Progress in rehabilitation medicine最新文献

Objectives: Delayed initiation of postoperative rehabilitation may be detrimental for improving everyday activities in postoperative patients with valvular heart disease. Rehabilitation is essential for postoperative valvular heart disease; however, the effective starting time of rehabilitation is unknown. This study aimed to investigate whether a delay in postoperative rehabilitation affects outcomes in patients after waiting for surgery for valvular heart disease.

Methods: Data from the JMDC database were extracted for 4330 patients diagnosed with valvular heart disease and who underwent surgery within 5 days of admission. Patient characteristics were compared between the usual rehabilitation group (started rehabilitation within 2 days postoperatively) and the delayed rehabilitation group (started rehabilitation at 3-5 days postoperatively). The primary outcome was hospitalization-associated disability (HAD); that is, the proportion of patients who showed a decline in the Barthel Index during hospitalization. Barthel Index at discharge, pulmonary complications following hospitalization, and postoperative complications were the secondary outcomes. Outcomes were compared in the usual and delayed rehabilitation groups after propensity score matching.

Results: Of the 4330 patients, 3845 patients were assigned to the usual rehabilitation group, and 485 patients were assigned to the delayed rehabilitation group. After propensity score matching, statistical analysis was performed on the usual and delayed rehabilitation groups, which each contained 418 patients. The delayed rehabilitation group had significantly higher rates of HAD (10.5% vs 8.1%) and respiratory complications (14.8% vs 11.2%) than the usual rehabilitation group.

Conclusions: Delayed postoperative rehabilitation may be associated with poor prognosis in patients with valvular heart disease.

Objectives: In an ultra-aged society, the increasing number of elderly individuals requiring nursing care because of complications and disabilities poses a significant challenge for healthcare providers, along with a decline in the quality of life (QoL). Therefore, investigating the underlying causes and establishing effective preventive measures is imperative. Sarcopenia, characterized by a reduction in muscle strength throughout the body, can negatively impact QoL because of declining physical function. This study aimed to elucidate the interrelationship between physical function and health-related quality of life (HRQoL) in elderly individuals requiring long-term care.

Methods: The participants (n=67) were elderly individuals (32 men, 35 women) requiring light nursing care. HRQoL was assessed using the EuroQol Group 5-Dimensions 5-Level (EQ-5D-5L) scale. Relationships between the EQ-5D-5L score and age, body mass index, SARC-CalF, and sex were examined. The relationships between the EQ-5D-5L score and the 10-s chair stand test, functional reach test (FRT), grip strength, 10-m walking test, and Timed Up-and-Go (TUG) test were investigated separately for men and women.

Results: A correlation was identified between EQ-5D-5L score and sex. In men, a correlation was identified between EQ-5D-5L and TUG test results. In women, a comparable correlation was observed between EQ-5D-5L score and the 10-m walking test, FRT, and TUG test.

Conclusions: The findings revealed a correlation between physical functions, including standing and walking, and QoL in elderly individuals requiring light nursing care. Maintaining and enhancing standing and walking abilities among this demographic group should be a high priority.

Objectives: This study examined the relationships between preoperative posterior pelvic tilt with muscle strength, gait speed, hip function, and quality of life in older patients with hip osteoarthritis.

Methods: This cross-sectional study included 65 patients with hip osteoarthritis (75.0 ± 10.4 years; 83.1% female). Pelvic tilt angle was calculated from the frontal view of the hip joint in the standing position using radiographic images. The patients were divided into anterior (n=13) and posterior (n=52) groups based on a standard pelvic tilt angle of 27.9°. Clinical outcomes included preoperative isometric hip flexion and knee extension muscle strength, a five-time sit-to-stand test, gait speed, the Harris Hip Score (HHS), and the Japanese Orthopedic Association Hip-Disease Evaluation Questionnaire score. Multiple regression analysis was performed to clarify the relationships between the posterior pelvic tilt and clinical outcomes.

Results: The posterior pelvic tilt group had significantly lower isometric knee extension muscle strength (P=0.032), HHS (P=0.020), and gait speed (P=0.006) than the anterior pelvic tilt group. Multiple regression analysis showed that the posterior pelvic tilt was significantly associated with lower gait speed (β=-0.271, P=0.046) and HHS (β=-0.272, P=0.045).

Conclusions: Preoperative posterior pelvic tilt is associated with decreased gait speed and hip function in patients with hip osteoarthritis. Given that a posterior pelvic tilt may compromise stability during gait, restrict daily activities, and increase the risk of falls, physical therapy interventions targeting these factors are essential, even before total hip arthroplasty.

