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Purpose：This study aimed to clarify the conditions necessary for patients with a proximal femoral fracture in the convalescent ward to return home using a decision tree analysis. This study included 181 patients who were discharged from the convalescent ward between January 2018 and June 2022.Methods：Patients divided into two groups：home vs. facility according to the outcome. Basic characteristics, FIM at admission, and MMSE at admission were compared using the unpaired t-test, χ2 test, and Mann-Whitney U test, and a decision tree analysis was performed.Results：The decision tree analysis based on functional independence measures (FIM) on admission and toileting activities, etc. found that discharge was difficult (return home rate：9.7％-28.6％) when the problem-solving aspect of the FIM on admission was less than 4 points.Conclusion：When discharging patients with a proximal femoral fracture from the hospital, it is important to consider a combination of problem-solving in the admission FIM and toileting activities.
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Objective：Home visits conducted in the early rehabilitation phase through an online connection between the patient's home and the hospital are termed online home visits. They enable real-time sharing of home information and patient and family wishes between the family and the therapists participating from home with healthcare professionals at the hospital. This study aimed to evaluate the usefulness of online home visits.Methods：We enrolled 75 patients with musculoskeletal or cerebrovascular disease discharged from a convalescent rehabilitation ward and classified them as those who received online home visits (online group, n＝25) and in-person home visits (non-online group, n＝50) within 7 days of hospitalization. Functional independence measure (FIM) efficiency was compared between the groups. Rehabilitation treatment changes made by therapists after virtual home visits were surveyed.Results：In patients with musculoskeletal diseases, FIM efficiency was significantly higher, and the length of hospital stay was significantly shorter in the online group (n＝14, 1.0 ± 0.5 points/day) than in the non-online group (n＝26, 0.7 ± 0.5 points/day) (p＜0.05). Many therapists who participated in virtual home visits modified their rehabilitation therapy afterwards by recreating the home environment in the rehabilitation room and implementing rehabilitation therapy for home activities.Conclusion：Virtual home visits can facilitate rehabilitation therapy more appropriate to the home environment because they provide visual information about the home. The present findings indicate the contribution of online home visits to FIM efficiency improvement and home discharge preparation.
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Objective：Home visits conducted in the early rehabilitation phase through an online connection between the patient's home and the hospital are termed online home visits. They enable real-time sharing of home information and patient and family wishes between the family and the therapists participating from home with healthcare professionals at the hospital. This study aimed to evaluate the usefulness of online home visits.Methods：We enrolled 75 patients with musculoskeletal or cerebrovascular disease discharged from a convalescent rehabilitation ward and classified them as those who received online home visits (online group, n＝25) and in-person home visits (non-online group, n＝50) within 7 days of hospitalization. Functional independence measure (FIM) efficiency was compared between the groups. Rehabilitation treatment changes made by therapists after virtual home visits were surveyed.Results：In patients with musculoskeletal diseases, FIM efficiency was significantly higher, and the length of hospital stay was significantly shorter in the online group (n＝14, 1.0 ± 0.5 points/day) than in the non-online group (n＝26, 0.7 ± 0.5 points/day) (p＜0.05). Many therapists who participated in virtual home visits modified their rehabilitation therapy afterwards by recreating the home environment in the rehabilitation room and implementing rehabilitation therapy for home activities.Conclusion：Virtual home visits can facilitate rehabilitation therapy more appropriate to the home environment because they provide visual information about the home. The present findings indicate the contribution of online home visits to FIM efficiency improvement and home discharge preparation.
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Objective：This study aimed to clarify the objective criteria for assessing walking independence using cane in patients with stroke in the convalescent rehabilitation ward.Methods：Participants were in-patients with hemiparetic stroke who could walk with a cane, and they were categorized into the independent (ID) and supervised (SV) walking groups. Stroke impairment assessment set-motor for lower extremity (SIAS-LE), trunk control test (TCT), Berg balance scale (BBS), 10-m walking speed (m/s), and functional independence measure-cognitive (FIM-C) were assessed. ID and SV used the scores at the time of independent walking and at the discharge time, respectively. Additionally, falls after independence were investigated. Statistical analysis was performed using univariate analysis and decision tree analysis.Results：In total, 148 patients (ID：n=101, 68±13 years, SV：n=47, 79±12) were included. Significant differences were observed in walking speed, TCT score, BBS score, and FIM-C score between the groups. Moreover, walking speed, FIM-C score, and BBS score were selected in the decision tree analysis in this order and divided into five groups namely：1) walking speed ≥ 0.42 and FIM-C ≥ 22 (percentage of independent patients 97％/percentage of fallers 5％), 2.) walking speed ≥ 0.42, FIM-C＜22, and BBS ≥ 50 (100％/0％), 3.) walking speed ≥ 0.42, FIM-C＜22, and BBS＜50 (52％/8％), 4.) walking speed＜0.42, and BBS ≥ 28 (49％/28％), and 5) walking speed＜0.42 and BBS＜28 (0％/0％). The overall percentage of fallers was 8.9％, with group 4 having the highest number of fallers.Conclusion：Walking speed, FIM-C, and BBS, in decreasing order, were involved in walking independence. Patients with low walking speed were more likely to fall. Therefore, careful assessment of walking independence is particularly required.
