Progress in rehabilitation medicine最新文献

Background: Peripheral magnetic stimulation is increasingly used to treat dysfunctions associated with various disorders. However, there is currently no consensus regarding its efficacy across specific populations, disease conditions, intervention settings, treatment durations, or outcomes. This scoping review aimed to identify, summarize, and map relevant literature on peripheral magnetic stimulation, clarifying its application by disease type, treatment site, functional impairments, outcomes, and intervention setting.

Methods: A systematic search was conducted across several databases, including PubMed/MEDLINE, CINAHL Complete, Cochrane Library, Web of Science, and PEDro. Studies that examined the impact of peripheral magnetic stimulation on dysfunction across all disease types and populations were included.

Results: Of 804 screened articles, 97 met the inclusion criteria. Peripheral magnetic stimulation was primarily used for musculoskeletal, neurological, and incontinence-related diseases, focusing on disease-specific outcomes related to muscle and physical function in the affected areas. Conversely, its use in internal diseases was predominantly limited to chronic obstructive pulmonary disease, with few studies addressing its efficacy in cardiovascular diseases, cancer, and diabetes mellitus. Furthermore, peripheral magnetic stimulation settings varied widely, even when applied to similar diseases or dysfunctions.

Conclusions: Peripheral magnetic stimulation is primarily used to treat musculoskeletal, neurological, and incontinence-related diseases, with outcomes centered on disease-specific assessments of muscle and physical function. However, its application in internal diseases remains limited, especially in cardiovascular disease, cancer, and diabetes mellitus. In addition, standardized peripheral magnetic stimulation prescriptions have not yet been established. Future studies should emphasize its implementation in underserved diseases and dysfunctions and establish standardized treatment protocols.

Objectives: : This study aimed to clarify the relationship between early postoperative regional phase angle (PhA) and walking ability at discharge in older patients with hip fractures.

Methods: : The study included patients aged 75 years or older who underwent treatment for hip fractures at our hospital. We calculated the regional PhA from bioelectrical impedance analysis conducted between 3 and 7 days after surgery and investigated the association of PhA with walking ability at discharge.

Results: : Overall, 255 cases were included in the analysis (61 men, average age 86.3 years; 194 women, average age 88.1 years). The results of intergroup comparisons based on walking ability demonstrated that the effect size (r) was large for lower limb PhA in men and upper limb PhA in women, whereas the effect size was small for trunk PhA in both men and women. Multiple logistic regression analysis with walking ability as the dependent variable revealed that cognitive function and sound-side lower limb PhA were associated with walking ability in men, whereas age, fracture type, cognitive function, and sound-side upper limb PhA were associated factors in women.

Conclusions: : The prediction of walking ability in older patients with hip fractures may be possible using PhA data. The results of this study suggest that lower limb PhA for men and upper limb PhA for women are optimal indicators of walking ability at discharge.

Objectives: Non-older adults are at risk of developing sarcopenia, and exercise and increased physical activity are effective preventive interventions. Digital interventions, including gamification, may enhance the effects of exercise interventions. This systematic review and meta-analysis examined the effects of digital health interventions on muscle strength, muscle mass, and physical function in non-older adults at risk of sarcopenia.

Methods: We conducted a systematic review of randomized controlled trials that evaluated the effects of digital health interventions on outcomes related to sarcopenia. Literature searches were performed in MEDLINE (Ovid), Web of Science Core Collection, and CENTRAL databases. Risk of bias was assessed according to established guidelines, and meta-analyses were conducted. The certainty of evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework.

Results: In total, 28 studies were analyzed. The pooled results indicated that digital health interventions led to improvements in grip strength, performance in the chair-stand test, walking speed, Dynamic Gait Index, and Timed Up-and-Go test. In contrast, lower limb muscle strength and lean body mass did not show meaningful improvements. Although no major risks of bias were identified, the strength of the evidence remained limited because of the small number of studies and participants included.

Conclusions: This systematic review suggests that digital health interventions may lead to modest improvements in muscle strength, muscle mass, and physical function in non-older adults at risk of sarcopenia, although the current evidence remains inconclusive. Further studies are needed to establish their effect.

The aging of the world's population has caused a dramatic change in the overall health of patients, with many suffering from disuse syndrome-a condition caused by immobility and bed rest. Even among people who are able to live independently, newly defined issues such as frailty, sarcopenia, locomotive syndrome, and hospitalization-associated disability have rapidly emerged, and it has been found that physical inactivity is a key cause of these issues. Disuse syndrome is a term that is mainly used in Japan but not widely accepted elsewhere because of its negative connotations. Moreover, although the term physical inactivity is widely used, it has a strong connotation of simply referring to reduced physical activity and does not emphasize that it also poses systemic and multi-organ risks. To solve these problems, in this narrative review, I propose a new academic term-physical inactivity syndrome (PIS)- to describe the diverse physical, mental, and social symptoms and disorders caused by bed rest and decreased physical activity. PIS serves as an umbrella term for disuse syndrome, physical inactivity, frailty, sarcopenia, and related diseases. Furthermore, the effects of rehabilitation and exercise therapy required to prevent and treat PIS are introduced. It is necessary for medical professionals to be fully aware of the risks of PIS, properly acquire the skills needed to improve patient activity, and carry out prevention and treatment with sufficient confidence.

