking speeds. [Subjects and Methods] Ten healthy males performed a constant load exercise test twice at walking speeds of 4.5 km/h and 6.0 km/h, and the MDC of τVO₂ was calculated for each speed condition. [Results] The MDC of 4.5 km/h was 14.7 seconds and that of 6.0 km/h was 4.9 seconds. [Conclusion] The MDC of τVO₂ obtained at 6.0 km/h had less measurement error and was similar to the change due to intervention. These results suggest that the intervention effect can be evaluated when τVO₂ changes by 4.9 seconds or more in a constant load exercise test set performed at 6.0 km/h.

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[Purpose] With the aim of improving physical therapist education, clinical training supervisors’ views of an ideal supervisor and differences in such views related to the length of clinical experience were examined. [Subjects and Methods] A questionnaire survey was conducted, asking physical therapists working in 42 facilities to voluntarily respond. [Results] The 5 most frequent words were “student”, “supervision”, “can”, “training”, and “ability”. Furthermore, responses were classified into 3 clusters: <conveying the enjoyment of clinical practice>, <being able to supervise students according to their abilities>, and <considering appropriate approaches for individual patients together>. When focusing on the length of clinical experience, differences were observed in 5 words: “student”, “thinking”, “enjoyable”, “according”, and “together”. [Conclusion] Clarifying and understanding views of an ideal supervisor may contribute to the improvement of physical therapist education. This may also be needed to enhance physical therapists’ qualities.

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[Purpose] To confirm the criterion-related validity and reliability of surae muscle tendon unit stiffness measured using a custom-made passive torque indicator (CPTI), a portable device composed of an angle-adjustable foot plate and strain gauge. The data were compared to readings obtained using an isokinetic dynamometer. [Subjects and Methods] Fourteen healthy young adults participated in this study. Torques at four angles of dorsiflexion of the ankle joint of the subjects were recorded using the CPTI and a dynamometer. The slope of the portion of the passive torque-angle curve was defined as stiffness. Three measurements were performed with each device. [Results] The intra-class correlation coefficients (ICC) (1, 3) were 0.81 and 0.86 for the CPTI and dynamometer, respectively. The degree of stiffness determined using the CPTI was significantly less than that determined using the dynamometer. A Bland-Altman plot revealed there was a fixed error between the CPTI and dynamometer. [Conclusion] The results of this study indicate that three measurements with the CPTI are as reliable as those made with an isokinetic dynamometer. However, the degree of stiffness determined using the CPTI tended to be less than that determined using the dynamometer.

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[Purpose] To measure broken shoehorn braces (SHB), to determine the mechanical stress points and characteristics of breakages. [Subjects and Methods] Six polypropylene SHBs which had broken during use were examined. [Results] The height of the breakage point was the upper part than the point of tangential line which drawn at an angle of 45 degrees from the base and the trimming line. Breakage points were divided into the upper part and the lower part. The measurement suggested that upper part breakages were caused by plantarflexion stress while lower part breakages were caused by dorsiflexion stress. [Conclusion] Angles of the breakage points determined by a quadratic equation of the trimming line derived from actual measurements ranged from 82–90°. From macro observation, it was concluded that breaks occurred in transformations from irregular to smooth surfaces.

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[Purpose] The purpose of this study was to evaluate factors affecting the weight loss of patients after surgery for colorectal cancer. [Subjects and Methods] We recruited 57 patients with colorectal cancer scheduled for surgery. Body weight, short physical performance battery score, 6-minute walk distance, grip strength, skeletal muscle index, and percent body fat at, before, and 10 days after surgery were measured. For the 10 days following surgery, we also recorded the start day of early mobilization, start day of walking, the day patients restarted oral intake, total energy intake, and energy satisfaction rate. We examined the relationships between the dependent variables and rate of body weight loss. [Results] The rate of body weight loss significantly correlated with change in skeletal muscle index (r=-0.62) and change in percent body fat (r=0.33). [Conclusion] Body weight loss after colorectal surgery is correlated with change in skeletal muscle mass and body fat.

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[Purpose] The purpose of this study was to investigate the kinematic characteristics of patients with low grade knee osteoarthritis using three-dimensional gait analysis. [Subjects and Methods] The subjects were 44 patients with low grade knee osteoarthritis and 50 healthy adults. [Results] A large knee adduction moment at mid stance and a decrease in the range of knee motion in the sagittal plane were found in the osteoarthritis group. There were differences between the groups in ankle inverse motion at the loading response. [Conclusion] The results of this study suggest that the kinematic characteristics of gait of patients with low grade osteoarthritis are different from healthy adults in the frontal and sagittal planes.