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In Japan, as a Social Security Reform measure against workforce decrease by 2040, robotic devices for nursing care and medication intake support have been utilised. However, evaluation reports about the robots and studies about their evaluation by patients are lacking. Therefore, we studied medication status with robotic assistance as well as patients’ evaluation of usability of robotic assistance. Participants were twelve patients whose median age was 73.0 (min 39.0-max 82.0), the median of number of drugs of a maximum intake day, which means the one of the week in which drugs are taken most, was 10.0 (min 4.0-max 17.0), and the median of maximum number of times to take drugs per day was 3.0 (min 1.0-max 4.0). Four were suspected of having dementia, based on the evaluation of their cognitive function tests. No patient missed any dose during the utilisation of the support device in taking medicine. All patients reported that the conditions of taking medicine and the recognition of the time to take it were improved. Therefore, the incorporation of support devices in taking medicine is expected to avoid missing to doses.
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Heterotopic ossification (HO) is one of the complications of a cervical cord injury that results in limited range of motion, which can interfere with basic movements and activities of daily living. We encountered a case of a cervical cord injury patient with limited range of motion and mobility due to HO of the hip joint who experienced improvement in both as a result of early surgery and rehabilitation. A 17-year-old boy was diagnosed with a cervical cord injury due to an anterior fracture of the sixth cervical vertebrae following a fall into a pool. It was classified as bilateral C6BII according to the Zancolli's classification for cervical cord injury. The patient presented with limited range of motion in his left hip and was diagnosed with HO four months after the injury. Eight months after the injury, his hip range of motion deteriorated further；consequently, he required continuous transfer assistance. Therefore, surgical HO removal was performed during this period of convalescent rehabilitation. The patient underwent constant post-operative rehabilitation, and the range of motion in his left hip joint improved；thus, he became independent in transfer activities. A concomitant HO after a cervical cord injury can lead to functional impairment in convalescent rehabilitation. In addition, no practice guidelines have been developed that include recommendations on when to perform surgical procedures for HO. Treatment of HO with a combination of immediate surgery and aggressive rehabilitation can be expected to restore function and maximize activity and participation in patients with cervical cord injury with concomitant HO.
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Heterotopic ossification (HO) is one of the complications of a cervical cord injury that results in limited range of motion, which can interfere with basic movements and activities of daily living. We encountered a case of a cervical cord injury patient with limited range of motion and mobility due to HO of the hip joint who experienced improvement in both as a result of early surgery and rehabilitation. A 17-year-old boy was diagnosed with a cervical cord injury due to an anterior fracture of the sixth cervical vertebrae following a fall into a pool. It was classified as bilateral C6BII according to the Zancolli's classification for cervical cord injury. The patient presented with limited range of motion in his left hip and was diagnosed with HO four months after the injury. Eight months after the injury, his hip range of motion deteriorated further；consequently, he required continuous transfer assistance. Therefore, surgical HO removal was performed during this period of convalescent rehabilitation. The patient underwent constant post-operative rehabilitation, and the range of motion in his left hip joint improved；thus, he became independent in transfer activities. A concomitant HO after a cervical cord injury can lead to functional impairment in convalescent rehabilitation. In addition, no practice guidelines have been developed that include recommendations on when to perform surgical procedures for HO. Treatment of HO with a combination of immediate surgery and aggressive rehabilitation can be expected to restore function and maximize activity and participation in patients with cervical cord injury with concomitant HO.
