Factors affecting short-term functional gain following total knee arthroplasty in patients aged from 75 years at a postacute rehabilitation setting.

The intensive rehabilitation of older patients after total knee arthroplasty (TKA) is vital for short-term improvement in mobility and daily living activities. We aimed to investigate the effectiveness of multidisciplinary rehabilitation and assess the early postoperative predictors that are associated with functional gain in TKA patients aged from 75 years in a postacute care setting. This study included 190 patients following primary TKA who were admitted at the postacute rehabilitation hospital. The main outcome measures were the motor component of functional independence measure (M-FIM), M-FIM effectiveness, numerical rating scale, knee extension strength and range of motion, 10-m walk test, Berg balance scale (BBS), and mini-mental state examination (MMSE). The functional gain between patient age groups of ≥75 ( n = 105) and <75 ( n = 85) years were compared. Although patients aged ≥75 years showed lower improvement in BBS score compared with <75 years, the M-FIM gains and other physical functions were similar in both age groups. In multivariate analysis, the results for M-FIM at admission (ß: -0.703; P = 0.001), BBS (ß: 0.342; P = 0.032) and MMSE (ß: 0.446; P = 0.021) were independently associated with functional gain in the patients following TKA aged ≥75 years. Multidisciplinary inpatient rehabilitation was beneficial for basic functional gain except for improvement in balance ability in patients after TKA aged ≥75 years. Functional level, balance ability and cognitive status in the early postoperative period can be useful predictors for short-term functional gain in the postacute care phase.

Factors Affecting the Length of Convalescent Hospital Stay Following Total Hip and Knee Arthroplasty.

OBJECTIVES: : An important role of convalescent rehabilitation wards is the short-term improvement of mobility and activities of daily living (ADL). We aimed to identify predictors associated with the length of stay (LOS) in a convalescent hospital after total hip and knee arthroplasty. METHODS: : This study included 308 patients hospitalized in a convalescent ward following total hip or total knee arthroplasty. The following factors were examined: age, sex, orthopedic comorbidities, motor component of the functional independence measure (M-FIM), M-FIM gain, pain, 10-m walk test, timed up and go (TUG) test, functional ambulation category (FAC), cognitive function, and nutritional status. LOS was categorized as shorter (≤40 days) or longer (>40 days), based on the national average LOS in a convalescent ward, and was statistically analyzed with predictor variables. RESULTS: : In our hospital, the average LOS was 36.9 ± 21.4 days, and the average M-FIM at admission to the convalescent ward and the M-FIM gain were 71.1 ± 7.0 and 16.3 ± 6.9, respectively. In univariate analysis, there was a significant correlation between LOS and M-FIM at admission and M-FIM gain, pain, TUG time, and FAC. Logistic multivariate analysis identified M-FIM at admission (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.88-0.98) and TUG time (OR 1.10, 95% CI 1.03-1.18) as independent predictors of LOS. CONCLUSIONS: : The M-FIM and TUG test can be used to accurately estimate LOS and to plan rehabilitation treatment in a convalescent rehabilitation ward after lower-limb arthroplasty. Furthermore, preoperative or early postoperative intervention may lead to better quality motor activity and shorter LOS during the convalescent period.

Effects of anodal and cathodal transcranial direct current stimulation combined with robotic therapy on severely affected arms in chronic stroke patients.

OBJECTIVE: The purpose of this study was to examine the effects of combined therapy using transcranial direct current stimulation (tDCS) with robot-assisted arm training (AT) for impairment of the upper limb in chronic stroke patients, and to clarify whether differences exist in the effect of anodal tDCS on the affected hemisphere (tDCS(a) + AT) and cathodal tDCS on the unaffected hemisphere (tDCS(c) + AT). METHODS: Subjects in this randomized, double-blinded, crossover study comprised 18 chronic stroke patients with moderate-to-severe arm paresis. Each patient underwent 2 different treatments: tDCS(a) + AT; and tDCS(c) + AT. Each intervention was administered for 5 days, and comprised AT with 1 mA of tDCS during the first 10 min. Outcomes were identified as changes in Fugl-Meyer Assessment (FMUL), modified Ashworth scale (MAS) and Motor Activity Log (MAL) for the upper limb. RESULTS: Both interventions showed significant improvements in FMUL and MAS, but not in MAL. Distal spasticity was significantly improved with tDCS(c) + AT compared with tDCS(a) + AT for right hemispheric lesions (median -1 vs 0), but not for left hemispheric lesions. CONCLUSION: Although this study demonstrated that combined therapy could achieve limited effects in the hemiplegic arm of chronic stroke patients, a different effect of polarity of tDCS was seen for patients with right hemispheric lesions.