Progress in rehabilitation medicine最新文献

Objectives: Improving ankle joint contracture is important because stiffness in ankle dorsiflexion can lead to pain, especially when weight-bearing during walking, which tends to concentrate on the forefoot. We hypothesized that the contraction of the gastrocnemius muscle in ankle dorsiflexion would increase the Achilles tendon length and improve the dorsiflexion range of motion. We evaluated the effects of walking with and without a gradient on Achilles tendon length.

Methods: This study included 23 men who underwent ultrasound imaging to measure the Achilles tendon length while they stood on an inclined table adjusted according to the dorsiflexion angle. Treadmill walking was performed for 10 min with a 10° incline (gradient condition) or without gradient (level condition). The measurements were compared using a paired t-test.

Results: In the gradient condition, the range of motion for ankle dorsiflexion was significantly increased after the intervention. In the gradient condition, the Achilles tendon length while standing on an inclined surface was significantly increased after the intervention.

Conclusions: Walking under gradient conditions led to the extension of the Achilles tendon in the ankle dorsiflexion position. This was accompanied by contraction of the gastrocnemius muscle, resulting in lengthening of the Achilles tendon. This finding suggests that such interventions may have clinical applications.

Objectives: The purpose of this study was to examine the association between baseline dysphagia and the improvement of activities of daily living performance and cognitive level among inpatients after stroke.

Methods: This was a retrospective cohort study of patients undergoing convalescent rehabilitation after stroke. Dysphagia was assessed using the Food Intake LEVEL Scale. Outcomes were the motor and cognitive scores of the Functional Independence Measure (FIM) at discharge. Multiple regression analysis was performed to examine the association between dysphagia at admission and these outcomes.

Results: There were 499 participants with a median age of 74 years. A multiple regression analysis was carried out after adjusting for potential confounders including age and sex. Dysphagia at admission was independently and negatively associated with motor (β=-0.157, P<0.001) and cognitive (β=-0.066, P=0.041) FIM scores at discharge.

Conclusions: Baseline dysphagia in patients after stroke was negatively associated with improvement in performance of activities of daily living and cognitive level.

Objectives: This study aimed to clarify whether phase angle can be a predictor of walking independence in older women with vertebral compression fractures (VCFs) and to determine a clinically usable cutoff value.

Methods: We retrospectively assessed data of older women (n=59; median age, 83.0 years) with VCFs. Propensity score-matching and logistic regression were performed to examine the association between phase angle at admission and walking independence at discharge. The cutoff value for the phase angle at admission for predicting walking independence was calculated based on the receiver operating characteristic curve.

Results: Thirty-one patients (52.5%) could walk independently at discharge. Thirty patients were extracted from the independent and non-independent groups according to the propensity score. After propensity score matching, there was no significant difference between the groups for age, medical history, knee extension strength, skeletal muscle mass index, mini nutritional assessment-short form score, or revised Hasegawa's dementia scale score. However, the phase angle of the independent group was significantly higher than that of the non-independent group (P<0.05). Logistic regression revealed that phase angle at admission was significantly associated with walking independence at discharge (odds ratio, 12.2; 95% confidence interval, 2.1-72.0; P<0.01). The area under the receiver operating characteristic curve was 0.868, and the calculated phase angle cutoff value was 3.55°.

Conclusions: This study revealed that the phase angle can predict walking independence in older women with VCFs. The cutoff values for women calculated in this study can be used as a simple and objective predictive index of walking independence.

Objectives: It is unclear whether improvements in knee pain or physical function lead to improvements in activities of daily living (ADL) and quality of life (QOL) in patients with moderate to severe knee osteoarthritis (KOA). This study aimed to investigate whether improvements in knee pain and physical function, achieved through exercise therapy, lead to improvements in ADL and QOL in patients with moderate to severe KOA.

Methods: This case-control study included 18 patients with KOA. We evaluated knee range of motion, knee extension muscle strength (KEM), gait speed, knee pain, Knee Injury and Osteoarthritis Outcome Score (KOOS)-ADL, and KOOS-QOL at the first visit and after 3 months of exercise therapy. Patients were classified into the ADL and QOL improvement or no-improvement groups. Statistical analysis used split factorial analysis of variance with time and group as the main effects. When interactions were observed, post-hoc analysis was performed with two-sample t-tests.

