Progress in rehabilitation medicine最新文献

Objectives: This study aimed to establish standardized categories of rehabilitation approaches in long-term care and evaluate their appropriateness through a Delphi survey with an expert panel.

Methods: We adopted the Delphi method using the RAND/UCLA Appropriateness Method. A panel of 15 multidisciplinary rehabilitation experts comprising physicians, physical therapists, occupational therapists, and speech-language-hearing therapists was established. We developed a questionnaire comprising 10 main categories and 58 subcategories based on the glossary review and cross-sectional survey. Panelists rated the categories on a Likert scale from 1 (extremely inappropriate) to 9 (extremely appropriate). The survey was repeated until all categories reached a consensus on "appropriate" and "agreement."

Results: All 15 panelists participated in three rounds of the Delphi survey. In the first round, although all categories were deemed "appropriate," one main category and six subcategories did not achieve "agreement." In the second round, all categories reached the status of "appropriate" and "agreement." However, some of the comments needed further consideration. After making minor revisions, all items ultimately reached the status of "appropriate" and "agreement."

Conclusions: This study achieved consensus on the terminology for standardized categories of rehabilitation approaches in long-term care. Future research should assess their reliability and validity using real-world clinical data.

Objectives: Reactive stepping is necessary to prevent falls when a person slips or trips while walking, particularly in outdoor activities. Individuals with stroke usually exhibit reactive balance impairment. Trunk training is effective for improving balance and mobility after stroke; however, its effect on reactive stepping remains unknown. This study aimed to examine the effects of trunk training on reactive stepping in community-dwelling individuals after stroke.

Methods: This study was conducted using an A-B-A single-subject design. Two community-dwelling women with chronic stroke (79 years old, 9 years post-stroke and 83 years old, 17 years post-stroke) participated in this study. The baseline (A) and intervention (B) phases lasted for 6 weeks. Specifically, the participants did not receive any intervention in phase A, whereas they performed home-based trunk training in phase B. Outcome measures included the foot-off time, maximum trunk rotation angular velocity, number of steps during forward reactive stepping following perturbation, and Trunk Impairment Scale (TIS) score.

Results: Decreased trunk rotation and step count corresponding to improved TIS score were observed in one case after the intervention. However, trunk control did not improve in the other case after the intervention, and reactive stepping kinematics remained unchanged.

Conclusions: Enhancing trunk control may improve reactive stepping in individuals with chronic stroke; nevertheless, further evidence is required.

Objectives: This study aimed to investigate the sedentary time of patients with hip fractures, including those with cognitive decline, in the early postoperative period.

Methods: Participants were patients with hip fractures treated at our hospital. A triaxial accelerometer was attached to the contralateral hip, and activity was recorded for three postoperative days (4320 min).

Results: Thirty patients (mean age: 86.5 years; female, n=23) were included in the analysis. The mean activity times were: sedentary time, 1364.0 ± 59.9 min/day (mean ± standard deviation); light-intensity physical activity time, 71.9 ± 57.8 min/day; and moderate-to-vigorous-intensity physical activity time, 4.1 ± 3.2 min/day. Sedentary time was linked to the scores on the Mini-Mental State Examination-Japan.

Conclusions: : Early postoperative patients with hip fractures have long sedentary times and less time for moderate-to-vigorous-intensity physical activity. Patients with hip fractures with cognitive decline have significantly longer sedentary time than those without cognitive decline.

Objectives: Predicting postoperative clinical outcomes from preoperative physical factors of patients undergoing total knee arthroplasty (TKA) would be useful. This study aimed to investigate the association between preoperative physical factors and postoperative outcomes.

Methods: This study included 119 patients. The preoperative physical factors and 1-year postoperative clinical outcomes were collected and assessed. Physical factors included age, sex, body mass index, skeletal mass index, knee range of motion, 5-m walk time, and Timed Up-and-Go (TUG) test result. Postoperative outcomes were evaluated using a sum of symptoms, pain, activities of daily living, and quality of life subscales of the Knee injury Osteoarthritis Outcome Score (KOOS-4), and the Oxford Knee Score (OKS). Correlation between physical factors and postoperative outcomes was analyzed by Spearman's rank correlation coefficient, and the association between physical factors and KOOS-4 or OKS was analyzed using multiple regression analysis. Receiver operating characteristic analysis was performed to calculate the cut-off value for the TUG test time associated with minimum postoperative OKS of 40.