Objectives: This study aimed to examine the physical characteristics of participants who can and cannot perform the short foot exercise (SFE).

Methods: This prospective observational study was conducted in a university laboratory in Japan. University students (aged ≥18 years) enrolled between April and December 2024 were recruited as participants. We measured height, weight, foot length, medial longitudinal arch height, and toe grip strength. Ultrasonography captured transverse images of the intrinsic foot muscles, including the abductor hallucis, flexor hallucis brevis, and flexor digitorum brevis. Participants received single-instruction SFE training in a sitting position and were classified into two groups: SFE possible and SFE not possible. Those in the SFE not possible group received an additional 10 min of instruction before reattempting SFE. Based on performance, participants were categorized into three groups: those who succeeded after initial instruction (SFE-A), after practice (SFE-PT), or remained incapable (SFE-NP). Statistical analysis was conducted using one-way analysis of variance (ANOVA) and multiple comparison tests for each measurement and analysis item, with the significance level set at P < 0.05.

Results: In female participants, toe grip strength was lower in the SFE-A group than in the SFE-PT and SFE-NP groups, whereas no significant differences were observed in male participants or in muscle morphology and the navicular drop index in either sex.

Conclusions: These findings suggest that immediate performance of the SFE may not necessarily be associated with greater toe grip strength or larger intrinsic muscle size but may relate to coordination between intrinsic and extrinsic muscles.

Background: No standard treatment has been established for acute-phase spasticity after spinal cord injury (SCI). This case report demonstrates the impact of combining extracorporeal shock wave therapy (ESWT) and botulinum toxin administration on mobilization in the acute phase of SCI-associated spasticity.

Case: A man aged in his 50s was admitted to our hospital following a bicycle collision with an automobile. The patient was diagnosed with a non-ossifying cervical SCI without radiographic abnormality. Spasticity in both lower limbs impaired the patient's ability to perform a standing movement and maintain a stable position. Considering the necessity of spasticity management, ESWT and botulinum toxin injection were administered.

Discussion: Range of motion (ROM) and Modified Ashworth Scale (MAS) score of the lower limbs, as well as the standing posture, were evaluated. After radical ESWT and botulinum toxin injection, both ROM and MAS improved. The patient gained the ability to maintain a standing position with the assistance of only one person and was able to sit stably without assistance.

Conclusions: The administration of ESWT and botulinum toxin injection during the acute care hospital stay for spasticity may be beneficial for promoting early mobilization.

Objectives: Hip fractures in aging populations pose a major healthcare burden, and predicting discharge motor function may enable timely interventions. We aimed to develop a machine learning model with statistically validated reliability to predict motor Functional Independence Measure (mFIM) scores at discharge in patients who underwent bipolar hip arthroplasty (BHA).

Methods: This retrospective study was conducted at a regional hospital providing integrated care. A total of 201 hips treated with BHA for femoral neck fractures were analyzed. The primary outcome was the discharge mFIM score. Ten predictors were assessed: age; sex; presence of hypertension, diabetes, or heart failure; body mass index; Hasegawa Dementia Scale-Revised (HDS-R) score; time from admission to surgery; time from surgery to transfer to the convalescent ward; pre-fracture mobility status; pre-fracture independence level; and mFIM score at transfer. Six machine learning models were developed with hyperparameter tuning. Feature importance was evaluated using SHapley Additive exPlanations (SHAP), and results were compared with multiple regression for consistency.

Results: Light gradient boosting machine achieved the highest predictive performance (R²= 0.84). SHAP analysis revealed that the most influential predictors were mFIM score at transfer to the rehabilitation ward, HDS-R score, and pre-fracture independence level. These factors were identified as significant variables in multiple linear regression.

Conclusions: We developed a reliable and interpretable machine learning model to predict discharge mFIM scores in patients who underwent BHA. Key predictors of the model were supported by SHAP and multiple regression analysis. This model can assist clinicians in setting appropriate rehabilitation goals and discharge plans early during recovery.

Objectives: : The Perme ICU Mobility Score is widely used to assess functional status, but no version of this assessment tool has been validated for use in Japan. This study aimed to translate the Perme Score into Japanese and evaluate its reliability and validity.

Methods: : Following forward-backward translation, the Japanese Perme Score was tested at ICU discharge. Inter-rater reliability was examined using weighted kappa coefficient. Construct validity was assessed through correlations with the Medical Research Council Sum Score (MRC-SS), Functional Status Score for the ICU (FSS-ICU), and ICU Mobility Scale (IMS). Predictive validity for activities of daily living (ADL) independence (Barthel Index ≥ 85) and discharge destination was evaluated using Receiver operating characteristic (ROC) analysis. Floor and ceiling effects were also analyzed.

Results: : In 69 patients, the Japanese Perme Score showed high inter-rater reliability (κ=0.83). It showed moderate correlation with FSS-ICU (rho=0.61) and IMS (rho=0.73), and it showed weak correlation with MRC-SS (rho=0.36). Predictive validity for ADL independence and home discharge yielded AUCs of 0.76 and 0.73, respectively. A ceiling effect was noted in 10% of cases, with no floor effect.

Conclusion: s: The Japanese Perme Score is a reliable, valid instrument for evaluating physical function at ICU discharge.