Progress in rehabilitation medicine最新文献

Objectives: Occupational therapy (OT) studies of delirium have attempted to test the effectiveness of interventions to reduce the incidence and duration of delirium. Although some cognitive stimulation appears to be important, appropriate approaches to delirium characterized by cognitive dysfunction remain unclear. This study aimed to determine the incidence and duration of delirium in postoperative cardiovascular surgery patients at the initial time of OT to identify characteristics of patient demographics and cognitive function according to the presence or absence of delirium.

Methods: This retrospective study included patients judged to have delirium by the Confusion Assessment Method at the first postoperative OT session (after extubation) in the intensive care unit (ICU). Patient data included age, sex, days until extubation, type of hospitalization, outcome at discharge, Sequential Organ Failure Assessment score and Glasgow Coma Scale (GCS) score at the first OT session, presence or absence of delirium, duration of delirium, and Mini-Mental State Examination-Japanese (MMSE-J) score. The Mann-Whitney U test was used to test differences between the delirium and the non-delirium groups, and a binomial generalized linear model (logistic regression model) with Bayesian estimation was adopted to investigate factors characterizing delirium.

Results: A Bayesian logistic regression model with delirium as the dependent variable and "days until extubation" and "spatial orientation" as adjustment variables suggested that "spatial orientation" was a significant factor in delirium.

Conclusions: For ICU patients with delirium, the provision of information tailored toward spatial orientation during the first day of OT may improve delirium.

Objectives: We aimed to conduct a preliminary evaluation of the effectiveness of integrating whole-body vibration training (WBVT) into conventional closed kinetic chain (CKC) exercises as an intervention strategy for early knee osteoarthritis (KOA).

Methods: : This non-randomized comparative study conducted at an orthopedic clinic involved 53 patients (with Kellgren-Lawrence grades 1-2); 37 patients received only physical therapy (CKC group), and 16 patients received both physical therapy and WBVT (WBVT group). The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscale score for pain, and the secondary outcomes were the WOMAC subscale score for physical function and muscle-strength assessments [isometric knee extension strength and the 30-second chair-stand test (CS-30) score]. Propensity score matching (PSM) was used to adjust for bias between the control and intervention groups.

Results: : After PSM adjustment, 13 patients were selected from each group. The WBVT group showed a significant improvement in the WOMAC pain score (d=1.16, P=0.007) and a significant increase in the CS-30 score (d=0.81, P=0.049). However, for the WOMAC physical function score, the between-group difference remained statistically insignificant (d=0.59, P=0.146).

Conclusions: : WBVT may be effective in reducing the pain of early KOA. WBVT is a non-invasive and convenient method, underscoring its potential as a novel therapeutic option.

Objectives: : Despite the frequent occurrence of visual cognitive impairment after anoxic encephalopathy, only a few studies have analyzed gaze movements following encephalopathy. This study determined the visual cognitive characteristics of patients with anoxic encephalopathy using an eye-tracking system.

Methods: : This study included ten patients with anoxic encephalopathy and ten age/sex-matched controls. Factors for anoxic encephalopathy onset and brain imaging findings were extracted from medical records. An eye-tracking system was used to track eye movements during three visual search tasks (pop-out, serial search, and saliency) in patient and healthy control groups. The average target search time, number of saccades, and number of fixations to salient stimuli were compared.

Results: : Stagnant blood flow, observed in six of ten patients, was the most common cause of disease onset, four of whom exhibited hypoperfusion in bilateral occipital or parietal lobes on single-photon emission computed tomography. The patient group required longer search times during all visual search tasks and a higher number of saccades during pop-out and serial search tasks. However, no significant difference was observed between the two groups for the number of fixations to salient stimuli during the saliency task.

Conclusions: : Following anoxic encephalopathy, bottom-up (pop-out task) and top-down (serial search task) gaze control were considered impaired because of extensive parieto-occipital lobe damage after blood flow stagnation. Patients exhibited reduced top-down function for finding targets (serial search task) but relatively retain inhibitory function for salient stimuli (saliency task). Gaze analysis can be used to reveal the clinical characteristics of anoxic encephalopathy.