Results: Among the preoperative physical factors, TUG test time showed significant correlation with OKS (ρ=-0.267), but none correlated with KOOS-4. Multiple regression analysis showed a significant association between TUG test time and OKS (95% confidence interval: -0.590 to -0.163) but not with KOOS-4. The cut-off value of preoperative TUG test time associated with minimum postoperative OKS of 40 was 12.96 s.

Conclusions: Among the preoperative physical factors of patients undergoing TKA, the TUG test time was associated with clinical outcomes at 1 year after surgery.

Objectives: This study aimed to investigate tongue pressure in patients undergoing maintenance hemodialysis (MHD) and identify factors associated with tongue pressure, such as nutritional status and sarcopenia components.

Methods: This cross-sectional study included 80 outpatients undergoing MHD at our hospital between February and August 2024. Tongue pressure was measured using a tongue pressure measuring device. Patients were divided into groups of low tongue pressure (<30 kPa) and high tongue pressure (≥30 kPa). The geriatric nutritional risk index (GNRI) and the nutritional risk index for Japanese hemodialysis patients (NRI-JH) were used as nutritional indicators. To identify factors strongly associated with tongue pressure in MHD, a multiple regression analysis was performed, with tongue pressure as the dependent variable.

Results: The median age of the participants was 81.0 years. The mean tongue pressure was 29.0 kPa, and 58.8% of the patients had tongue pressure less than 30 kPa. Tongue pressure was significantly lower in the oldest age group (≥85 years) than in the younger groups (≤64 years and 65-74 years). Significant correlations were noted between tongue pressure and age, serum albumin, skeletal muscle mass index, phase angle, and handgrip strength. In the multivariate analysis, age, GNRI, and handgrip strength were independent predictors of tongue pressure.

Conclusions: This study revealed that age, handgrip strength, and GNRI were independently associated with tongue pressure in patients undergoing MHD. These factors may be used as indicators of tongue pressure in patients undergoing MHD.

Background: Vacuum swallowing improves pharyngeal bolus passage by creating negative pressure in the esophagus. In this study, we aimed to (1) assess whether patients with dysphagia and lateral medullary syndrome (LMS) could reproduce vacuum swallowing and (2) evaluate its safety using a swallowing and breathing monitoring system (SBMS).

Cases: Two patients with dysphagia and LMS were instructed to perform vacuum swallowing. Videofluoroscopic examination of swallowing (VF) was performed. High-resolution manometry parameters, including the esophageal minimum pressure (Pmin) and maximum pressure (Pmax) in the lower esophageal sphincter, were compared to the values obtained during non-vacuum swallowing. The coordination between vacuum swallowing and breathing was evaluated using an SBMS. VF showed that pharyngeal residues in the pyriform sinus were sucked into the esophagus during vacuum swallowing. No aspiration was observed. During vacuum swallowing, Pmin was significantly lower, and Pmax was significantly higher than the respective measurements during non-vacuum swallowing. In the SBMS study, vacuum swallowing followed an expiratory swallowing pattern; this pattern was observed in three out of five swallowing episodes in Patient 1 and in all swallowing episodes in Patient 2. Deglutition apnea was observed during vacuum swallowing.

Discussion: Vacuum swallowing may be a feasible method for improving pharyngeal bolus passage. Patients could safely master vacuum swallowing. Instructions to exhale before and after vacuum swallowing are recommended to prevent aspiration.

Objectives: The purpose of this study was to determine which components of screening tests are important for assessing locomotive dysfunction during locomotive health checkups and best predict falls in a prospective cohort study.

Methods: Four hundred and sixty-eight residents were assessed for locomotive syndrome, frailty, knee and back pain, bone mass, muscle mass, grip strength, gait speed, gait variability, and kyphosis at a baseline locomotive health checkup. Residents were followed up after 1 year and surveyed about their incidence of falls.