Background: Immune-mediated necrotizing myopathy (IMNM) is a type of autoimmune myositis. Anti-signal recognition particle (SRP) antibodies are highly specific to this disease.

Case: A 76-year-old woman presented with a 4-month history of acute progressive limb muscle weakness and dysphagia. Blood examination revealed significantly elevated creatine kinase (CK) (3472 U/L) and SRP antibody positivity. The patient was near-bedridden and required alternative nutrition. She was treated with oral prednisolone and intravenous immunoglobulin. Rehabilitation therapy was initiated after confirming the decline in CK levels. She started with exercises on the bed and exercise load was gradually increased. Videofluoroscopic swallowing study showed severely weakened pharyngeal contractions and aspiration. Her symptoms improved slowly. She started transferring to a wheelchair after 2 months, gait training using parallel bars after 4 months, and was administered a paste diet once a day after 5 months. Rituximab was administered as additional treatment. Thereafter, the patient started gait training with a walker. The oral paste diet was increased to three times per day after 7 months, and a regular diet was adopted after 9 months. After 11 months, she was discharged home after achieving modified near independence in all activities of daily living.

Discussion: : Low-intensity rehabilitation therapies were initiated under the supervision of therapists with regular follow-up and progression of exercise intensity based on multidisciplinary team discussions. If CK levels indicate that the disease has stabilized, early intervention in rehabilitation is important to prevent declining physical function.

Objectives: Trunk control involves multiple brain regions related to motor control systems. Therefore, patients with central nervous system (CNS) disorders frequently exhibit impaired trunk control, decreasing their activities of daily living (ADL). Although some therapeutic interventions for trunk impairments have been effective, their general effects on CNS disorders remain unclear. This review aimed to clarify this issue in patients with stroke, cerebellar ataxia, and Parkinson's disease (PD), representing trunk control impairment by lesions in the cortical and corticospinal systems, cerebellum, and basal ganglia, respectively.

Methods: Using online databases, we searched for randomized controlled trials that investigated the effects of therapeutic interventions for trunk impairments in patients with stroke, cerebellar ataxia, and PD, reported in English from 2013 to 2023.

Results: Overall, 50 articles were reviewed. Core-stability exercise (CSE), which activates the trunk muscles, specifically in the lumbar and pelvic areas, through postural adjustment tasks, is effective in patients with stroke, cerebellar ataxia, and PD. Weight-shifting exercise, unstable surface training, training with transcutaneous electrical stimulation, and noninvasive brain stimulation have been effective in patients following stroke. The combination of CSE with task-oriented training based on daily activities has been effective in patients with cerebellar ataxia. Perceptual training, repetitive trans-spinal magnetic stimulation, and aquatic training effectively improved alignment and balance function in patients with PD.

Conclusions: This review provides evidence-based strategies to improve trunk control, ADL, and quality of life for patients with trunk control impairments caused by CNS disorders.

Objectives: Physical function assessments in patients with spinal muscular atrophy (SMA) are important indicators for assessing the effectiveness of treatment and changes over time in rehabilitation therapy. However, few reports exist on this indicator. This study calculated the minimal clinically important difference (MCID) for assessing motor function in the upper and lower limbs of individuals with SMA to estimate the degree of change within a functional score that is considered clinically meaningful.

Methods: This cohort study relied on individual participant measurements. A distribution-based approach was used to calculate the MCID values, incorporating data from 26 patients with SMA for the 6-Minute Walk Test (6MWT), Hammersmith Functional Motor Scale Expanded (HFMSE), Revised Upper Limb Module (RULM), and grip and pinch strength.

Results: The standard errors of measurement for all patients were: 58.38 m for 6MWT; 4.71 points for HFMSE; 3.25 points for RULM; 10.93 N and 9.86 N for right and left grip strength, respectively; 5.42 N and 4.73 N for right and left Palmar pinch; and 11.96 N and 8.66 N for right and left Key pinch. Significant correlations were observed between the physical function assessments.

Conclusions: We calculated MCID values for physical function evaluations of SMA and, as a sub-analysis, determined the SMA type and ambulatory status. These findings are expected to contribute to future SMA treatment and rehabilitation and promote the selection of appropriate physical function assessments.

Objectives: Managing presenteeism among patients with chronic kidney disease (CKD) is important for balancing disease management and employment. This study aimed to investigate presenteeism, exercise self-efficacy (SE), and physical function indices in workers with CKD and to examine the factors that influence presenteeism in this patient group.