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[Purpose] To clarify the influence of postural kyphosis on measurement values obtained using home body composition meters. [Subjects and Methods] There were 40 healthy male participants. In each of them, body composition measurement was performed using a home body composition meter under 3 conditions: normal measurement (normal condition), simulating a kyphotic level of 19.4 ± 2.0 using a kyphosis simulator and inputting the height (simulated kyphosis condition), and measuring the height in a kyphotic posture (kyphotic height condition). [Results] There were no significant differences in any measurement values between the normal and simulated kyphosis conditions. On the other hand, the total muscle mass and limb skeletal muscle mass were significantly less, and the SMI and body fat rate were markedly higher under the kyphotic height condition compared with the other conditions. [Conclusion] The results revealed that decreases in the height due to kyphosis also influence measurement values obtained using home body composition meters.

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[Purpose] The purpose of this study was to measure the number of steps of subjects with care needs, to clarify longitudinal changes and relationships with degree of care needs. [Subjects and Methods] The subjects were 18 elderly females with care needs (10 with care needs 1, and 8 with care needs 2). A pedometer with a triaxial accelerometer was used to measure the number of steps for one year. [Results] The number of steps decreased in both groups, especially in the summer. The number of steps of the group with care needs 2 was significantly lower than that of the group with care needs 1. Although ADL was maintained in both groups, the number of steps decreased, and the rate of decrease was different between the groups. [Conclusion] The number of steps is an important assessment item when performing physical therapy for the elderly with care needs, and the results of this study suggest they may reflect characteristics related to differences in care needs.

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[Purpose] Lack of exercise means the number of children likely to develop musculoskeletal diseases will rise. Our objective was to assess the current situation of children's exercise in Chiba. [Subjects and Methods] Some 336 children participated in a sports event. They performed seven exercise items and completed a questionnaire. We examined the relationships among motor items, musculoskeletal pain, and falling. [Results] The exercise items with large proportions of children reporting inability were sit-ups, push-ups, balance while crawling, and touching the toes while standing. Questionnaire responses showed 69.6% were exercising almost every day, 16.4% currently had musculoskeletal pain, while 37.2% had experienced it in the past, and 26.1% reported falling daily. For past musculoskeletal pain, squats and sit-ups showed significant results, and for motor items related to falling, push-ups, standing on tiptoe and one leg standing showed significant results. [Conclusion] It is possible that reduction in the ability to perform these basic motor functions may be a factor leading to future pain in exercisers and injuries due to falls.

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[Purpose] To examine the effect of slopes on standing balance control. [Subjects and Methods] Fifteen healthy adults (mean age: 21.0 years) maintained an eyes-open standing position for 30 sec with their feet 10 cm apart on level ground, and inclining and declining slopes of 8 degrees while their center of gravity sway was measured using a gravicorder. The Index of Postural Stability (IPS) was also calculated in the anteroposterior and mediolateral directions over a 10-second interval. [Results] Postural sway on the incline was significantly larger than that on the level ground, but IPS did not differ significantly among the conditions. [Conclusion] The results suggest that the standing postural control of healthy adults does not differ between sloping and a horizontal surfaces because, while there was a significant difference in sway, IPS did not significantly differ.

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[Purpose] To clarify the influences of neck and shoulder postures on the regional ventilation and rib cage-abdominal volumes in a supine position. [Subjects and Methods] Measurement was performed in 15 healthy young males who adopted 6 postures combining the following tasks in a supine position: maintaining the neck neutral, rotating it at 60°, and abducting the shoulder at 10°, 90°, or 135°. The participants breathed at rest with a pneumotachometer attached, and their respiration-related rib cage and abdominal movements were analyzed using a 3-dimensional motion analysis device. The rib cage-abdominal region was divided into 6 sections: the left and right upper thoraxes, lower thoraxes, and abdomens. The tidal volume (VT), end-expiratory rib cage-abdominal volume (EERAV), and EERAV in each section were calculated using Excel VBA. [Results] On examining the EERAV in each section, the value in the ipsilateral lower thorax was significantly higher when abducting the shoulder at 135° compared with 10°. Neither the VT nor EERAV was influenced by neck or shoulder postures. [Conclusion] A shoulder abduction angle of 135° may increase the end-expiratory lung volume in the ipsilateral lower thorax.

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[Purpose] To examine factors that affected the rehospitalization of patients who had been discharged from a comprehensive community-based care ward to long-term care welfare facilities, to help efforts to prevent rehospitalization. [Subjects and Methods] The subjects were 76 people. This was a retrospective study performed using medical records. The subjects were divided into two groups, those who were rehospitalized within 3 months from their discharge date, and those who were not. Disease, age, gender, functional independence measure, index of nutritional status, and method of communication when providing information to the discharge destination were compared between the groups, and a multivariate analysis was performed. [Results] Nursing and healthcare-associated pneumonia was the primary cause of rehospitalization. Other factors affecting rehospitalization were serum albumin value, diet form, and providing information by face to face communication. [Conclusion] The results suggest that efforts to improve nutritional status, the proper diet form, the positioning at the time of meal intake, and face to face information provision on assistance may help reduce rehospitalization.