Results: A total of 379 residents were analyzed in the study. Principal component analysis was used to divide components using all screening tests for locomotive dysfunction. The primary variable making up the first principal component was "mobility function," the second was "muscle function," and the third was related to "spinal alignment." The tests that showed the highest principal component loadings in each component were the five-question Geriatric Locomotive Function Scale, muscle mass index, and kyphosis index. Binary regression analyses, adjusted for age and past fall history, showed that the five-question Geriatric Locomotive Function Scale was independently related with the incidence of falling (odds ratio=2.04; 95% confidence interval: 1.04-3.99).

Conclusions: We propose that during a locomotive health checkup, mobility function, muscle function, and spinal alignment are important components for the assessment of locomotive dysfunction. Notably, the five-question Geriatric Locomotive Function Scale is a simple and convenient screening test that can predict the future incidence falls.

Objectives: This study investigated the relationship between the three phases of hyoid bone movement and pharyngeal residue using the videofluoroscopic swallowing study (VFSS).

Methods: We retrospectively analyzed the data from 66 patients who underwent VFSS between April 2019 and December 2019. Hyoid bone movement was classified into three phases: upward, forward, and downward. We measured the velocity and distance of hyoid bone movement in each phase, as well as the pharyngeal residue after swallowing. The correlation between hyoid bone movement and the amount of pharyngeal residue was analyzed using Spearman's rank correlation coefficient. A receiver operating characteristic (ROC) analysis was performed to evaluate the presence of pyriform sinus residue.

Results: Hyoid bone velocity and distance during the forward phase correlated with the amount of pyriform sinus residue (velocity: r=0.311, P=0.011; distance: r=0.255, P=0.0389). ROC analysis revealed that the cutoff value for hyoid bone velocity during the forward phase was 26.1 mm/s (0.846 sensitivity, 0.604 specificity) with an area under the curve of 0.717.

Conclusions: The velocity and distance of the hyoid bone during the forward phase were significantly related to the amount of pyriform sinus residue. In VFSS assessment, it is important to classify hyoid bone movement into three phases-upward, forward, and downward-and to calculate its velocity and distance.

Objectives: : This study aimed to investigate whether lower limb phase angle (LL-PA) at admission predicts functional outcomes in patients undergoing rehabilitation.

Methods: : In this retrospective study, we measured the LL-PA of 256 patients (mean age 74.09±12.86 years) admitted to a convalescent rehabilitation ward upon arrival. The primary outcomes at discharge were motor Functional Independence Measure (FIM) scores and walking independence. The secondary outcomes included a 10-m walking speed and Timed Up-and-Go test result.

Results: : The LL-PA independently predicted discharge motor FIM scores (β=0.323, P <0.001) and walking independence (odds ratio=3.302, 95% confidence interval: 1.714-6.360). The sex-specific cut-off value for predicting walking independence was 3.050° for men (sensitivity, 0.804; specificity, 0.853) and 2.650° for women (sensitivity, 0.769; specificity, 0.812).

Conclusions: : LL-PA at admission is a significant predictor of functional outcomes in patients undergoing rehabilitation, with potential utility in early prognostic assessments.

Objectives: This study aimed to determine the relationship between preoperative fatty infiltration of the lower extremity muscles and walking speed at 2 weeks after total hip arthroplasty (THA).

Methods: This was a single-institution retrospective cohort study. Participants in this study were patients undergoing primary THA. Fatty infiltration in each muscle (bilateral psoas major, gluteus maximus, gluteus medius, gluteus minimus, quadriceps, and triceps surae) was assessed using non-contrast X-ray computed tomography images obtained during a detailed preoperative examination. The outcome of this study was the normal comfortable walking speed at 2 weeks after THA. Decreased walking speed was defined as less than 0.8 m/s (non-decreased group, coded 0; decreased group, coded 1). Multivariate logistic regression analysis was used to analyze the relationship between fatty infiltration of each skeletal muscle and walking speed.

Results: A total of 168 participants were included in the analysis. On the operative side, the analysis identified fatty infiltration of the gluteus medius (odds ratio, 0.95; 95% confidence interval, 0.91-0.99) as a determinant of decreased walking speed after THA. On the nonoperative side, the analysis identified fatty infiltration of the quadriceps (odds ratio, 0.91; 95% confidence interval, 0.83-0.99) as a determinant of decreased walking speed after THA.

Conclusions: In patients undergoing THA, increased fatty infiltration of the gluteus medius on the operative side and the quadriceps on the nonoperative side were associated with decreased walking speed at 2 weeks postoperatively.