Methods: This cross-sectional study included 36 workers with stage 3-5 pre-dialysis CKD. Presenteeism was quantified using the Work Functioning Impairment Scale (WFun). Other factors to be evaluated included exercise SE, physical function, anemia, and renal function. Exercise SE was assessed using Oka's scale. Physical function was measured through grip strength, the 10-m walk test, the short physical performance battery, the 6-min walk test, and skeletal muscle mass index. The χ² and independent t-tests were used to compare patient characteristics between those with and without presenteeism. The WFun score was used as the dependent variable in the multiple regression analysis.

Results: Fourteen (38.9%) patients exhibited presenteeism. Comparisons between the two groups demonstrated significant differences in creatinine (Cr), exercise SE, and WFun and in the prevalences of CKD stage 3 and CKD stage 5 (P < 0.05). The WFun score was significantly correlated with Cr (r = 0.36) and exercise SE (r = -0.41) in a single correlation analysis. Multiple regression analysis showed that WFun was significantly related only to exercise SE (β = -0.34).

Conclusions: Presenteeism was significantly correlated with exercise SE in working patients with predialysis CKD. Our findings provide evidence to support the development of interventions for the prevention of presenteeism in predialysis CKD patients.

Background: Chronic limb-threatening ischemia is a condition of the lower extremities that requires therapeutic intervention. It is characterized by ischemia, tissue loss, neuropathy, infection, and risk of amputation.

Case: An 82-year-old woman with a history of bilateral total knee arthroplasty and rheumatoid arthritis underwent a left ankle arthroplasty. Wound healing was delayed, and chronic limb-threatening ischemia was diagnosed. When endovascular therapy was found ineffective, novel low-density lipoprotein apheresis was initiated. Pedicle flap and split-thickness skin grafting were performed to save the affected limb. However, skin necrosis progressed, and the patient underwent left lower limb amputation 17 days after ankle arthroplasty. The stump included a skin graft area, and the decision to fabricate a prosthetic leg was difficult because of the patient's advanced age, rheumatoid arthritis, and poor upper limb function. However, her cognitive function, muscle strength, and joint range of motion were good. No sign of wound infection was observed, and the patient was able to walk before surgery. Therefore, we decided to fabricate a prosthetic leg. Seventy-five days after amputation, the patient achieved independent walking using a cane and a silver-wheel walker.

Discussion: The benefit of novel low-density lipoprotein apheresis helped our decision to fabricate a prosthesis when uncertainty existed about the maturity of a recent amputation in an elderly patient with chronic limb-threatening ischemia. The patient successfully achieved a prosthetic gait under challenging conditions.

Objectives: This study aimed to determine the relationship between trunk muscle mass and progression of vertebral collapse in elderly patients treated conservatively for vertebral compression fractures.

Methods: This retrospective study was conducted in a convalescent ward and included 104 patients (36 men, 68 women; mean age: 83.8 years, minimum age: 65 years) with vertebral compression fractures. Using the semi-quantitative (SQ) method, patients were divided into two groups: the vertebral collapse group (SQ grade increased by at least 1 from admission to discharge) and the vertebral non-collapse group (no change in SQ grade from admission to discharge). The following data were retrieved from medical records: age at admission, sex, fracture site, Charlson Comorbidity Index, Appendicular Skeletal Muscle Mass Index, Trunk Muscle Mass Index (TMI), bone mineral content, Mini Nutritional Assessment-Short Form (MNA-SF), and Sagittal Vertical Axis (SVA) change. Intergroup and logistic regression analyses were performed to evaluate factors associated with the progression of vertebral collapse.

Results: Comparison between the vertebral collapse group and the non-collapse group showed significant difference in TMI (6.2±0.9 kg/m² vs. 5.5±0.6 kg/m², P<0.01), MNA-SF (9.4±1.8 vs. 8±2.1, P<0.01), and SVA change (0.3±0.2 cm vs. 0.7±0.3 cm, P<0.01). Logistic regression analysis showed that TMI was significantly associated with progression to vertebral collapse, regardless of sex [men, odds ratio (OR): 0.26, 95% confidence interval (CI): 0.06-0.73, P<0.05; women, OR: 0.32, 95% CI: 0.12-0.71, P<0.05].

Conclusions: Trunk muscle mass was associated with the progression of vertebral collapse in patients receiving conservative treatment for vertebral compression fractures.