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A 95-year-old woman was admitted to our hospital for rehabilitation after a subarachnoid hemorrhage, but her physical function deteriorated due to repeated aspiration pneumonia. On the first day of the illness, a painless erythema appeared on the right elbow fossa, and expanded soon afterwards. She developed a fever of unknown origin, which led us to the diagnosis of generalized herpes zoster by using a rapid diagnostic kit. The patient was placed in a private room to prevent nosocomial infection, and we took contact infection prevention measures, such as, restricting the number of staff in the room. Antiviral drugs were administered to the patient, quickly relieving her fever. The erythema became encrusted in about 2 weeks, and private room management was terminated.Recently, due the start of periodic vaccination, the incidence of varicella has decreased；however, the increasing incidence of herpes zoster infections among the elderly remains a concern, since the onset of herpes zoster infections is inhibited by the booster effect of contact with varicella patients. Many patients are at a high risk for herpes zoster in convalescent rehabilitation wards due to the long-term admission of elderly patients with underlying diseases. Because more patients with severe herpes zoster are expected in convalescent rehabilitation wards in the future, we herein reexamine the management of such patients from the perspective of early diagnosis, nosocomial infection prevention measures, and prevention of herpes zoster onset.
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It remains unclear how much rehabilitation training is suitable for stroke patients aged ≥ 75 years. To investigate this, especially in convalescent rehabilitation wards, we studied 65 patients (28, ≦ 74 years；37 ≧ 75 years) with cerebral infarction hospitalized in the acute care ward and then in a convalescent rehabilitation ward. From their medical records, we collected data regarding the length of their hospital stay, total amount of rehabilitation training, and activities of daily living evaluated using the total scores of the functional independent measure (FIM) measured on admission to the acute care and convalescent rehabilitation wards, respectively. From these data, we calculated the absolute functional gain, relative functional gain, and average amount of rehabilitation training per day. The correlation of each item and age was analyzed. Items that significantly correlated with age were compared between ≦ 74 and ≧ 75 years age groups. As a result, the absolute functional gain and average amount of rehabilitation training per day were not significantly different between groups. The relative functional gain was significantly lower in the ≧ 75 years group than in the ≦ 74 years group. The total FIM scores at discharge showed a positive correlation with the amount of rehabilitation training in patients aged ≧ 75 years. We believe that a large amount of rehabilitation training is beneficial for patients aged ≧ 75 years with cerebral infarction.
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It remains unclear how much rehabilitation training is suitable for stroke patients aged ≥ 75 years. To investigate this, especially in convalescent rehabilitation wards, we studied 65 patients (28, ≦ 74 years；37 ≧ 75 years) with cerebral infarction hospitalized in the acute care ward and then in a convalescent rehabilitation ward. From their medical records, we collected data regarding the length of their hospital stay, total amount of rehabilitation training, and activities of daily living evaluated using the total scores of the functional independent measure (FIM) measured on admission to the acute care and convalescent rehabilitation wards, respectively. From these data, we calculated the absolute functional gain, relative functional gain, and average amount of rehabilitation training per day. The correlation of each item and age was analyzed. Items that significantly correlated with age were compared between ≦ 74 and ≧ 75 years age groups. As a result, the absolute functional gain and average amount of rehabilitation training per day were not significantly different between groups. The relative functional gain was significantly lower in the ≧ 75 years group than in the ≦ 74 years group. The total FIM scores at discharge showed a positive correlation with the amount of rehabilitation training in patients aged ≧ 75 years. We believe that a large amount of rehabilitation training is beneficial for patients aged ≧ 75 years with cerebral infarction.
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Objective：The purpose of this study was to determine the reliability and predictive validity of the Judgement checklist for beneficial falls (hereafter called “Judgement checklist”) in stroke patients.Methods：Five raters evaluated the Judgement checklist for 20 fallers with stroke, and two raters reevaluated the same patients. Fleiss' Kappa and Cohen's Kappa for examination of inter-rater and intra-rater reliability were calculated. For predictive validity, beneficial fallers were identified from among 123 fallers with stroke, using the Judgement checklist. We compared the incidence rate of recurrent falls and motor Functional Independence Measure (FIM) in beneficial fallers and other fallers.Results：Fleiss' Kappa for Judgement was 0.838, and Cohen's Kappa was 1.000. Inter-rater and intra-rater reliability for the Judgement checklist was high. The rate of recurrent falls in beneficial fallers was significantly lower than that in other fallers. The motor FIM in beneficial fallers was significantly higher than that in other fallers, and beneficial fallers tended to have above average ability to recover.Conclusion：The reliability and predictive validity of the Judgement checklist were shown to be high. The Judgment checklist was effective in evaluating the quality of falls and was useful for patient instruction after a fall.