Results: For ADL improvement, the improvements in KEM of the affected side and gait speed were statistically significant. At 3 months, the gait speed of the improvement group was significantly higher than that of the no-improvement group. For QOL improvement, there was no significant interaction for any of the factors evaluated.

Conclusions: No factor showed significant contribution to improved QOL in patients with moderate to severe KOA. However, increased gait speed may improve ADL and contribute to the development of efficient rehabilitation programs for patients with moderate to severe KOA.

Objectives: To evaluate caregivers' fear of post-fracture patients falling, we previously developed the Caregivers' Fear of Falling Index (CFFI). In this study, we investigated the relationship between patient performance in activities of daily living (ADLs) and CFFI.

Methods: We surveyed 55 patients receiving home-visit rehabilitation after fall-related fracture and their primary caregivers. Participants (patient and caregiver pair) were divided into two groups based on patient performance in basic ADLs (BADLs) and instrumental ADLs (IADLs). ROC analysis was conducted to assess the usefulness of CFFI and Falls Efficacy Scale-International (FES-I) in determining declines in performance in BADLs and IADLs. Multivariate logistic regression analysis was performed to examine the association between CFFI and declining performance in BADLs and IADLs.

Results: ROC analysis showed that CFFI exhibited a higher accuracy than FES-I (AUC: 0.73 in BADLs, 0.77 in IADLs) as an indicator of reduced ADL performance. Multivariate logistic analysis adjusted for age, sex, and physical function showed that CFFI was associated with a decline in patients' performance in IADLs (odds ratio, 0.92; 95% confidence interval, 0.85-0.99).

Conclusions: Caregivers' fear of post-fracture patients falling was associated with a decline in patients' performance in IADLs. These findings may serve as a guide for supporting caregivers of post-fracture patients.

Objectives: Poor adherence to home exercise programs (HEPs) is a significant barrier to continuity of care and eventual outcomes, thus requiring innovative mitigating approaches. This study aimed to develop and test the feasibility of a remote support application (RSA) designed to encourage adherence to HEPs.

Methods: Using standard computer programing, an RSA with administrator and user interfaces was developed for mobile phone or tablet. Consenting patients receiving physiotherapy for musculoskeletal conditions (n=19) were randomly assigned into the experimental group (n=10) or the control group (n=9). The experimental group received their customized HEP reminders via the RSA, whereas the control group used conventional paper handouts for HEPs. Adherence to HEPs was assessed over 4 weeks. The feasibility of the RSA was assessed using the Mobile Application Rating Scale and System Usability Scale (SUS) questionnaires. Data were summarized using descriptive and inferential statistics.

Results: The adherence rate of patients in experimental group was significantly higher than that of patients in the control group after 2 weeks [median diff.=-6.0, 95% confidence interval (CI): -8.0 to -5.0; U=5.00; Z=-3.304; P=0.001; r=0.75] and 4 weeks (median diff.=-7.0, 95% CI: -8.0 to -5.0; U=0; Z=-3.695; P<0.001; r=0.84) of intervention. The RSA had a mean SUS score of 82.53±9.04 (out of 100) and a mean app quality rating score of 75.95±4.98 (out of 95).

Conclusions: The use of an RSA to improve adherence to HEPs is feasible for patients with musculoskeletal conditions.

Background: Functional neurological disorder (FND) is a clinical syndrome characterized by abnormal involuntary movements and specific clinical features that are incongruent with known neurologic diseases. Clinical information is lacking on outpatient rehabilitation for patients with FND.

Case: A 28-year-old woman visited our hospital for gait disturbance. She had experienced an occupational accident 20 months earlier. Her injuries were relatively minor, but subsequently, she was unable to move her ankle voluntarily and began receiving workers' compensation benefits. The patient had persistent gait disturbance and preferred to walk with an ankle-foot orthosis. However, at her first visit, her ankle could move while walking without her ankle brace. Nerve conduction studies showed no abnormalities. Shortly after receiving an explanation regarding the diagnosis of FND, the patient was able to move her ankle voluntarily; however, her gait disturbance was partially persistent. After outpatient rehabilitation, she was able to walk in different types of footwear without an ankle brace. Satisfied with the result, she agreed to end rehabilitation and her access to workers' compensation.

Discussion: After diagnosis and rehabilitation for FND following an occupational injury, our patient was eventually able to walk without an ankle brace. In this case, providing the patient with information regarding a diagnosis of FND and obtaining her informed consent for subsequent rehabilitation may have helped to improve the symptoms of FND.