Objectives: Lumbar spondylolysis is a common condition; nonetheless, its cause in patients with spastic cerebral palsy (CP) remains unknown. Furthermore, examination of children with CP may not accurately capture complaints, thus causing diseases to be overlooked. Understanding the clinical features and gait patterns of lumbar spondylolysis in CP can aid in diagnosis. This study aimed to identify the clinical features and specific gait patterns of lumbar spondylolysis in ambulatory children with CP.

Methods: Seventy-three children with CP were divided into two groups according to the presence or absence of lumbar spondylolysis on X-ray and magnetic resonance imaging. Three-dimensional gait analysis (3DGA) was performed to evaluate the kinematic data of the lower limbs.

Results: Eight participants (11.4%) had lumbar spondylolysis primarily affecting the L5 vertebra. The lumbar spondylolysis group had a higher body weight and Body Mass Index, along with a smaller left popliteal angle on the spastic side. In 3DGA, detailed kinematic data indicated significant group differences in the mean angles of hip internal rotation (39.6° vs. 20.2°) during an entire gait cycle. The gait profile score was 19.7° in the lumbar spondylolysis group and 14.9° in the spinal uninvolved group; the difference in gait profile score between the two groups showed a minimal clinically important difference of 2.75.

Conclusions: The overall gait profile score revealed that the gait of the lumbar spondylolysis group was deteriorated. Excessive internal rotation of the hip during gait might be a contributing factor to lumbar spondylolysis in children with CP.

Objectives: This study aimed to evaluate the effects of locomotion training on bone mineral density (BMD) and the factors associated with increased BMD in patients with rheumatoid arthritis (RA).

Methods: We enrolled 85 patients with RA who underwent locomotion training for 6 months after receiving instructions from a physical therapist. We evaluated the BMD of the lumbar spine, total hip, and femoral neck 1 year before baseline (the start of locomotion training) and 1 year after baseline.

Results: The change in BMD from 1 year before baseline (non-exercise period) and 1 year after baseline (exercise period) were 0.1 ± 3.1% and 1.6 ± 3.7% (P=0.007) for the lumbar spine, -0.2 ± 2.4% and 1.0 ± 2.4% (P=0.005) for the total hip, and -0.6 ± 3.9% and 1.8 ± 3.5% (P<0.001) for the femoral neck, respectively. The Health Assessment Questionnaire Disability Index score at baseline was associated with increased BMD at the femoral neck. No factor was associated with increased BMD in the lumbar spine or total hip.

Conclusions: Locomotion training increased the BMD of the lumbar spine, total hip, and femoral neck during the exercise period compared with that during the non-exercise period. The current treatment for RA and osteoporosis accompanied by optional therapy with locomotion training might be effective in increasing BMD in patients with RA.

Objectives: The prevalence of peripheral arterial disease (PAD) is on the rise, with endovascular treatment being a widely accepted surgical intervention. Patients with PAD often experience reduced activities of daily living (ADL). Therefore, we conducted a retrospective cohort study to investigate the impact of early rehabilitation after endovascular treatment in patients with PAD.

Methods: Using data from the JMDC hospital database, the study included 529 patients who were hospitalized for PAD and underwent endovascular treatment. Patients were classified into two independent variables: early rehabilitation group (rehabilitation started within 2 days postoperatively) and control group (rehabilitation started within 3-7 days postoperatively). The outcome measures were the occurrence of hospital-associated disability (HAD) and duration of hospitalization.

Results: Unadjusted data showed that the early rehabilitation group (n=469) had fewer HAD events (8.5% vs. 23.3%, P <0.001) and a shorter mean hospitalization duration (4.4 vs. 18.9 days, P <0.001) than the control group (n=60). The difference remained significant after adjustment by propensity score analysis.

Conclusions: In patients with PAD, early rehabilitation after endovascular treatment may be beneficial in preventing the development of HAD and reducing the duration of hospitalization.

