Development and Validation of a Decision Tree Analysis Model for Predicting Home Discharge in a Convalescent Ward: A Single Institution Study.

OBJECTIVES: Accurately predicting the likelihood of inpatients' home discharge in a convalescent ward is crucial for assisting patients and families in decision-making. While logistic regression analysis has been commonly used, its complexity limits practicality in clinical settings. We focused on decision tree analysis, which is visually straightforward. This study aimed to develop and validate the accuracy of a prediction model for home discharge for inpatients in a convalescent ward using a decision tree analysis. METHODS: The cohort consisted of 651 patients admitted to our convalescent ward from 2018 to 2020. We collected data from medical records, including disease classification, sex, age, duration of acute hospitalization, discharge destination (home or nonhome), and Functional Independence Measure (FIM) subitems at admission. We divided the cohort data into training and validation sets and developed a prediction model using decision tree analysis with discharge destination as the target and other variables as predictors. The model's accuracy was validated using the validation data set. RESULTS: The decision tree model identified FIM grooming as the first single discriminator of home discharge, diverging at four points and identifying subsequent branching for the duration of acute hospitalization. The model's accuracy was 86.7%, with a sensitivity of 0.96, specificity of 0.52, positive predictive accuracy of 0.88, and negative predictive accuracy of 0.80. The area under the receiver operating characteristic curve was 0.75. CONCLUSION: The predictive model demonstrated more than moderate predictive accuracy, suggesting its utility in clinical practice. Grooming emerged as a variable with the highest explanatory power for determining home discharge.

Effect of a controlled starting position on the relationship between the forward reach distance and movement distance of the center of pressure in the functional reach test using the ankle joint strategy.

[Purpose] This study aimed to clarify whether the distribution range of the forward reach distance and the relationship between the forward reach distance and the movement distance of the center of pressure differed depending on whether the controlled starting standing position during the functional reach test with an ankle joint strategy. [Participants and Methods] Sixteen healthy male volunteers participated in the study. The distribution range of the forward reach distance and the relationship between the forward reach distance and movement distance of the center of pressure in the controlled starting standing position and non-controlled starting standing position conditions were analyzed. [Results] The distribution range of the forward reach distance was significantly smaller in the controlled starting standing position than in the non-controlled starting standing position. In both groups, the forward reach distance was associated with the movement distance of the center of pressure. [Conclusion] The findings suggested that the use of an ankle joint strategy with a controlled starting standing position in the functional reach test may be a more accurate method to evaluate standing balance ability.

Long-term changes of psychological factors regarding exercise in patients with type 2 diabetes after discharge and the effect of these changes on glycemic control.

[Purpose] In the medical treatment guidelines for type 2 diabetes, the utility of the approach using self-efficacy and stage of change has been previously demonstrated. Although the effects of short-term approaches have been shown, a few studies have examined long-term changes over time. The purpose of the present study was to investigate longitudinally the factors that affect the stage of change, self-efficacy for exercise, and glycemic control for 12 months in patients with type 2 diabetes after the intervention of the disease by receiving diabetes and glycemic control education. [Participants and Methods] The study included 29 patients with type 2 diabetes as participants who were able to follow up for 12 months after the intervention. The changes over time were investigated using stage of change and self-efficacy as psychological indicators of exercise. Factors affecting HbA1c values after 12 months of intervention were examined with information on diabetes and social background. [Results] There was no significant difference in self-efficacy for exercising at 3, 6, and 12 months after discharge. In contrast, participants in the stage of change showed a significant improvement at 6 and 12 months after discharge in comparison to 3 months after discharge. HbA1c values decreased at 12 months while comparing patients after 3 months and 12 months after discharge. The only factor affecting HbA1c value 12 months after discharge was the duration of diabetes. [Conclusion] The results suggested that stage of change and self-efficacy for exercise might have a little long-term effect on glycemic control.

Structured Rehabilitation Program for Multidirectional Shoulder Instability in a Patient with Ehlers-Danlos Syndrome.