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[Purpose] We examined the comfort of children with severe motor and intellectual disabilities in the supine position, the hugging sitting position with the mother, and a seated position maintained with support. [Subjects and Methods] The subjects were seven children with Gross Motor Function Classification System Level V. Their heart rate was recorded using a wireless electrocardiogram in the three postures. The low-frequency (LF) and high-frequency (HF) components obtained from analysis of the data were compared among the three postures, using the LF/HF ratio, as an index of sympathetic nerve activity, and the HF component, as an index of parasympathetic nerve. [Results] Both the LF/HF and HF components showed significant changes from the other postures in the hugging sitting position. [Conclusion] The results seem to show that comfort was obtained in the hugging sitting position, because parasympathetic nerve activity increased and sympathetic nerve activity decreased.

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[Purpose] To clarify difficulties perceived by clinical instructors during clinical training and effective teaching methods. [Subjects and Methods] Semi-structured interviews were conducted with 16 physical therapists with experience of clinical education, and content analysis was performed. [Results] Difficulties/problems faced by the clinical instructors during clinical training were classified into 15 categories labelled A, such as A4) students’ emotional aspects, behavior during training, and attitudes toward learning, and A11) clinical instructors’ qualities and teaching skills. Based on these, 17 categories of effective teaching methods labelled B, such as B7) leading students to acquire experience on a step-by-step basis, according to their abilities, and B14) offering opinions regarding practical training tasks, were created. [Conclusion] As categories, A and B were consistent. It may be possible to develop measures to address these difficulties by organizing them.

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[Purpose] The enhancement of the results of scientific research, in order to impressively present the impact of studies, is called “SPIN”. The aim of this study was to investigate the SPIN of randomized controlled trials in rehabilitation. [Subjects and Methods] The literature was searched using the Medline database. Research articles not clarifying the primary outcome in the main text and significant effects in the primary outcome were excluded. The extracted papers were evaluated for SPIN as specific reporting strategies, such as stressing the treatment is beneficial, despite a statistically non-significant difference for the primary outcome, or to distract the reader from statistically non-significant results. [Results] The Abstracts of 32/42 papers (76.2%) were judged to contain SPIN, as were 20/42 (47.6%) Results in the main text. [Conclusion]: The results of the present study should be a warning to paper readers against judging clinical decision-making from only the Abstract or Results of the main text in randomized controlled trials in rehabilitation.

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[Purpose] The present study was undertaken in order to obtain objective knowledge for revising rubric style. [Subjects and Methods] In the study, samples from 189 clinical training facilities were gathered. The questionnaire reply form used in this part of this research was free descriptions about feedbacks on using rubric, and the replies were subjected to content analysis. [Results] Fifty-four context units and 98 record units were extracted from the feedbacks. From the results, we were able to form 14 new sub categories and four more categories in rubric style. [Conclusion] The results of the content analysis explain that the feedbacks showed rubric’s advantages, issues, improvement points, and future possibilities. The results of this study indicate that rubric can be a proper performance evaluation method. This study will be of value in the field of developing and revising very practical rubrics for authors.

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[Purpose] We investigated whether an early mobilization program for patients undergoing abdominal aortic aneurysm (AAA) replacement surgery prevented complications and contributed to a shorter length of stay. [Subjects and Methods] The subjects were 23 cases who underwent AAA replacement surgery. Survey items were the duration between surgery and start of walking, independent ambulation, duration of hospitalization after surgery, and incidence of complications. [Results] Adverse events such as bleeding were not observed. All cases of elective surgery were in the early walking independence group. Compared to previous studies, the early walking independence group was significantly older, but the start of walking was significantly earlier, and the duration of hospitalization after surgery and incidence of complications were both reduced. [Conclusion] Early ambulation from the first day after surgery may contribute to early discharge from hospital by contributing to acquisition of independent ambulation and the prevention of complications.

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[Purpose] The aim of the present study was to examine whether the onset time of hip and trunk muscle activity during prone hip extension is related to hip and pelvic motion during gait. [Subjects and Methods] Twenty-nine healthy subjects participated in this study. Surface electromyography of the erector spinae, lumbar multifidus, gluteus maximus, and semitendinosus activities during prone hip extension were recorded. In addition, the hip and pelvic angles at the time of terminal stance during gait were measured. The correlations between the onset time of hip and trunk muscle activities during prone hip extension and the hip and pelvic angles at the time of terminal stance during gait were analyzed. [Results] A negative correlation was found between the onset of bilateral multifidus and contralateral erector spinae activities during prone hip extension and the hip joint angle at the time of terminal stance during gait. [Conclusion] The results show that later onset of bilateral multifidus and contralateral erector spinae activities during prone hip extension resulted in a smaller hip joint angle at the time of terminal stance during gait.