Objectives: Evidence is scarce regarding the association between hyponatremia and functional outcomes among older hospitalized patients. We aimed to evaluate the associations between baseline hyponatremia and improvement in activities of daily living (ADL) and muscle health in hospitalized post-stroke patients.

Methods: This retrospective cohort study included hospitalized post-stroke patients. Serum sodium concentrations were extracted from medical records based on blood tests performed within 24 h of admission, with hyponatremia defined as a serum sodium concentration below135 mEq/L. Primary outcome was the discharge ADL as assessed by the motor domain of the Functional Independence Measure (FIM-motor) and its corresponding gain during hospitalization. Other outcomes encompassed the discharge scores for skeletal muscle mass (SMI) and handgrip strength (HGS). Multivariate linear regression analyses were used to determine the association between hyponatremia and outcomes of interest, adjusted for potential confounders.

Results: Data from 955 patients (mean age 73.2 years; 53.6% men) were analyzed. The median baseline blood sodium level was 139 [interquartile range: 137, 141] mEq/L, and 84 patients (8.8%) exhibited hyponatremia. After full adjustment for confounders, baseline hyponatremia was significantly and negatively associated with FIM-motor at discharge (β=-0.036, P=0.033) and its gain during hospital stay (β=-0.051, P=0.033). Baseline hyponatremia exhibited an independent and negative association with discharge HGS (β=-0.031, P=0.027), whereas no significant association was found between baseline hyponatremia and discharge SMI (β=-0.015, P=0.244).

Conclusions: Baseline hyponatremia demonstrated a correlation with compromised ADL and muscle health in individuals undergoing rehabilitation after stroke.

Objectives: : This study aimed to describe the classification of goal domains, goal traits, and the goal-setting process as revealed by previous life goal-setting practices of healthcare professionals collaborating with cancer survivors.

Methods: : The design was a scoping review. The MEDLINE, Academic Search Premier, and CINAHL databases were searched and mapped for papers with descriptions of goal domains, goal traits, and the goal-setting process. Goal domains were classified as life goals that were health-related, psychological, social, achievement-related, and leisure goals. Goal traits were classified based on specific, measurable, achievable, relevant, and timed (SMART) criteria. The goal-setting process was classified based on the frameworks of goal-setting phases (preparation, formulation, follow-up) and their components.

Results: : In total, 229 papers were identified, and 24 papers were included in the final analysis. All papers included health-related goals, followed by psychological and social goals. All goal domains were included in 41.7% of the papers. Relevant goals were the most common and timed goals were the least common. All papers included either of the components that comprise the preparation or formulation phases. We found that 12.5% of papers did not include any of the three components of the follow-up phase.

Conclusions: : The life goals collaboratively set between cancer survivors and healthcare professionals were characterized by the following: psychological and social goal domains, numerous goal domains, more relevant goals and fewer timed goals, low proportion of patient education in the preparation phase, and high proportion of evaluation of progress or achievement in the follow-up phase.

Objectives: Blood flow restriction training (BFRT) is useful for improving muscle strength. However, it involves a long training time and is unsuitable for vigorous exercise. Muscle blood flow restriction training (MBFRT), which uses multiple parallel pneumatic cuffs (MPCs) to compress large areas of the extremities and restrict blood flow, was subsequently developed to address these issues. This study compared the effects of MBFRT with normal training (NT).

Methods: Ten healthy adults underwent low-intensity MBFRT. MPC pressure was increased to 200 mmHg just before training. The exercise was a bodyweight half-squat. Three sets of 30 squats were performed. Two weeks later, the participants underwent NT with the same exercise. Blood lactate levels were measured before the start of training and at 1 and 5 min after training. The Borg index was also measured at the end of the training.

Results: The blood lactate level was elevated at 1 min after MBFRT and NT. The elevated blood lactate level was maintained at 5 min after MBFRT, whereas the lactate level was significantly decreased at 5 min after NT. The Borg index at the end of the training was significantly higher in MBFRT than in NT.

Conclusions: Lactic acid accumulates in the muscles during low-intensity MBFRT, thereby initiating type II fiber activity.