Patients with Ehlers-Danlos syndrome (EDS) present many musculoskeletal disorders. The purpose of this case report was to describe the effectiveness of a scapular motor control program for a patient with multidirectional severe shoulder instability due to EDS, with 6-month follow-up. The patient was a 14-year-old female with EDS hypermobile type who suffered recurrent shoulder dislocation. Her chief complaints were bilateral shoulder discomfort and instability during writing motion. In the early part of intervention, she was prescribed exercise therapy for multidirectional instability (MDI) with orthosis. In the latter part of intervention, she was instructed in the scapular motor control program. Active and passive range of motion (ROM), sulcus sign, and Rowe score for shoulder instability were measured at baseline and at 3, 6, and 12 months after interventions. The shoulder ROM and instability score were improved after 6-month intervention. The findings from this report indicate that the scapular motor control program for shoulder instability would be effective even for patients with EDS hypermobile type. A patient who could not increase passive ROM due to dislocation is also able to achieve fair function of the shoulder joint instead of increasing active ROM. These positive outcomes indicate the possibility of benefit from the scapular motor control program for an MDI patient with EDS as a conservative treatment.

Impact of combination of therapeutic exercise and psychological intervention for a patient with first-time traumatic shoulder dislocation.

[Purpose] A young female with first-time traumatic shoulder dislocation showed a good outcome at the 1 year follow-up in returning to work and sports after undergoing a combination of exercise therapy and psychological intervention. [Participant and Methods] A 24-year-old female who worked as an occupational therapist and played badminton for recreation had dislocated her shoulder in a fall. We evaluated her compliance with home-exercise, range of motion, return to work, fear of movement, sports activity level, and instability of shoulder joint using the modified Rowe score at each timepoint necessary. During early sessions of the physical therapy, the range of motion and instability score for the shoulder joint were poor. We treated her using a phase-based approach, and subsequently, added the Watson program to restore normal kinematics. Because of a psychological problem during middle sessions of the physical therapy, we provided psychological education and support. [Results] At the final session of the therapy, her compliance with home-exercise was good. She had achieved almost a full range of motion. The fear of movement decreased, and she could play sports again. The modified Rowe score improved from 5 to 85. [Conclusion] As a conservative treatment for patients with first-time traumatic shoulder instability, a combination of therapeutic exercise and psychological intervention may be useful.

Measurement of the cross-sectional area of the hamstring muscles during initial and stretch positions with gravity magnetic resonance imaging.

[Purpose] We aimed to investigate the change rate in the cross-sectional area of each hamstring component to evaluate muscle extensibility and to contribute to the studies on hamstring strain prevention. [Participants and Methods] Fifteen healthy young males volunteered to participate in this study. They performed a knee extension test. For the measurements, we used multi-posture magnetic resonance imaging (gravity magnetic resonance imaging), the open shape of which allows performing body scanning in various positions. We measured the maximum cross-sectional area of the hamstring during the initial and stretch positions from the obtained images. Then, for each muscle, we calculated the maximum cross-sectional area change rate relative to the initial position. [Results] For all hamstring muscles, the maximum cross-sectional area during stretching was significantly smaller than that in the initial position. The maximum cross-sectional area change rate of the semimembranosus was significantly smaller than that of the other 3 muscles (there were no significant differences among these 3 muscles). [Conclusion] The results suggest that the semimembranosus has higher resistance to morphological change than the other muscles, which could be an important limiting factor for the extensibility of the hamstring muscle group.

Walking gait changes after stepping-in-place training using a foot lifting device in chronic stroke patients.

[Purpose] The goal of this study was to investigate the efficacy of stepping-in-place training using a foot lifting assist device on the walking gait of chronic hemiparetic stroke patients. [Subjects] Seven patients with chronic hemiplegic stroke (age 80.9±4.9 years) who were attending a local adult daycare facility participated in this study. [Methods] The participants had 2 or 16 weeks of intervention after a baseline period of 2 weeks. Evaluations were performed before the baseline period and before and after the intervention period. The evaluation consisted of a two-dimensional motion analysis of walking and stepping-in-place exercises and a clinical evaluation. [Results] Walking speed increased in three participants after 2 or 16 weeks of intervention. The swing phase percentage increased in the paretic gait cycle, and the time from non-paretic heel contact to paretic heel off decreased during stepping-in-place in these participants. [Conclusion] Given that the transition from the support phase support to the swing phase was shortened after the intervention, the stepping-in-place exercise using the device designed for this study may improve the muscle strength of the lower limb and coordination in the pre-swing phase of the paretic limb.