Physical therapy research最新文献

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.

Impairments resulting from stroke lead to persistent difficulties with walking. Subsequently, an improved walking ability is one of the highest priorities for people living with stroke. The degree to which gait can be restored after a stroke is related to both the initial impairment in walking ability and the severity of paresis of the lower extremities. However, there are some patients with severe motor paralysis and a markedly disrupted corticospinal tract who regain their gait function. Recently, several case reports have described the recovery of gait function in stroke patients with severe hemiplegia by providing alternate gait training. Multiple studies have demonstrated that gait training can induce "locomotor-like" coordinated muscle activity of paralyzed lower limbs in people with spinal cord injury. In the present review, we discuss the neural mechanisms of gait, and then we review case reports on the restoration of gait function in stroke patients with severe hemiplegia.

Objective: The purpose of the study was to clarify the causal effect of toe-grasping exercises on the improvement of static or dynamic balance ability in home-based rehabilitation users.

Method: Our study included 34 subjects who met the criteria and were evaluable out of 98 rehabilitation service users at home nursing stations. This study was a randomized controlled trial. The intervention group performed towel gathering exercises in addition to the regular home-based rehabilitation program. The primary outcome was one-leg standing time, and the secondary outcomes were two-step test and toe grip strength.

Results: Seventeen subjects were assigned to the intervention group and seventeen to the control group by block randomization. Data from 15 and 12 subjects in the intervention group and control group, respectively, who were able to complete the initial evaluation and the evaluation after 3 months, were analyzed. We compared the amount of change after 3 months of evaluation in the intervention group with the change in the control group. The results showed that the left/right mean value of oneleg standing time in the intervention group was significantly greater than that in the control group. In terms of the amount of change in the intervention period (T2-T1) within each assessment, there were significant improvements in both the toe-grip strength and the two-step values in the intervention group.

Conclusion: We found that toe-grasping exercises could improve the balance ability of home-based rehabilitation users. This suggests the clinical significance of toe function in rehabilitation programs.

Objective: Anterior cruciate ligament (ACL) injury is one of the most frequent sportsinjuries, and previous studies have shown that fatigue is a risk factor for sports injuries.This study aimed to inform prevention of ACL injury by investigating how exercise and desk tasks affect trunk and lower limb alignment and ground reaction force (GRF) during one-legged landing movements.

Methods: The study subjects were 12 men who performed a one-legged landing movement from a 30-cm platform before and after fatigue tasks, including lower-limb muscle fatigue, cardiopulmonary fatigue, and brain fatigue tasks. For the measurement of joint angles and moments and GRF, a three-dimensional motion analysis device and a floor reaction-force meter were used. Statistics were performed using Wilcoxon's signed rank sum test as a multiple comparison test with Bonferroni adjustment to compare the difference in effects.

Results: The maximum trunk flexion angle during landing on one leg was significantly lower in the brain fatigue group than in the control group. The time to peak vertical GRF (pGRF) was significantly shorter in the leg-muscle fatigue group than in the control group.

Conclusion: Brain fatigue may have altered the postural strategy before and after landing, resulting in a decrease in trunk flexion angle. Time to pVGRF was shortened in the leg muscle fatigue group, suggesting that there may be an increased risk of ACL injury. Time to pVGRF during lower extremity muscle fatigue and trunk flexion angle during brain fatigue may be more pronounced during actual sports activities.

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.

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: To clarify the effect of intervention with dynamic motor control exercise (DMCE) for the lumbar region on low back pain in sedentary office workers (SOWs).

Methods: The participants comprised 32 SOWs with low back pain who were randomly categorized into two groups: the DMCE group and the normal trunk exercise (NTE) group. Both groups performed each exercise for three days per week for 8 weeks. The primary endpoints were evaluated for the lumbar and hip flexion angles during trunk forward bending, effect of low back pain on activities of daily living (using the Oswestry Disability Index), and intensity of low back pain (using the Visual Analog Scale) pre- and post-intervention. The extent of changes was calculated by subtracting the pre-intervention value from the post-intervention value and was compared between the two groups using an unpaired t-test.

Results: The extent of changes in the lumbar flexion and hip flexion angles at 10° of trunk forward bending were significantly greater in the DMCE group than in the NTE group, and no significant differences were noted between the two groups at other angles of trunk forward bending. The extent of changes in the Oswestry Disability Index and the Visual Analog Scale scores were significantly greater in the DMCE group than in the NTE group.

Conclusion: DMCE is effective in improving motor control in the lumbar region and hip joints, thereby ameliorating low back pain in SOWs.