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Objective：The purpose of this study was to determine the reliability and predictive validity of the Judgement checklist for beneficial falls (hereafter called“Judgement checklist”) in stroke patients.Methods：Five raters evaluated the Judgement checklist for 20 fallers with stroke, and two raters reevaluated the same patients. Fleiss' Kappa and Cohen's Kappa for examination of inter-rater and intra-rater reliability were calculated. For predictive validity, beneficial fallers were identified from among 123 fallers with stroke, using the Judgement checklist. We compared the incidence rate of recurrent falls and motor Functional Independence Measure (FIM) in beneficial fallers and other fallers.Results：Fleiss' Kappa for Judgement was 0.838, and Cohen's Kappa was 1.000. Inter-rater and intra-rater reliability for the Judgement checklist was high. The rate of recurrent falls in beneficial fallers was significantly lower than that in other fallers. The motor FIM in beneficial fallers was significantly higher than that in other fallers, and beneficial fallers tended to have above average ability to recover.Conclusion：The reliability and predictive validity of the Judgement checklist were shown to be high. The Judgment checklist was effective in evaluating the quality of falls and was useful for patient instruction after a fall.
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<p>Objective：In Parkinson's disease and Parkinsonian syndrome (referred to collectively as PD), the progression of functional decline is influenced by complications such as bone fracture or pneumonia. We aimed to assess the efficiency of short-term inpatient rehabilitation therapy for patients with PD in terms of functional recovery and cost-effectiveness.</p><p>Methods：We investigated differences in outcomes of inpatient rehabilitation for 84 patients with PD, in relation to reasons for hospitalization. Patients with complications, including orthopedic diseases (n＝15), and disuse syndrome (n＝16) received therapy for 3 hours/day in Kaifukuki postacute convalescent rehabilitation wards (KRW) or 2 hours/day in other facilities. Fifty-three patients without complications and thus not eligible for admission to KWR were provided with short-term inpatient rehabilitation therapy (training for 2 hours/day, 6 days/week for 1 month).</p><p>Results：In the patients without complications, the efficiency of FIM (FIM gain/hospital stay) was significantly greater (p＝0.03) and the amount of training and the medical expenses needed to improve the FIM score by 1 point, calculated as total training units (1 unit＝20 minutes of therapy as per the Japanese medical insurance system) divided by FIM gain and total medical cost divided by FIM gain, showed a decreasing trend (p＝0.07, 0.10, respectively) in comparison with that in the patients with complications.</p><p>Conclusion：Short-term inpatient rehabilitation for PD patients without complications is beneficial in terms of rehabilitation efficiency and cost-effectiveness, and appears effective at preventing complications and reducing costs. Reconsideration of the medical insurance system may be necessary so that short-term inpatient rehabilitation can be offered in various facilities, including Kaifukuki wards.</p>
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Objective : We analyzed changes in the affected side motor function according to the region and severity of motor paralysis in patients during convalescent rehabilitation. Methods : The subjects recruited were 1,903 hemiplegic patients with primary stroke from a supratentorial unilateral lesion, for which a full-time integrated treatment (FIT) program was implemented. We excluded patients with severe complications, those in whom the stroke recurred or its condition rapidly changed during hospitalization, and those in whom the duration from the onset to admission to our hospital was 61 days or longer. The remaining 1,634 patients served as the study subjects, from among whom we chose 917 patients who had been hospitalized for 8 weeks or longer. The affected side motor function was assessed using 5 motor items of the Stroke Impairment Assessment Set (SIAS) every 2 weeks starting from admission. Results and Conclusion : The affected side motor function significantly improved from admission to a convalescent rehabilitation ward through to week 8 in stroke patients, who were actively engaged in daily routines and had mainly walking and ADL exercise. In addition, improvement was more likely to occur for the lower-limb compared to upper-limb, as well as for the proximal compared to distal motor function. This tendency was more marked for more severe cases of paralyses.
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Dialysis treatment was first introduced in the convalescent rehabilitation ward after the medical fee revision in April 2012 in Japan. In this study, we examined 4 stroke patients who underwent rehabilitation in the convalescent rehabilitation ward while receiving dialysis. We collected information on the patients' age, sex, disease, dialysis period, duration of hospitalization during the acute and recovery phases, the number of units of exercise, discharge destination after hospital, complications, and their Functional Independence Measure (FIM) scores. The average age of the subjects( 2 men and 2 women) was 71.0±9.5 years. Two of the 4 patients had cerebral hemorrhage and the other 2 had cerebral infarction. The dialysis period was 16.8±21.7 months. The duration of hospitalization during the acute phase was 50.0±20.3 days, while that in the convalescent rehabilitation ward was 120.0±28.2 days. The average exercise amount per day was 6.01±1.17 units in the convalescent rehabilitation ward. The total FIM score was 59.3±19.2 at admission and 94.5±27.0 at discharge. The FIM efficiency was 0.29±0.16. In all cases, the discharge destination was home. Three of the subjects showed progression of their renal anemia. One subject developed shunt vessel stenosis and one developed delirium as complications. We conclude that rehabilitation in the convalescent rehabilitation ward for dialysis is beneficial to patients due to the increased amount of exercise that they receive. In addition, such rehabilitation enables the patients to return home in good health, similar to the case of non-dialysis patients.