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[Purpose] The purpose of this study was to observe the surface cerebral blood flow related to associative reaction in the legs. [Subjects and Methods] The subjects were 20 male adults. The participants performed isometric resistance abduction movement of the right hip joint. The intensity of the resistance was 80% of the maximum muscular strength. Contraction of the left gluteus medius was checked by EMG to judge the associative reaction. The surface cerebral blood flow of the motor area of the frontal lobe during the task was measured using functional near- infrared spectroscopy. [Results] The surface cerebral blood flow on the left side of the primary motor area and both sides of the premotor area significantly increased during the task. [Conclusion] Even though the associative reaction in the left leg was an involuntary muscular contraction, the activity of the premotor area of the right side during the task was confirmed.

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[Purpose] The purpose of this study was to examine changes in fatigue and exercise tolerance after discharge in strong and weak groups with gastrointestinal cancer. [Subjects and Methods] The subjects were 51 patients with gastrointestinal cancer. The Cancer Fatigue Scale (CFS) and 6-minute walk distance (6MWD) were evaluated before surgery, after surgery, and after discharge. The subjects were divided into two groups on the basis of CFS score: 19 or over, strong group, and less than 19, weak group. This retrospective study considered changes in CFS and 6MWD differences between the two groups at the three time points. [Results] CFS showed interaction and a main effect, while 6MWD showed a main effect between the groups. The CFS of the weak group gradually decreased. However, the CFS of the strong group was continuously high from before surgery. [Conclusion] The results suggest that patients who show fatigue after discharge always show fatigue because of low exercise tolerance.

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[Purpose] The purpose of this study was to examine the relationships between knee swelling following total knee arthroplasty (TKA) and preoperative physical function (quadriceps strength and gait speed) and dietary polyunsaturated fatty acid (PUFA) intake. [Subjects and Methods] Fourteen patients who underwent unilateral TKA participated in this prospective study. Preoperatively and on postoperative day 4, the thigh circumferences at 1 and 10 cm above the knee were measured using a inelastic tape measure. Knee swelling was defined as the increased rate of the thigh circumference. In the preoperative assessment, quadriceps strength of the operated side, gait speed, and PUFA intake values were measured using a pull-type hand-held dynamometer, the 10-meter walk time, and a food frequency questionnaire, respectively. [Results] Regarding preoperative factors related to knee swelling, a relationship was only found between knee swelling at 10 cm above the knee and the n-6 PUFA intake values (r=0.57; p=0.03). [Conclusion] Our results suggest that preoperative n-6 PUFA intake is associated with knee swelling following TKA.

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[Purpose] The purpose of this study was to clarify the motions of the body joints during sitting up from the supine position. [Subjects and Methods] Ten healthy young men (ages 21–26) participated in this study. The subjects sat up from the supine position without trunk rotation. The joint motions were recorded using a three-dimensional motion analysis system (MAC3D). [Results] The head moved from a neutral position to about 50° flexion in the early phase of sitting up. The right shoulder moved in the flexion direction in the early phase of sitting up. The right hip moved slightly in the direction of extension and then moved in the direction of flexion. [Conclusion] Collecting knowledge about the motions of body joints while sitting up from the supine position might provide information about the range of motion in the joints required for sitting up from the supine position.

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We performed physical therapy for a patient with right hemiplegia following cerebral infarction six years earlier. The patient had pain in the iliocostal muscle during standing. Related to the standing posture, the patient’s pelvis tilted to the rear, both hip joints showed extension, and there was trunk flexion at the thoracolumbar junction. The cause of the pain was continuous contraction of the iliocostal muscle to maintain the flexion position of the trunk. We prescribed muscle strengthening exercises for extension muscle strength of the right hip. Consequently, the extension muscle strength of the right hip improved to 4 from 2 on the MMT, and the pain level decreased to 3 from 8 on the NRS. Moreover, the patient showed improvement in the pelvic tilt to the rear.

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[Purpose] The purpose of this study was to clarify the roles of physical therapists in renal rehabilitation for elderly hemodialysis patients based on two case studies. [Subjects and Methods] The subjects were two patients receiving hemodialysis (a 76-year-old woman and a 74-year-old man). For the method, we analyzed data collected from two case studies. [Results] The results suggest that physical therapists have four roles in renal rehabilitation for elderly hemodialysis patients: improvement of physical function through therapeutic exercise, support for behavior modification, management of physical activities, and implementation of social work for rebuilding of life. [Conclusion] The results of this study suggest that physical therapists have four roles in renal rehabilitation for elderly hemodialysis patients.

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