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Objective : The aim of this study was to examine the influence of a liaison-clinical pathway for stroke rehabilitation. Methods : We initiated the pathway in January 2008. The patients enrolled in this study included 82 patients with acute stroke sustained during the 4 months after the initiation of the pathway and 151 patients with acute stroke sustained during the same period in the following year. Results : The mean length of stay in acute stroke centers was significantly reduced in the second year of employing the pathway. However, an evident reduction of the functional independence measure gain was observed in the convalescent rehabilitation wards, especially in severely physically handicapped patients. Conclusion : The liaison-clinical pathway is an effective approach for advancing a regional cooperation network among hospitals and for shortening the stay in acute stroke centers. On the other hand, the clinical outcome of stroke patients can deteriorate if enough efforts are not made to improve the medical management of severely physically handicapped patients in convalescent rehabilitation wards.
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Purposes<br> The purposes of this study were to analyze the relationship between the discharge destinations of patients with cerebrovascular diseases (CVD) in our convalescent rehabilitation ward and their levels of activities of daily living (ADL), and also to consider the factors causing those patients difficulties upon discharge. <br>Methods<br> The subjects were 114 CVD patients in our Convalescent Rehabilitation Ward. <br> The investigation was conducted to examine their ADL score, both at hospitalization and at discharge, and to analyze the relationship between changes in their ADL scores and their discharge destinations. <br>Discussion<br> It was suggested that reduction of the ADL score from above 8 points at hospitalization, to less than 4 at discharge, contributed to improvement of the rate of discharge to the patients' own homes, and that four items in the ADL assessment scale, such as ‘transfer’, ‘ability to communicate’, ‘locomotion’ and ‘oral care’, had an effect on their discharge destinations.
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We collected and analyzed large-scale data concerning the fall of stroke inpatients in convalescent rehabilitation wards. Three hundred seventy-four of 1,107 inpatients experienced one fall or more, and 16 factors associated with falls were clarified by the chi-square test. To extract the significant item from a multifactor, the logistic regression analysis of 16 factors was carried out, and we developed an assessment sheet for the risk degree of first fall prediction in stroke inpatients. We selected eight variables as the items on the assessment sheet : history of previous falls, central paralysis, visual impairment, sensory disturbance, urinary incontinence, use of psychotropic medicines, mode of locomotion, and cognitive impairment. The total score of the assessment sheet was ranged from 0 to 10 and the mean score of fallers (6.4±1.5) among subjects was significantly higher than that of non-fallers (5.1±1.9) (<i>p</i> <0.001). When the subjects were classified into three groups, a significant difference (<i>p</i><0.001) in the tendency of fall incidence in term of days after admission was found among the three groups on the basis of the Kaplan-Meier survival curve.
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@#Objective To observe rehabilitation effect of synthetic intervention on convalescent schizophrenia.Methods 200 patients with schizophrenia in remission were randomly divided into the intervention group and control group with 100 cases in each group. The cases of the intervention group were gave synthetic intervention for 3 months but those of the control group not. All patients of two groups were evaluated with Brief Psychiatric Rating Scale (BPRS), Inpatient Psychosis Rehabilitation Observe (IPROS), Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) before and after intervention.Results Total and factor scores of every scale were not significant different between two groups before intervention ( P>0.05), but there was a significant difference after intervention, the total and factor scores of the patients of the intervention group were significantly lower than that of the control group ( P<0.01).Conclusion Synthetic intervention can improve depression and anxious symptoms of convalescent schizophrenes, elevate patients' social adaptability, promote patients recovering and returning society early.
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We examined the effect of increased rehabilitative training time on patients with cerebrovascular disorders at a convalescent rehabilitation ward in Japan. After April 2006, the Japanese Ministry of Health and Labor raised the permitted training time from 6 to 9 units (1 unit of training time corresponds to 20 minutes of exercise with a therapist) for patients in a convalescent rehabilitation ward. We compared patients who underwent rehabilitation during the period from April 2006 to March 2008 (9-unit group, 131 patients) with those rehabilitated from April 2003 to March 2006 6-unit group, 153 patients) in the convalescent rehabilitation ward of our hospital. The patients were evaluated with FIM instruments at admission and discharge. Length of hospital stay and rate of return to the patient's home were also examined. The 9-unit group had a shorter hospital stay, and higher FIM efficiency scores, and also a higher rate of home return compared with the 6-unit group.